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 But that came with a promise to tackle problems with the increasingly outdated wage structure and backdate any improvements in pay to April.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 The unions say the process is outdated and unable to deal with the modernisation the pay system needs to remain effective.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.”