Without action, tens of thousands of employees on the lowest wage bands will once again drop beneath the statutory minimum level when it rises by 50p an hour to £12.71 from April 2026*.
That’s also the date all NHS staff are due their annual pay rise. But UNISON says delays and a failure to tackle low earnings properly mean the government risks having to resort to a temporary top-up to avoid falling foul of the law.
UNISON has written to trusts across England to highlight how the pay system is at ‘constant risk’ of breaching minimum wage rules.
The union says this is because the government has yet to deliver on its July 2024 promise to hold formal talks with unions on fixing the pay structure.
Health unions including UNISON made a plea to ministers in September this year to have one set of talks which combines headline pay and restructuring, with proper funding on the table.
Negotiations need to start now for a package to be ready for April, the union says.
UNISON and many other health unions say the long-winded NHS Pay Review body process is discredited and no longer fit for purpose.
They have not submitted evidence for the 2026/27 pay round and are instead pressing the need for direct talks to allow issues to be tackled at the same time.
UNISON’s letter to trusts warns that the government’s failure to make good on overdue talks is increasing the risk of ‘serious industrial escalation’. The union also advises that funding allocations for pay will need to be higher than the amount that the government and NHS England have told trusts to plan for.
The statutory minimum wage rate rise was confirmed last Tuesday but the Low Pay Commission forecast a similar figure as long ago as May. UNISON says ministers failed to plan properly to ensure NHS wages will be compliant with the increase.
The government gave a commitment to make the NHS the ‘best employer’ in its 10-year health plan for England, which was published this year.
That aim must start with eradicating poverty pay in the NHS, says UNISON, using the real living wage rate as a benchmark, as many supermarkets do.
UNISON head of health Helga Pile said: “NHS pay needs sorting now to avoid letting down hundreds of thousands of staff yet again.
“Nurses, healthcare assistants, paramedics and porters need to see ministers stick to their promises. Those in the lower pay bands feel completely devalued by this annual minimum wage merry-go-round.
“The government needs NHS workers on its side to deliver on health reforms, but too many of them are worried sick about making ends meet.
“The NHS knows full-well the damage financial stresses cause to people’s health and wellbeing. Yet too many staff working in the service are struggling.
“Paying at least the real living wage so everyone can have a basic standard of living would reap big benefits and help staff give their best for patients.
“Time is running out to deliver a pay rise on time for April despite all the government’s promises to sort this. The pay review body is slow, ineffective and must be replaced with direct negotiations with unions.”
Notes to editors:
– *More than 170,000 NHS employees in England are on pay points that are now below the new £12.71 statutory minimum wage.
– UNISON is the UK’s largest union with more than 1.3 million members providing public services in education, local government, the NHS, police service and energy. They are employed in the public, voluntary and private sectors.
Media contacts:
Anthony Barnes M: 07834 864794 E: a.barnes@unison.co.uk
Sophie Goodchild M: 07767 325595 E: s.goodchild@unison.co.uk
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