disclaimer
This post is written in a personal capacity and reflects my own evidence-informed analysis. It does not represent the views of my employer, the NHS, or any professional body. I will not discuss identifiable patients, colleagues, or confidential workplace information. Please interpret this as commentary on public policy and publicly available data, shared in line with the NMC Code and the NMC’s Guidance on using social media responsibly (NMC, 2025a; NMC, 2025b)
Why this comparison matters (and why Zoe is right to nudge it)
Coverage of industrial action has focused heavily on resident doctors’ claims of pay “restoration” to regain lost purchasing power relative to the late-2000s baseline (BMA, n.d.; Full Fact, 2025). Yet nursing pay—largely set through Agenda for Change (AfC)—has experienced its own long, complex trajectory of pay restraint, uneven catch-up, and renewed cost-of-living pressures (House of Commons Library, 2025; Health Foundation, 2025).
If we care about workforce sustainability, the key question is not “who is louder?” but “what do the data imply about recruitment, retention, and in-work hardship across the largest clinical workforce group?” (Health Foundation, 2025; IFS, 2024).
What we mean by “pay deflation”: real-terms pay and the inflation index problem
“Pay deflation” here means real-terms pay erosion: pay that rises more slowly than prices, reducing purchasing power. Crucially, the size of any “real-terms cut” depends on the inflation index used (ONS, 2024; Full Fact, 2025).
In UK policy analysis, CPIH (CPI including owner occupiers’ housing costs) is often used as a headline measure for real-terms comparisons (ONS, 2024; IFS, 2022). RPI persists in some public debate but is widely treated as methodologically problematic for many official uses (ONS, 2024).
This is not a minor footnote: it can shift the headline “since 2008” figure from “large” to “moderate,” as illustrated by recent fact-checking of resident doctors’ pay claims (Full Fact, 2025).
Doctors since 2008: pay erosion, plus a training-and-conditions overlay
Resident doctors’ argument has two strands:
- Purchasing power relative to 2008/09 (BMA, n.d.; Full Fact, 2025).
- Workforce conditions and career structure, including job security and training bottlenecks (Reuters, 2025).
Independent analysis of NHS doctor earnings highlights that recent uplifts can improve short-term pay trajectories, but long-run patterns depend on whether future awards consistently match or exceed inflation and market pressures (Nuffield Trust, 2025; House of Commons Library, 2025).
Takeaway: even when there is disagreement about the precise “since 2008” percentage, the policy question remains: do pay and conditions support retention and a stable training pipeline? (Nuffield Trust, 2025; Health Foundation, 2025).
Nurses since 2008: the quieter curve—and why it still bites
Nursing pay is commonly benchmarked from 2010 onwards due to the public-sector pay restraint era, but the broader “post-crisis” arc overlaps strongly with the doctors’ baseline debate (IFS, 2024; Health Foundation, 2025).
Key credible signals from public sources:
- Over the last decade, the House of Commons Library reports that FTE nurse basic pay fell in real terms, whereas FTE doctor basic pay rose over the same 10-year window; both groups saw real-terms increases in the most recent year ending June 2025 (House of Commons Library, 2025).
- The Institute for Fiscal Studies notes that in the English NHS, nurses saw a notable real-terms reduction over the 2010s and only a modest recovery thereafter, within a broader pattern of public-sector pay pressures (IFS, 2024).
- The Health Foundation’s analysis summarises how NHS pay for many roles remains lower in real terms than earlier benchmarks and discusses implications for recruitment/retention and system performance (Health Foundation, 2025).
- Professional bodies argue the cumulative effect of below-inflation awards has materially reduced nursing purchasing power and contributed to retention risk (RCN, 2024).
In-work hardship is the “canary in the staffing mine”
Hardship among healthcare workers is not merely a cost-of-living story; it is a workforce stability and patient safety story because it links to burnout, sickness absence, turnover, and reduced willingness to take on additional shifts (RCN Foundation, n.d.; Health Foundation, 2025). Reports and professional commentary have documented worsening financial pressures and hardship support needs among nursing staff during the cost-of-living period (RCN Foundation, n.d.).
Comparing doctors and nurses: same storm, different umbrellas
1) Pay-setting mechanisms are different
Nursing pay is predominantly shaped through AfC and associated review processes, while doctors have distinct contractual and review body arrangements and different labour-market dynamics (House of Commons Library, 2025; NHS England, 2024).
2) Visibility and narrative simplicity differ
“Restore to 2008” is a clean narrative hook. Nursing’s pay reality is more structural: banding, progression ceilings, regional cost pressures, and the interaction with wider workforce shortages (Health Foundation, 2025; IFS, 2024).
