Chart of the week: Pay has fallen in real terms for most NHS staff groups since 2010

Strike action is affecting a number of sectors across the UK this month, including within the NHS. With widespread discontent over pay and conditions, Lucina Rolewicz, Mark Dayan and Billy Palmer have expanded on our previous staff pay analysis to include other NHS staff groups.

Chart of the week

Published: 16/12/2022

Over the next few weeks, much of the UK will see a wave of strike action across multiple professions, affecting a number of sectors. The NHS is no exception – nurses and paramedics are taking strike action this week and next, with others holding ballots on industrial action. Strikes have now been confirmed for physiotherapists and may extend to other NHS staff, such as junior doctors and consultants. Given the widespread discontent over pay and conditions, we have expanded on our previous analysis on changes to NHS and private sector pay to other key NHS staff groups.


We know that pay has fallen in real terms for the majority of NHS staff groups in the 11 years to 2021/22. In particular, consultants saw an 11% fall in their pay, and junior doctors' pay fell by 8%. For this year, our analysis suggests that consultants and junior doctors may see their pay fall to around 15% and 14% respectively, relative to 2010/11 levels. Midwives appear to be in a similar position, with the chart showing a 14% fall in their pay over the same period.

The reasons for strike action across professions are highly complex. Though all staff will see a fall in their pay, we predict that this decline will not be as large for some groups as it is for others. For example, this year ambulance workers may see their pay fall to around 4% behind inflation. However, and as reported elsewhere, ambulance staff were a notable exception in pay trends to 2021/22, with their average earnings being restored to levels seen in 2010/11. This may be partly due to the nature of the work as a 24-hour emergency service, with ambulance staff receiving the highest level of overtime and shift work payments, but also due to differences in how unsocial hours payments are calculated for this group.

There are also differences between professional groups in the proportion of staff eligible for a pay increment to reflect their years of service – for example, nearly one in four ambulance staff will benefit from progression payments, as well as the 4.2% average increase to their basic pay. In contrast, nearly a third of midwives sit at the top of a single pay band, meaning they will not receive these pay increments (unless they are promoted to a higher band). Although this was partly compensated for by this year’s pay settlement, which offered a 4% pay increase rather than the £1,400 flat rate for those at the top of this band, we estimated that this only equated to an additional 43p a day in take-home pay.

As we have stated previously, there are a multitude of factors leading to NHS staff feeling dissatisfied and undervalued, and pay is just one of these. Nonetheless, it is important for pay settlements to be fair and transparent, and to consider the wider economic landscape of spiralling inflation. In any case, voting in favour of strike action is indicative of longstanding discontent with pay and working conditions, and walking out in protest is clearly a last resort for many staff who voted in favour of it.

Data notes

We used NHS Digital salary data for hospitals and other trusts to obtain average total pay in NHS financial years for different staff groups. We adjusted this for the average proportion of a full-time role worked by staff and for the average price level over the same year using the Office for National Statistics’ consumer price index.  

To derive an estimate of the average uplift in 2022/23 for Agenda for Change staff, we calculated the average increase to basic pay based on the number of staff at each spine point between 2021/22 and 2022/23, and applied this increase to the price level in September 2022. 

We combined some staff groups due to changes in how these staff were defined in the data: 

  • Ambulance staff and support to ambulance staff 

  • Support to doctors, nurses & midwives and support to scientific, therapeutic & technical staff 

  • Foundation year doctors, doctors in core training and specialty registrars.

We then applied a weighted average (using full-time equivalents) to calculate overall changes in pay for these groups. 

*This analysis expands on our previous analysis on NHS staff pay, which was published on 16 November.