UNISON Report: NHS Pay Leaves Workforce Underpaid

NHS Pay Crisis Snapshot

Key points from the UNISON report and why NHS pay now matters beyond the health service.

Main Issue

NHS staff report rising financial pressure

Most Affected

Lower Agenda for Change pay bands

Wider Impact

Recruitment, retention and patient care

Key Takeaways

• The UNISON report suggests many NHS workers are struggling to meet everyday living costs despite working full-time.
• Staff in lower pay bands are particularly exposed to financial pressure, especially as wages compete with retail and private sector roles.
• Pay concerns are closely linked to NHS recruitment, retention, overtime reliance and staff morale.
• The issue affects patients through waiting times, continuity of care and pressure on frontline services.
• Businesses and taxpayers are also affected when NHS staffing shortages increase sickness absence, agency costs and productivity losses.

Area	What It Means	Why It Matters
NHS Pay	Many staff say wages have not kept pace with living costs.	Financial pressure can push workers towards extra shifts or alternative jobs.
Workforce	Recruitment and retention remain major concerns across the health service.	Staff shortages increase workload and can worsen burnout.
Patients	Workforce instability can affect service delivery and waiting times.	Stable staffing supports safer, more consistent care.
Economy	NHS pressures can affect businesses through sickness absence and delayed treatment.	Healthcare capacity is closely linked to workforce productivity.

 

The financial wellbeing of NHS staff has become one of the most pressing workforce challenges facing the UK’s healthcare system. While debates around NHS funding often focus on waiting lists, hospital capacity and patient outcomes, a new report from UNISON suggests that the financial pressures experienced by healthcare workers are becoming increasingly difficult to ignore.

Published in June 2026, the report highlights growing concerns among NHS employees about the gap between wages and the rising cost of living. According to the findings, many healthcare workers are relying on credit cards, overdrafts and additional shifts simply to meet everyday expenses. For a workforce that forms the backbone of public healthcare, the report raises important questions about workforce sustainability, recruitment, retention and the wider economic impact of NHS pay policy.

The issue extends beyond healthcare employees. NHS pay has implications for taxpayers, businesses, policymakers and patients. When staffing shortages increase, waiting times grow longer, agency staffing costs rise, and productivity across the wider economy can suffer. The latest UNISON findings therefore represent more than a workplace concern; they offer insight into broader structural challenges facing the NHS and the UK economy.

What Does the Latest UNISON Report Reveal About NHS Pay?

UNISON’s report, NHS pay crisis forcing staff to rely on credit cards and take on extra shifts, was based on responses from more than 3,000 NHS employees across England, Wales and Northern Ireland. The survey explored how rising living costs and existing pay structures are affecting healthcare workers across different roles and pay bands.

The findings point to a workforce experiencing increasing financial strain. Respondents reported difficulties covering routine household expenses, including housing costs, food, fuel and utility bills. Many described taking on additional shifts or using short-term borrowing to bridge the gap between income and expenditure.

Particularly affected are employees working within the lower Agenda for Change pay bands, where wage growth has struggled to keep pace with inflation over an extended period. The report also highlights concerns about pay compression, where the difference between entry-level and more experienced roles has narrowed, reducing incentives for progression.

While the survey reflects the experiences of union members, its findings align with wider concerns raised by workforce analysts, healthcare organisations and independent policy experts regarding recruitment and retention within the NHS.

Understanding NHS Pay Bands in 2026

Most NHS employees are paid under the Agenda for Change framework, which establishes salary bands for non-medical staff across England. The system was designed to provide transparent career progression and reward increasing levels of responsibility.

Following the 2026 pay award, salary ranges broadly reflect the following structure:

While these salaries may appear competitive on paper, many healthcare employees argue that they do not adequately reflect rising living costs, increasing workloads and the responsibilities associated with frontline healthcare delivery.

