Executive Summary
The Society of Radiographers (SoR), representing over 34,000 diagnostic imaging and radiotherapy professionals across the NHS, submits this evidence to the NHS Pay Review Body (PRB) at a time of acute workforce crisis. Radiographers are central to patient care and to reducing diagnostic and treatment waiting times, yet continued pay erosion, poor working conditions, and hostile recruitment policies threaten service delivery and patient safety.
We are submitting evidence to the Pay Review Body (PRB) to make the radiography case for improvements to pay and reward. We also make reference to important areas of wider workplace experience and culture which have a significant impact on professional recruitment, retention and progress. In several of these we acknowledge it is not within the PRBs expertise or remit to recommend specific solutions - although we argue the PRB can and should specifically acknowledge these challenges. Doing so would add positive encouragement towards the Government implementing solutions identified through the Social Partnership Forum and parallel workforce reform discussions between the members of Staff Council, including the SoR.
Key Issues
- Pay Restoration: NHS radiographers have experienced a devaluing of their pay and terms and conditions compared to the rest of the economy since 2008. For SoR members the pay gap is between 22% - 24%. IN managerial grades the gap is even higher, between 26%-32%. The 2025–26 pay award of 3.6% widened the gap between NHS pay and average earnings, further undermining morale, recruitment, and retention.
- Gender Pay and Pension Gaps: Inequities persist, with Agenda for Change (AfC) staff—predominantly women—falling further behind groups such as doctors and dentists. The NHS pension scheme’s gender gap is significantly higher than in comparable public sector schemes.
- Pensions and Retention: High opt-out rates, particularly among Band 5 staff and internationally trained recruits, undermine pensions as a cornerstone of NHS reward. Contribution rates are disproportionately high compared with other public sector schemes, worsening affordability and retention. Opt-out rates are especially high for those engaged through NHS Banks or agencies. Opt-out rates are also especially high in London, where member contributions are proportionately higher by grade because of London weighting. There is a link between groups with higher opt-out rates and the gender pension pay gap.
- Workforce Crisis: Vacancy rates remain critical—14.9% in diagnostics in England, 15.3% in Wales, and much higher in specialist areas. New graduates are struggling to secure posts due to shirt-term job freezes, risking long-term attrition. Demand for imaging and radiotherapy continues to rise faster than workforce supply. This prompts a need for the new Workforce strategy to sustain a credible long-term fully funded plan to continue to grow the radiography workforce at all levels, alongside imaging capacity, as a priority.
- International Recruitment: The Government’s restrictive immigration policy will deter internationally trained radiographers, who currently make up nearly 30% of registrants and account for two-thirds of workforce growth since 2020. This threatens the NHS’s ability to meet waiting list reduction and cancer treatment targets.
- Specialist Shortages: Sonographers and mammographers face vacancy rates of up to 48% in some regions, with widespread reliance on agency staff at unsustainable cost.
- Leadership Roles: Senior management posts (Bands 8a–9) are increasingly unattractive due to excessive workload and inadequate pay differentials, further undermining NHS service delivery. As radiography becomes ever more central to patient support, especially regarding reducing patient waiting times for diagnosis and early cancer treatment, developing more managers and leaders from radiography would have a wider benefit for the NHS. There need to be more and easier pathways for career progression for radiographers.
SoR Recommendations
- Immediate Significant Pay Award (2026–27) to begin addressing pay restoration and prevent further workforce loss. Paying this early in 2026 will re-enforce support for and momentum around parallel pay and reward discussions between unions, employers and the DHSC.
- Commitment to Full Pay Restoration by 2030, as endorsed by the TUC, with PRB oversight to prevent further erosion.
- Gender Equality Action: Assess AfC pay awards to ensure they consistently narrow, rather than widen, gender pay and pension gaps.
- Pension Reform: Recommend a review of contribution levels. Test awards against perceived inequities to reduce pension opt-outs and improve recruitment/retention.
- Support for New Professionals: Implement structured preceptorships, fair starting pay, and incentives such as student loan write-offs or pension holidays.
- Investment in the Support Workforce: End exploitation at Bands 2–3 and improve the consistency in job evaluation. Demonstrate support for growing the radiography support workforce, recognising their roles as critical to service delivery. Support wider investment in extending career pathways options for the support workforce to progress their careers (e.g. more graduate apprenticeship posts)
- Positive International Recruitment Policy: Replace the “hostile environment” approach with incentives to attract and retain skilled overseas professionals.
- Targeted Support for Specialist Areas (sonography, mammography) with urgent pay reform and easier training pathways open to increase recruitment and retention. This can be funded by savings arising from containing agency or outsourcing costs, especially in sonography.
- Strengthening Leadership: Introduce fairer pay differentials and overtime recognition for managers to encourage progression into senior roles.
Conclusion
The NHS stands at a crossroads: pay erosion and underinvestment have left radiography in crisis. Without immediate and substantial pay action, alongside structural reform, the workforce will continue to shrink, waiting times will rise, and patient care will deteriorate. The PRB must use its independence to recommend urgent pay restoration and highlight systemic reforms needed to stabilise and grow the workforce.