The government has awarded a 3.6% pay rise to directly-employed NHS staff in England. This will be in your pay packets in August, backdated to April.
It’s an imposed award, with no negotiations, so we are not deciding on whether to accept or reject. But we have an important choice as to how we respond collectively.
We consulted you in April when the government missed the pay date but we didn’t hear from enough of you.
We’re only able to challenge this pay award if a big enough proportion of members are willing to back industrial action.
So now you know the outcome, we’re asking you all again, would you be willing to take part in industrial action to seek improvements to this year’s pay award? If you work directly for an NHS employer, you’ll be sent a secure email to make your decision in the online consultation from the 23rd June.
Haven’t got your consultation email? Check your employer and contact details at unison.org.uk/my-unison.
You can also vote on our online voting page. You will need your UNISON membership number to access the consultation.
FAQs
How far does this pay award meet our goals to put NHS Pay Right?
A proper pay rise. The right banding. A shorter working week. That’s what UNISON members want and it’s what NHS staff deserve.
So how far does this year’s pay award meet our goals?
A proper pay rise
All NHS staff need an above-inflation pay rise so we can continue to restore the value of your wages and kick poverty pay out of the NHS for good. It seems unlikely this 3.6% pay award will beat inflation this year. And once again, it falls short of the real living wage, this time by 9p per hour.
We also need reforms to make sure that when you progress or get promoted you notice a real difference in your pay packet. We’ve been calling for the government to sit down with unions and employers and invest in fixing the issues with your pay scale, but they keep kicking the can down the road.
The right banding
The government has recently agreed to the programme of work we asked for to ensure staff are paid properly for the work they do. But this progress hasn’t come through the pay review process, and we know it will be a while before you see the impact of these changes.
A shorter working week
UNISON’s ambition is for a reduced working week in the NHS with no loss of pay to improve wellbeing, reduce burnout and keep colleagues in their jobs. We have been making the case but there has no move yet from government to open up discussions on reducing the working week.
How does the 3.6% pay award compare to the cost of living?
We know the cost of living is increasing and it seems unlikely this 3.6% pay award will beat inflation this year. CPI is currently at 3.5% and RPI is at 4.5%.
How does this pay award compare to other public sector pay awards?
Many of you will have heard that many doctors have been awarded 4% plus £750, after their previous 2-year 22% settlement. We know this may feel unfair when the NHS can only succeed by working together as one team. This once again highlights the failings of the pay review body process which has led to two different awards for employees working in the same health service.
And many NHS staff will also have seen that teachers in England were awarded a 4% pay rise, with no explanation given as to why NHS staff deserve less.
How does this pay award compare to the negotiated pay offer for NHS Scotland?
In Scotland, ministers don’t use the pay review body process – they negotiate directly with unions. As a result, salary scales for NHS workers in Scotland are now significantly higher than yours. This year Sottish ministers have made a two-year above-inflation pay offer to NHS staff and UNISON members there voting overwhelmingly to accept it.
What does this pay award mean for staff on lower bands?
Due to interim awards made in April 2025 for to meet statutory minimum wage requirements, staff on 2 and the entry point of band 3 will only receive a 1.2% or 1.3% increase in August, bringing the total value of both awards to 3.6%. This is unjust. That April payment was not an agreement with those staff – it was something the government had to do to avoid breaking minimum wage law.
What can I do now?
The most important thing you can do is to have your say on how we respond to the pay award. You’ll be sent a secure email to make your decision in the online consultation from 23 June.
Once you have voted, please encourage your colleagues to take part too.
It’s essential that we always have the right contact details and employer information for every single member so we can keep you updated on any developments with your pay.
What happens next?
The consultation closes at 4pm on Wednesday 30 July. We’re only able to challenge this pay award if a big enough proportion of members are willing to back industrial action. So it’s really important we hear from as many members as possible.
Once the consultation closes, your elected committee of NHS staff – the Health Service Group Executive – will meet to go over the results of the consultation and decide what we do next.
If the decision is to move to industrial action, we would need to run postal ballots. We would focus our efforts on winning a series of strong strike votes in selected groups of employers, balloting members where we are confident we can win and where strike action would have the greatest impact. That would mean only some members taking part in the first phase of a postal ballot. But we would bring in more groups of employers later if the government still doesn’t budge. And all members would have a part to play in delivering and supporting our campaign.
How is NHS pay decided?
Over 1.5 million NHS staff have their pay, terms and conditions set by a national scheme known as Agenda for Change (AfC). This was first negotiated by UNISON, the other health unions and NHS employers back in 2004. Many more are affected by the scheme as they work for other employers that follow AfC arrangements in the public and private sectors.
UNISON has worked to defend and improve this system in order to maintain fair pay, standard terms and conditions across the UK, and better career progression options for all NHS staff.
Each year the pay system is subject to an independent review to make recommendations on pay. This is carried out by the NHS Pay Review Body (PRB) based on evidence submitted by NHS unions, employers’ bodies and the government. UNISON’s evidence draws on what members tell us about how they feel about pay, cost-of-living pressures, and recruitment and retention problems where they work.
