Defending Agenda for Change

UNISON members 

are feeling the impact of government’s

successive pay freezes with

pay rates falling behind inflation by

8% to 12%

UNISON is campaigning to maintain Agenda for Change, the nationally agreed UK-wide package of pay, terms and conditions for NHS staff. Agenda for Change is under attack as a result of shrinking NHS resources, lack of support from the Westminster government and some vocal employers. This could mean cuts to pay and conditions for hard-working NHS staff.

What is Agenda for Change and why should we support it?

In 2004, pay, terms and conditions for NHS staff were harmonised into one package, known as the Agenda for Change agreement. UNISON campaigns and negotiates to maintain Agenda for Change as the UK-wide package of terms and conditions for all staff delivering NHS services, and to improve and extend its terms and scope.

The national Agenda for Change agreement has come under attack as a result of shrinking NHS resources across the four nations, lack of political support for national bargaining from the Westminster government and the activities of a small number of vocal ‘anti-Agenda for Change’ employers. These factors have led to:

  • threats to Agenda for Change, including threats to change the parts of the terms and conditions package that are set locally;
  • downbandng jobs, where employers move staff to a lower pay band to cut costs;
  • threats to downgrade pay for hard-working NHS staff.

UNISON members working in the NHS are also feeling the impact of government’s successive pay freezes, with pay rates falling 8% to 12% behind inflation. This makes it even more vital that we keep the national Agenda for Change agreement.


Nurses and midwives say their hospital is at risk of becoming the next Mid Staffordshire because chronic short-staffing means they are unable to give patients the care they need

Sam Webb

Daily Mail, 19 April 2013


The current state of play

In England, revisions to Agenda for Change were consulted and agreed on last year in response to a number of NHS trusts attempting to ‘break away’ from the national agenda for change agreement. 

Members in these trusts had to organise, campaign and take industrial action to try and stop the employers reducing terms and conditions and moving to local contracts. 

As a result of members accepting the England-only revisions to Agenda for Change, this halted breakaway trusts from pursuing local agreements and has ensured that the national agreement was maintained.   

Proposals exist for similar changes in Wales.

What is UNISON doing to defend Agenda for Change?

UNISON runs courses to help activists understand and defend their Agenda for Change terms and conditions and to organise, negotiate and campaign on pay, terms and conditions.

UNISON set up a campaign called 'Postcode Pay? No Way!' in 2012 to oppose the South West Pay Cartel’s attempt to cut terms and conditions. A mix of parliamentary lobbying, local organising and a strong regional and national media presence led to the cartel’s announcement in March 2013 that there were no further plans to introduce regional pay. Most of the 20 trusts have confirmed that they will stick with Agenda for Change.


We want all trusts to continue to adhere to Agenda for Change, because it is a national framework that delivers for staff and employers alike

Christina McAnea

In Wales, the union has been negotiating with the Welsh Assembly around maintaining Agenda for Change. 

Defending Agenda for Change in Wales

Downbanding jobs

NHS staff are placed on a pay scale by reference to a UK-wide NHS job evaluation scheme. The scheme ensures that staff doing the same job in different places are paid the same. This protects employers from equal pay legal cases.

Many employers have responded to shrinking budgets by moving staff to lower pay bands but without changing the content of the job. If employers do this without following proper processes it can recreate the unequal pay that led to the need to introduce Agenda for Change in the first place as well as leading to serious misapplication of skills in vital areas of the NHS. 

What is UNISON doing about downgrading jobs?

UNISON and the other NHS trade unions negotiated a new section of Agenda for Change to curb the worst impact of downbanding. UNISON branches have also run strong local campaigns to oppose downbanding plans in their employing trusts. One example is Mid-Yorkshire Healthcare Foundation Trust, where UNISON members have taken a series of days of industrial action in protest over plans to save money by slashing their pay. We also work to highlight the problem nationally by lobbying politicians and talking to the media.

NHS pay

NHS pay rates are included in the Agenda for Change agreement, but the annual changes to pay rates are made by the four UK governments following recommendations from the NHS Pay Review Body. 

UNISON gives detailed written evidence to the pay review body as well as often speaking to the Body directly. We organise a national and trade media campaign to accompany this to give us extra impact.

NHS staff earning above £21,000 had pay frozen in 2011-12 and again in 2012-13. In March 2013 the NHS Pay Review Body recommended a 1% pay rise for all NHS staff. This falls well below the 8% to 12% gap that has opened up between NHS pay and inflation since 2010. 

The minimum NHS rate of pay is now 14p an hour less than the living wage.

What is UNISON doing about NHS pay?

UNISON is campaigning on NHS pay issues, in particular on the impact of the pay freeze on our members as well as on the economy and on the morale and motivation of NHS staff. In addition to preparing and submitting evidence to the pay review body, we do this nationally by lobbying politicians and talking to the media and locally by helping our activists run local campaigns. 

UNISON's 2013 health conference determined to make pay a high priority during 2013-14, to work with other parts of the public sector to demonstrate why pay matters, to campaign to make the living wage apply across the NHS, and to highlight the ongoing impact of the pay freeze on NHS staff and services.

UNISON Health is working with other parts of the union on our high profile Worth It campaign – making sure pay stays at the top of the agenda – and continuing to campaign for better and fairer pay. 

UNISON's Worth It campaign