In September, UNISON confirmed it will not take part in the government’s 2026/27 NHS pay review body process, saying that the current system is outdated and no longer fit for purpose
CREDIT: This is an edited version of an article that originally appeared on Unison.org
The review body system, which has been used for years to recommend wage increases for health service staff, is seen by the union as outdated, slow and unfit for purpose. Instead, UNISON is calling for direct negotiations with ministers to decide on the next annual wage rise and tackle deeper issues with the NHS salary framework. The move raises an important question: how did talks over staff pay reach this stalemate, and what changes are unions demanding to break the cycle?
Frustrations With Pay Review Body
The decision reflects mounting frustration with how the pay review body operates. UNISON argues the process regularly runs late, leaving staff waiting months for increases that are quickly overtaken by inflation. This year’s 3.6% rise, for example, did not reach staff until four months after the April due date and is already outpaced by the current 3.8% CPI inflation rate.
The union also highlights that the review body cannot address wider structural issues in the Agenda for Change pay system – the framework that sets pay, bands and progression for most NHS staff. Ministers had promised reforms to this system in 2024, but no formal process has begun. Without modernisation, UNISON says, the NHS cannot properly reward staff who take on greater responsibilities or develop new skills.
The Mood Among NHS Staff
Discontent is widespread among health workers. A consultation carried out by UNISON over the summer revealed that 70% of members who responded would support industrial action over the 2025/26 NHS pay award. The delays and inadequacies in the current system are not just an administrative issue – they are affecting morale and retention. Only 31% of NHS staff are happy with their level of pay or the level of staffing in their organisation. Staff who feel undervalued are more likely to leave, making it harder for the NHS to fill critical roles and provide quality care.
Why It Matters
UNISON’s stance represents a wider debate about how the NHS should adapt to future challenges. General secretary Christina McAnea stressed that while ministers are focused on transforming the health service to meet patient needs, that change must also extend to how staff are treated. Pay, she argues, cannot be separated from broader reforms, especially if the government wants to improve efficiency and maintain industrial harmony. The rejection of the pay review body signals a demand for a more responsive and accountable system – one that links annual wage rises with long-term improvements in the pay structure.
At its heart, the problem is one of pace. NHS staff are working in an environment that is constantly evolving – facing rising demand, new clinical challenges and mounting pressure to deliver more with fewer resources. Yet the pay review system moves at a glacial speed, disconnected from these realities. By the time recommendations are made, debated and implemented, the circumstances on the ground have already shifted.
If the NHS is to retain staff and remain sustainable, its pay and reward system must be as dynamic and responsive as the workforce it is meant to support.
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