The challenge becomes particularly visible at Bands 2 to 4, where salaries sit only marginally above the National Living Wage. As a result, NHS employers increasingly compete with retail, logistics and hospitality businesses that can offer similar hourly rates with fewer responsibilities and less emotional strain.

How Inflation Has Reduced NHS Workers’ Purchasing Power?

One of the most significant themes emerging from the UNISON report is the impact of inflation on real earnings.

Although NHS salaries have increased over time in cash terms, the cost of living has risen substantially. Research drawing on inflation data and public sector pay trends suggests that many healthcare workers have experienced a notable decline in purchasing power compared with a decade ago.

For NHS employees, this means that pay rises may not necessarily translate into improved living standards. Housing costs, energy bills, food prices and transport expenses have all increased sharply in recent years. Consequently, many workers report that their salaries no longer stretch as far as they once did.

This issue is particularly pronounced in London and the South East, where housing costs remain among the highest in the country. Although additional payments such as High Cost Area Supplements are intended to offset regional cost differences, many staff argue that these allowances have not kept pace with the realities of the housing market.

How NHS Pay Has Changed Over the Past Decade?

To understand current workforce concerns, it is important to view NHS pay within a broader historical context.

The period following the 2008 financial crisis saw prolonged public sector pay restraint. Pay freezes and capped increases were introduced as part of wider efforts to reduce government spending. While intended as temporary measures, the effects continued to shape earnings growth for many years.

The COVID-19 pandemic brought renewed attention to healthcare workers and their contribution to society. Public appreciation for NHS staff increased significantly, yet many employees continued to express frustration that pay settlements failed to match rising living costs.

Since then, industrial action involving nurses, ambulance staff and other healthcare professionals has highlighted growing dissatisfaction with pay and working conditions. The latest UNISON report suggests that these concerns remain unresolved and continue to affect workforce morale.

Is the NHS Workforce Crisis Linked to Pay?

Workforce shortages represent one of the greatest operational challenges facing the NHS.

According to workforce statistics, tens of thousands of NHS roles remain vacant across England. While staffing pressures cannot be attributed solely to pay, compensation plays an important role in attracting and retaining skilled professionals.

Recruitment challenges exist across multiple disciplines, including nursing, diagnostic services, mental health care and community healthcare. At the same time, experienced staff are leaving due to retirement, burnout, workload pressures and opportunities elsewhere.

Pay becomes particularly important when healthcare employers compete with sectors that offer comparable salaries but lower levels of responsibility and stress.

The result is a cycle that can be difficult to break. Staff shortages increase workloads, increased workloads contribute to burnout, and burnout encourages more employees to leave. This places additional pressure on the staff who remain, further worsening retention challenges.

Why Some NHS Workers Are Choosing Retail and Private Sector Employment?

One of the most striking findings emerging from workforce discussions is the growing comparison between NHS wages and salaries available in other sectors.

Large retailers and logistics companies have increased wages significantly in recent years to attract workers in a competitive labour market. In some cases, entry-level retail positions now offer hourly pay rates similar to those available in lower NHS bands.

For healthcare support workers, the decision is not solely financial. Retail and private sector roles may offer:

• More predictable schedules
• Reduced emotional pressure
• Lower workplace risk
• Greater flexibility
• Fewer staffing shortages

While many healthcare professionals remain deeply committed to patient care, financial realities increasingly influence career decisions.

The loss of experienced support staff can create operational difficulties across hospitals and community services, increasing pressure on already stretched teams.

How NHS Pay Compares with Other Countries?

The NHS is not only competing with employers within the UK. Increasingly, it is competing in a global market for healthcare talent.

Countries such as Australia, Canada, New Zealand and Ireland have actively recruited healthcare professionals from overseas for many years. These healthcare systems often promote higher salaries, structured career development opportunities and improved work-life balance as part of their recruitment strategies.

For many UK-trained clinicians, particularly nurses and allied health professionals, international opportunities can appear increasingly attractive. While relocating abroad is not an option for everyone, healthcare organisations and workforce analysts have observed growing interest in overseas employment among experienced NHS staff.

