Despite government claims, the pay awards to NHS workers are poor deals once long-term inflation is taken into account. Their unions need to fight this, argues Simon Midgley 

In December of 2024, when the Starmer government suggested that the NHS pay review bodies should recommend just 2.8% for 2025-26, health unions rightly denounced this as derisory and an insult, considering the cost-of-living crisis we are going through. 

On 22 May this year, the Doctors and Dentists Review Body (DDRB) recommended a 4% rise for doctors, and the NHS Pay Review Body (NHSPRB) recommended a 3.6% rise for nurses and all other NHS staff. Junior doctors are to get an additional consolidated lump sum payment of £750, meaning the rise for them is equivalent to 5.4%. Labour Health Minister Wes Streeting immediately agreed to these recommendations, and announced they would be implemented without negotiation. 

Junior doctors in dispute 

Streeting also claimed that junior doctors have seen a cumulative rise of 28.9% since 2022. That might be true, but this figure was calculated from a rock-bottom starting point. The bigger picture is that between April 2008 and April 2022, the value of junior doctors’ pay shrank by a cumulative percentage of 31.7%, due to the imposition of public sector pay freezes, pay rise limits, and the impact of Retail Price Index inflation (RPI).ⁱ In April this year, it was still worth 22.6% less in real terms than it was in 2008. 

The long pay dispute of 2023-24 saw junior doctors (now renamed resident doctors) take strike action eleven times, totalling 44 days. They struck to restore the value of their pay, which was then 25% lower in real terms since 2008 (due to RPI inflation). In September 2024, Starmer’s incoming government agreed a 22% rise over two years, covering both 2023-24 and 2024-25. At the time, the BMA said that this had not been enough to achieve restoration, and more would be needed in future deals. 

(Source: BMA: https://www.bma.org.uk/our-campaigns/resident-doctor-campaigns/pay-in-england/pay-restoration-for-resident-doctors-in-england) 

The BMA response to the suggested 4% rise in 2025 has been clear: it fails to redress historic losses of pay, provides no path to pay restoration, and is below the rate of the Retail Price Index (RPI) inflation which is currently 4.5%. At the rate of 4% per year, the BMA has calculated it would take 32 years to achieve their goal of full pay restoration. Even at a rate of 6% per year, it would take nine years. So the BMA has launched an industrial-action ballot of resident doctors, which runs till 7 July. 

(Source: BMA: https://www.bma.org.uk/our-campaigns/resident-doctor-campaigns/pay-in-england/pay-restoration-for-resident-doctors-in-england) 

NHS Agenda for Change staff 

For all other NHS staff, including nurses, midwives, paramedics, ambulance drivers, physiotherapists, health-care assistants, porters, cleaners, caterers, etc. who are on the Agenda for Change pay scales, the NHS Pay Review Body (NHSPRB) recommended a 3.6% rise. 

In 2024, to end the NHS pay dispute, the incoming Starmer government, within weeks, announced an ‘above inflation’ rise of 5.5% for Agenda for Change staff. Unions such as Unison recommended acceptance of this, with the proviso that it would allow them to return and fight for more in the next pay deal. However, this 3.6% rise just doesn’t cut it. 

On the day of the NHS PRB announcement, Wes Streeting put out a press release aimed at Agenda for Change staff, claiming that the 3.6% for 2025-26 means the Band 2 (NHS Band 2 includes healthcare assistants, porters, receptionists, phlebotomists, administrative staff, domestic staff and catering staff) starting salary has increased by over £4,000 above what it was in 2022-23. This bold statement distorts the reality. In 2022-23, the Band 2 salary was £20,270, and this 3.6% rise would now bring it to £24,465, a difference of £4,295. That much is true. 

However, when inflation is taken into account, according to the Bank of England’s online CPI-inflation calculator, the 2022 starting salary would have to have increased by £2666 to £22936 just to keep up with the rise in CPI prices over that period. Worse yet, according to the Hargreaves Lansdown online RPI inflation calculator, the 2022 Band 2 salary of £20,270 would have to be £24,365 today, to keep up with RPI price inflation over that period. A real-terms increase of just £100 from this figure to £24,465 isn’t much to crow about! 

