NHS pay remains a major concern as staff continue to face post-pandemic pressure, rising costs, and ongoing workforce shortages. The 2026/27 pay cycle arrives during economic uncertainty, inflation shifts, and tight public funding.
Early government submissions to the NHS Pay Review Body suggest a possible 2.5%–3% rise, while unions argue this falls short after years of real-term pay decline. With political pressures and retention challenges intensifying, the upcoming settlement will be closely watched.
This guide outlines proposals, union reactions, forecasts, and how wider economic forces may shape the next NHS pay award.
What Are the Government’s Official Proposals for the 2026 NHS Pay Rise?
The government’s approach to the 2026 NHS pay rise involves multiple stakeholders working through a structured review process.
With an earlier-than-usual start, the aim is to secure a timely agreement that avoids backdated payments and ensures fairness, affordability, and alignment with broader NHS financial and workforce planning priorities.
Who Is Involved?
The NHS pay review process involves several stakeholders:
- Department of Health and Social Care (DHSC): Provides affordability assessments and evidence.
- NHS Pay Review Body (NHSPRB): An independent body that reviews evidence and recommends pay awards.
- Treasury and Ministers: Decide whether to accept the recommendations and implement changes.
- Trade Unions and Professional Bodies: Represent staff views, often submitting evidence or opting for direct negotiation.
This year, the government initiated the pay round earlier than in previous years to encourage a timely decision. The goal is to avoid backdated pay awards and ensure changes are applied at the start of the financial year.
What Has the Government Proposed for the 2026 NHS Pay Rise?
The Department of Health and Social Care has proposed a maximum pay increase of 2.5% for Agenda for Change staff.
This recommendation is based on existing NHS budget allocations and the anticipated rise in operating costs due to non-pay-related NHS reforms, such as digital infrastructure upgrades and transformation projects in the 10-Year Health Plan.
The government has made it clear that any pay rise must be funded from within departmental budgets. There is concern that exceeding this figure could affect service delivery, delay new hiring plans, or increase pressure on local NHS trusts.
While the DHSC figure appears conservative, it typically acts as a starting point. In previous years, final awards have exceeded initial recommendations, especially when inflation and industrial relations demanded stronger responses.
How Are Unions and Healthcare Staff Responding to the Proposal?
Unions have strongly criticised the government’s proposed 2.5% cap, arguing it falls below inflation and does little to address long-standing real-term pay losses across the NHS.
Representatives for nurses, physiotherapists, and support staff have already signalled they will not engage with the NHSPRB process for 2026/27, instead pushing for direct negotiations with ministers to secure a meaningful settlement.
Their concerns extend beyond basic pay. Union leaders highlight slow progression at the top of pay bands, limited career pathways, and inadequate regional allowances outside London as key barriers to retention.
Many insist that the pay system must be modernised to reflect changing responsibilities and to ensure the NHS remains competitive in a difficult staffing market.
What Are Experts and Analysts Predicting for the 2026/27 NHS Pay Rise?
While the government has set a proposed limit, independent analysts predict a 3% increase across all bands. This estimate is based on current inflation levels, expected budget growth, and political considerations.
In recent years, expert predictions have proven remarkably close to final outcomes, within 0.3% in some cases. Analysts suggest that if inflation remains above 3% into early 2026, the government may be forced to exceed the proposed cap to prevent further dissatisfaction and potential strike action.
There is also a growing belief that a 3% rise may be seen as a political compromise: enough to appear fiscally responsible while addressing worker demands. However, anything below inflation may still be considered a real-terms pay cut.
How Will Salary Bands Change Across the NHS in 2026/27?
Based on a predicted 3% pay rise, most salary bands under the Agenda for Change framework are expected to see modest but important increases. Here’s a simplified breakdown of how this may look:
Sample NHS Pay Bands (Predicted Increases):
| Band | Starting Salary 2025/26 | Predicted 2026/27 |
| Band 2 | £24,465 | £25,199 |
| Band 3 | £24,939 | £25,687 |
| Band 5 | £31,049 | £31,981 |
| Band 6 | £38,458 | £39,611 |
| Band 7 | £47,809 | £49,244 |
| Band 8a | £55,690 | £57,360 |
| Band 9 | £109,277 | £112,555 |
Salary increases are applied progressively within bands depending on experience and region. For example, inner London pay typically includes High Cost Area Supplements, which significantly increase total earnings.
How Do Inflation and Economic Conditions Influence NHS Pay Deals?
Inflation is a defining factor in any public sector pay negotiation. As of late 2025, the UK inflation rate hovers between 3.5% and 4%, far exceeding the government’s 2% target. For NHS workers, this means that a 2.5% or even 3% pay rise could still amount to a real-terms pay cut.
