We welcome the opportunity to submit evidence to the NHS Pay Review Body (PRB) on behalf of NHS trusts and foundation trusts, to inform the 2025/26 pay round for Agenda for Change (AfC) staff.

For the purposes of this submission, we are providing relevant findings from our annual survey of trust HR directors and our annual ‘State of the Provider Sector’ survey, accompanied by key
messages and context.

• Context: The current context for NHS staff is challenging, with sustained high service demand and dilapidated physical working environments, industrial relationships that are still in recovery, and a new government with plans for service reform which staff are key to. With AfC staff making up the majority of the NHS workforce, the role of the PRB as an independent pay review process remains important, as pay is a key lever to ensuring that the NHS can attract and retain the staff it needs.
• Trust finances: In order to manage or improve the current financial position of their trust, 85% of our survey respondents said it is very likely or likely that their trust will have to reconfigure services, and 87% said they are very likely or likely to review responsibilities within clinical roles with a view to optimisation. Other common themes centred on staffing and recruitment, including recruitment freezes across non-clinical roles, eliminating bank and agency spend and scaling back spending on training and personal development.
• Agency spend: Agency spending is significantly reduced this year, following sustained focus on this area from trust leaders, and is now at its lowest since 2017, with trusts on plan to meet the target reduction in agency spending of £500m for 2024/25.
• Timing: We welcome the earlier timing of the remit letter, and consequent commencement of the pay round, this year. While this is progress on previous years, it is disappointing that the 2025/26 pay award will again not be confirmed in time for the start of the financial year. We are keen to see this amended for the 2026/27 pay round.
• Band 2 and National Living Wage: The annual issue of band 2 falling below National Living Wage (NLW) each April must be resolved for the long term. Band 2 should be set above the NLW. There is an opportunity for the PRB to align AfC pay scales with the real living wage.
• Pay award process: In our annual survey of trust HR Directors, we asked our members which model for NHS pay awards they would prefer to see in future years. Over half (56%) would like to see multi-year pay awards recommended. Only 10% of respondents said they would like to see annual pay awards via the pay review bodies (which is the current model).
• Funding (national): We again ask that the PRB makes an explicit recommendation for government to commit to fully funding any pay uplifts it decides to award NHS staff, to ensure that cost pressures are not passed onto trusts. This is of particular importance this year, with trusts already under significant financial strain, concerned about staff numbers and quality of patient care.
• Funding (community and mental health trusts): The calculation of funding allocations for pay costs disadvantages community and mental health trusts, which is an ongoing concern for these providers.
• Funding (local authority contracted NHS staff): 80% of survey respondents were either not at all confident or not confident that they will receive national funding to cover the costs of AfC pay uplifts for NHS staff working on local authority contracts in the next financial year.
• AfC deal implementation: Industrial relationships with AfC staff remain strained. Implementation of most of the non-pay elements of the 2023 AfC deal remains outstanding. It is important for the 2023 AfC deal to be implemented in full, and if there is intention not to do so from any party, this should be clearly communicated.
• Mandate to address AfC pay structure: Last year the PRB recommended for “the UK Government to issue the NHS Staff Council with a funded mandate to begin to resolve outstanding concerns within the AfC pay structure.” Trust leaders would welcome further information on this as part of DHSC’s submission to the PRB this year. More than 80% of our survey respondents said this was important for recruitment and retention.
• Pay for 2025/26: 64% of respondents said that a pay uplift of at least 5% would be needed for 2025/26 to support recruitment, retention and morale for AfC staff.
• Ethnicity pay gap: 31% of survey respondents said their trust’s ethnicity pay gap has decreased in the last two years, while 36% said their trust’s ethnicity pay gap has stayed the same. 7% said they have seen their trust’s ethnicity pay gap increase in the last two years, and 26% said they did not know.
• Staffing: Only 26% of survey respondents are confident about their trust having the right numbers, quality and mix of staff in place to deliver high quality healthcare to patients and service users. Just 3% were very confident. 20% were very worried and 34% were worried.
• Burnout: 75% of respondents were extremely or moderately concerned about the current level of burnout across their workforce.