Health secretary Yvette Cooper must take care of “unfinished business” and conclude government talks to fix deep-seated problems with the NHS pay structure. Fourteen unions representing more than 1.2m health workers have urged her to make up for lost momentum following the departure of her predecessors Wes Streeting and James Murray in quick succession, causing progress to stall.
In April this year, ministers imposed a 3.3% pay increase for NHS staff on the Agenda for Change (AfC) salary scale following a pay review body recommendation. But that came with a promise to tackle problems with the increasingly outdated wage structure and backdate any improvements in pay to April. That commitment came on the back of previous assurances from Labour dating back to when the government first came to power.
The unions say most NHS workers in England, Wales and Northern Ireland feel they are getting second-class treatment, with pay awards consistently and significantly below those given to doctors and dentists.
Wage gaps
This means wage gaps are ever widening, which does little to make health staff feel they are all part of one team, working together in the interest of patients, the unions said.
Over the past four years, resident doctors have seen their pay rise at double the rate of AfC staff, who include pharmacists, nurses, healthcare assistants, paramedics and porters. At the same time, pay satisfaction levels among the wider NHS workforce are trailing those of doctors by a huge margin, according to union analysis.
Cumulative uplifts for resident doctors in England from 2023 to 2026 have increased their pay by 35%. Agenda for Change staff, meanwhile, have had headline pay rises of 18.5% over the same period.
The unions said it has not gone unnoticed that long-running strike action by resident doctors has led to significantly increased pay offers in recent years.
Ministers have said they want to resolve problems through talks, not strikes, so the urgent resumption of talks to fix salary scales is essential, the AfC unions said. The delays mean the 2027 pay rise must also now be considered in the same set of talks, they added.
Ministers must concentrate on bringing the negotiations to a conclusion rather than diverting time and effort into the pay review body (PRB).
Pay review body boycott
All but one of the 14 unions have said they will boycott the PRB process, which has begun its lengthy evidence-gathering period. The unions said the process is outdated and unable to deal with the modernisation the pay system needs to remain effective.
It has led to wage awards below those recommended by the equivalent doctors’ body and those for all other public sector groups. And the reform talks are clearly outside the PRB’s remit, the unions added.
That means it will be harder to recruit and retain staff, with wages failing to compete with lower-stress work in supermarkets that pay at least the real living wage.
Failure to overhaul the AfC structure also means degree-level pay bands have fallen behind other graduate jobs. That is especially true for the more experienced staff the NHS so desperately needs to retain, the unions said.
In Scotland, the government has ditched the PRB and negotiates directly with unions. Staff in Scotland now earn considerably more than colleagues elsewhere in the UK doing the same jobs.
For example, the entry rate at the very bottom of the pay structure is £1,424 higher in Scotland than in England, and a healthcare assistant, administrator or porter at the top of their pay band in Scotland gets £3,933 more in basic salary than their counterpart in England.
‘Unfinished business’
Chair of the NHS unions Helga Pile, who is also Head of Health at UNISON said: “NHS workers have been promised time and again the government will fix structural pay issues at the heart of Agenda for Change contracts. But this is unfinished business and they’re still waiting.
“A government that says it cares about efficiency and better industrial relations can’t continue to put its faith in a pay review system that belongs to a bygone era.
“There’s no sensible way to review pay in isolation from the overhaul clearly needed for the entire salary structure. That’s something even the pay review body says it’s not best placed to do.
“Staff have had enough of broken promises to fix their pay. Ministers must now inject pace and serious cash into the talks so unions and employers can reach a settlement.”
Secretary of the NHS unions Jim Fahie, Chartered Society of Physiotherapy assistant director added: “Changes to the pay structure are desperately needed and long overdue. We entered into talks in good faith, and it’s essential those discussions now move to a definitive outcome.
“Without those changes, resentment will grow over deals made with other groups of NHS workers, and we risk undermining efforts to retain the staff that patients so badly need.
“With a new secretary of state now settled in, the government must return to the table without further delay and help us deliver a pay structure that fairly rewards the enormous contribution of all Agenda for Change staff.”
The chair and secretary spoke on behalf of all AfC unions: the Association for Laboratory Medicine, British Association of Occupational Therapists, British Dietetic Association, British Orthoptic Society, Chartered Society of Physiotherapy, GMB, PDA Union, Prison Officers Association, Royal College of Midwives, Royal College of Nursing, Royal College of Podiatry, Society of Radiographers, UNISON and Unite. By working together the unions provide a collective voice for staff working in the National Health Service.