NHS pay remains a major concern for healthcare workers across England, with many employees questioning whether current pay awards and progression opportunities fairly reflect their skills, experience and responsibilities.
The latest UNISON campaign argues that while NHS staff received a 3.3% pay award for 2026/27, broader reforms are needed to address issues within the Agenda for Change pay structure.
The union is calling for above-inflation pay increases, improved career progression, fair banding and measures to support recruitment, retention and staff wellbeing.
Key Takeaways:
- NHS staff received a 3.3% pay award for 2026/27.
- UNISON believes the increase does not keep pace with rising living costs.
- The union is seeking reforms to the Agenda for Change pay structure.
- Career progression remains a key concern across several NHS pay bands.
- UNISON wants all staff to be paid the correct band for their role.
- Better pay and progression could help improve recruitment and retention.
- The campaign also supports a shorter NHS working week without loss of pay.
- NHS staff can support the campaign by signing the open letter and sharing their experiences.
Why Is the UNISON Report on the NHS Pay Campaign Important for NHS Staff?
For many healthcare workers, pay is about more than monthly earnings. It reflects professional recognition, career development and the value placed on their contribution to patient care.
Over recent years, NHS employees have faced a combination of economic pressures, including inflation, rising household bills and increased living costs. Against this backdrop, many staff feel that pay awards have not provided sufficient financial relief.
UNISON believes the current system requires meaningful reform to address concerns raised by workers across different pay bands. The union argues that employees should see clear financial benefits as they gain experience, take on additional responsibilities and progress within their careers.
NHS Pay Concerns and Their Impact
| Issue | Impact on Staff |
| Rising living costs | Reduced spending power |
| Slow pay progression | Lower morale and motivation |
| Staff shortages | Increased workload pressures |
| Burnout | Greater risk of staff leaving |
The campaign also highlights the connection between pay and workforce stability. When staff feel undervalued, recruitment and retention become more challenging, creating additional pressure on healthcare services.
What Does the Latest NHS Pay Award Mean for England Staff?
NHS employees covered by Agenda for Change contracts received a 3.3% pay award for the 2026/27 financial year. The increase followed recommendations from the NHS Pay Review Body and was implemented in April 2026.
While any pay increase is welcomed by many staff, UNISON maintains that the award falls short of what is needed. According to the union, inflation and wider economic pressures have already reduced the practical value of the increase.
A senior NHS workforce adviser described the situation clearly:
“In my experience working with healthcare organisations, staff are not only concerned about annual pay rises. Many are looking at whether their earnings grow meaningfully as they gain experience and take on additional responsibilities. When progression feels limited, retaining skilled employees becomes far more difficult.”
This concern reflects a wider frustration among NHS workers who believe that progression through the pay structure does not always provide rewards that match increased responsibility or professional development.
NHS Pay Award vs Key Staff Concerns
| Area | Current Situation |
| Annual pay award | 3.3% for 2026/27 |
| Cost-of-living pressures | Continuing to rise |
| Career progression | Ongoing concerns |
| Recruitment challenges | Present across many services |
As a result, discussions around NHS pay have shifted beyond annual percentage increases and towards broader structural reform.
What Are UNISON’s Key Demands for NHS Pay Reform?
UNISON has identified several priorities that it believes would improve fairness and help create a more sustainable workforce.
An Above-Inflation Pay Rise
One of the union’s primary demands is a pay rise that exceeds inflation. According to UNISON, this would help restore the value of wages and provide meaningful financial support to NHS employees.
The union also argues that higher pay would strengthen recruitment efforts and encourage experienced workers to remain within the health service.
A Fairer Pay Structure and Better Career Progression
Another major focus is reforming the existing pay structure. Many staff report that progression between certain pay points and bands does not adequately reward growing expertise or additional responsibilities.
UNISON believes employees should experience noticeable improvements in earnings when they develop their careers or move into more demanding positions.
Ending Poverty Pay and Ensuring Correct Banding
The campaign also highlights concerns about lower-paid NHS workers. UNISON argues that no NHS employee should earn below the real living wage.
In addition, the union wants greater investment in job evaluation processes to ensure staff are placed on the correct pay bands. Many roles have evolved significantly over time, yet some job descriptions have not been updated to reflect changing responsibilities.
Current Challenges vs UNISON Proposals
| Current Challenge | Proposed Reform |
| Limited pay progression | Improved progression pathways |
| Under-banding concerns | Updated job evaluations |
| Low entry-level pay | Better minimum pay rates |
| Pay compression | Greater differences between bands |
The union has also supported measures such as Annex 31, which strengthens employees’ rights to have up-to-date job descriptions and access to review processes when their roles change significantly.
Why Are Problems Within the NHS Pay Scale Causing Concern?
Many of the concerns raised by UNISON relate to specific areas within the Agenda for Change pay structure.
Challenges Affecting Lower Pay Bands
The union has highlighted concerns around Bands 1 and 2, arguing that some staff continue to face low pay despite playing essential roles within NHS services.
