Unite, the UK’s leading health union, has rebuked the government’s plan of a 2.4 per cent pay rise for NHS Agenda for Change (AfC) staff in 2027/28 as a real terms pay cut.

The proposal is contained in written evidence to the NHS Pay Review Body (PRB) from the Department of Health and Social Care and NHS England, published today. It says anything above 2.4 per cent would force “difficult trade-offs”.

Inflation currently stands at 3.1 per cent and that the Bank of England expects it to climb further. Private sector pay settlements are averaging 3.6 per cent this year. A 2.4 per cent rise would deepen a pay squeeze that has run for over a decade.

Unite general secretary Sharon Graham said: "NHS workers are overworked, underpaid and undervalued, and the lowest paid are barely above the minimum wage. Workers are being asked to carry ever heavier workloads with fewer colleagues.

“Yet another real terms pay cut would be an insult. The government must deliver restorative pay, put all NHS workers firmly above the real living wage, and fund the increase in full so that it doesn’t cost jobs.”

The lowest paid will be hit hardest. Band 2 workers, including healthcare assistants and support staff, currently earn £12.92 an hour, only 21p above the National Living Wage. A 2.4 per cent rise would take that to around £13.23. That is roughly just 5p above the Low Pay Commission’s central projection for the minimum wage from April 2027, and far below the real living wage, currently £14.10 an hour.

Workers are being asked to do more with less. The government’s evidence shows the AfC workforce shrank in the year to March 2026, with clinical support staff down 2.3 per cent. Over the same period A&E attendances were more than 12 per cent above pre-pandemic levels..

The government’s own data shows the toll. Fifty-six per cent of NHS staff went to work despite not feeling well enough, only 31 per cent are satisfied with their pay, and sickness absence is 5.1 per cent.

Unite national officer for health Richard Munn said: “Ministers are telling NHS staff to deliver more productivity while planning to pay them less in real terms. "A rise below inflation isn’t restoration, it’s another cut.”

“The constant wage erosion of the clinical workforce will mean fewer people remain in the NHS leading to a downward spiral in service. We regularly hear of band 5 and 6 staff struggling, taking on all the hours they can just to meet the rising costs of living.”

Unite is calling for:

  • Restorative pay: a settlement above inflation that begins to recover years of lost value.

  • A real floor: band 2 pay set clearly above the real living wage, with differentials protected up the bands.

  • Full funding: no costs pushed onto trusts to be met through job cuts.

  • Direct negotiation: Unite has withdrawn from the PRB process and will keep demanding direct talks with government.

ENDS