NHS staff should get at least a 4% pay rise, say independent experts

Exclusive: Pay review body recommendation higher than government’s figures but less than unions want

NHS staff should receive a pay rise of at least 4%, independent experts have advised, setting healthcare workers on a collision course with ministers who have set a firm maximum of 3%.

The pay review body (PRB) will recommend that NHS personnel should get an increase this year of somewhere between 4% and 5%, the Guardian understands, despite warnings from the government that undertaking such advice would break the bank.

Health unions warned that even a rise of that order will do little to appease nurses, midwives and other staff – and struggle to head off the prospect of strike action across the NHS.

They have stressed that NHS workers are struggling with the soaring cost of energy, petrol, food and other basic commodities, which have left some having to use food banks.

Unions are seeking rises that at least match inflation, which is running at 9.1%, the highest for 40 years, though the Royal College of Nursing (RCN) is seeking an increase five percentage points higher – 14%.

For every extra 1% NHS staff in England receive, it would cost NHS England about £700m a year, the Department of Health and Social Care (DHSC) has calculated.

Pat Cullen, the RCN’s general secretary, claimed that a pay offer of 4% would be “an insult”, resulting in a real-terms pay cut for nurses and exacerbate the NHS’s shortage of them.

“A pay rise of 4% would be an insult, leaving an experienced nurse more than £1,400 a year worse off. Ministers have a very important choice to make – deliver an above inflation pay rise for the nursing profession or the current exodus of staff will continue, putting more patients at risk,” she said.

Health experts and staff groups had widely expected the PRB to recommend a 3% rise for 2022/23, the same sum as last year, when they submit their detailed written advice to the DHSC.

While it was initially minded to plump for 3% again, the independent group of eight experts has revised its thinking and settled on a figure of around or over 4%, the Guardian has been told.

Its decision to recommend at least 4% will add to the pressure on ministers to abandon their insistence, outlined in their written evidence to the PRB in February, that 3% was the most the government could afford to give staff this year. Anything above 3% would not be “affordable”, it said, given the NHS’s need to focus spending on tackling the huge backlog of people waiting for hospital treatment. “Financial restraint on pay is needed,” it told the PRB.

Unison also maintained that 4% would not avert the growing push for industrial action. “Anything less than inflation would be a pay cut,” said Sara Gorton, the union’s head of health.

“But 4% is less than half the current cost of living. Such a low award could also see unhappy health workers asking their unions to act.”

The PRB advises the prime minister, DHSC, cabinet secretary and three devolved administrations on pay rises for the 1.5 million NHS personnel across the UK who are covered by the longstanding Agenda For Change agreement – all staff except doctors and dentists.

It takes a range of factors into account when forming its view, including the need to recruit and retain staff as well as the budgets available to the health departments in the four home nations.

However, the DHSC this week has not repeated its previous stance that 3% was the most it could afford, leaving open the possibility that it might back a higher figure.

A DHSC spokesperson said: “NHS staff received a 3% pay rise last year, increasing nurses’ pay by £1,000 on average despite a public sector pay freeze, and we are giving NHS workers another pay rise this year.

“No decisions have been made and we will carefully consider the recommendations from the independent pay review bodies.”

If the government decides to ditch its 3% plan and approve a higher pay offer to try to ward off strikes, it could do so – but leave NHS England to pay the extra costs involved from within its budget. It did that last year, when it only sanctioned a 2.1% rise.

Sajid Javid, the health secretary, has insisted twice this month that the NHS “doesn’t need any more money”.

Anita Charlesworth, the director of research and economics at the Health Foundation, said a 4% pay award would make it harder for the NHS to recruit and retain staff and would also intensify the NHS’s battle to balance its budget.

“This is still above the pay award the NHS has budgeted for and would add pressure to already stretched NHS finances. Even without this pay award, the NHS funding settlement was around £2bn below what would be needed to meet all the demands on the services after Covid-19,” she said.

• This article was amended on 25 June 2022 to remove text stating that the DHSC had given the NHS £1.5bn extra to help cover the cost of big price rises this year; this sum is how much the NHS estimates its costs will rise by, but it has not received any extra government funding.


Denis Campbell Health policy editor

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