Delegates at UNISON’s national health conference, in Edinburgh, this week discussed a raft of motions related to Agenda for Change pay, terms and conditions, touching on everything from job evaluation and banding, to pensions, overtime, mileage rates, holiday pay, and the living wage.
It took three sessions over two days to cover some of the most important issues to members. Sandwiched in between was an address by guest speaker Peter Kelly (pictured below), the chief executive of the Poverty Alliance, Scotland’s anti-poverty network. And his words touched on the very urgent reason why all those motions were so important.
Mr Kelly’s theme was the relationship between poverty and health, against the backdrop of the devastating increases in poverty in the UK in recent years.
He told delegates that whenever the public is polled about the things of most concern to them, health was always near the top of the list. “But we rarely focus on why we have the particular patterns of health,” he said. “We need to have a different kind of conversation about health, one that focuses less on individual behaviours, fate or chance. Today, it should be about the relationship between health and poverty – and how we change that relationship.”
Peter Kelly. Image: Connor Mollison
Along with the increase in poverty in general, there has been a growth of poverty in work. Today, around 60% of UK households living in poverty have someone in work. That includes a “staggering” 20% of residential care workers.
And poverty is “both a cause and a consequence of poor health outcomes”, Mr Kelly said, describing a vicious circle in which trying to make pay stretch – and having to decide between rent, food or heating – can lead to depression and anxiety.
All of this was “magnified by austerity”, which has had a devastating effect on the health and wellbeing of millions of people in the UK. Food banks and warm banks are now commonplace. Life expectancy stalled in mid-2010 and is now in reverse, while there are increases in infant mortality.
“This is injustice in its most brutal form,” he said. “But it’s a situation that we can change. There’s no doubt that we should be able to do better than this.”
A fundamental solution is pay. “Adequate incomes are the clean water of anti-poverty policy,” Mr Kelly said, describing the Scottish government’s proposed minimum income guarantee as a transformative idea, among others.
Struggling for political reasons
Pay of course was a central theme in the Agenda for Change debates. The emergency motion ‘Pay up for NHS staff – stepping up the fight’ condemned the “handbrake turn” made by the Westminster, Wales and Northern Ireland governments when they “lurched back” to the Pay Review Body (PRB) process in respect of the 2026/27 pay year.
The motion further criticised the governments’ decision, announced in February, to impose the PRB recommendation of a 3.3% award – another real-terms pay cut.
But it commends the inflation-proofed, two-year deal for AfC staff in Scotland, which delivered a 4.4% increase for 2025/26 and at least 3.75% for 2026/27 – further widening the substantial gap between AfC pay points in Scotland and the rest of the UK.
James Anthony. Image: Connor Mollison
Proposing the motion, UNISON vice-president James Anthony (above) told delegates that “members are struggling to make ends meet for political reasons… We know that paying staff properly is the right thing to do for the NHS and for the wider economy. When you put money in health workers’ pockets it goes straight back into local communities, not in offshore accounts in tax havens.”
There is too much month left at the end of my wages
Noting the upcoming meetings between unions and governments to discuss structural improvements to AfC, Mr Anthony said: “As we move into these negotiations, our motion sets out clear priorities: pay for the lowest bands and embedding the real living wage. Making sure pay rates are competitive across the pay structure.
“The motion also sets out our wider priorities: reducing the working week and the vital, important work of making sure our Agenda for Change terms and conditions and pay rises are delivered across all those who provide NHS services.
“We need to be catching up, not falling behind.”
Of the many delegates speaking in support of the motion, one made an observation that would ring true for so many of her colleagues: “There is too much month left at the end of my wages,” she said.
“You lie awake worrying about money, you skip meals, you put off things like the dentist. That’s the real cost of low pay in the NHS. The whole NHS must be a real living wage employer. Not just for some, and when convenient, but for all of it. We have to be honest: the system itself is broken. There are structural anomalies across Agenda for Change that make a mockery of progression.”
Conference was reminded that members in Northern Ireland are having insult added to injury in the continuing delays in implementing their pay uplift for 2025/26. It had been promised in February this year, which would have ben six months late; but members are still waiting.
As one exasperated delegate said: “We can only wait so long and then it should be the first priority. Why wait another six months to give people the pay they are due?”
We will not accept part-time work leading to poverty in retirement
Maria Alberts. Image: Connor Mollison
On average, women have less money in retirement, often due to the cumulative effect of lower earnings and interrupted work history.
In the motion on the NHS gender pensions gap, Maria Alberts (above) told delegates that, while the gender gap in the NHS pension scheme has reduced over time, it remains high – 34% for active members, according to 2023 data for the England and Wales scheme.
“Workplace pensions reflect pay. We need career progression and proper application of job evaluation schemes,” she said. “We should work to improve our pension schemes and to end the inequalities of pay.”
Supporting the motion, one speaker added: “The NHS and wider society depend on women, our labour, our care and our sacrifice, but the system leaves us with less.
