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Reforms to fix Band 8 pay gap at risk, ministers warned

Published on: 15 Jan 2025

Unions are warning the government it risks derailing “comprehensive” reforms to fix the Agenda for Change pay band structure, including the lack of an incentive to promotion to Band 8a.

The NHS Pay Review Body in July recommended the government task the NHS Staff Council – which is made up of employer and staff representatives – with developing proposals for change to the structure.

The independent review body said the “UK government [should] issue the [council] with a funded mandate to begin to resolve outstanding concerns within the AfC pay structure”. 

It said multiple groups had indicated that “the AfC pay structure has now been in existence for 20 years” and may require “comprehensive rather than piecemeal reform”.

The chief concerns were about “significant compression at Bands 1 to 3”, disincentivising promotion from the very lowest bands, and “the pay differential between Band 7 and 8a”. It was “clear… pay and incentives on promotion to 8a and beyond is a matter of concern for many staff and their representatives”, the body said, adding it was “important” for being able to “retain and motivate the managers on whom the service is depending”.

Multiple unions are now raising the alarm, saying that, six months on, ministers have issued no “funded mandate” to the NHS Staff Council, but instead have asked the PRB to look again at its reform proposal. The Department of Health and Social Care is also suggesting the changes be met from within the government’s 2.8 per cent overall pay uplift envelope in 2025-26, unions argue.

The DHSC’s 2025-26 pay round evidence said: “We are asking the review body to provide a view to the government on the relative priorities of investing in headline pay and investing in the pay structure mandate this year, with an affordable overall pay settlement for the DHSC, as set out in its report.”

The board has faced significant criticism from unions in recent years over its effectiveness, with some refusing to submit evidence, and calling for it to be abolished.

‘Beyond its core role’

In written evidence submitted to the PRB earlier this month, and seen by HSJ, the Chartered Society of Physiotherapy said the PRB should not consider matters “beyond its core role”, and the DHSC risked reopening pay disputes.

Jim Fahie, the CSP’s assistant director of employment relations and union services, said: “It’s back-to-front to ask the PRB to decide how much should be allocated to changes when we haven’t yet agreed what those reforms should be, or how much they should cost.

“It’s also incredibly important that these discussions take place outside of the PRB process, so as to not constrain what will be vital reforms that support recruitment and retention.”

Helga Pile, Unison’s head of health, told HSJ: “Leaving it to the review body to determine the costs of bringing the AfC [structure] into the 21st century, and insisting money comes out of the 2.8 per cent pot, has understandably gone down terribly with staff.

“Without urgent action, those on the lowest pay bands will be earning illegal rates when the national minimum wage rises in April. If the NHS is to recruit, and more importantly, keep the staff it needs, then pay levels that continue to bump along at the bottom are not the answer.”

Jo Galbraith-Marten, the Royal College of Nursing’s director of legal services and member relations, said: “Any negotiations must take place outside of the PRB process, so as to not reduce the already constrained financial envelope the government has indicated is available for the forthcoming pay award.”

Unite’s national health officer Richard Munn said: “The government needs to disband the PRB and enter into direct negotiations with the trade unions.”

In response, a DHSC spokesman said it “remains committed” to giving a “funded mandate” to the NHS Staff Council for the restructure.

He added: “We continue to look at all areas where we can improve staff recruitment and retention. This summer, we will publish a refreshed workforce plan to ensure we have the staff we need.”

In August, the government and NHS Staff Council confirmed an interim measure to add “intermediate pay points” to all Agenda for Change bands from 8a and above.

At lower bands, recent years have seen multiple local disputes around rebanding of lower-paid staff, and backpay for this. Unions believe outdated AfC bands no longer reflect growing complexity of some low-band roles.

UPDATED, 11.01: This article has been updated to reflect the Chartered Society of Physiotherapy’s name and Mr Fahie’s job title