The PRB then makes recommendations to the UK governments as to what pay increases NHS staff should get at their 1 April pay date. These recommendations are not binding.
Does UNISON want to negotiate directly on NHS pay going forward?
Yes. NHS staff have become disillusioned with the PRB system because they do not believe it is independent. They see the process as long-winded, too often at the mercy of government and unfit for purpose.
From now on, UNISON wants to negotiate directly with the government on NHS pay, along with our sister unions in the NHS. But we don’t only want to talk about a headline number.
There are a growing number of structural issues in the pay scales affecting staff morale and progression that need fixing through negotiation. Collective bargaining like this creates great opportunities for problem solving, expert input, and genuine involvement and engagement with NHS staff on the day-to-day problems they face.
What are some of the key problems with the NHS pay scale?
Here are the 2024/25 pay scales for NHS staff in England.
Bands 2-3
Band 2 has become a spot rate so there is no reward for progression. There should be an incentive for gaining experience and confidence: that means restoring pay progression for Band 2.
The rate for Band 3 is not a great deal more than Band 2. Combined with a reduction in unsocial hours payments, this creates a massive disincentive for staff looking to take on more responsibility. We need to increase this gap to create a real promotion incentive.
Bands 5-6
We are at greatest risk of losing new clinical staff in the first two years in their role. The progression from entry to intermediate in Band 5 is too small. Shouldn’t in-band progression for early-career staff come with meaningful reward?
Promotion to Band 6 does not come with enough of pay rise for experienced staff. In our autumn survey we saw this was a real priority for experienced nurses working at band 5.
Bands 7-9
At 8a, staff often lose all eligibility for unsocial hours payments and overtime, but working at Band 8a often means a big jump in responsibility – shouldn’t there be a decent reward for those making the move up from band 7?
New graduates
NHS salaries are at risk of not being competitive with other public sector jobs. Graduate entry into the NHS is at band 5 – compare this with teachers’ starting pay rates, and jobs in the private sector which are often higher. We run the risk of not being able to fill vacancies if we let the NHS fall behind.
How can we make sure staff are on the right band?
Unions won a big victory with Agenda for Change when it came in 20 years ago, but employers have not invested properly in checking banding as they have given staff more complex work.
The government has recently agreed to the programme of work we asked for to ensure staff are paid properly for the work they do. This includes work to build capacity at an employer level to ensure the job evaluation scheme is applied consistently and that staff can access their contractual entitlements, such as up-to-date job descriptions and access to timely JE processes. But we know it will be a while before you see the impact of these changes.
UNISON has been helping band 2 healthcare support workers come together in their thousands to win re-banding through our Pay Fair for Patient Care campaigns up and down the country.
With the publication of new national job profiles for nursing, we’ve also launched our campaign for nurses, to ensure you are on the right band and being paid fairly for the work they do.
Why campaign for a shorter working week?
Did you know the NHS 37.5 hour working week is the longest official working week in the public sector? We know that long hours reduce efficiency and increase stress – shouldn’t we be talking about how to address the issues in NHS employment and staffing, with nothing off the table?
Reducing the standard working week wouldn’t result in a reduction in patient services – the NHS is already open overnight, every night, and 7 days a week! Hundreds of thousands of staff already work part-time or flexibly.
The Scottish and Welsh governments are already committed to reducing the standard NHS working week and in talks with the NHS and NHS unions. Staff in England deserve the same conversations.
We’re very concerned about the response to our survey which found that ambulance staff were more likely than most NHS staff to experience stress and burnout at work, and that long hours and shift overruns don’t help. 37.5hrs is still the standard working week for such a physically and emotionally intense job. Fixing shift patterns and improving handovers could reduce staff workload without having to reduce patient services.
What about staff working for GPs, private contractors or other employers?
UNISON has long campaigned for GP and contractor staff to be paid the same rates and benefits as their colleagues who are directly employed by the NHS. At the moment some contractors mirror Agenda for Change pay rates and uplift pay accordingly; others implement pay rises when put under pressure to do so; and many don’t match NHS rates at all.
What about bank staff?
There is no national agreement on bank pay so what employers do in relation to bank staff depends on local terms and conditions. Depending on your contract, your pay may go up in line with the national pay award. However, we would push for and expect employers to update their bank pay rates in line with national pay awards.
UNISON wants to make work better for bank workers. We are encouraging all NHS employers to adopt the principles in our Better NHS Bank Charter. This shows support and values NHS bank staff. Speak to your UNISON branch and your bank colleagues about building a campaign to get your employer to sign up to our charter.
What’s happening in Scotland, Wales and Northern Ireland?
This information applies to NHS staff in England. For the latest updates on NHS pay in Scotland and Wales or health and social care pay in Northern Ireland, please check the relevant website:
*The above article is from the unison.org.uk website
