Pay in the NHS

NHS staff have their pay and terms and conditions set by a national scheme known as Agenda for Change.

UNISON and the other health unions negotiated the UK-wide Agenda for Change (AfC) pay system and terms and conditions agreement with the NHS employers back in 2004. Ever since then 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) – an independent body of experts.

UNISON submits evidence to the PRB each year, drawing on what our members tell us about how they feel about pay, their cost of living pressures, and recruitment and retention problems where they work. We also work with our sister unions in the NHS to submit evidence on behalf of NHS staff.

NHS employers’ bodies and the government also make submissions to the PRB.

The PRB then makes recommendations to the UK governments as to what pay increases NHS staff should get at their April pay date.

In 2022 the pay process is significantly delayed. The formal letter which begins the process is known as the remit letter. This is usually done in summer but it was delayed until November 2021. This has created long and unnecessary delays and uncertainty for NHS staff. Both trade unions and government have made their views known but there has not yet been any formal outcomes for the pay round. The UK government has said it expects the PRB to report in May, which means the process will not complete until June 2022 at the earliest.

Governments have traditionally implemented the PRB’s recommendations in full. However, this tradition was broken for the first time in the PRB’s history in the run-up to the 2015 pay review date, triggering major industrial action in England and Northern Ireland in 2014.

One and a half million NHS workers are covered by the Agenda for Change pay system and many more are affected by it as they work for other employers that follow AfC arrangements in the public and private sectors.