This briefing sets out the latest updates on NHS pay for 2026/27, the position of the Health Service Group Executive (HSGE) and the next stages of our pay campaign including key activities for branches and activists.
The full PDF can ben found and downloaded here.
Context and actions taken by the Health Service Group Executive (HSGE) so far
• Close of the 2025/26 pay round in England
The outcome of the 2025 pay round was a 3.6% pay increase for NHS staff in England. This was paid in August salaries, and effective and backdated from 1 April 2025.
As part of the 2025 pay award the government also re-committed to provide a funded mandate to NHS Staff Council to agree structural reforms to the pay structure, with changes implemented from 1 April 2026.
While in our consultation we hear from enough members to move to an industrial action ballot, 70% of those who did take part told us they were prepared to take action. clear that dissatisfaction and anger are still running high and that will only grow without proper investment in pay. Read our branch briefing on the consultation outcome for further information on the 2025 pay round.
- Member survey
In September we launched a member survey to ask their feedback on the 2025/26 pay award of 3.6%, their views on how much their pay would need to increase by to meet rising living costs, and their broader priorities on reforms to the pay structure.
The results of this survey show that, for most members across all pay bands, the 3.6% pay award did not make a significant difference to them or their finances, with satisfaction even lower for members in bands 1-4. Members were most likely to select a figure around £3,000 when asked how much their pay would need to increase by to keep up with rising living costs, clearly showing that 2.5% (the level of funding currently ring-fenced for pay as referenced in the government’s evidence to the PRB ) would not be sufficient to meet the rising living costs of the majority of members.
Members continue to have very high levels of support for collective bargaining – 9 in 10 members say important to them that NHS pay is set through negotiations between trade unions, the government and employers. There also continues to to broad support for UNISONs existing policy positions, with members wanting to see progression rewarded, promotion to come with a meaningful increase in reward, and strong support for the shorter working week and real living wage.
- Joint union consensus to reject Pay Review Body process
The HSGE has chosen not to participate in the PRB process this year and for the first time most Agenda for Change unions have followed suit. This is a major development, as last year only two other unions joined us.
The unions representing AfC staff issued a joint letter to the Secretary of State for Health and Social Care setting out our calls for the PRB to be set aside in favour of a combined set of negotiations on structural and headline pay.
The government has yet to respond to the AfC negotiations and has continued with the PRB process.
- Department of Health and Social Care 2026/27 evidence to the Pay Review Body
The government finally published their evidence to the PRB on 30 October over a month behind schedule. In their submission, the government said: “pay uplift of 2.5% without having to make trade – offs against headline government health commitments. Should the independent pay review bodies recommend an award above this level, we would need to consider whether and how this could be made affordable from within existing DHSC budgets. Accepting such an award would inevitably have an impact on healthcare.”
We must be clear that 2.5% figure is neither a final position, nor a pay offer. But it’s clear that the level of funding is far too small to see the level of our members’ rising living costs and address the long-standing issues with the pay structure.
An envelope of 2.5%:
• Falls well behind the current rate of inflation (4.5% on RPI measure)
• Compares poorly with the inflation (CPI measure) proofed deal in NHS Scotland where staff will receive an increase of at least 3.75% in April 2026
• Falls well behind the 2026 Real Living Wage rates that were increased by 6.7% (see our press release)
- Would mean band 5 starting salaries continue to trail other graduate comparators such as teachers also made a broad reference to the outstanding pay structure mandate:
“The government continues to operate within an extremely challenging position, and following the Spending Review (SR), we are finalising the allocations that will inform the final pay structure mandate. We are clear the importance of d elivering this mandate and have committed to work Staff Council such that changes are made from 1 April 2026.
We recognise the timing constraints involved in delivering this and delivering the mandate by 1 April 2026 and, to ensure continued progress on this priority, the government therefore asked the NHS Staff Council to conduct exploratory talks to identify the areas of the pay structure that it would like to see reformed. We have subsequently requested that these talks are progressed to the next stage, with the aim of identifying joint priorities and seeking a consensus that can feed into formal negotiations once the mandate is finalised.”
The government has received a report from the Staff Council on areas of consensus for reforms to the NHS pay structure. The government must now issue a formal and funded mandate to enable negotiations to get underway.
Now, we need branches to back the calls for meaningful funding and talks on NHS pay and encourage members to join the campaign.
- Minimum wage
On 25 November 2025 the government announced the national minimum wage rates for 2026. The minimum wage for over-21s will rise to £12.71 an hour from April 2026, an increase of 4.1%.