Economic constraints remain tight. The government has pledged fiscal discipline amid competing priorities such as defence, energy subsidies, and tax reform.
However, failing to match or exceed inflation risks further industrial action, staffing shortages, and negative impacts on patient care.
Scotland offers a useful comparison. The Scottish government has already agreed to a 3.75% rise for 2026/27, with a guarantee that the final award will be at least one percentage point above CPI inflation. This highlights a more responsive and worker-friendly approach to public sector pay north of the border.
Are There Any Planned Reforms to the NHS Pay Structure Beyond 2026?
With staffing shortages and rising dissatisfaction, NHS pay reform talks are accelerating. Although a full redesign is unlikely before April 2026, the government is expected to launch consultations on core changes.
Proposed reforms aim to improve fairness, boost retention, and strengthen competitiveness, ensuring the NHS remains attractive in a difficult economic and recruitment climate.
Key Reform Areas Under Discussion
Several structural reforms have been under active discussion, and while no major overhaul is expected before April 2026, the government is under pressure to launch formal consultations.
- High Cost Area Supplements (HCAS) Expansion: There’s growing momentum to extend location-based pay supplements beyond London to reflect rising living costs in other urban centres.
- Separate Contracts for Nurses and Midwives: One proposal is to establish a distinct pay scale for nursing professionals to better align with their clinical responsibilities and shortages in the workforce.
- Pay Progression and Retention Measures: Reforms may include improved pay for staff at the top of their bands and clearer promotion pathways, addressing concerns over stagnation.
These changes are likely to form part of the broader 10-Year NHS Workforce Plan and may be formally consulted on in 2026.
What Are the Key Differences Between NHS Pay Strategies in England and Scotland?
Scotland’s pay policy has diverged significantly from England’s in recent years. The Scottish government’s approach includes:
- Higher percentage pay increases: 3.75% vs 2.5% cap in England
- Inflation-protected awards: CPI + 1% guarantee
- Closer union collaboration: Resulting in fewer strikes and faster resolutions
These strategies reflect a broader political willingness to prioritise NHS worker retention and satisfaction. While not without financial challenges, Scotland’s policy highlights the impact of proactive negotiation and inclusive policymaking.
When Can NHS Workers Expect the Final Pay Rise Announcement?
For the 2026/27 cycle, the government has started the process two months earlier than in previous years. As a result, the final announcement is expected between January and February 2026.
This shift aims to avoid delays and ensure that new rates are applied by April 2026, preventing backdated payments. Earlier announcements also support smoother payroll adjustments and clearer financial planning for NHS trusts.
Timeline Comparison:
| Pay Cycle | Proposal Submitted | Announcement |
| 2024/25 | January 2024 | July 2024 |
| 2025/26 | October 2024 | May 2025 |
| 2026/27 | October 2025 | Jan–Feb 2026 |
This more proactive timetable marks a positive step, especially for financial clarity and workforce morale.
Conclusion
The NHS pay rise for 2026/27 is shaping up to be another pivotal moment in public sector pay policy. While the government has proposed a 2.5% cap, independent predictions lean closer to 3%.
Unions are pushing back hard, calling not just for higher pay but a comprehensive overhaul of the pay structure itself.
Inflation and political strategy will undoubtedly play a significant role in the final decision. With Scotland setting a higher bar and reform debates intensifying, the outcome of this pay round could influence NHS staffing, service quality, and morale for years to come.
For NHS workers across the UK, staying informed and engaged with the process is essential. The next few months will be critical in determining whether the NHS can meet the challenges of recruitment, retention, and recognition through meaningful pay reform.
Frequently Asked Questions
How does the NHS decide what staff should be paid each year?
NHS pay is determined by the NHS Pay Review Body, which considers government evidence, union input, and economic conditions to recommend annual pay awards.
What’s included in the government’s 2026/27 pay proposal for NHS workers?
The government has suggested a 2.5% maximum increase, citing budget limits and the need to manage non-pay NHS reforms within existing funding.
How are trade unions reacting to the suggested NHS pay increase?
Many unions have rejected the offer as insufficient, especially given inflation. Some have chosen to bypass the Pay Review Body and seek direct negotiations.
What do independent experts think NHS workers will actually get paid?
Most forecasts suggest a 3% increase across bands, slightly above the government proposal but potentially still below inflation.
Which NHS pay bands are expected to see the biggest changes in 2026?
While all bands are predicted to receive a similar percentage increase, the impact is more noticeable in Bands 2–5 due to lower base pay.
Why does inflation matter so much in NHS pay talks?
If pay increases don’t match inflation, NHS workers experience a real-terms pay cut, reducing their purchasing power and satisfaction.
Could there be long-term changes to how NHS pay is structured?
Yes, several reforms are under discussion, including location-based supplements, distinct nursing pay scales, and better progression opportunities.
