Government must commit to pay awards after 15 years of underfunding

SoR tells the NHS Pay Review Body that without fully funded pay awards, UK will face growing waiting lists and a shrinking workforce

Published: 14 February 2024 Government & NHS

If the government does not fully fund pay awards for NHS professionals after 15 years of underfunding, it will face ever-growing waiting lists and a shrinking workforce, the SoR has told the NHS Pay Review Body (PRB).

In written evidence to the PRB the SoR made explicit the “acute shortages” in the radiography workforce and explained the need for significant investment to avoid further deepening the NHS crisis and putting patients at serious risk.

The NHS Pay Review Body is an independent entity responsible for making recommendations on pay for all staff on the Agenda for Change (AfC) system and employed in the NHS, with the exception of doctors, dentists, and very senior managers.  

Each year, the PRB receives evidence from a variety of healthcare organisations, including trade unions like the SoR, and compiles a report for the Prime Minister, the Secretary of State for Health and Social Care, the First Minister and Minister for Health and Social Services in Wales, and the First Minister, the Deputy First Minister, and the Minister for Health in Northern Ireland. 

In the NHS, nine out of 10 patients are supported by a radiographer, the SoR explained. From X-rays to MRI and CT scans, ultrasounds to breast screening to radiotherapy for cancer, doctors and nurses cannot do their jobs without a team of radiographers, sonographers and radiography assistants.

Weak foundations

The SoR said: “Critically, our evidence highlights how the crisis is founded upon poor short-term political choices – chiefly to under-fund the NHS and social care. Laid on top of the foundations is the complicity of NHS leaders in compromising around these poor choices, then failing to develop and sustain a credible strategic workforce plan. These weak foundations now threaten to bring down the AfC structure.”

Radiographers are central to addressing the ever-growing NHS waiting lists. More than a million patients are currently waiting to see a radiographer. 

Figures published earlier this month show that one in five patients – 19.7 per cent – is now waiting at least six weeks to be seen by a member of the radiography workforce. Long waiting times mean that cases become more complex, with significant delays putting them in serious danger.

Breaking point

Dean Rogers, director of industrial strategy for the Society of Radiographers, said: “NHS professionals are not only paid less than private-sector employees, but less than those in other parts of the public sector as well.  

“NHS pay scales look like they are designed to make people want to leave. Recent pay awards have failed to address our key concerns, and have exacerbated the workforce crisis. This means the service is at breaking point.”

The average vacancy rate for radiography has risen to 13.4 per cent. A recent survey of SoR members revealed that 82 per cent could only fill their departmental roster with regular overtime shifts, because of staff shortages.

The radiography workforce crisis is particularly acute in the fields of sonography and mammography. The vacancy rate for mammographers has risen to 17.5 per cent in the last year. Sonographer vacancy rates are at 14.8 per cent. The SoR estimates that 29 per cent of the sonography workforce is near or beyond retirement age. 

Reboot the NHS

“If the government seeks yet again to restrain the pay remit to within existing spending plans, the PRB must say unequivocally that it will not be enough,” Mr Rogers added. “No government can be allowed to say that the UK is spending enough on the NHS. 

“Whichever party makes up the next government, it will need to reboot the NHS.” 

Last year, some SoR members voted to reject the 2023-24 below-inflation pay award, which resulted in SoR members at some trusts taking strike action in July and October. ​​The union remains in a formal trade dispute with the Department of Health and Social Care and with individual NHS trusts that directly employ members.

Mr Rogers said: “If the PRB misses another opportunity to state clearly the need for different and better choices from government, then it makes further industrial disputes more likely.

“The NHS workforce cannot continue to be an afterthought. If the NHS continues to fail radiographers, then the NHS – and the nation’s health – will continue to fail. Our members deserve better. Our patients deserve better.”

Evidence to the PRB

The SoR called for the following in its evidence to the PRB:

  • The PRB must find its independent voice and recommend a significant, above-inflation pay award for 2024-25 for all NHS professionals at all grades. This should be paid as close to 1 April as possible.  
  • The PRB must acknowledge that NHS professionals are paid significantly less than equivalent professionals in other sectors, and recommend that the government commit to funding the closure of this pay gap over the coming years. 
  • The government must recognise that one above-inflation pay award will not undo 15 years of underfunding and devaluing NHS professionals. 
  • The government must commit to full pay restoration by providing above-inflation pay awards at least until NHS pay is restored to 2008 levels – with the bill footed by the government.  
  • There must be a minimum pay award of inflation plus 1 per cent on all future NHS pay reviews, to prevent the pay gap from re-emerging. 
  • The PRB must specifically highlight the pay gap at the entry point for NHS professionals. Starting salaries are increasingly uncompetitive, even compared with other public-sector professions, such as teaching, social work or probation.  
  • The PRB should explore ways to counter the long-term devaluation of NHS professional roles, such as writing off student loans or offering pension holidays for those remaining in the NHS for an agreed period.  
  • The PRB should support protections on working time for new professionals entering the NHS, with recommendations to limit excessive hours and guarantee CPD time. This is vital to recruitment and retention.   
  • The PRB must recommend an increase to the minimum salary for each pay band at a managerial level (Band 8a upwards).  
  • All managers must have access to paid overtime, reducing the risk that promotion will lead to an effective pay cut and providing a disincentive to sustaining excessive working hours.  

(Image: Manchester Rally on October 3, by Breige Cobane)