The Royal College of Nursing (RCN) has issued a stark warning to the government: reform the NHS pay structure or face the prospect of industrial action. This comes after a record-breaking consultation revealed that 91% of nursing staff in England rejected the government’s 3.6% pay award as insufficient.
In the largest vote in the union’s history, over 170,000 nursing professionals took part, with 56% turnout—well above the threshold required for industrial action ballots. The result reflects deep discontent within the profession, with many nurses feeling trapped on low pay bands despite years of experience, training, and growing responsibilities.
RCN General Secretary and Chief Executive, Professor Nicola Ranger, said:
“My profession feels deeply undervalued and that is why record numbers are telling the government to wake up, sense the urgency here and do what’s right by them and by patients.”
The union says that rather than demanding an increase to this year’s award, it is calling for long-overdue reform of Agenda for Change, the NHS pay system introduced over 20 years ago. Critics argue the system leaves nurses stuck on Band 5—starting just above £31,000—even after years of service, with little opportunity for career progression.
A staggering 87% of nurses surveyed said their pay band fails to reflect their knowledge, qualifications, and responsibilities. Many also report working significant unpaid overtime to keep patients safe amidst ongoing NHS pressures, including corridor care and staffing shortages.
The government has indicated willingness to discuss pay structure reform but has ruled out revisiting the current pay award. A spokesperson from the Department of Health and Social Care said:
“This government is clear we can’t move any further on headline pay, but will work with the RCN to improve their major concerns, including pay structure reform, career progression and wider working conditions.”
However, the RCN insists those discussions must begin immediately or the union will escalate to a formal dispute and a strike ballot this autumn.
Professor Ranger added:
“To avoid formal escalation, the government must be true to its word and negotiate on reforms of the outdated pay structure which traps nursing staff at the same band their entire career.”
RCN members in Wales and Northern Ireland have also overwhelmingly rejected the 3.6% offer. In Northern Ireland, no funding has been made available to implement the uplift. Scotland has agreed to a separate two-year deal providing an 8% rise.
With frustration boiling over and staff morale at critical lows, the government faces a pivotal summer. A failure to act could see the NHS plunged into another wave of strike action—this time from its largest and most trusted workforce.