Consultation response on reforms of zero hours contracts summary
We have developed a summary of NHS Employers response to the Department of Business, Innovation, Science and Trade's consultation, Make Work Pay: Ending one-sided flexibility – reforms of zero hours and similar contracts, which closed on 25 August 2026.
Government's policy has proposed three aims:
- The right to guaranteed hours.
- The right to reasonable notice of shifts.
- The right to payment for shifts cancelled, curtailed or moved at short notice.
Through our engagement with nearly 200 workforce colleagues and other key stakeholders, we have concluded that the government should not proceed with the current proposals as is, due to the potential impact they would have on patient care and the additional costs to the NHS.
Our main points submitted to the consultation
The NHS supports action to end exploitative employment practices. But the current proposals risk solving the wrong problem in the wrong place.
NHS bank arrangements are not typically used to transfer business risk onto workers but instead provide two-way flexibility to both the NHS organisation and to the worker. The flexible workforce is a core part of maintaining safe patient care in a 24-hour, seven-day service, while also giving many workers genuine choice and control over when and how they work.
Changes to employment rights
The NHS has been supportive of all the other employment changes being made under the Employment Rights Act 2025 and related ones as part of the Make Work Pay agenda. This is the only element which we believe would have significant consequences under the current proposals.
Many NHS bank workers choose to work on an internal bank and/or undertake agency work because it gives them total control of when, where and how often they work.
Approximately 85 per cent of NHS bank workers have an existing substantive NHS contract and choose to work additional hours flexibly on the bank. For the 15 per cent without a substantive contract, the findings from the most recent survey of the group (the 2025 NHS Staff Bank Survey) showed that the majority wished to remain working through the internal bank. 74 per cent said they were able to work the shifts and hours they wanted.
The current proposals could create major new bureaucracy at odds with the NHS drive for efficiency, productivity and digital-first people services.
Applying the current model to NHS internal banks would require repeated monitoring, payroll changes, dispute handling and manager follow-up. Our conservative estimates suggest this could require at least 800 additional administrative whole-time equivalent roles and around 610 whole-time equivalent managers’ time distributed across the NHS, diverting capacity from service improvement and frontline support. This is at the same time that government has committed to transform people services through digitisation and concurrent reductions in HR management and administration.
Up to £900m in additional cost to the NHS if plans proceed without redesign. Reducing flexibility for workers and putting patient care at risk.
Flexible staffing is essential for responding to patient acuity, sickness absence, seasonal pressures and major incidents. Guaranteed hours administration and short-notice compensation rules could add up to £900m in annual costs and reduce the availability of bank workers, undermining national efforts to reduce agency spend and improve value for money.
Our consultation response asks the government not to proceed as planned, but to have further discussions with sectors that require a flexible workforce, like the NHS in order to provide a safe service. We have also made suggestions to what could be done differently, such as providing the worker with:
- the right to request guaranteed hours if they work regularly and the employer has a right to respond to this reasonably
- an opportunity to opt out, knowing that 79 per cent of NHS bank workers wish to remain on the bank.
We have also requested that a full financial and equality impact assessment are undertaken before finalising any legislation.
If the decision is taken by government to proceed without redesign or refining the proposals, we have also submitted our preferences for hours thresholds, reference periods and reasonable notice.
We have heard from most employers that they will also be submitting their own responses, with individual trust impacts, and we thank colleagues for the time they have taken to do this.
Next steps
In relation to next steps and in addition to locally driven work to improve the experience of bank only workers, there has been a commitment made through the NHS Social Partnership Forum (SPF), to take forward work in partnership on improving the experience for bank workers.
We are committed to implementing the guidance produced by this partnership group with employers, and to exploring other areas of good work practice which includes:
- reducing unwarranted variation in temporary workers contracts
- enhancing recruitment and development opportunities
- improving processes to raise concerns
- improving communication channels for bank workers.
We will also continue to raise your concerns with the government, while we wait for the outcome of the consultation.
