Socialist Worker

Health pay deal would cut wages and strengthen bosses in the NHS

by Tomáš Tengely-Evans
Issue No. 2597

Health workers pay has been cut to the bone

Health workers' pay has been cut to the bone (Pic: Guy Smallman)

The Tories have showed their contempt for the NHS and health workers with a miserly pay offer.

They have been forced to put more on the table than in the previous seven years—but it’s not nearly enough and has some features which are worse than at present.

It represents a real terms pay cut, and tries to sneak productivity-linked pay through the back door.

Oner a million health workers in England would get a 6.5 percent pay rise over three years—3 percent in 2018-19, then 1.7 percent in both of the following years. They would also get a 1.1 percent lump sum in the second year.

Some at the very bottom of the pay scale would get a higher increase.

Scottish health secretary Shona Robison has said NHS staff will be paid “at least as much” as those in England.

With the RPI rate of inflation running at 3.6 percent, the proposals still represent a real terms pay cut. The Office for Budget Responsibility forecasts that inflation will increase by 9.6 percent during the next three years.

It could easily be more than that.


The deal certainly does nothing to claw back the 14 percent pay cut that health workers have suffered since the Tories came to office in 2010.

And one of the most pernicious part of the proposals—overhauling pay increments—could see thousands lose out and boost bullying bosses.

Each pay band within the NHS’s Agenda for Change (AfC) pay system is subdivided into increments. Health workers move up automatically from one to the next annually until they reach the top of their band.

Moving up the increments generates a pay increase on top of the nationally agreed deal.

This is how many health workers have survived under the Tories’ pay restraint—although around half of NHS workers have reached the top of their band and receive no further increments.

The deal would see fewer increments and progression would not be annual, meaning it would take longer to reach the top of a pay band.

It would give power to mangers to discriminate against those who are “difficult”, or union activists.

Perhaps even worse, the deal says “all employers will need to apply a process linked to appraisals before allowing staff to progress to the next pay point.”

This is potentially productivity linked pay through the back door—making health workers work more for less.

It would give power to mangers to discriminate against those who are “difficult”, or union activists. And because there is institutional racism and sexism in the NHS, black workers and women are likely to suffer most.

Health workers deserve much better than this—and can win it.


Preliminary details of the deal, leaked to the Guardian newspaper last month, included axing one day’s annual leave. These plans have now been dropped after a wave of anger from health workers—in another sign of the Tories’ weakness.

The proposals follow negotiations about restructuring AfC between the Tories and 14 health unions. The leadership of Unison and the Royal College of Nursing, the largest health union and staff organisation, are pushing for their members to accept the deal.

But that need not be the end of the story. Unison head of health Sara Gorton, who was the lead pay negotiator for the NHS unions, said, “All affected members will have a chance to have their say on NHS pay and to have a vote.”

The consultation will begin in mid-April. There has to be a big campaign for rejection.

The GMB union is the only union that has called on members to reject the “jam tomorrow” pay offer. It represents in particular ambulance workers and the growing army of outsourced NHS workers, whose pay in negotiated separately.

The 14 unions had originally put in an above-inflation pay claim of 3.9 percent and an £800 lump sum.

Activists have to tell their union leaders to reject the deal and ballot their members for strikes.

Video: Remembering the nurses' strike of 1988

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