“This motion says we will not accept lifelong financial penalties. We will not accept part-time work leading to poverty in retirement… A system that relies on women but leaves them poorer at the end of their working lives is fundamentally unjust.”
We’ve won millions. But we must not stop there.
Maura McKenna. Image: Connor Mollison
Introducing the motion on NHS job evaluation, Maura McKenna (above) told delegates: “We have to celebrate how far we’ve come in pushing job evaluation up the agenda.” Alongside winning re-banding and over £200m in back pay for healthcare assistant members, UNISON’s Pay Fair for Patient Care campaign has helped to drive the union’s concerns to the top of the NHS Staff Council agenda.
Work by UNISON in the devolved administrations to ensure that job evaluation is fully resourced, and capacity is maintained has also played an important role.
But Ms McKenna added: “We must not stop there. Now is the time for course correction on job evaluation, particularly in England… As the leading union in the job evaluation space, we must think about securing its future. We need to take some time over the next year to develop some principles and criteria to engage with any discussions about what happens next with the scheme.”
A speaker for the motion said: “Good job evaluation is about more than pay, it is about respect. It is about retention of staff. Robust, fair and transparent job evaluation processes are essential. We must learn from bad practices and highlight good practices to deliver the right outcomes for our members.”
Another speaker noted that in job evaluation schemes, “we see HR deferring to UNISON panellists instead of managers, because we’re more experienced.”
The motion called on the SGE to:
- Support branches and regions across the UK to capitalise on the recent developments, to hold employers to account for poor JE practice and to work in partnership to develop plans for proper delivery locally.
- Step up UNISON’s work to recruit, support and train new JE practitioners and utilise current expertise in regions by establishing JE networks across the UK.
- Call for more investment in JE locally and nationally to future proof the scheme.
- Work closely with other Agenda for Change unions across all activity to safeguard and improve JE practice.
We’re worth a wee bit more than that
In similar vein, the motion ‘right band for the right job – supporting phlebotomy rebanding campaigns’ acknowledged that while Pay Fair for Patient Care notably achieved rebanding wins for healthcare assistants, the issues affecting HCAs were also experienced by many others.
The scope of many phlebotomy jobs has changed significantly, with some working across more varied NHS settings such as community hospitals, community diagnostic centres, GP surgeries and even in patient homes. Yet UNISON’s growing number of phlebotomy campaigns – including the longest strike in NHS history by Gloucester phlebotomists – show that these practitioners are angry that their job descriptions are inaccurate, rarely updated and understate the complexity of their roles. And they want to be rebanded.
Elaine Henderson, from Lanarkshire Health branch, has been with the NHS for 40 years, and as a phlebotomist for 25. She told delegates that in that time has job “has changed considerably” including working with people with complex needs and training new members of staff.
“But I have been left on a band 2. And I feel that my skills and the experience I have matches up to more than that. I think this goes for a lot of band 2 phlebotomists. I think we’re worth a wee bit more than that.”
The SGE will work with UNISON’s science, therapy and technical occupational group to learn from successful re-banding phlebotomy campaigns – in which phlebotomy staff are now being paid fairly for the work that they do at band 3 – and work to achieve wins in NHS employers across the country.
You want more hours? It’s overtime – pay the rate!
A number of delegates spoke on the controversial issue of overtime, namely the fact that many NHS trusts are now using internal banks or commissioning NHS Professionals (NHSP) to manage additional hours – side-stepping traditional overtime as enshrined in Agenda for Change.
The result, said Gillian Hobson of North West region, is “more hours, more energy, more sacrifice. But in real terms we’re being paid less and less.”
Introducing the aptly named motion ‘You want more hours? It’s overtime – pay the rate!’, Ms Hobson said the practice of offering staff additional hours via banks or the NHSP, on lesser rates than they would get in their substantive roles, was “exploitation plain and simple.”
But across the country members have organised with collective grievances, demonstrations, and boycotts of bank shifts. “If we stand together, we can stop this race to the bottom. Defend the principle of overtime shifts as paid overtime. Stop employers breaking national agreements,” she said.
“NHS staff are exhausted, stretched, giving everything they have. They deserve to be paid fairly for every hour and minute they work.”
Supporting the motion, one delegate said that trusts were taking advantage of members’ need for extra work during the cost-of-living crisis. “Many members are struggling to feed their families. You would think they would help us, but they just want to exploit us.”
The SGE will survey branches and staff to find good examples of workers resisting changes and share these in updated bargaining guidance that includes guidance on running disputes on the issue.
Further motions related to AfC passed by conference included:
- Structural reform of the Agenda for Change pay spines
- Tackling unacceptable delays in putting pay right in Northern Ireland
- Challenging low pay under AfC
- Mileage rates
- Securing fair banding for lower banded members
- Make the NHS a true Living Wage employer
- Holiday pay for regular overtime worked (‘Flowers pay’).
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