How is pay for NHS staff decided?

With nurses, doctors and health care unions urging for a U-turn, we take a closer look at the furore and exactly how pay rises for NHS staff are decided. Credit: PA

The government is facing a backlash over its proposal to give NHS staff in England a pay rise of 3% - up from the initial offer of 1%.

We take a closer look at the furore and exactly how pay rises for NHS staff are decided.

How are NHS pay rises decided?

The size of a pay rise for NHS, or the lack of one, is decided by the government, however it must consider recommendations made by the NHS Pay Review Body (NHSPRB).

The pay rise proposal wasn't in the Budget - where did come from?

The debate about a pay rise for NHS staff came about after the Department for Health recommended the 1% pay rise to the NHSPRB.

It would cover nearly all hospital staff, but not GPs and dentists.

After pressure, the government did a U-turn in July and boosted the offer to 3%.

How often is pay of NHS staff reviewed?

NHSPRB produces an annual report on pay in the NHS.

However, the last time NHSPRB made a recommendation on pay in the NHS within its report was in 2017 as the pay for staff on Agenda for Change terms and conditions, between 2018/19 and 2020/21, was covered by a three-year agreement between employers and unions.

The NHS has been on the front line of the fight against Covid-19 Credit: Stefan Rousseau/PA

What information does the NHSPRB use to base its pay recommendations on?

NHSPRB recommendations are informed by the parties’ written and oral submissions and by analysis of a range of pay and workforce information.

These are supplemented by visits to NHS organisations.

Which groups contribute to the pay review?

This year’s review is yet to finish. However the parties from which evidence was taken in the 2020 report were:

Government departments and NHS organisations

  • The Department of Health and Social Care for England

  • NHS England and Improvement

  • Health Education England

  • The Welsh Government

  • The Department of Health, Northern Ireland

Employers’ bodies

  • NHS Employers

  • NHS Providers

Bodies representing NHS Staff

  • The Joint Staff Side

  • The Royal College of Midwives

  • The Royal College of Nursing


  • Unite

  • GMB

Other parties can make their own submissions.

The public have been encouraged to clap for NHS staff and care workers during the pandemic. Credit: PA

The Department for Health has said it had "assumed a headline pay award of 1%" - what does that mean for NHSPRB?

Any of the parties can make proposals for a pay award as part of their evidence submissions.

Who takes the final decision on the pay review?

Decisions on pay are a matter for the respective governments.

Sir Keir Starmer has called on the Conservatives to do more for NHS workers. Credit: PA

Can the respective government’s ignore the NHSPRB?

The NHSPRB provides recommendations to the governments, which can accept or reject those recommendations as it sees fit. The last time NHSPRB recommendations were rejected was in 2014.

When is a final decision expected on pay?

The final decision came in July - offering a 3% after the government bowed to pressure over its previous offer of just 1% which caused fury among health workers.

Despite the slightly increased offer of 3%, however, many in the industry are still not happy.