Category: BOSTU

Health secretary Yvette Cooper must take care of ‘unfinished business’ and conclude government talks to fix deep-seated problems with NHS pay structure, unions say today (Friday).

BOSTU have joined with a further thirteen unions, representing more than 1.2m health workers, to urge 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 staff on the NHS’ 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 But that came with a promise to tackle problems with the increasingly outdated wage structure and backdate any improvements in pay to April.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 it first came to power.

The unions say most NHS workers in England, Wales and Northern Ireland feel they’re getting second-class treatment with pay awards consistently and significantly below those given to doctors and dentists.

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 add.

Over the past four years, resident doctors have seen their pay rise at double the rate of AfC staff, who include 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.

Unions say 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 urgently resuming talks to fix salary scales is essential, say the AfC unions. The delays mean the 2027 pay rise must also now be considered in the same set of talks, they add.

Ministers have to concentrate on bringing the negotiations to a conclusion rather than diverting time and effort into the pay review body (PRB).

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 The unions say the process is outdated and unable to deal with the modernisation the pay system needs to remain effective.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 say.

That means it will be harder to recruit and hang on to staff, with wages failing to compete with lower-stress work in supermarkets paying 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’s especially true for the more experienced staff the NHS so desperately needs to retain, the unions say.

In Scotland, the government has ditched the pay review body and negotiates directly with unions. Scottish staff now earn considerably more** than colleagues elsewhere in the UK doing the same jobs

BOSTU President Deborah Podmore said: “BOSTU agree with the collective unions and no longer have any faith in the AfC Pay Review Body. Reform of the pay structures is vital to address current inequalities and create a rewarding career structure for our members.”

BOSTU General Secretary Sam Aitkenhead said: “While the government continues to push inadequate awards that fail to match the rising cost of living, we know what our members are truly worth. Years of eroded pay have left staff overstretched and undervalued, and we refuse to let this stand.

“We are actively pressing ministers and health leaders to return to the negotiating table with a real, funded plan for structural pay reform. The recent 3.3% pay award imposed by the government simply does not go far enough. It fails to repair a decade of real-terms pay cuts, it ignores the ongoing cost-of-living pressures, and it does nothing to solve the severe recruitment and retention crisis holding our health service back. Our members keep the NHS running every single day, and they deserve to be compensated properly for their vital work.”

UNISON head of health and chair of the NHS unions Helga Pile 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 the entire salary structure clearly needs. Something that 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.”

BIOS joined with other health unions to deliver our joint letter to the Secretary of State for Health and Social care, calling for the focus and investment needed to make fair pay in the NHS a reality.

In the letter, signed by 78,000 NHS staff and supported by the 14 health unions, our members have told the government that 3.3% is not enough, and it must now put money on the table to reform Agenda for Change.

We also warned that the pay award fails to keep pace with the cost of living, won’t repair years of lost pay and doesn’t address the lower pay rises for those on Agenda for Change contracts than other groups in recent years.

Fair pay for NHS staff is the first step to safe and effective care in every setting, and a health service fit for the future, but talks without new funding won’t deliver the change needed. The Health Secretary must ensure there is no further delay. Hundreds of thousands of NHS workers are losing faith and won’t wait much longer.

We joined with other health unions to insist that the government must improve its inadequate 3.3% pay rise for NHS staff by putting significant extra funding into long-delayed pay restructure talks or the workforce crisis will continue to grow.

In a joint letter to health secretary Wes Streeting, they warn the pay award fails to keep pace with the cost of living, won’t repair years of lost pay and doesn’t address the lower pay rises for those on Agenda for Change contracts than other groups in recent years.

Staff are angry and feel deeply let down after years of falling wages and relentless pressure, say the 14 unions representing more than a million health workers.

They point out that by relying on the discredited NHS Pay Review Body process rather than negotiating directly with unions, ministers have wasted an opportunity to tackle headline pay awards and much-needed reform of the pay structure at the same time through comprehensive talks.

The 2026/27 headline rise will be imposed in a fortnight (on April 1), with negotiations to follow on structural fixes, which would mean additional rises for some staff if a deal is reached.

But staff say those talks were promised more than 18 months ago and the ongoing delay has wrecked trust.

The letter says: “Day in, day out staff are battling understaffing, overwork and the constant worry that – despite their best efforts – patients are not getting the care they deserve.

“To rebuild confidence, negotiations must now move quickly and show clearly how they will improve on what staff have already been offered.”

The government must provide sufficient funding to make sure talks succeed, unions add.

Despite the anger over pay, staff say they remain committed to the future of the health service.

“No one wants the NHS to succeed more than the staff who keep it running. But that requires a workforce that is properly valued and properly paid.”

The unions are also asking health workers to sign an online version of the letter to demonstrate the strength of feeling.

