The English NHS pay deal – in six charts

Agenda for Change Pay UNISON News

A lot has been written about the NHS pay deal in England and what it will mean to individuals’ pay packets. But how does it affect staff at different stages of their career?

July saw the implementation of the new NHS pay deal in England, negotiated by UNISON and other unions.

The pay deal marked the biggest changes to the NHS pay structure since 2004, when Agenda for Change was introduced.

A lot has already been published about the impact on individuals but in this piece we’re going to look at the structure as a whole and how it benefits staff at different stages of their career.

Beginnings, journeys and destinations

To understand the changes we need to look at the old structure and why trade unions wanted to change it.

It is over 13 years since Agenda for Change was introduced. It introduced a pay system in the NHS based on the principle of equal pay for work of equal value. All NHS roles are evaluated and placed on a salary band, from people like porters and health care support workers on bands one and two, to nurses on band five and biomedical scientists, senior clinicians and managers on bands eight and nine.

But the pay scales we ended up with were far from perfect. For years, staff complained that it took far too long to reach the full rate of pay for their job, and that some of the pay increments were so small they were meaningless.

In addition, big overlaps between pay bands meant that staff on different pay grades could be on the same salary, which was both unfair and a real risk to equal pay.

These issues were compounded by nearly eight years of austerity and pay restraint. Pay did not keep pace with the cost of living and NHS starting salaries fell behind other places, making it difficult to recruit new staff.

That is why UNISON members wanted more than a straightforward pay rise. It was time to refresh Agenda for Change.

The priorities

The changes brought in with the new deal are complex – mostly because the existing NHS pay structure is so complicated to begin with – so here we’re going to break it down.

This pay deal:

  • Improves starting salaries
  • Increases the rate of pay for the top of each band
  • Reduces the length of time that it takes people to get from that starting salary to the top of the band.

Under the new pay deal, everybody working for the NHS will be better off, but the impact on individuals is different depending on whether they are at the bottom, middle or top of their salary band.

Bottom of the band

This is people who are just starting working for the NHS, or who have switched jobs or got a promotion and moved to a new band.

The new deal means that a lot of the lower increments within those bands are being abolished completely, effectively making the starting salaries considerably higher.

This means someone starting a new job as, for example, a physiotherapy assistant (band 3), would have been paid £17,138 under the pay cap but will now receive £17,787, under the new deal.

The increase in starting salary for bands one and two is something UNISON is especially proud of, as it takes the lowest salary above the living wage.

Top of the band

People who have been doing their role for many years will be at the top of their pay band.

This means they have received all the incremental pay rises available to them, and the only way they receive a pay rise is from the annual percentage increase, which is why, during negotiations, UNISON pushed for as much money as possible to be added to the top of the band.

These people will get a 3% rise in their salary from 1 April this year. This means a nurse or midwife (band 5) at the top of their band will receive an extra £500, moving from £29,033 to £29,608 in this year, and to £30,112 next year and £‎30,615 the year after. That’s an increase of 6.5% by the end of the agreement.

Neither top nor bottom

For people in the middle of their band, the key difference will be that they move to the top of their band much faster.

With the old deal it could take as long as eight years to reach the top of a band, but by the end of the new deal it will take a lot less. People on band 2 will now take two years to reach the top of their band, whilst it will take four years for band 5, and those on higher bands like 6 and 7 will take five.

That is not all happening straight away (it’s a big change to switch from eight years to five years) but most staff in the middle of their pay bands will reach the top sooner than they would have done otherwise. And they’ll also benefit from the fact that the top rate is increasing in value, just like staff already at the top.

These people may not see a huge difference in their pay packets straight away, but when they reach the date of their next incremental increase they will see a significant bump in their pay packet.

To sum up, the starting salaries for each band are higher, people will have higher incremental rises, and those at the top of their bands are getting a bigger percentage increase.

*Reproduced from an original post on

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