What the next government must do on NHS pay

As part of our ongoing series of general election blogs, Elaine Sparkes, CSP assistant director of employment relations and union services, outlines how the next government should address NHS pay.

by sparkese

Pay scales

The CSP call for fair pay will need to continue whatever the result on 4 July  – as pay will not be resolved in a single year. However, while we recognise it has to be part of a longer-term plan, the next government must begin to address the workforce crisis in the NHS, and fair pay has to be part of the solution.  

After many years, which have frequently seen below inflation rises, the link between pay and recruitment and retention is all too clear. Without the staff, the services that are so badly needed across the country cannot be delivered.   

And it is not just about pay in the NHS. Whatever pay uplift is awarded by the government in the NHS, it is often reflected across all sectors, many of which use NHS pay as the benchmark.  NHS pay is therefore critical in the value placed on physiotherapy staff throughout the UK. 

But what is fair pay? 

Fair pay is more than the headline uplift on pay each year. While this is a significant element, particularly during a cost of living crisis, it is not the only factor.  

Physiotherapy staff do deserve a pay rise that rewards them fairly and recognises the impact of inflation, but they also need a robust system that pays them the proper rate for the job. 

Too many physios and support workers are taking on additional work above their current banding but with no additional pay.  

Others are taking on significant extra responsibilities at a higher band but find there is little or no increase in pay due to the structure of Agenda for Change. This disincentive to career progression is yet another barrier to retaining the skills and experience needed in our services. Both elements must be addressed going forward. 

Reform is needed

The pay dispute in 2023/24 saw CSP members taking industrial action on pay for the first time. This was never an easy decision, particularly faced with a government that did not want to negotiate - or even meet - but eventually members’ voices were heard, and an offer was forthcoming that improved on the original award.   

Whilst the offer was far from what was deserved, there is no doubt the action of members did result in an improved outcome. It also gave the CSP, and other health unions, the opportunity to negotiate and agree to work on a number of other key related issues.    

Central to these for CSP members has been a work stream on the NHS job evaluation scheme and one on the Pay Review Body (PRB) pay setting process. It is the NHS PRB that recommends the level of pay award to the government, and then the government that makes the final decision about the pay award.    

Once the work of these groups is finalised recommendations will go forward to the new government and, if implemented, would begin the work to address some of the long-term problems around banding and the Agenda for Change structure.

We are also seeking to address practical issues such as the delay to pay awards, which is once again an issue this year despite the health unions and NHS Employers consistently raising it with the government over several years.   

Next steps 

There is a huge challenge for the next government to deliver improvements to the NHS.  This cannot happen without addressing workforce issues and recognising the link between pay and career progression in the recruitment and retention needed to deliver high-quality services. 

We know it cannot all be solved immediately, but there must be a long-term commitment to both improving pay and delivering on the reform of Agenda for Change that is so overdue.   

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