NHS pay crisis forcing staff to rely on credit cards and take on extra shifts, says UNISON

The government’s failure to reform NHS pay is forcing staff to do long additional shifts and rely on credit cards to cover bills, according to a report published today (Thursday) by UNISON.

Workers are also being deterred from taking promotions that aren't financially worthwhile, the union says.

The findings are based on the experiences of more than 3,000 staff across the NHS – including nurses, technicians and senior managers – and show how issues linked to the current pay system* are affecting job satisfaction, morale and life outside work.

The report is being released to coincide with the union’s annual conference, taking place in Brighton this week. UNISON says the evidence from NHS workers across roles, grades and regions demonstrates full-time salaries barely cover essential outgoings.

Those at the lower end of the wage scale are relying on credit cards to fund basic living expenses. Pay for bands 1 to 4 is so close to the minimum wage these workers are unable to access salary sacrifice schemes available to other staff to help manage outgoings such as childcare and car parking charges**.

In the report, long-serving NHS staff say the value of their pay has been eroded significantly over time. Many are forced to pick up gruelling overtime and bank shifts to cope, a trend which UNISON says is affecting work-life balance and wellbeing.

More senior staff also say any financial gains from promotion are minimal despite significant increases in their workloads and job responsibilities. UNISON says this creates a disincentive to advance their careers and leaves the NHS short of much-needed expertise.

Some on higher pay grades are even earning less than colleagues lower down the wage scale due to discrepancies in the system. The union says this is due to differences in overtime and qualifying for extra pay when working unsocial hours.

The report highlights how the loss of experienced staff to the private sector increases the workload and stress levels for those left behind. Staff at band 2 and 3 in particular point out many employers in the retail sector including supermarkets pay higher wages than the NHS.

UNISON says wage structure issues add to the failure of many NHS employers to match staff to the correct pay band for the jobs they do. The union's long-running campaign to correct this has seen tens of thousands of healthcare assistants win a higher grade and hundreds of millions in back pay settlements. Work to address this for other occupations such as band 5 nurses is also under way***

UNISON is calling on ministers to include reforms to modernise the NHS pay system in their forthcoming ten-year NHS workforce plan. Priorities must include above-inflation pay rises and commitments for the lowest paid staff to stay at least in line with the real living wage. 

Also key are effective systems to allocate staff to the right pay bands, says UNISON. In addition, career progression and promotion must always come with meaningful salary increases. 

UNISON head of health Helga Pile said: “This report paints a worrying picture of a demoralised workforce stretched to the limit and struggling to pay the bills.
“Staff are exhausted, financially insecure and uncertain about a long-term future in the NHS.

“Pay isn’t the only factor that motivates health service staff – they care passionately about the people they look after and saving lives.
“But years of annual wage rises well below the cost of living and a staffing crisis are to blame for increasing numbers leaving.

“The NHS used to be a place where staff could at least have some security, steady career prospects and a reasonable standard of living.

“These first-hand testimonies show that's no longer the case with damaging consequences for patient care.

“Ministers have the chance now in their 10-year workforce plan to address long-term investment in workforce pay, which is essential to give staff a reason to stay."

Notes to editors:

–*More than a million NHS staff are on the national pay and grading system known as Agenda for Change (AfC).

–**Employment laws prohibit salary-deduction schemes (such as salary sacrifice) in situations where they would effectively take workers pay below national minimum wage rates.

–***The union’s Pay Fair for Patient Care campaign has been running since 2021. The campaign has secured nearly £300m in back pay and £100m in ongoing wage rises for healthcare assistants across the UK.

– As part of ongoing pay research UNISON has been surveying 220,000 NHS staff. Further detailed testimony was gathered about the experiences of 3,160 workers across AfC pay bands in May and June 2026. The report can be viewed here.

Case studies:

“I have three degrees and would be paid double if I was working in industry. I’m also a line and team manager and can see this is negatively affecting staff morale.” Manager on band 6 from the North West

“I’ve considered leaving the NHS to get a job in Aldi or Lidl. That way, you’re not under the same pressures you experience in the NHS due to staff cuts. And they get paid a lot more than NHS workers.” Housekeeper on band 2 from the North East

“I’m not living, I’m surviving. Every month I have more outgoings than income when when it comes to my salary. I don’t even have enough money to put away for an emergency fund or retirement. NHS pay is the biggest joke ever.” Radiographer on band 5 from London

“Rising living costs make it increasingly difficult to feel financially secure. Especially working long hours and unsociable night shifts. Nursing is a skilled and demanding profession, but many staff have little left over after essential bills.” Staff nurse on band 5 from the North East

“I moved up a band and only pick up an extra £40 to £50 a month after tax. Yet my responsibilities have increased a lot.” Pharmacy technician on band 4 from the West Midlands

“I’ve been working for the NHS for 20 years and I’m at the top of my pay structure. I can’t earn any more money than I’m on now. I work shifts because my salary hasn’t kept up with rising living costs. It’s incredibly difficult to balance the money coming in and going out.” NHS driver on band 2 from the South East

– UNISON’s annual national conference began on Tuesday (15 June) and continues until Friday (19) at the Brighton Centre, Kings Road, Brighton BN1 2GR.

– UNISON is the UK’s largest union with more than 1.3 million members providing public services in education, local government, the NHS, police service and energy. They are employed in the public, voluntary and private sectors.

Media contacts:

Anthony Barnes M: 07834 864794 E: [email protected]

Dan Ashley M: 07789 518992 E: [email protected]