Chair of the NHS unions and UNISON head of health Helga Pile said: “For most NHS staff this will feel like a pay cut not a wage rise. After years of rising pressure and falling wages, health workers expected better from this government. If ministers really want the NHS to recover, they have to start by valuing the staff who keep it going.

“There’s a lot riding on these talks. Real money on the table from government will be key.”

Secretary to the NHS unions and assistant director for employment relations at the Chartered Society of Physiotherapists Jim Fahie said: “The letter is a way for NHS staff to make their voices heard and show ministers that they need to do more on pay.

“It’s important that as we enter negotiations over the pay structure, ministers and civil servants know that it remains an issue of high importance to the brilliant staff who have kept the NHS afloat under enormously difficult circumstances in recent years.”

Sign the open letter here.

NHS leaders must make flexible working the norm to deliver better patient care and help resolve the staffing crisis, say unions today.

BOSTU has joined with a coalition of 18 unions* who represent every part of the NHS workforce to launch a new initiative to promote more choice for staff over how, when and where they work.

The Get Ahead on Flex pledge is aimed at getting employers to speed up their progress on working arrangements that offer more freedom, such as team-rostering and ‘any hours’ contracts, which offer staff the hours they want to work from the outset, say the NHS unions.

We’re encouraging all workplace reps to join with the NHS unions in persuading their employers to sign the Get Ahead with Flex pledge. You can find out more and download a resource pack here.

Those who sign up will commit to highlighting flexible working in every job advert, setting targets to increase the number of requests approved, publishing data such as the number of requests staff make and training all managers on how to champion choice for workers.

Sussex Community NHS Foundation Trust and Milton Keynes University Hospital have already signed up to the pledge. The pledge is also backed by equality campaigners, including Kate Jarman, who champions flexible working in the NHS, and Professor Alison Leary from London South Bank University.

At present, all NHS workers have the right to request flexible working from day one of employment and to make unlimited requests without providing a reason.

However, health unions say too often accessing the flexibility they need is a struggle for staff, including those with childcare and other family commitments. The inconsistent approach by employers has created a postcode lottery across the NHS.

Some staff are being forced to accept less favourable contracts – or bank shifts which are lower paid – in return for being granted flexible working. Employers often reject applications from workers who want to determine their own schedule and instead insist they have to fit in with rigid shift patterns.

A health worker, who cares for her elderly mother, said: “I applied for flexible working twice, but it was declined both times.

“I used all my annual leave to have weekends off (to care for her mother). It meant I had no holidays or time away for me for several years until we got a different manager.”

The health unions say flexible working should be adopted as standard to help attract and retain experienced staff. Tens of thousands of workers have already left the health service due to poor work-life balance, according to data*.

Get Ahead on Flex is also aimed at ensuring managers know how to handle requests in a way that benefits individual staff. The campaign also encourages them to take the initiative to redesign jobs and services to meet the needs of staff and patients.

The benefits of flexible working, such as better performance and higher quality care for patients, are well-understood at the policy level. But the unions say that financial and other pressures on the health service get in the way of real change.

In England, a new standard on flexible working is expected to be introduced for NHS employers in April as part of the government’s 10-year workforce plan.

Trusts that sign up and meet the commitments of the Get Ahead on Flex pledge will already have a head start on implementing the new standards, say the unions.

And in 2027, tougher statutory requirements on flexible working are due to come into force for all employers.

Chair of the NHS unions and UNISON head of health Helga Pile said: “Too many NHS staff are struggling to balance work with other parts of their life including caring commitments. This affects their health and well-being, and forces many to consider jobs elsewhere.

“The NHS has long talked about the importance of improving flexible working options. However, old-fashioned attitudes and rigid one-size-fits all shift patterns are still getting in the way.

“This pledge provides a real opportunity to improve working life for staff and give patients a better service.”

Campaign lead for the NHS unions on flexible working and Society of Radiographers head of industrial relations Leandre Archer said: “Flexible working shouldn’t depend on which employer you work for or who your manager happens to be.

“NHS staff deserve fair, consistent access to flexibility so they can deliver the best possible care without sacrificing their own wellbeing.

“The Get Ahead on Flex pledge is a vital step towards ending the postcode lottery and making flexible working a genuine reality across the NHS.”

Notes to editors:
–*Of those workers who left the NHS in 2024/25, around 12,000 (9%) blamed work-life balance, according to the King’s Fund. This represents nearly double the percentage who left for the same reason in 2012/13 (4%).
–Get Ahead on Flex pledge is part of the Let’s Talk About Flex campaign. The 18 unions behind the Get Ahead on Flex pledge together represent a health workforce of over a million. They are the Association of Laboratory Medicine, British Association of Occupational Therapists, British Dental Association, British Dietetic Association, British Medical Association, British Orthoptic Society, Chartered Society of Physiotherapy, GMB, Hospital Consultants and Specialists Association, Managers in Partnership, the Pharmacists’ Defence Association, Prisoner Officers’ Association, Royal College of Midwives, Royal College of Nursing, Royal College of Podiatry, Society of Radiographers, UNISON, and Unite.