This puts the rate just 4 pence below the entry point of band 3, bringing further urgency to the need for the government to open talks to address compression in the lower bands and avoid the need for emergency tops in April 2026.
Next steps of pay campaign
The Health Service Group Executive has agreed to refresh and escalate our pay campaign for 2026/27. This includes a new campaign “Pay Up For NHS Staff”, new member-facing actions as well as wider lobbying work to make the case for change to the pay setting process.
The core campaign ask right now is that the government open negotiations backed by sufficient funding to ensure a fair deal on pay for NHS workers.
The rest of this briefing outlines the next stages of our pay campaign in England and the initial key activities for branches.
Additional guidance for branches will be issued in the coming weeks to support further campaigning and lobbying activities.
New call to action for members
In November, we launched a new online action, encouraging members and supporters to email their MPs about NHS pay in England.
The tool can be found here: unsn.uk/pay-up
The pre-written message asks MPs to back the talks that were promised and to ask the Secretary of State for Health and Social Care to move ahead with fully funded negotiations on pay structure and headline pay as soon as possible.
The action has tailored messages for health ministers, other frontbenchers, Labour backbenchers, and opposition parties. There is a parallel ally action for the public and UNISON members not in the NHS in England (accessed via the same link).
What can branches and activists do?
- Encourage members to use our “email your MP” tool.
• Promote the campaign on your social media channels, branch website and in your communications with members.
o The tool can be accessed via the main campaign webpage as well as directly via the shortlink: unsn.uk/pay-up.
o We have an updated set of social media graphics and short videos using our new Pay up for NHS Staff branding. These can be downloaded here.
o We have a flyer to promote the action which you will also find in the same location.
o Where possible, encourage members to add personal details to their email like the work they do in the NHS, and how the broken pay structure and late pay awards affect them.
2. Use the NHS pay cards to support conversations with members on problems with the pay structure and the need for change.
The cards are available for branches to order through the catalogue:
o Hourly rates: https://shop.unison.site/product/nhs-hourly-pay-rates-for-england-card-2025-26/
o Annual rates: https://shop.unison.site/product/nhs-annual-pay-scales-for-england-card-2025-26/
3. Continue to encourage members to complete our latest survey on NHS pay.
The survey can be accessed here https://survey.alchemer.eu/s3/90898662/8bf437c5f75f.
4. Take every opportunity to get members to update their contact details:
Many members only provide us with their work email addresses. To make sure that we can convey important updates effectively, really important that we hold personal email addresses and phone numbers.And with the likely introduction of electronic balloting in the near future, we need to make sure we are ready and getting members to switch to their personal email addresses.
Details that UNISON should hold for every member include:
• Email addresses and mobile numbers
• Postal addresses
• Current employer
• Current job title/occupation
- Current workplace
It’s important that you get members to opt into our communications. While we can email all members about formal consultations and statutory ballots, we can only email members about the political aspects of our campaigns if we have consent to email them.
Members can update their contact preferences themselves through My UNISON or by contacting UNISON Direct. Branches can also update members’ contact preferences (with their consent) through Merlin.
Next steps from the service group
The HSGE has also agreed to the following activities:
- Escalate wider press and public affairs work on why the PRB system is broken and why a new approach of collective bargaining is needed to achieve good industrial relations.
2. Nationally, we will write directly to individual NHS trusts setting out:
• our members’ priorities on pay
• the need for urgent and properly funded talks
• the risks of allowing minimum wage compliance issues to go unaddressed in light of the 2026 rate of £12.71 being confirmed
- our concerns that the latest medium term planning framework for NHS trusts includes a pay planning assumption of only 2%, well below the level needed to fix the issues with the pay structure that hamper recruitment and retention of staff.
We will share the details of this letter with branches, with suggested actions for local follow up.
3. Continue work with employers and fellow health unions through the Staff Council to develop priorities for restructure of the NHS pay structure, using our influence to promote UNISON’s positions.
4. Continue work with regional health committees, in line with the targeted ballot strategy which was endorsed by Health Conference 2025, to confirm initial target employers for ballot should the HSGE make the decision to proceed to a dispute. The HSGE has also committed to co-ordinate as far as is possible with other Agenda for Change unions on dispute planning.
5. Use findings from the member survey to develop position on headline pay award if talks progress or break down.
6. Review progress and make further decisions in HSGE January meeting.
