Historic strikes by nurses in the UK's NHS over pay and working conditions mirror the struggle of many health workers in other European countries.
Nurses in England are staging their biggest strike so far on Monday, with the walkout affecting intensive care, emergency rooms and cancer wards for the first time as part of a dispute over pay.
Health unions, ministers and National Health Service (NHS) bosses are due to meet on Tuesday to discuss the government's offer of a 5 per cent pay rise for 2023-24 and a lump sum of at least £1,655 (€1,884) to top up last year's salary.
Unions say wages, especially in the public sector, have fallen in real terms over the past decade, and a cost-of-living crisis fuelled by double-digit inflation has left many struggling to pay their bills.
Annual gross salaries of hospital nurses in the UK increased by 10 per cent in nominal terms but fell by 6 per cent in real terms between 2010 and 2019, according to a dataset released by the Organisation for Economic Co-operation and Development (OECD).
The UK is not the only country in which health workers went on strike over the past year.
In Spain, thousands of health personnel, including doctors working in emergency services, were on strike in November. Besides a considerable increase in their wages, they requested more staff and more resources.
In France, health workers joined protests in several cities last June with similar demands.
In Turkey, health personnel went on strike for better pay and work conditions last year. They took to the streets in several Turkish cities in July to call for more action to prevent violence after a cardiologist was shot dead by a patient’s relative.
According to the Turkish Medical Association, thousands of Turkish doctors have left their posts to work abroad over the past decade. They mostly prefer to move to Western countries, especially Germany.
Health personnel, particularly hospital nurses, have worked ceaselessly during the COVID-19 pandemic. In many European countries, they are demanding better wages, improved working conditions, and more resources.
How much are nurses paid in Europe? Which countries pay nurses the most and the least, and how much have nurses’ salaries changed in the last decade?
There are significant differences in nurses’ salaries across Europe.
In 2020 or the closest year with available data, official annual gross salaries in hospitals ranged from about €11,880 in Lithuania to €101,151 in Luxembourg, according to the OECD. The dataset includes 25 European countries.
Annual gross salaries of nurses (2020)
Besides Luxembourg, the annual gross starting salary was above €50,000 in seven countries. Germany (€46,829) and the UK (€42,588) are not among them, according to OECD data.
Nurses in France and Italy earn half what they do in Belgium and Switzerland
The annual salary for a nurse in France (€35,531) or Italy (€29,222) was less than half the annual salary in Belgium (€72,508) and almost exactly half that in Switzerland (€70,965).
With the lowest salaries for nurses, Lithuania (€11,880) is followed by Turkey (€12,172) and Latvia (€13,551).
Salaries and purchasing power parity
The ranking changes when we look at salaries in terms of purchasing power parity (PPP). PPP is an indicator of price level differences. In other words, it reveals how many currency units a particular quantity of goods or services costs in different countries.
The use of PPP can “eliminate the effect of price level differences across countries,” according to Eurostat as it can be used as a currency conversion rate of sorts to convert expenditures expressed in national currencies into an artificial common currency.
In 2020, nurses’ PPP-based salaries ranged from €18,700 in Lithuania to €66,800 in Luxembourg. The average among 20 EU countries was €35,300. While the gaps in PPP between countries are narrower compared to the differences in nominal salaries, they still vary significantly.
Belgium (€62,300) and the Netherlands (€50,600) follow Luxembourg in terms of highest PPP-based salaries. At the bottom, Lithuania is followed by Latvia (€18,800) and Portugal (€21,400).
Annual gross salaries of nurses in terms of purchasing power parity (2020*)
In Finland (€31,200), the PPP-based salary of nurses was lower than the EU average.
Remarkably, Turkey (€31,700) had a higher PPP-based salary for nurses than several EU countries such as Finland, Italy, and Greece.
Nurses are paid less than the average wage in France
The ratio of nurses’ salaries to average wages in each county is also a useful indicator. The average wage in a country is based on the total wages paid and the average number of employees in the total economy.
In 2020, the ratio of a nurse’s salary to the average wage varied from 0.88 in Lithuania to 1.58 in Belgium. This means that nurses in Belgium earn 1.58 times more than the average wage in the country. This ratio was 1.2 on average for 20 EU countries.
In Finland, Latvia, France, Switzerland, and Lithuania, nurses are paid less than the country’s average wage. The ratio of a nurse’s salary to the average wage was 0.91 in France and 0.88 in Switzerland. Ratios were higher in Spain (1.5), the Czech Republic (1.42), and Poland (1.36).
Ratio of nurses' salaries to average wages
How have nurses' salaries changed in the last decade?
The nominal change in annual gross salaries of nurses between 2010 and 2020 was highest in Iceland, where wages rose by 123 per cent in the last decade. Nominal change refers to values obtained when inflation is not taken into account.
Some EU member states, such as Hungary (104 per cent), Estonia (94 per cent), the Czech Republic (92 per cent), and Slovakia (91 per cent), also saw dramatic increases in this period.
Nominal changes in salaries of nurses in euro between 2010 and 2020
Nurses’ salaries fell in three European countries between 2010 and 2020: Norway (1 per cent), Italy (4 per cent), and Greece (16 per cent). In Norway, the decrease was caused by changes in the exchange rate.
Change in real terms: Decline in the UK and stagnation in France
Change in real terms is more meaningful as it takes inflation into account. Among nine selected countries, salaries increased in seven countries in real terms between 2010 and 2020 (Hungary, Slovakia, Poland, the Czech Republic, the Netherlands, Spain, and Belgium). However, they declined by 6 per cent in the UK in this period (2010-2019) and did not change in France.
Changes in salaries of nurses in real terms* between 2010 and 2020
A closer look at the UK
When we look more closely at the UK, the figures show how the salaries of nurses declined in real terms whereas nominal salaries rose between 2010 and 2019.
Nominal salary and salary in real terms were equal in 2010 at 100 points. The nominal salary then constantly increased, reaching 110 points in 2019. However, taking inflation into account, salary in real terms gradually decreased until 2017, reaching 93 points, and increased by only one point in 2019.
Annual gross salaries of nurses in the UK: Nominal salary and salary in real terms
This figure reveals that the annual gross salaries of hospital nurses in the UK increased by 10 per cent in nominal terms but fell by 6 per cent in real terms between 2010 and 2019.