From April 2026, the National Minimum Wage (NMW) rises to £12.71 per hour. This creates a serious problem for the NHS: Band 2 staff currently earn less than this.
Over 170,000 NHS employees could fall below the legal minimum wage when the new rate takes effect — unless the government acts.
The Problem Explained
Here is the issue in simple terms:
| Current Situation | Amount |
|---|---|
| Band 2 maximum hourly rate (2025/26) | £12.51 |
| National Minimum Wage from April 2026 | £12.71 |
| Shortfall | 20p per hour |
Band 2 staff — including healthcare assistants, maternity support workers, porters, and domestic staff — will technically earn below the legal minimum when the NMW rises.
Band 3 entry-level staff will earn just 4p above the new minimum wage. Take on any extra duties and you effectively work for minimum wage.
Who Is Affected?
UNISON estimates over 170,000 NHS employees in England are on pay points that will fall below the new £12.71 minimum.
| Band | Current Hourly Rate | April 2026 NMW | Status |
|---|---|---|---|
| Band 2 (all points) | £12.51 | £12.71 | Below legal minimum |
| Band 3 (entry) | £12.75 | £12.71 | 4p above |
| Band 3 (top) | £13.60 | £12.71 | Safe margin |
| Band 4 (entry) | £14.06 | £12.71 | Safe margin |
The lowest-paid NHS workers — the people doing essential frontline support work — face the biggest problem.
How Did This Happen?
The Agenda for Change pay structure was designed years ago. It has not kept pace with National Living Wage increases.
Each year, the government raises the minimum wage. But NHS pay awards have been below inflation for most of the past decade. The gap has closed steadily until now — Band 2 has finally dropped below the legal floor.
Gill Walton, Chief Executive of the Royal College of Midwives, said:
This has put a spotlight on out-of-date NHS pay bands, which no longer reflect even the legal national minimum wage.
What Is the Government Doing?
The government has not announced a specific fix for this problem. Their 2026/27 evidence to the NHS Pay Review Body proposes only 2.5% — which would bring Band 2 to approximately £12.83 per hour.
This barely scrapes above the new minimum wage by 12p.
If the final award is lower than 2.5%, or if there are delays in implementation, Band 2 staff could legally be paid below minimum wage for months.
Emergency Top-Up Likely
The government may need to implement an emergency top-up payment to ensure legal compliance. This has happened before when minimum wage rises outpaced NHS pay.
UNISON has written to NHS trusts warning that the current pay system is at “constant risk” of breaching minimum wage rules.
Union Response
Health unions have been vocal about this crisis.
Helga Pile, UNISON Head of Health:
“It’s likely this amount won’t even be enough to ensure the NHS can comply with minimum wage laws when the rate goes up in April.”
Gill Walton, RCM Chief Executive:
“If we want to attract and retain staff to provide quality maternity care, we need a pay system that is fit for purpose. This means pay reform to make sure every member of staff is paid fairly.”
UNISON is calling for the Real Living Wage (currently £12.60, rising to approximately £13.50 in 2026) to be the minimum benchmark for NHS pay — not just the legal floor.
Impact on Staff
This is not just about numbers. It affects real people.
Financial Stress
Band 2 staff often:
- Work multiple jobs to make ends meet
- Rely on overtime and unsocial hours payments
- Struggle with rising housing and food costs
Being told your job pays minimum wage — after years of NHS service — damages morale.
Recruitment Problems
Why would anyone join the NHS as a healthcare assistant when supermarkets pay the same or more? Tesco, Lidl, and Aldi all pay above the Real Living Wage.
NHS trusts are already struggling to fill Band 2 vacancies. This crisis makes it worse.
Retention Issues
Experienced healthcare assistants and support workers may leave for better-paid retail or hospitality jobs. The NHS loses trained staff and institutional knowledge.
Scotland Comparison
Scotland does not have this problem. Their 2-year pay deal ensures:
| Band | Scotland 2026/27 Hourly | England 2026/27 Hourly (at 2.5%) | NMW April 2026 |
|---|---|---|---|
| Band 2 Entry | £14.20 | £12.83 | £12.71 |
Scottish Band 2 staff earn £1.49/hour more than the minimum wage.
English Band 2 staff earn just 12p more — and that assumes the 2.5% award happens on time.
What Needs to Happen
Unions and workforce experts agree on several necessary steps:
1. Immediate Fix for April 2026
The government must ensure no NHS worker earns below minimum wage from 1 April 2026. This may require an emergency top-up or accelerated pay award.
2. Structural Pay Reform
The Agenda for Change pay structure needs fundamental reform. Entry-level bands should be rebuilt to create a sustainable gap above the National Living Wage — not just scrape above it each year.
3. Real Living Wage as Minimum
UNISON and other unions want the Real Living Wage (independently calculated based on living costs) to be the floor for NHS pay. This would put Band 2 at approximately £13.50/hour — a meaningful improvement.
4. Direct Negotiations
Unions argue the Pay Review Body process is too slow and disconnected from reality. Direct talks with the government — as Scotland achieved — could deliver faster, fairer outcomes.
Timeline: What Happens Next
| Date | Event |
|---|---|
| 1 April 2026 | NMW rises to £12.71/hour |
| 1 April 2026 | NHS pay award effective date (but not paid yet) |
| Late Summer 2026 | Government expected to announce final pay award |
| Late 2026–Early 2027 | New pay rates implemented |
There is a gap of several months between the NMW increase and likely NHS pay implementation. During this period, Band 2 staff could technically earn below legal minimum — unless the government acts sooner.
Frequently Asked Questions
Will Band 2 NHS staff earn below minimum wage in 2026?
Without intervention, yes. Band 2 staff currently earn £12.51/hour. The National Minimum Wage rises to £12.71/hour from April 2026. This puts Band 2 below the legal floor by 20p/hour until the 2026/27 pay award is implemented.
How many NHS staff are affected?
UNISON estimates over 170,000 NHS employees in England are on pay points that fall below the April 2026 minimum wage threshold.
What is the government doing about it?
The government’s proposed 2.5% pay rise would bring Band 2 to approximately £12.83/hour — just 12p above minimum wage. An emergency top-up may be needed if there are implementation delays.
How does this compare to Scotland?
Scotland’s 2026/27 pay deal sets Band 2 at £14.20/hour — £1.49 above the minimum wage. England’s proposed rate is just 12p above. Scottish staff are significantly better protected.
What do unions want?
Unions are calling for the Real Living Wage (approximately £13.50/hour in 2026) to be the minimum NHS pay benchmark. They also want structural reform of Agenda for Change and direct negotiations with government instead of the Pay Review Body process.