A new analysis by the union of NHS data for England over three years shows no marked improvement, and a decline in some cases, in pay satisfaction levels for workers on Agenda for Change (AfC) contracts.
Medical and dental staff are the only group where pay satisfaction levels have risen to any extent, with an 18% increase in the past three years.
UNISON says these findings demonstrate how many NHS employees continue to feel undervalued and that nothing has changed under the new government.
They also underline the need for pay restructuring talks between the government and AfC unions – expected to begin in the coming weeks – to yield results.
Today (Wednesday), the government will impose the 2026/27 headline wage rise of 3.3% for AfC staff. Some workers could receive additional rises if a deal is reached with the government.
The UNISON analysis of pay satisfaction was based on data from annual NHS staff surveys for England covering the three years to 2025.
Results show the proportion of support staff such as porters, catering staff, IT workers and administrators who were content with their earnings dropped by 2% from 2023 to 2025. Levels of satisfaction did not increase at all among nurses and midwives during the same time period.
The data reveals a rise in pay satisfaction of just 1% among nursing and healthcare assistants, and other clinical professions. It is 2% among ambulance workers including paramedics.
Healthcare assistants and ambulance staff had the lowest satisfaction levels of all groups in the 2025 data with only 21% and 25% satisfied with their pay.
Leaving these dissatisfaction levels unchecked risks more staff leaving for better paid jobs elsewhere, which represents a real risk to patient care at a time when the NHS has barely begun to recover, the union says.
UNISON head of health Helga Pile said: “It’s no wonder there’s been no improvement in pay satisfaction among staff on Agenda for Change contracts.
“The government’s failure to invest in the NHS workforce has left many angry and disillusioned. Paramedics, nurses, porters and other staff feel neglected and ignored especially in the current staffing crisis.
“Soaring living costs have eaten into the pay of all health workers and inflation will quickly wipe out the pay award that kicks in today.
“The government must ensure there’s proper funding when talks with Agenda for Change unions finally begin in the coming weeks.”
Notes to editors:
– UNISON’s analysis uses figures from the 2025 NHS England Staff Survey published on Thursday 12 March 2026. It shows the following figures for staff who indicated they were satisfied or very satisfied with pay:
|
Occupation group |
2023 |
2024 |
2025 |
Percentage point change 2023 to now |
|
Wider healthcare team |
35% |
34% |
33% |
-2% |
|
Registered nurses and midwives |
28% |
27% |
28% |
0% |
|
Other |
43% |
43% |
43% |
0% |
|
Nursing and healthcare assistants |
20% |
19% |
21% |
+1% |
|
Allied health professionals / healthcare scientists / scientific and technical |
33% |
34% |
34% |
+1% |
|
Social care |
40% |
41% |
42% |
+1% |
|
Ambulance (operational) |
24% |
26% |
25% |
+2% |
|
Medical and dental |
32% |
48% |
50% |
+18% |
– Staff on the Agenda for Change salary scale begin to receive their pay award for 2026/27 from today (Wednesday).
– UNISON and 13 other health unions have written to the health secretary Wes Streeting to call for significant extra funding to be put into pay restructure talks. More than 47,000 NHS staff have added their names to an online version of the letter so far. Further details can be found here.
– 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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