3) The evidence base points to shared risk: retention
Across credible analyses, the common thread is that persistent real-terms pay pressure is associated with recruitment and retention challenges across NHS staffing groups (Health Foundation, 2025; IFS, 2024).
Should nursing “stand shoulder to shoulder” and strike?
This is ethically and professionally serious. Three evidence-informed positions can coexist:
Position A: Yes—because pay is a retention and safety issue
If pay contributes materially to vacancies, turnover, and workforce instability, industrial action can be framed (by unions and members) as action taken to protect long-term service viability (RCN, 2024; Health Foundation, 2025).
Position B: Not automatically—because nursing has distinct moral and operational burdens
Even with derogations and safety planning, the moral weight of withdrawing labour can be experienced differently in nursing, especially amid understaffing (NMC, 2025a). That does not negate the case for better pay, but it complicates the route to change.
Position C: “Strike vs no strike” is too narrow—structural reform matters
Even above-inflation awards may fail to stabilise the workforce if pay structures and progression do not align with skills, responsibilities, and regional living costs, or if non-pay factors (staffing levels, workload intensity) remain unaddressed (Health Foundation, 2025; NHS England, 2024).
My synthesis: nurses do not need to mirror doctors’ tactics to validate the problem. Nursing can legitimately argue—using credible sources—that real-terms pressure and hardship are now intertwined with workforce sustainability. Whether that leads to industrial action is a democratic decision for members and unions, but the underlying economic case is not trivial (House of Commons Library, 2025; IFS, 2024; Health Foundation, 2025).
closing paragraph
Doctors have successfully made pay restoration a nationally legible story. Nursing’s pay erosion is less headline-friendly but is strongly evidenced across parliamentary analysis and independent health economics commentary. The question is not whether one profession deserves attention more than another; it is whether the NHS can remain safe and sustainable while large parts of its clinical workforce experience long-run real-terms pay pressure and visible hardship. If policy wants stability, it must treat pay as workforce infrastructure—not a periodic crisis-payment exercise (House of Commons Library, 2025; Health Foundation, 2025; IFS, 2024).
References
British Medical Association (BMA) (n.d.) Why resident doctors are striking – a guide for patients. Available at: BMA website.
Full Fact (2025) Have resident doctors really had a 21% real-terms pay cut? (18 December). Available at: Full Fact website.
Health Foundation (2025) How much should NHS staff be paid? (16 May). Available at: The Health Foundation website. health.org.uk
House of Commons Library (2025) NHS pay and pensions (CBP-10374, 13 November). Available at: UK Parliament website. House of Commons Library
Institute for Fiscal Studies (IFS) (2022) Pay levels in 2010 vs. real-terms pay growth 2010 to 2021, by NHS staffing group. Available at: IFS website. Institute for Fiscal Studies
Institute for Fiscal Studies (IFS) (2024) Recent trends in public sector pay (26 March). Available at: IFS website. Institute for Fiscal Studies
NHS England (2024) Submission to the NHS Pay Review Body – evidence for the 2025–26 pay round (10 December). Available at: NHS England website. NHS England
Nuffield Trust (2025) Exploring the earnings of NHS doctors in England: 2025 update (23 July). Available at: Nuffield Trust website. Nursing and Midwifery Council
Nursing and Midwifery Council (NMC) (2025a) Guidance on using social media responsibly (2 July). Available at: NMC (PDF). Nursing and Midwifery Council
Nursing and Midwifery Council (NMC) (2025b) Social media guidance (web page, 2 July). Available at: NMC website. Nursing and Midwifery Council+1
Office for National Statistics (ONS) (2024) Consumer Price Inflation (includes CPIH, CPI and RPI) – Quality and Methodology Information (QMI) (19 December). Available at: ONS methodology pages. Office for National Statistics
Office for National Statistics (ONS) (2025) Inflation and price indices (accessed December 2025). Available at: ONS website. Office for National Statistics+2Office for National Statistics+2
Royal College of Nursing (RCN) (2024) Half of England’s nursing staff could quit as new analysis reveals decade-long attack on pay (22 March). Available at: RCN website. The Royal College of Nursing
RCN Foundation (n.d.) Cost-of-living crisis impacts the nursing and midwifery professions. Available at: RCN Foundation website.
Reuters (2025) UK doctors strike: job insecurity and working conditions (reporting, accessed December 2025). Available via Reuters.
Pseudocyst 
What do you think?