NHS workers on Agenda for Change contracts in England and Wales will receive a 3.3% consolidated pay rise from April, the Department of Health and Social Care (DHSC) and the Welsh Government have announced.

The increase follows a recommendation from the NHS Pay Review Body (PRB), which advised a 3.3% uplift with effect from 1 April 2026.

However, unions reacted with disappointment, describing the award as a “betrayal,” an “insult,” and a “real-terms pay cut.”

Above Inflation, Says Government

The DHSC had planned for a 2.5% pay uplift for 2026-2027 without affecting headline health commitments, the PRB said. After reviewing the evidence, it recommended a higher consolidated increase of 3.3%.

England’s Health Secretary Wes Streeting said the award was above the Office for Budget Responsibility’s forecast inflation rate of 2.2% for 2026-2027 and represented a “real-terms pay rise” for NHS staff. He also noted that it exceeded the 2.5% figure the government had previously indicated was affordable.

Unions Cite ‘Real-Terms Pay Cut’

Several health unions said the award failed to keep pace with current inflation and did not address longer-term pay erosion.

Jim Fahie, assistant director of employment relations at the Chartered Society of Physiotherapy, said the rise was below last year’s award and current inflation, adding that it “makes absolutely no ground on restoration.”

Gill Walton, general secretary of the Royal College of Midwives, described the increase as “an insult” to midwives, who she said had worked 100,000 unpaid hours each week to keep maternity services running. She added that midwives were “sick and tired of these broken promises to sort out pay and staffing.”

Helga Pile, head of health at UNISON, said, “Hard-pressed NHS staff will be downright angry at another below-inflation pay award.”

Paid On Time for First Time in 6 Years

For the first time in 6 years, the pay award will be implemented in April salaries.

NHS Employers said colleagues working on the Electronic Staff Record had received the pay details and confirmed that the increase would be paid on time.

Dean Royles, interim chief executive of NHS Employers, said previous awards had been implemented as late as September or October.

“We have listened to the workforce and understand the difficulties they face when pay awards are not delivered on time,” Streeting said.

Pile said timely payment was only “small comfort,” adding that for thousands at the bottom of the pay scale in England, “half their increase has gone on bringing their hourly pay rate up to the legal minimum.”

Recruitment and Retention Concerns

NHS Employers said a “fair and timely” award was essential to retain experienced staff and attract new recruits.

Dean Rogers, executive director of industrial strategy at the Society of Radiographers, said the gap between NHS pay and average earnings continued to grow, “further undermining morale, recruitment, and retention.”

Helen Whyley, executive director of the Royal College of Nursing Wales, said the award “falls well short of what is needed to value and retain staff.”

Unite general secretary Sharon Graham said, “Today’s announcement will simply increase the problems of low pay that has seen thousands of healthcare workers leave, worsening the recruitment and retention crisis in our NHS.”

Rob Hicks is a retired National Health Service doctor. A well-known TV and radio broadcaster, he has written several books and has regularly contributed to national newspapers, magazines, and online publications. He is based in the United Kingdom.