The first three grades are for non-registered nurses, and cover health care assistants and auxiliaries. Unions have called for their low pay rates to be addressed. Their work generally consists of jobs such as cleaning bed pans and looking after patients' non-clinical needs. Within each grade there is a sliding pay scale which matches a person's experience. Qualified registered nurses, from D grade upwards, carry out basic clinical tasks.
Nurses can specialise within hospitals, or move out into the community and work as a school nurse.
Midwives can however, have specialist midwife training, and do not need to have trained as a nurse. At the top end of the nursing pay scale are ward managers, nurses who specialise in a particular field of nursing, ward managers who take on extra responsibilities and senior nurses who have a trust-wide remit. The government and nursing unions disagree about how best to reward senior nurses. Around half are already in post, but many do not earn the top rate for their grade. Many more nurses are needed, say unions.