A comparison of nursing salaries highlights some of the differences:

While salary is not the sole factor influencing migration decisions, it remains one of the most important considerations. When combined with concerns about workload, staffing levels and career progression, pay differences can influence whether healthcare professionals remain in the NHS long term.

The Impact of NHS Underpayment on Patient Care

Discussions about NHS pay often focus on employees, but the consequences extend directly to patients.

When healthcare organisations struggle to recruit and retain staff, operational pressures increase across the system. Vacancies can lead to:

• Longer waiting times
• Reduced continuity of care
• Increased pressure on existing staff
• Delayed treatment pathways
• Greater reliance on temporary workers

Healthcare delivery relies heavily on stable, experienced teams. When vacancies persist for extended periods, hospitals and community services face greater challenges in maintaining consistent levels of care.

Burnout also becomes a significant concern. Staff working additional shifts to supplement income may experience physical and emotional fatigue, increasing pressure on already demanding healthcare environments.

While NHS professionals continue to deliver high-quality care under difficult circumstances, workforce experts consistently highlight the connection between workforce stability and patient outcomes.

Why NHS Pay Matters to UK Businesses and Taxpayers?

The debate surrounding NHS pay is often framed as a discussion between government and healthcare unions. In reality, its implications extend across the wider economy.

The Productivity Challenge

When NHS staffing shortages contribute to longer waiting lists, businesses can experience indirect consequences.

Employees waiting for diagnostic procedures, surgery or specialist treatment may spend longer periods away from work. Delays in healthcare access can affect workforce productivity, particularly for organisations that rely on experienced employees in specialist roles.

For small and medium-sized businesses, prolonged staff absence can create operational difficulties that are difficult to absorb.

The Cost of Agency Staffing

Staff shortages also create financial pressures for taxpayers.

When permanent positions remain vacant, NHS trusts frequently rely on agency and temporary staff to maintain safe staffing levels. Agency workers play an important role in supporting healthcare services, but their use can increase staffing expenditure significantly.

This creates a challenging cycle:

1. Staff shortages increase agency spending.
2. Higher staffing costs place pressure on budgets.
3. Budget pressures limit investment opportunities.
4. Workforce challenges continue.

Many workforce experts argue that improving retention could reduce some of these costs over the long term.

The Wider Economic Impact

The NHS employs more than one million people across the UK.

When large numbers of workers face financial pressure, consumer spending patterns can be affected. Reduced discretionary spending impacts local businesses, while financial stress can contribute to broader economic challenges within communities.

Consequently, NHS pay is not solely a healthcare issue; it is also a labour market and economic issue.

The Government’s Position on NHS Pay

Any discussion of NHS pay must also consider the government’s perspective.

The Department of Health and Social Care and the Treasury face the challenge of balancing workforce expectations with wider public spending priorities. NHS budgets must support not only staff salaries but also:

• Hospital infrastructure
• Medical equipment
• Digital transformation projects
• Workforce training programmes
• Community healthcare services

Government representatives have consistently argued that pay settlements must remain affordable within the broader context of public finances.

The NHS Pay Review Body also plays a significant role in informing pay recommendations. Its assessments consider workforce recruitment, retention, inflation, labour market conditions and affordability.

From the government’s perspective, large-scale pay increases must be weighed against competing demands for limited public resources.

This tension lies at the heart of the ongoing NHS pay debate.

The Structural Challenges Behind NHS Pay Reform

While pay remains a central issue, experts generally agree that salary alone will not solve all NHS workforce challenges.

Workload and Burnout

Healthcare professionals continue to report concerns about workload intensity, staffing shortages and workplace pressures. Even substantial pay improvements may have limited impact if underlying operational challenges remain unresolved.

Career Progression

The UNISON report highlights concerns about pay compression, particularly at lower Agenda for Change bands. When salary differences between grades become relatively small, employees may feel there is limited incentive to take on additional responsibility.

