How the anchor programme's ambitions are breaking down barriers by striving to make NHS London a Living Wage Employer for all

In this blog, Lizzie Smith, Director for Workforce, Training & Education in the London Region for NHS England and Senior Responsible Officer for the NHS London Anchor Programme, shares valuable insights into her personal crusade championing the London Living Wage in London's NHS Trusts. 

What is the National Living Wage, Real Living Wage and London Living Wage, and why are they different?

The London Living Wage is £13.85, higher than the Government National Living Wage which is £11.44 across the UK for those over 21. It is called the real Living Wage because it is calculated according to the cost of living in London, based on a basket of household goods and services.  

Founded in 2001 by Citizens UK, the Living Wage movement has grown to include more than a million people worldwide. The Living Wage Foundation was established in 2011. Since then, it has delivered over £3 billion in extra wages to low-paid workers across the country, including £1.4 billion in London alone. 

 What is the business case for the NHS to pay its staff the London Living Wage?

We know we need to do more to support Londoners, as the capital has the second highest rate of worker poverty in the UK.  A recent survey from the Living Wage Foundation has found that over half (51%) of low-paid workers in London use a food bank, with 23% visiting once per week or more. 

At the heart of our Corporate Social Responsibility strategy is a commitment to fair employment practices. Additionally, we ensure that wages are fair and sufficient to meet the needs of our employees and their families.  

Providing a wage that meets every day needs is a basic human right, but more importantly, it transforms the NHS as a whole. It boosts staff retention, recruitment, and overall effectiveness, ensuring everyone is paid enough to live. A living wage pledge is more than a pay rate; it is a commitment to fair compensation and decent working conditions.  

By ensuring that everyone is paid enough to live, we not only enhance the well-being of our employees but also foster a more motivated and productive workforce. In addition to our commitment to fair wages, we are also committed to the welfare of our workforce and the broader community. 

How has the NHS approached embedding the living wage across London?

While the average NHS wage is higher than the Living Wage rate, it's estimated that 11% of jobs in the sector pay less than the real Living Wage. This includes roles in secondary care (hospitals), primary care (general practices, opticians, dentists, pharmacists), and social care. 

As part of the NHS Staff Council and devolved negotiating structures, significant steps have been taken over recent years to address low pay for directly employed staff. This was driven by the belief that our staff deserve a salary that allows them to do more than just make ends meet. 

Since then, we have committed to ensuring that all London trusts in secondary care are accredited Living Wage Employers. Working closely with the Living Wage Foundation, we have gained an understanding of the long-term commitments involved. I'm proud to say (as of September 2024) that 28 out of 35 (80%) London Trusts are now on board. 

The Living Wage Foundation has been incredibly supportive as we navigate complex mergers and systems and other significant financial pressures impacting the sector. By leveraging their role as anchor institutions, NHS organisations can significantly affect the long-term health of their communities, addressing social and economic inequalities and improving the workforce experience. 

Living Wage accreditation ensures that third-party contracted staff, including those in facilities management, portering, and catering, are also paid a real living wage. This guarantees that future contracts stipulate fair wages, enabling a healthy standard of living for all. 

Implementing the London Living Wage is a crucial part of the anchor programme across the NHS in London. The lowest-paid members of our workforce shouldn't suffer further due to financial constraints. Our health and care system should be sustainable for the capital by paying a fair wage to all contributors. We've set ambitious targets and are proud of our progress, but there is still much more to do. 

What challenges have you faced, and how have you overcome them?

While many NHS staff already earn a living wage, we face challenges extending this to our contractors. However, the NHS in London is committed to ensuring this standard is also met by third-party contracts. It is through these contracts that the maintenance of buildings, the cleaning of facilities, portering services, and the security of NHS buildings are delivered. 

Although we face many challenges, we are making progress. We have seen the introduction of Living Wage terms on contract renewals, the bringing of services in-house through TUPE, the exploration of collective Living Wage commitments through NHS networks, and the identification of new suppliers who are Living Wage Employers or Recognised Service Providers by using our Living Wage Map. 

As of September 2024, the total number of accredited health and social care organisations in London is now 174, although the number of general practices, dentistry, pharmacy, and optometry services for the NHS in London remains low. This sector encounters a variety of barriers, including financial constraints, which have been widely covered in the media, and fragmented small businesses. According to the Living Wage Foundation, receptionists are often adversely affected by low wages. 

As the nation's largest employer, the NHS has a moral and social obligation to pay fair salaries. Paying the London Living Wage positively impacts the health of the community and the well-being of the public. Despite financial challenges, the collective ambition for London, supported by the Mayor's vision for a 'Living Wage City,' has driven the success of NHS Trust accreditations. 

London has the second highest rate of in-work poverty in the UK, making it even more crucial for the NHS to lead by example in paying fair wages. By doing so, we can help reduce social and economic inequalities and improve the overall health of our communities. 

What would you hail as your biggest success to date in championing the London Living Wage in the NHS?

It has been a long journey for many of our London Trusts to attain Living Wage Employer status, a testimony to their hard work and determination to 'do-the-right-thing' for their staff.  

Furthermore, it is even more impressive that what has been achieved has happened during a very turbulent time for the NHS, with industrial action, reduced funding, and increased service demand, all contribute to operational pressures. Trusts have stepped up to their moral obligation to pay our staff a fair wage for what is often hard work. 

Making London a Living Wage City includes the NHS London as a key partner, collaborating with civil society, businesses, and public organisations to inject £635 million into the hands of Londoners living on low wages. 

As a founder member of the London Anchor Institutions' Network (LAIN), NHS London is committed to leading by example and championing the London Living Wage initiative so that it continues to grow and benefit more workers across the city. LAIN members as anchor organisations are best placed, as the city's largest employers, to improve more lives of Londoners. 

When the London Living Wage rate increased on October 23, 2024, over 140,000 Londoners received a pay rise, now that's something to celebrate! 

How many people do you estimate have benefitted from pay uplifts in recent years?

Over the past three years, the number of NHS Trusts accredited as Living Wage employers has more than tripled, rising from 8 to 28 by September 2024. The accreditations by the NHS in London have resulted in over 10,406 Londoners receiving a pay uplift. 

We believe the actual number is even higher, as this figure does not account for NHS employees from Trusts or other primary care organisations that pay a real London Living Wage but are not officially accredited as Living Wage Employers. 

The London Anchor Institutions Network (LAIN) supports London Living Wage Week for several compelling reasons, reflecting their commitment to social equity, economic stability, and community well-being.