The history of pay in the NHS

Background into the history of pay including details on the establishment of the General Whitley Council and the introduction of Agenda for Change.

14 March 2024

Pay in the NHS has a long history that spans several decades and has remained a prominent issue since the NHS was first established in 1948.  

When the NHS first began, it employed approximately 144,000 members of staff and it adopted the principles and practices of the Whitley Industrial Relations System. These were born out of a report produced by John Whitley, chairman of a committee during World War One. His remit was to reflect on suggestions “for securing a permanent improvement in the relations between employers and their employees.” 

The General Whitley Council was set up to deal with the rates of pay and conditions of service of staff employed in the then newly formed NHS. The General Council's main function was to determine conditions of service aside from pay, which were of general application to all staff in the NHS. Responsibility for determining conditions of service and in some instances, rates of pay affecting only staff within a particular field or specialism sat with functional Whitley Councils, which covered: 

  • administrative and clerical  
  • ancillary  
  • dental (Local Authorities)  
  • medical and (hospital) dental  
  • nurses and midwives  
  • optical  
  • pharmaceutical  
  • professional and technical A  
  • professional and technical B 
  • ambulance staff. 

Each council had staff side and management side representatives and served as a forum for consultation between employees and employers. The aim of these councils was to take steps to improve industrial relations which had been damaged during World War One.  

In the early 2000s it became apparent that the Whitley Council System was complex due to staff being employed under a number of different pay and grading systems. There was a lack of transparency around the different pay scales and grades used for each staff group, which made it hard for staff to identify how their pay was determined. In an important case for the NHS, speech and language therapists submitted equal value claims comparing their work to that of clinical psychologists and clinical pharmacists. The European Court of Justice found in favour of the claimants (Enderby v Frenchay Health Authority and Secretary of State for Health (1993)). This, together with the need to simplify the existing pay systems, was the catalyst for the introduction of Agenda for Change (AfC) and a new Job Evaluation Scheme in the NHS. 

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