Health unions are calling on the government to get on with promised direct talks to get wage structures right and to deliver pay awards on time.
The 14 unions representing staff on 'Agenda for Change' contracts within the NHS, including the British Dietetic Association have written jointly to health secretary Wes Streeting, urging him to honour a commitment made last year to tackle the 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. This would need to be decided early next year if it is to be paid on time in April, which ministers have committed to do.
Unions say staff trust and confidence in the current pay process, involving a time-consuming pay review body, has hit rock bottom and a more efficient approach is needed. This means setting aside the pay review body process and focusing efforts on comprehensive talks backed by investment from ministers to allow a deal to be reached.
The deal must be enough to cover the cost of reforming pay bands and an acceptable pay increase. 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.
This year's pay rise of 3.6% was lower than almost all public sector wage increases decided through pay review bodies. 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 process is not fit for purpose. All but one of the NHS unions have announced that they will not be participating in the next pay review body process for 2026/2027.
In addition to ensuring NHS workers get the decent pay rise they deserve, the unions say they will focus their efforts on pushing for extra "meaningful funding" to reform Agenda for Change.
Problems have mounted with the current Agenda for Change system put in place two decades ago but the absence of regular negotiations means that 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.
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."
Annette Mansell-Green, BDA Director of Trade Union and Public Affairs said, "BDA members have waited long enough for a decent pay award and pay restoration. The time had come to begin urgent work on the structure of Agenda for Change and to set up a system for annual pay setting, which includes all parties getting round the table.
"Our members deserve meaningful recognition and reward."
