NHS Pay FAQ's

What problems do members want to fix in the NHS pay scale? 

In our autumn survey, 80% of members said improving pay is one of their top priorities. In our 2024 wellbeing and mental health survey, members reported that increasing pay and reward was the single most important way employers could alleviate stress at work – better than offering free counselling sessions, wellbeing apps, more staffing, or better shift and work patterns.

And it’s not just about a headline pay rise – we need to fix problems up and down the pay scale. For example:

Bands 2-3

• The lowest rate of pay in the NHS is £11.45 an hour – only a penny above the minimum wage. This is shocking – NHS staff need a proper pay rise to end poverty pay in the NHS.

• 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.

• With pay at Band 2 so low, lots of staff are being excluded from salary sacrifice schemes or buying and selling leave because it would take them under the minimum wage. This proves that the rate of pay is just too low.

• The rate for Band 3 is just £433 a year more than Band 2. Combined with a reduction in unsocial hours payments, this is a massive disincentive for staff looking to take on more responsibility. We need to double 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 in intermediate in Band 5 is just £1.14 an hour. Shouldn’t in-band progression for early-career staff come with meaningful reward?

• Promotion to Band 6 is worth just £0.57 an hour for experienced staff. Shouldn’t promotion mean a real pay rise? 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 promotion to 8a roles is worth just £896 a year. Band 8a often means a big jump in responsibility – shouldn’t there should be a decent reward for it?

• Staff in Bands 8 and 9 need to wait 5 years with no progression 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 – a salary of £28,407. Teachers start at £30,000, with jobs in the private sector often higher. We run the risk of not being able to fill vacancies if we let the NHS fall behind.

How can we make 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 campaigns up and down the country. (Find out more about the Pay Fair for Patient Care campaign.)

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 reduces efficiency and increases 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 saying 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. 37.5 hrs 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.