A separate pay spine for nursing staff
What we demanded of government
In 2024, the Westminster government launched a consultation to explore the creation of a separate pay structure, also known as a pay spine, for nursing staff working for the NHS in England.
More than 7,000 members working in the NHS and independent health and social care settings helped shape our response to the consultation. Thousands of you told us your job descriptions don’t match the reality of your work and stop you progressing in your career. We told the government this in our response.
In April 2025, the Westminster government ruled out the option of pursuing a separate pay spine for nursing. This is despite ministers confirming that 94% of nursing staff who responded said the change would improve career progression and professional development. This is disappointing, but we'll continue to campaign for nursing to be recognised fairly through structural reform to pay and career structures.
We'll fight for:
- effective and funded implementation of new band role profiles, due to be published in June 2025
- a significant above-inflation pay rise for NHS nursing staff
- band 5 to 6 progression after a period of preceptorship
- a place for nursing at every table where decisions are made, from the government through to service providers and employers
What we told the government
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Nursing needs a fresh start
In the 20 years since the Agenda for Change (AfC) pay structure was introduced, nursing has transformed. AfC no longer provides equal pay for work of equal value. Patients and service users hold nursing staff in high regard. Politicians need to catch up.
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Nursing is not a calling
Or a vocation. Or 鈥榳omen鈥檚 work鈥�. We are a profession. We are experts. We are leaders. There is an art and a science to what we do.
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Nursing needs recognition
Nursing support workers should be paid starter salaries in the region of 拢27,500, and registered nurses in the region 拢35,000, with progress towards 拢50,000. A path towards more advanced career levels should be clearly and credibly marked out.
The previous experience of internationally educated nurses should be recognised 鈥� as happens in the medical workforce. In the UK, nurses educated overseas are automatically employed at the bottom of band 5, regardless of their experience in different countries.
Patient-facing professionals in NHS pay band 2 are paid just a single penny more than the national living wage of 拢11.44 per hour. As valued members of the nursing team, they deserve far greater recognition.
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Nursing needs a new career framework
A new pay structure must be aligned to a new nursing career framework to allow professional development of nursing staff that is similar to the medical workforce in the UK, and the nursing workforces in the US, Australia and the Republic of Ireland.
What our members told us
The proportion of respondents who said their banding is appropriate or very appropriate – a significant drop from 44% in 2015*.
The proportion of respondents who don鈥檛 think that the difference between bands is significant enough to recognise the increased experience and requirements between roles.
The proportion of respondents who disagree or strongly disagree that their pay band recognises their knowledge, skills, education and responsibility.
I manage complexity and acuity in a high-stress environment. I’m a highly skilled nurse with 14 years’ experience, a Diploma of Higher Education, a bachelor’s and master’s degree. In any other profession my salary would track my extended skills. This simply hasn’t happened. I get paid the same as a 1-year post midwife or other health care professional.
