Pay rises for most NHS staff should be restricted to an “affordable” 2.5% next year to deliver improvements to NHS services and avoid “difficult” trade-offs, the UK government has said.

In their evidence to the NHS Pay Review Body (PRB) for 2026-27, ministers said a rise above 2.5% would “affect the ability of the NHS to maintain or expand staffing levels”.

Despite inflation running at 3.8%, the government claimed 2.5% is the maximum that could be afforded within the departmental limits set in this year’s spending review. “Further pay awards above what is considered affordable will require difficult government trade-offs from within existing… budgets, including a reduction in ambitions for service or performance improvement,” it said.

The evidence also indicated that the government would propose the same 2.5% pay rise for very senior managers in the NHS in England, who are covered by the Senior Salaries Review Body.

NHS trade unions—who have boycotted the PRB process since 2023—described the government’s pay proposals as “not good enough” and an “insult”.

MiP chief executive Jon Restell said: “Ministers had an opportunity to show staff that they are indeed valued by offering a fair pay rise, but this below-inflation figure comes nowhere near achieving that. It’s frankly not good enough.

“The government’s chaotic reorganisation of the NHS in England has meant staff have had a miserable year. Morale is rock bottom throughout the system,” he added.

UNISON’s head of health, Helga Pile described the proposals as “the final nail in the coffin” for the PRB process and called for direct pay talks between NHS unions and ministers.

“Yet again ministers are trying to get away with giving staff a way-below-inflation pay rise. This is an insult,” she said. “It will go down badly right across the NHS, just as workers are bracing themselves for the challenges of winter.”

The PRB covers staff on Agenda for Change (AfC) grades in England, Wales and Northern Ireland. In recent years, it has recommended pay rises slightly higher than the UK government has claimed to be affordable, but each government can decide independently whether or not to accept the recommendations.

The Scottish government doesn’t take part in the PRB process and negotiates pay directly with NHS staff and unions. Earlier this year, it agreed a pay deal worth 8% over two years with an ‘inflation guarantee’.

Following the 2025 PRB report, published in May, the UK government committed to negotiate with unions to resolve long-running structural issues with the 20-year old AfC pay framework—including grading errors and compression of the pay bands, which discourages promotion—but talks had yet to begin at the time of going to press.

Restell described the continuing delay as “another kick in the teeth for staff”. He added: “If the government are serious about fixing the NHS for patients and staff then these talks must start well before the pay award is due.” //