NHS Employers' evidence to the NHS PRB 2027/28

1. Competitive pay for entry-level roles: Establish a futureproofed plan to create and retain a sustainable competitive market position on pay for entry-level roles to align with planned changes to the statutory National Living Wage (NLW) and the expected trajectory of Living Wage Foundation rates of pay (band 2 and closed spot salary for band 1).
2. Competitive pay progression for graduate roles: Ensure NHS pay progression remains competitive to attract and retain graduates in an increasingly competitive labour market, while enhancing the band 5 entry point to strengthen the NHS's position as an attractive career destination for new graduates. 
3. Pay incentives for promotion: Develop a sustainable and targeted plan for more appropriate pay increases to be received on promotion between the pay bands. This process begins with actions to address the gaps between bands 2 and 3, bands 6 and 7, and bands 7 and 8a. Further structural reform is required across the whole system. But given affordability constraints, it is recognised this will need to be addressed over the longer term. 
4. Anomalies in unsocial hours payments: Targeted action to address anomalies created by the implementation of consolidated pay changes in 2023/24 and successive years of investment in base-pay changes to band 1 (closed) and band 2 in relation to unsocial hours premium payments.
5.  Pay for apprentice roles: Introduction of a consistent national pay framework to govern the rate of pay for apprentices in the NHS.

Read PRB 2025/26  (PDF opens in a new window)

Key messages

Read the 2024/25  (PDF opens in a new window)

Key messages

• Employers continue to express their concerns about the impact of the delay of the pay award and the inability to implement this from its effective date of 1 April each year.  We recommend that the timetable in relation to the pay-setting process is adjusted, thereby enabling a return to prompt implementation and more timely payment of awards. Any pay award should be fully funded across the whole of the health sector and not just provider trusts.
• The publication of the LTWP is a positive step forward in addressing the ways in which staff are recruited, trained and retained in the NHS. However, employers welcome more clarity on the sustainable longer-term funding commitments needed to deliver the priorities set out in the plan. The same applies to the new workforce strategy for adult social care in terms of government support and sustainable financial investment.
• The position on entry-level pay in the NHS should be considered on a longer-term basis alongside the future trajectory of the National Living Wage, to ensure it remains competitive and sustainable and avoids the need for further temporary adjustments to be made.
• The nursing and midwifery national profile review work is continuing. It has already noted that a considerable number of job descriptions have not been reviewed in recent years, resulting in out-of-date and inaccurate job descriptions where additional duties have been taken on and/or work procedures have changed over time. As a result, there is likely to be an increase in the number of requests to review job descriptions at an employer level.
• Offering flexibility across the NHS Pension Scheme for the entire workforce makes the scheme a stronger tool for reward, recognition and retention. We welcome conversations to explore the options around introducing greater flexibilities and how these could be implemented.
• Staff engagement, health and wellbeing and workload pressures have been highlighted as key factors that affect the retention of staff. While pay is also a factor in why people leave their NHS career, to improve retention and achieve the goals set out in the LTWP, more action is needed to improve staff experience. 

Read PRB 2023/24 (PDF opens in a new window)

Key messages

• The additional £3.3 billion revenue budget funding announced in the recent Autumn Statement is welcomed, however, this needs to be backed up with a sustainable and longer-term financial settlement to enable the NHS to address the underlying challenges facing the health and social care system.
• The current competitive labour market is adding to NHS employers’ workforce challenges around attraction, recruitment and retention, particularly in lower-banded roles where other sectors can offer competitive reward packages.
• Employers are increasingly concerned about the impact of the delay of the pay award and the inability to implement this from its effective date of 1 April each year.
• We strongly urge that every effort is made to get the pay award timetable back on track to support future annual pay award uplifts being implemented on time and on the effective date (1 April).
• Base pay and take-home pay in the NHS are becoming an increasingly important issue with the rising cost-of-living pressures impacting on NHS staff. Increasing competition between sectors also means that base pay rates are becoming a recruitment and retention challenge for employers.
• Pay in the NHS and across the public sector has also been falling relative to the private sector. This is shaping views of staff on the attractiveness of alternative employment offers for working outside of the NHS, even for relatively small and marginal differences. 

In addition to the key messages above, there are some specific workforce challenges:

• There are simply not enough people working in health and social care to meet rising levels of demand for services. While NHS workforce numbers have increased by 2.4 per cent (headcount) in the year to August 2022, employers have told us that this growth has not been sufficient to keep pace with rising demand on services.
• High vacancies have impacted on service provision as employers cover vacant posts with agency staff and other temporary staff, which comes with significant financial impact. It can also create challenges in ensuring continuity of care.
• In addition to increased demand, employers are dealing with a reduction in workforce capacity due to rising sickness absence rates. NHS staff were working under pressure even prior to the COVID-19 pandemic, but the pandemic brought increases in the amounts of pressure on NHS staff and has led to many staff experiencing symptoms of burnout.
• For the NHS to fully recover long-term from the pandemic, tackle the waits for treatment for our patients, and support its staff, it will need the government to provide the necessary investment for an ambitious and sustainable long-term plan for the workforce.

Read PRB 2022/23 (PDF opens in a new window)

Key messages

• The ongoing effects of the COVID-19 pandemic continue to present the NHS with the biggest set of challenges that it has ever faced. Demand levels continue to rise and service delivery pressures show no sign of reducing.
• A long period of funding at levels below the long-term average, combined with inadequate workforce planning and insufficient investment in training, have resulted in a workforce which is not sufficient in size and capability to deal with the multiple challenges the NHS (and social care) is facing.
• There are not enough staff to meet demand in health and social care.
• Recruitment and retention do not depend only on pay or wider reward. Employers believe it is important to create a culture and environment where people want to work; where they feel safe to raise concerns and to learn from mistakes; where employers listen to and empower their people, work hard to keep them safe, and ensure bullying and harassment is not tolerated.

• Read PRB 2021/22  (PDF opens in a new window)

  Key messages:

  • The NHS Long Term Plan continues to set the future direction for the NHS in England and is the basis for a five-year funding programme up to 2023/24. While this provides some stability for longer-term planning, the overall level of investment is still lower than in previous years.
  • The NHS We are the NHS People Plan 2020/21 – Action For Us All , along with Our People Promise, sets out what our staff can expect from their leaders and from each other. It builds on the creativity and drive shown by our staff in their response, to date, to the COVID-19 pandemic and the interim NHS People Plan . It focuses on how everyone in the NHS must continue to look after each other and foster a culture of inclusion and belonging, as well as take action to grow the workforce, train staff, and work differently to deliver patient care.
  • The NHS faces the multiple challenges of rising demand for services, insufficient capital investment, tackling the causes of trust financial deficits and growing workforce shortages. While the NHS must focus on the immediate demands of the pandemic it must not become a reason for avoiding policy decisions on these critical longer-term issues.
  • Workforce shortages remain the highest concern for employers and the supply issues need to be addressed. Employers remain committed to retaining staff but the health and wellbeing of staff and the risks of staff burnout, especially considering the pandemic, coupled with gaps in the workforce make this a greater challenge.