nurse smiling in sunny room

UNISON members are feeling the impact of the 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.

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.

Talks underway to renew Agenda for Change NHS pay structure

For NHS members the Pay Review Body recommends the annual pay award but it is down to UNISON, working with the other NHS unions, to make sure that the pay structure itself remains fit for purpose. Following on from the 2015 pay dispute we have been holding preliminary talks with NHS employers about how to redesign the Agenda for Change structure for the future. That includes trying to deal with problems members have identified such as the excessive time it takes to get to the rate-for-the-job in some roles. To find out more read our briefing


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The health unions across Wales have released a joint statement regarding the NHS Wales proposals for the terms and conditions of the NHS Wales workforce

The facts

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.

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.



The Welsh government has seen its funding from the UK government cut by £1.8 billion since 2010. This is having a direct and devastating effect on funding for the NHS in Wales.

What is happening to NHS funding?

Health boards in Wales need to find savings of between 4% and 5% each year over the next three years due to the cut.

The Welsh government is putting an additional £570m into NHS Wales over that period, but this is still not enough.

Of the 4%-5%, the health minister is looking at finding 1% of those savings from staffing costs.

The minister has made it clear that he expects savings to be found across all budget headings, including staffing, which accounts for 60-70% of NHS costs.

Proposals to modify Agenda for Change

Unions have been in discussion with NHS Wales employers to see if we could find ways of delivering such savings.

UNISON and other unions will be working with them to try to agree how this can be done through efficiency savings that protect both jobs and services.

Now the employers have a set of proposals for a three-year agreement which, in the main, mirrors changes to terms and conditions that were agreed and implemented in England last year.

The NHS unions have only agreed to consult members on these proposals on the basis that staff costs are looked at across the board, including doctors, dentists and senior managers.

It is also important to note that the proposal on offer is a significant improvement on the original proposal that was tabled by the employers, which also included cuts to annual leave entitlement, changes to unsocial hours payments, two years of incremental freezes and a two-year pay freeze on pay uplifts.

The removal from the proposals of all these additional elements are a direct result of the input the trade unions have had in the negotiations.

If these proposals are rejected in Wales, the Welsh government has indicated that it will instruct the individual NHS health boards in Wales to find the financial savings needed on a board-by-board basis, threatening Agenda for Change as a national pay system.

This is the most important decision that the NHS workforce in Wales has taken since devolution

Dawn Bowden, UNISON Cymru/Wales head of health

UNISON is now consulting members on the proposals, recognising that they will have a greater impact on some members than others.

We will also continue to work with the NHS employers and Welsh government to limit the damage inflicted on Wales by these cuts imposed from Westminster, to ensure that we deliver a safe and sustainable Welsh NHS that also safeguards as many jobs as possible.

Have your say

UNISON is not making a recommendation to members on which way to vote, acknowledging that the changes will affect different members differently.

If the proposals are accepted, it would mean that savings of around £12.7m on staffing costs could be delivered, but it would also mean that some staff will potentially find themselves worse off.

However, those savings could be offset against potential job losses, making compulsory redundancies less likely.

When deciding how to vote, you will also be asked to indicate whether you would be prepared to take part in industrial action if you vote to reject the proposals: we are unlikely to be able to get any improvement in this package without taking such action.

This is a difficult time for everyone working in the NHS and these are difficult decisions that members are being asked to make.

However, you can be assured that UNISON will continue to support you, whatever you decide.

Stay informed

You can follow us on Twitter @UNISONOurNHS and our Facebook page at to keep informed and be part of the campaign, or contact us at and we will put you in touch with your local branch and activists.