Streeting also stated that nurses and others on Band 5 starting salary (NHS Band 5 includes nurses, newly qualified midwives, paramedics, physiotherapists, occupational therapists and speech therapists) will now be on around £31,050, nearly £4,000 more than three years ago. This claim also distorts the reality. Three years ago, in April 2022, the Band 5 starting salary was £27,055. This 3.6% rise would bring it to £31,050, a difference of £3,995. So far, so good. 

However, when inflation is taken into account, even at the CPI rate, the 2022 Band 5 starting salary of £27,055 would have to have increased by £3,559 to £30,614 just to keep up, so Streeting’s £4,000 increase shrinks to £441. Worse, in order to keep up with RPI price inflation, Band 5 pay would now have to be £32,520, not just £31,050. So, in real terms, this 3.6% rise for Band 5 actually results in nurses still being £1,470 worse off in real terms than they were three years ago! 

The simple fact is that in order to have kept up with the rising cost of living (as measured by the RPI) between April 2022 and April 2025, NHS Band 5 pay would have to have risen by a total of 20.2%, at an average rate of 6.3% per year! 

Nurses and others yet to respond 

Reacting to the recommended 3.6% rise, Professor Nicola Ranger, RCN General Secretary and Chief Executive, quite rightly, said: ‘This pay award is entirely swallowed up by inflation and does nothing to change the status quo – where nursing is not valued, too few enter the profession and too many quit.’ The RCN is launching a consultation with its members on how to respond, which is due to begin on 9 June. 

Unison, the largest union in the UK, representing around 500,000 health workers in the NHS, has criticised the Labour government’s decision to ‘impose’ the 3.6% pay rise, but at the time of writing, its Health Service Group Executive committee (HSGE) is yet to announce its next move. Both RCN and Unison members should demand that their unions reject this derisory rise and launch serious campaigns for a real pay rise. 

Unison’s initial online response to the 3.6% figure also points out an issue that low-paid Band 2 workers already know: they won’t even be getting the full 3.6%. On 1st April 2025, workers on the NHS Band 2 already had a pay rise, of sorts, even though no deal had been reached and the NHS Pay Review Body had not yet made any recommendation. 

Why? Because on 1 April, the National Living Wage was increased to £12.21 per hour, overtaking this paltry NHS pay Band, making it illegal to leave them at £12.08 per hour. So, in response, the Band 2 rate was increased by the government, by 28p per hour, to £12.36. This was equivalent to a 2.3% rise. 

Well, a rise is a rise, after all, we might say. Plus, given that the 2025 NHS pay deal had not yet been agreed, you’d be forgiven for thinking that this legally-required increase was ‘in the bag’, and the still to be agreed 2025 deal would bring another rise on top. 

But, no. This is the NHS, and Starmer is PM. On April Fools’ Day, it was announced that this mandatory, unavoidable increase was just a ‘temporary’ one, and was only an ‘advance’ on the 2025 pay rise yet to come. 

If the full 3.6% rise was simply added on top of the actual current rate of £12.36, then this would rise by 44p per hour to £12.80. Even if it were only added on top of the new National Living Wage rate of £12.21, this would bring it up by 44p per hour to £12.65. 

But no. NHS Band 2 won’t be getting the full 3.6% rise on top of their actual current hourly rate. Instead, the 3.6% rise will be calculated from the lower (now illegal) 2024 rate of £12.08. This means that the new rise will effectively only be 1.3% above the actual current pay rate of £12.36 which Band 2 are already getting, increasing it by just 15p to £12.51 per hour. 

This figure itself is only 30p above the new 2025 National Living Wage of £12.21. Even back in 2023-24, NHS Band 2 pay was 63p above the then National Living Wage of £11.45. This shows clearly how NHS pay continues to be eroded. 

The Starmer government’s acceptance of the pitiful rises recommended by the NHS Pay Review bodies clearly shows that under Starmer, Labour is set on continuing, not correcting, the erosion of NHS staff pay that workers suffered during sixteen years of austerity and Tory government. It is effectively a policy of austerity 2.0 in the Health Service. NHS workers should reject this and fight it with all their strength. 

Simon Midgley (Porters Steward & International Officer, Bradford, Calderdale and Huddersfield Health Unison, in personal capacity)