Media contacts:
Anthony Barnes M: 07834 864794 E: a.barnes@unison.co.uk
Mark Conrad M: 07809 623703 E: m.conrad@unison.co.uk

The NHS Workforce is more diverse than it ever has been, and this is something to be celebrated. The violence, racism and islamophobia that we have seen over recent months is a disgrace, and alongside other NHS trade unions, we stand together as part of a movement that opposes racism in all its forms in workplaces and wider society.

NHS unions have released guidance for trade union representatives with information and questions that can be raised through local staff-sides, health and safety committees and more widely.

We will be sharing this with local workplace reps and would encourage all to ensure that this issue is on the agenda for your local JNCC meetings and that local policies reflect the guidance.

BOSTU joined with 14 other health unions today to call on the government to get on with promised direct talks to get wage structures right and deliver pay awards on time.

The 14 unions representing staff on ‘Agenda for Change’ contracts within the NHS have written jointly to health secretary Wes Streeting, urging him to honour a commitment made last year to tackle problems in the pay system that are harming staffing and morale.

Given the delay, unions say these talks should now be widened to also include the headline pay award for 2026, which would need to be decided early next year if it is to be paid on time in April, as ministers have committed to do.

Unions say staff trust and confidence in the current pay process, involving a time-consuming pay review body (PRB), has hit rock bottom and a more efficient approach is needed for the coming year.

That means setting aside the PRB process and focusing efforts on comprehensive talks backed by sufficient investment from ministers to allow a deal to be reached, the unions say. This must be enough to cover the cost of reforming pay bands and an acceptable pay increase.

Hardworking staff need to see the government values them and understands their cost-of-living struggles, say the health unions.

Most NHS workers received a pay rise this year that was significantly lower than the one given to doctors and dentists, and which has now slipped below the level of inflation.

The unions – representing more than a million NHS workers – say discontent with the 2025 pay award and the broken promises on talks have “heightened industrial tension” and time is running out.

As a result all but one of the NHS unions have today announced they will not participate in the next pay review body process for 2026/27.

This year’s pay rise of 3.6% was lower than almost all public sector wage increases decided through pay review bodies. And with CPI inflation standing at 3.8%, unions point out pay is being outstripped by the rising cost of living.

The unions say this is further evidence of how the current pay review body (PRB) process is not fit for purpose.

Meanwhile, problems have mounted with the current Agenda for Change system put in place two decades ago, but the absence of regular negotiations means these have not been addressed. Pay bands need to be adjusted to ensure skills and responsibilities are correctly rewarded, the unions point out.

They say it makes little sense to tackle pay rises and structural adjustments separately when a streamlined process would be more efficient.

In their letter the unions say of this year’s rise: “Far from being what the government claimed to be an ‘above-inflation award’, it is in fact a real-terms cut as things stand.

“This has done nothing to boost workforce morale or generate the goodwill needed to deliver the government’s much-needed NHS recovery plan.”

The unions say they will focus their efforts on pushing for extra “meaningful funding” to reform Agenda for Change, in addition to ensuring NHS workers get the decent pay rise they deserve.

Chair of the NHS unions and UNISON head of health Helga Pile said: “The government promised talks over a year ago and they still haven’t got round the table with unions with any proper plan to sort things out.

“The only way to get a system that’s fit for purpose and meets the needs of staff in a modern health service is to fix the structure at the same time as making sure staff can cope with the cost of living.

“Some things need sorting urgently while others will take longer to work through. But the important thing is that we agree a plan and get the funding needed to reach a deal.

“The health secretary wants a more efficient system and that begins with getting pay right. Tackling this now will help to deliver the pay rise when it’s due in April rather than kicking the can down the road leaving staff with months of delays.”

Secretary to the NHS unions and assistant director for employment relations at the Chartered Society of Physiotherapy Jim Fahie said: “The government’s failure to honour the structural reform commitment for the 2025/26 pay year, alongside a lower pay award than other PRB groups, has led to high levels of dissatisfaction among our members.

“Our collective efforts are focused on securing a fair annual uplift in pay for our members and for separate funding to be provided for Agenda for Change (AfC) structural reform.

• Notes to editors:
  The 14 Agenda for Change unions are the Association for Laboratory Medicine, British Association of Occupational Therapists, British Dietetic Association, British Orthoptic Society, Chartered Society of Physiotherapy, GMB, Pharmacists’ Defence Association, Prison Officers Association, Royal College of Midwives, Royal College of Nursing, Royal College of Podiatry, Society of Radiographers, UNISON and Unite.
• The NHS pay review body is due to take evidence over the coming months in order to prepare its recommendation on the 2026/27 wage increase. Ministers have separately promised they will ask the NHS Staff Council negotiating body to hold talks on structural issues, but they have still not confirmed funding and a mandate for formal talks.