How do NHS staff earnings compare to 15 years ago?

For the first time in nine years, the NHS pay review body’s report has been published ahead of the financial year that the pay recommendations are meant for. This is a positive shift for staff: timely publication means that pay uplifts should reach pay packets earlier, avoiding the mid-year backdating that has become common in recent times.

The government accepted the 3.3% uplift to Agenda for Change pay packets for 2026/27 recommended in the report (covering all NHS staff besides doctors, dentists and very senior managers). While detailed data is not yet available across every professional group, trends up to 2024/25 – combined with estimates for 2025/26 – provide a clear picture of how NHS pay has changed over the last 14-15 years. Our new analysis shows that the earnings of nurses and midwives are being particularly impacted from low real-terms growth.

The situation with pay has largely improved since 2022/23, when wages struggled to keep pace with particularly high levels of inflation, with CPI peaking at 11.1% in October 2022. That said, in the 14 years to March 2025 (the last complete financial year for which data is available), the change in real-terms average earnings for ambulance staff (-8.1%), resident doctors (-8.6%), consultants (-10.0%), nurses (-10.7%) and midwives (-13.5%) all still fell below the public sector average (-6.9%). Meanwhile, average private sector earnings were 3.3% higher over the same period.

If we estimate the effect of the 3.6% uplift to Agenda for Change staff earnings made in the current financial year, we see only a very modest improvement. Midwives and nurses continue to lag behind other staff groups, with their pay still below the level it was 15 years ago in real terms (by 13.1% and 10.3% respectively). Consultants’ earnings – following a 4% pay rise last year – are still 9.3% behind their pay in 2010/11, and resident doctors are also still predicted to fall behind by 6.9%, despite a 4% + £750 increase. However, this would be a clear recovery from where doctors’ pay had decreased to just two to three years ago. 

Looking ahead, with CPI inflation estimated to be 2.2% in 2026/27, the new pay uplift of 3.3% for Agenda for Change staff is still unlikely to restore earnings for most NHS workers to 2010/11 levels. Uncertainty also persists for resident doctors, who remain in a long-standing dispute with the government over pay and jobs. While there are rumblings of a pay rise on the horizon, the exact uplift is yet to be confirmed.

However, there have been some positive steps towards better valuing the nursing profession, including improving preceptorships, reviewing job roles (that may result in salary uplifts), and improving graduate pay. On the latter, we expect all clinical graduates on the Agenda for Change pay framework to benefit from this commitment, which would be in addition to the 3.3% due in April this year. Targeting early career staff is much needed, given around one in five nurses, radiographers, occupational therapists and physiotherapists leave NHS hospital and community settings two years into their role.

As we have previously noted, there are many ways to calculate changes to pay, and calculations are sensitive to the assumptions that are chosen to measure it. As one illustration, with the exception of nurses and midwives, we estimate that 2025/26 pay would be higher in real terms when using 2018/19 as the comparator year. We index our findings to 2010/11 to align with financial years as far back as the time series on NHS earnings allows.

The nuances of alternative methods and subsequent calculations across multiple staff groups and data sources are not possible to capture in one single chart. However, by accounting for inflation using a statistically robust measure such as CPI, we can demonstrate the downward pressure that the last 14-15 years has had on real wages. Certainly, through this lens, pay recovery for nurses and midwives in particular is still out of reach.