Employer evidence to the NHS PRB

NHS leaders and frontline staff reported growing difficulty meeting demand, as local demand has increased faster than planned. This has intensified pressure on staff and reduced funding available for service transformation. 

Although the planned 2.8 per cent real-terms funding increase is relatively generous given fiscal constraints, it is below both the historic average and the level needed to restore services. Employers warned that it will be hard to meet waiting time targets and deliver NHS reforms with this level of funding. 

Employers said that any future pay awards must be fully funded across the entire health sector to protect financial sustainability and frontline services. 

Employers said that targets to reduce reliant on international recruitment in the Ten Year Health Plan alongside cuts to central government funding, would mean an increased dependence on local labour markets. 

Employers stressed that financial pressures were shaping recruitment decisions, with strict vacancy controls making it hard to maintain safe services. This has increased pressure on existing staff and, for the first time, made it difficult to recruit all newly qualified local nurses, midwives and AHPs, despite the graduate guarantee.

Maintaining funding for health and wellbeing initiatives was difficult as post-pandemic central funding was being withdrawn; affecting employers’ capacity to support staff with long-term health conditions to return to work.

Employers said lower‑paid staff viewed the 2025/26 pay award as unfair compared with awards for doctors and dentists. They also warned that industrial relations are fragile and being further strained by delays in issuing a funded mandate for structural reform. 

The PRB were encouraged by hearing from employers who were developing comprehensive plans to migrate their temporary staffing spend from agency to bank. Caution was given by employers that increased dependency on bank staff had lead to some individuals taking on excessive shift patterns causing fatigue.

Employers told the PRB that the interaction between the National Living Wage and salary sacrifice schemes was affecting lower‑paid staff, many of whom were unable to access these schemes despite them being part of some organisations’ total reward packages. 

NHS Employers told us the priorities that employers had identified for pay reform including, competitive pay for entry-level roles, band 5 graduate pay, pay incentives for promotion, pay progression, and pay for apprentice roles.