How pay has changed over the last decade
Over the last decade, NHS pay has been shaped by national pay awards, changes to the Agenda for Change pay structure, pay progression and wider economic factors including inflation and increases in the National Living Wage.
The impact of these changes has not been uniform across the workforce. Changes to the pay structure have affected pay bands and pay points differently, while individual experiences of pay have also depended on progression within a band and career progression.
This page looks at how Agenda for Change pay has changed over the period, the impact on different parts of the workforce and the factors that influence total NHS earnings.
How the NHS workforce has changed
When analysing and developing a pay and reward system, it is important to look at how the workforce has changed over time. Below we explore some key workforce trends between 2016 and 2026.
How the pay structure has changed
Agenda for Change was introduced in October 2004 to provide a unified grading and pay structure for non-medical jobs in the NHS, which had previously been covered by multiple systems (leading to equal pay risk and challenge).
From the outset, there were nine main bands, with band 8 further subdivided into four levels (8a, 8b, 8c and 8d). Each band was aligned to a pay range based on spine points, providing the opportunity for incremental progression, subject to meeting criteria. This approach to pay structure is similar to local government, all levels of the education system, policing and some other public services.
The NHS terms and conditions has seen a number of alterations to pay structure, particularly in 2018 as part of the three-year pay deal. Below we highlight what the main effects were as a result of the restructuring:
Pay increases and pay progression
One source of NHS pay movement comes from the national pay increases. The table below shows the pay awards for agenda for change staff over a ten-year period. In 2008 and 2009, we saw the financial crisis hit worldwide. The private sector was able to recover quickly, but the public sector was hit badly, followed by several years of zero per cent national settlements.
National settlements in the NHS between 2016 and 2026
| Year | 2016/17 | 2017/18 | 2018/19 | 2019/20 | 2020/21 | 2021/22 | 2022/23 | 2023/24 | 2024/25 | 2025/26 | 2026/27 |
| Increase | 1% | 1% | 3% | 1.7% | 1.57% | 3% | 4.75% | 5% | 5.5% | 3.6% | 3.3% |
| Comment | - | - | Multi-year pay deal covering 2018/19, 2019/20 and 2020/21 | - | +Cash | Band 2 spot salary | |||||
Over the decade the NHS pay structure has seen a number of changes to the levels of pay at the minimum and maximum of each band.
Changes in AfC minima and maxima from 2016/17 to 2026/27
| Band | 2016/17 minimum | 2026/27 minimum | Percentage change | 2016/17 max | 2026/27 max | Percentage change |
| 1 | £15,251 | £25,272 | 65.7% | £15,516 | £25,272 | 62.9% |
| 2 | £15,251 | £25,272 | 65.7% | £17,978 | £25,272 | 40.6% |
| 3 | £16,800 | £25,760 | 53.3% | £19,655 | £27,476 | 39.8% |
| 4 | £19.217 | £28,392 | 47.7% | £22,458 | £31,157 | 38.7% |
| 5 | £21,909 | £32,073 | 46.4% | £26,302 | £39,043 | 48.4% |
| 6 | £26,302 | £39,959 | 51.9% | £35,225 | £48,117 | 36.6% |
| 7 | £31,383 | £49,387 | 57.4% | £41,373 | £56,515 | 36.6% |
| 8a | £40,028 | £57,528 | 43.7% | £48,034 | £64,750 | 34.8% |
| 8b | £46,625 | £66,582 | 42.8% | £57,640 | £77,368 | 34.2% |
| 8c | £56,104 | £79,504 | 41.7% | £68,484 | £91,609 | 33.8% |
| 8d | £66,582 | £94,356 | 41.7% | £82,434 | £108,814 | 32% |
| 9 | £78,629 | £112,782 | 43.4% | £99,437 | £129,783 | 30.5% |
It is evident to see that:
- the biggest investment due to national living wage threshold increases, cost of living pressures and negotiated increases has gone to the lower graded jobs and least to the highest graded
- more investment has gone into raising entry level salaries for each band (and latterly into shortening the ranges) than into increasing pay at the top of each scale.
A second component in pay increases is progression through the salary range. Salary progression depends on individual circumstances, for instance their role and starting point. We have demonstrated this using a number of individual examples below.
Example 1:
A band 5 nurse joining in April 2016 on £ 21,909 will have risen to the top of their scale (subject to meeting progression criteria) leaving them – if they are still in the same band – on £ 39,043 in April 2026. This is a cash increase over the decade of 78.2 per cent and a real-terms rise of over 26 per cent.
This is true for all other pay bands, whereby those who started at the bottom of their range in 2016 and have stayed in the same pay band have gained in real terms in the past decade. The increases do vary, with the biggest being in bands 5, 6, and 7.
Example 2:
There will be some roles who have been promoted during this time.
A band 5 midwife who started in April 2016 and promoted to band 6 once achieved professional autonomy, would have experienced a salary increase between April 2016 and April 2026 of 120 per cent - or over 55 per cent in real terms – subject to meeting progression criteria.
Example 3:
A band 7 ward manager started at the top of their band in 2016 on £41,373. They remained at the top of their band and received the annual pay uplifts during this time. By 2026 their salary was £56,515. This means that they will have experienced a decline in their pay in real terms of 4 per cent (CPI adjusted).
Except for bands 1 and 5, this experience is similar for all staff who were at the top of their pay bands in 2016 and remained there.
