UK Health Unions Threaten Strikes Over Below-Inflation Pay Offer

Health unions have put the National Health Service (NHS) on notice for further strikes after ministers recommended a pay rise of 2.4% for the 2027/28 financial year, a figure unions say is below inflation and represents a real-terms pay cut.

Doctors, nurses, and other healthcare workers have reacted with anger to the government's proposal. The British Medical Association (BMA), representing doctors, called the offer "derisory" and stated it "beggars belief." The Royal College of Nursing (RCN) described the recommendation as a "betrayal" of nursing staff.

The Department of Health and Social Care (DHSC) and NHS England informed the NHS Pay Review Body that they could not afford a higher increase without making "difficult trade-offs," which could include cutting services or extending patient waiting times. Their joint submission highlighted that NHS pay represents a "significant material pressure," with each 0.5% pay increase adding approximately £750 million to the wage bill. This cost, they noted, is equivalent to more than 89,000 hip or knee replacement operations.

Officials also pointed to existing financial pressures, including higher inflation, energy costs, ongoing industrial action, and reduced income from the immigration health surcharge. The review bodies are expected to consider evidence from both employers and unions before making recommendations to ministers, who ultimately decide whether to accept or overrule them.

Consumer Price Index (CPI) inflation rose to 3.1% in August 2026, with core inflation at 2.6%. The Bank of England anticipates further inflation increases due to global energy price pressures.

Union leaders expressed their dismay. Dr. Tom Dolphin, chairman of BMA Council, stated, "It beggars belief that at a time when patients are being treated in hospital corridors and car parks, people are waiting too long for a GP appointment and the Government's pledge to bring down waiting lists is stalling, ministers are saying doctors deserve a pay cut." He warned that failing to value doctors' expertise risks "further industrial unrest and disruption."

Professor Nicola Ranger, general secretary of the RCN, argued that a 2.4% pay rise would lead to falling living standards for nursing staff and would not address "more than a decade of collapsing real terms pay." She added that hundreds of thousands of members would be "furious" and that the government was in danger of proving it was no different from previous administrations.

Helga Pile, head of health at the union Unison, noted that over 200,000 NHS staff earn less than the real living wage. She criticized the proposed increase as an "insulting pay rise, falling well short of expected inflation," especially as winter pressures and rising bills loom.

In 2026, the government did accept a 3.5% pay increase recommended by the Doctors' and Dentists' Remuneration Body (DDRB), which exceeded its initial proposal of 2.5%. However, past industrial action by resident doctors, comprising 15 rounds of strikes, has cost the NHS over £3 billion and led to the cancellation of 1.5 million appointments.