Band 2 has also become a particular focus because it operates as a spot rate, meaning employees no longer receive progression within the band. UNISON believes this removes an important incentive for staff developing their skills and experience.
The gap between Bands 2 and 3 has also been criticised for being relatively small, reducing the financial reward associated with taking on additional responsibilities.
Career Progression and Promotion Issues Across Higher Bands
At Band 4, employees must wait three years before becoming eligible for pay progression, a situation UNISON believes should be reviewed.
The union has also raised concerns about Bands 5 and 6, where progression opportunities may not always provide sufficient financial recognition, particularly for early-career clinical staff.
For employees moving from Band 7 to Band 8a, the increase in responsibility is significant, yet the financial reward can appear limited when compared with the additional duties involved.
Examples of Pay Scale Concerns
| Band Area | Concern Highlighted by UNISON |
| Bands 1–2 | Low pay levels |
| Bands 2–3 | Small pay gap |
| Band 4 | Delayed progression |
| Bands 5–6 | Limited reward for advancement |
| Bands 7–9 | Small increases despite added responsibility |
These concerns form a central part of the union’s argument for structural reform.
How Could NHS Pay Reforms Improve Recruitment, Retention and Staff Wellbeing?
Recruitment and retention remain significant challenges across many NHS services. Vacancies can increase workloads for existing staff, contribute to burnout and affect workforce stability.
UNISON believes that better pay and clearer progression opportunities would make NHS careers more attractive to both new and experienced professionals.
A healthcare workforce consultant shared a similar perspective:
“I regularly speak with NHS teams facing recruitment difficulties. Pay is rarely the only issue, but it is often one of the first factors people consider when deciding whether to stay in a role, seek promotion or leave the profession altogether.”
The union is also campaigning for a shorter working week without loss of pay. Its view is that reducing standard working hours could improve wellbeing, reduce stress and help retain experienced staff.
Supporters of the proposal point to developments in Scotland, where discussions around reducing NHS working hours have already begun.
Improving pay, progression and working conditions together could help create a more sustainable workforce while supporting long-term service delivery across England.
What Can NHS Staff Do to Support the Campaign?
UNISON is encouraging healthcare workers to take an active role in the campaign for pay reform.
Readers who wish to support the campaign can add their names to the open letter addressed to the Health Secretary:
https://action.nhspay.org/page/187023/petition/1
Staff can also:
- Sign the open letter.
- Share personal experiences of pay progression issues.
- Discuss concerns with colleagues and representatives.
- Help raise awareness of the campaign within professional networks.
The union believes that stronger participation from NHS employees can help demonstrate the level of support for reform.
What Could the Future Hold for NHS Pay in England?
Formal negotiations on the NHS pay structure represent an important opportunity to address concerns that have been raised for several years.
Future discussions may focus on progression arrangements, banding issues and measures designed to strengthen recruitment and retention. While the outcome remains uncertain, many NHS employees will be looking for evidence that reforms can deliver meaningful improvements rather than temporary solutions.
The decisions made during these negotiations could influence workforce planning, employee satisfaction and service sustainability for years to come.
Conclusion
The issues highlighted by the UNISON report NHS pay campaign extend beyond annual salary increases. They reflect broader concerns about career progression, workforce retention, staff wellbeing and the long-term sustainability of NHS services.
While the 3.3% pay award provided an increase for NHS staff, UNISON argues that more substantial action is needed to address persistent structural challenges within the pay system.
From improving progression opportunities to ensuring employees are correctly banded, the union’s proposals aim to create a fairer and more rewarding framework for NHS workers.
As negotiations continue, the outcome will be closely watched by staff across England who want a pay structure that better recognises experience, responsibility and commitment to patient care.
Frequently Asked Questions
What is Agenda for Change?
Agenda for Change is the national pay system covering more than 1.5 million NHS employees in England. It sets pay bands, terms and conditions for most NHS staff, excluding doctors, dentists and some senior managers.
Why does UNISON believe the current pay award is insufficient?
UNISON argues that the 3.3% pay award does not keep pace with rising living costs and fails to address longstanding issues relating to progression, pay band structures and workforce retention.
How is NHS pay determined in England?
NHS pay is generally informed by recommendations from the NHS Pay Review Body. Final decisions are made by the government and implemented through national pay arrangements.
What are the main concerns with NHS pay bands?
Key concerns include limited progression opportunities, small pay differences between some bands, delayed advancement and concerns that certain roles may not be banded appropriately.
Why is recruitment and retention linked to pay?
Competitive pay can help attract new staff and encourage experienced employees to remain in their roles. Inadequate pay progression may contribute to workforce shortages over time.
What is UNISON’s proposal for a shorter working week?
UNISON supports reducing the NHS working week without reducing pay. The aim is to improve staff wellbeing, reduce burnout and strengthen retention.
How can NHS staff support the campaign?
Employees can support the campaign by signing the open letter, sharing experiences, engaging with union activities and helping raise awareness of the issues affecting NHS pay and progression.