NHS staff in England may have only just received their 2024 pay rise but we’re already concerned that the 2025 pay round isn’t moving fast enough. We also know there have been issues with how the 2024 pay award has been implemented by some employers.
The government had also promised to hold meaningful talks with unions and employers to address significant issues with the pay structure, like banding and progression. But we have seen no concrete progress and time is slipping by.
We’ve written to health secretary Wes Streeting, calling on the government to urgently open direct negotiations with unions and employers to get your next pay award agreed ahead of 1 April 2025.
We need to show the government that the outdated pay-setting process – relying on a Pay Review Body recommendation – is drawn-out, keeps NHS staff locked out, and simply doesn’t address the real problems with your pay.
So your input now is essential.
Please tell UNISON how the 2024 award was implemented by your employer – including any problems with back pay, tax, new pay points, salary sacrifice, Universal Credit or anything else.
And tell us how important it is that the government begins direct talks with your union and employer on your pay rise for next year.
You deserve a pay structure that works. We’ve been making the case for change and increasingly other unions agree too. With your involvement, we can secure it.
FAQs
- How is NHS pay decided?
- Does UNISON want to negotiate directly on NHS pay going forward?
- What will it take to put NHS pay right?
- What are some of the key problems with the NHS pay scale?
- How can we made sure staff are on the right band?
- Why campaign for a shorter working week?
- What about staff working for GPs, private contractors or other employers?
- What about bank staff?
- What’s happening in Scotland, Wales and Northern Ireland?
- What can I do now?
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 will it take 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.
The NHS is in a staffing emergency with over 110,000 vacancies, spiralling workloads and a record patient backlog.
That’s why together we’re calling on the government to put NHS pay right to keep dedicated staff in their jobs and ensure more patients can be treated more quickly.
In our autumn 2023 survey, more than 40,000 NHS staff told UNISON that you want:
A proper pay rise
A majority of UNISON members – in every role, at every pay band – said that increasing core pay is the number one priority.
All staff working in the NHS need a proper pay rise to keep up with rising living costs and to provide a decent reward for the challenging work you do. Over a third of members report that they cannot get through the working day without worrying about finances and this cannot go on.
We need to fix problems up and down the pay scale to kick poverty pay out of the NHS for good; to maintain fairness between staff; and to make sure that when you progress or get promoted, you notice a real difference in your pay packet.
The right banding
Nurses, admin staff, catering staff and many others tell us that they are working above their band. Thousands of UNISON healthcare support workers have come together to fight for and win rebanding and back pay because the current creaking system leaves staff undervalued and underpaid.
A shorter working week
UNISON’s ambition is for a reduced working week in the NHS with no loss of pay. Better work-life balance would improve wellbeing, reduce burnout and keep staff in their jobs, reducing reliance on overtime and agency staff. While there may not be a quick route to a shorter working week, many staff have already identified areas of their work that could run more smoothly. Let’s start the conversation now!
You can read the evidence UNISON sent to the former Secretary of State in February.
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 it?
Staff in Bands 8 and 9 need to wait 5 years to reach the top of their bands. Members say that cutting this length is important – it should only take 4 years to reach the top of the Band for staff in Bands 8 and 9.
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 made 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. UNISON is arguing for a right to annual band reviews because too many people are now under-banded for the work they do.
UNISON has been helping band 2 healthcare support workers come together in their thousands to win re-banding with almost 100 active Pay Fair for Patient Care campaigns up and down the country.
UNISON has a track record of securing major wins in role redesign. We won the principle of Band 6 jobs for paramedics to reflect that the role was more advanced.
The underlying issues raised by nurses are real and urgently need to be addressed. Right now we are leading the nursing profile review. Our work is based on a survey of thousands of nurses who told us what they actually did in their role and how often they got a job evaluation review.
The NHS should get the right banding in general, so staff don’t have to constantly fight to be paid 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?
What employers do in relation to bank staff depends on the terms and conditions staff are on. Depending on your contract, bank staff may have changes to NHS pay values reflected in your pay rates.
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:
What can I do now?
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.
Talk to your colleagues about your pay and conditions, and encourage them along to any meetings your branch is holding. Whether it’s putting up posters, signing petitions, speaking to the public or explaining UNISON’s position to staff who haven’t joined yet, your union is only as strong as its members.
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