Addressing progression pathways could therefore form part of broader workforce reform.

Workforce Planning

Long-term workforce sustainability depends on:

• Recruitment pipelines
• Training capacity
• Career development opportunities
• Leadership support
• Flexible working arrangements

Many health policy organisations argue that successful workforce reform requires a combination of financial and non-financial measures.

What Could the NHS Workforce Look Like by 2030?

The future of NHS staffing will depend heavily on decisions made over the coming years. Several potential scenarios are frequently discussed by workforce analysts.

Scenario One: Continued Workforce Pressures

If current challenges persist, recruitment and retention difficulties could continue to affect workforce stability. Vacancy rates may remain elevated, agency spending could increase and waiting lists may remain under pressure.

Scenario Two: Targeted Structural Reform

Targeted interventions focused on lower pay bands could improve recruitment and retention among support staff. This approach may help stabilise parts of the workforce while limiting overall expenditure.

Scenario Three: Significant Pay Restoration

A more ambitious strategy could involve a multi-year programme aimed at restoring real-terms earnings and improving workforce competitiveness. Supporters argue that such an approach could improve retention and reduce long-term staffing costs. Critics point to the substantial funding requirements involved.

The most likely outcome may ultimately involve a combination of targeted pay reform, workforce planning improvements and operational modernisation.

Can the NHS Afford Not to Address Pay?

The central question raised by the UNISON report is not simply whether NHS workers deserve higher pay. It is whether the current system can remain sustainable if workforce concerns continue to grow.

Healthcare services rely on people. Buildings, technology and equipment are essential, but the NHS ultimately depends on the skills and commitment of its workforce.

When employees feel undervalued or financially stretched, recruitment becomes more difficult and retention becomes more costly.

The challenge facing policymakers is therefore not merely about increasing wages. It is about balancing workforce sustainability, public finances and long-term service delivery.

Finding that balance will be one of the defining healthcare policy challenges of the coming decade.

Conclusion

The latest UNISON report provides a detailed snapshot of the financial pressures affecting many NHS employees in 2026. Its findings suggest that concerns about pay are no longer limited to annual wage negotiations. Instead, they have become closely linked to wider issues including recruitment, retention, workforce morale and healthcare system performance.

For NHS staff, the report highlights the growing difficulty of maintaining living standards in an environment characterised by rising costs and sustained workforce pressures.

For patients, persistent staffing shortages risk affecting service delivery and waiting times.

For businesses and taxpayers, workforce instability within the NHS carries economic consequences that extend well beyond healthcare settings.

The debate over NHS pay is therefore about more than salaries. It is about the future sustainability of one of the UK’s most important public institutions and the workforce that keeps it running.

FAQs

Does the UNISON report represent all NHS staff?

The report reflects responses from NHS employees who participated in the survey. While it does not represent every NHS worker, the findings align with wider workforce concerns identified by healthcare organisations and policy experts.

What is Agenda for Change?

Agenda for Change is the NHS pay framework covering most non-medical staff, including nurses, healthcare assistants, therapists and administrative employees.

Why are some NHS workers struggling financially?

Many employees report that rising housing, food, energy and transport costs have outpaced salary growth, reducing their purchasing power.

How many NHS vacancies currently exist?

Recent workforce data indicates that NHS organisations continue to face significant staffing shortages across a range of clinical and non-clinical roles.

Why is retention important for the NHS?

Retaining experienced staff reduces recruitment costs, supports continuity of care and helps maintain workforce stability.

Could higher pay reduce agency staffing costs?

Some workforce experts believe improved retention could reduce reliance on agency workers over time, potentially lowering staffing expenditure.

Why do some NHS staff move overseas?

Higher salaries, improved working conditions and career opportunities are among the factors that encourage some healthcare professionals to seek employment abroad.

What is the biggest challenge facing the NHS workforce?

Most experts identify a combination of staffing shortages, workload pressures, retention difficulties and financial concerns as key challenges facing the workforce.