Nurses reject NHS pay award in record RCN vote

NHS nurses across England, Wales and Northern Ireland have voted to reject the government’s pay award for 2025/26 – with the Royal College of Nursing (RCN) now threatening a formal strike action ballot.

In the highest-ever turnout for an RCN pay ballot, 91% of voting members in England and Wales said the 3.6% pay award for NHS nurses on Agenda for Change staff was insufficient. In Northern Ireland, almost 80% of voting members also voted to reject the award.

Turnout for the vote was not only at a record level, but also above the 50% required for a formal industrial action ballot – at 56% (over 170,000) in England, 51% in Northern Ireland and the ‘highest turnout in the college’s history in Wales’, at 55%.

The RCN warned ministers must now use the summer to reach an agreement to invest in the nursing workforce ‘or face formal escalation to a dispute and an industrial action ballot’.

The college has also demanded that negotiations on reforming the Agenda for Change pay structure – as agreed to by the government following recommendations from the NHS Pay Review Body – commence as soon as possible.

RCN general secretary and chief executive, Professor Nicola Ranger, said the vote showed how nurses feel ‘deeply undervalued’ by the government.

‘As a safety-critical profession, keeping hold of experienced nursing staff is fundamentally a safety issue and key to the government’s own vision for the NHS,’ she said.

Related Article: GPNs deserve ‘clear pathway’ on pay and conditions, says RCN lead 

‘Long-overdue reforms to nursing career progression and the NHS pay structure aren’t just about fairness and equity but are critical for patient safety.’

In a recent survey by the RCN, 87% of nursing staff said their pay band does not match their knowledge, skills, education and current level of responsibility.

Professor Ranger added: ‘We deliver the vast majority of care in every service and deserve to be valued for all our skill, knowledge and experience.

‘To avoid formal escalation, the government must be true to its word and negotiate on reforms of the outdated pay structure which traps nursing staff at the same band their entire career.’

Executive director of RCN Wales, Helen Whyley, added that nurses ‘deserve to be listened to’.

‘Pay is not just a number – it reflects a package of terms and working conditions that shape how acknowledged, supported and motivated staff feel in their roles,’ Ms Whyley warned.

With a Welsh Government election due in May 2026, Ms Whyley added that nurses felt ‘desperately undervalued by the current government’.

‘That will stay the case unless they unveil major reforms in the remaining months and not just election promises,’ she said.

In Northern Ireland, no funding had been made available by the Executive to award the 3.6% uplift recommended by the government.

RCN Northern Ireland executive director, Professor Rita Devlin, said: ‘This vote is an overwhelming signal from our members that they feel undervalued and that meaningful change is needed in the nursing profession.’

‘Make no mistake, inaction over pay will not be accepted,’ Professor Devlin added.

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‘Since 2019, nursing staff in Northern Ireland have shown they are willing to stand up for fair treatment – not only for themselves but for the patients they care for. The current pay system is broken, and we are demanding change.

‘The first step must be for the Northern Ireland Executive to deliver the long-overdue pay award for this year, which should have been implemented in April,’ she said.

Earlier this week, a ballot by the union Unite saw 89% of voting NHS members also reject the 3.6% pay award given by the government for 2025/26, and that they are prepared to take industrial action, including strike action.

Last week the GMB union, which represents thousands of NHS staff, also rejected the government’s pay deal in an initial consultative vote – with a 67% majority voting against the pay award offered for 2025/26.

The 3.6% pay award for NHS staff in England and Wales, backdated to April, is in line with recommendations of the NHS Pay Review Body.

Separately, GP practices in England have been told by the government to pass on a 4% uplift to employed practice nurses, but concerns have been raised around the volume of practice nurses who miss out on pay rises because funding is not ringfenced.

Earlier this month, Nursing in Practice exclusively reported that changes to GPN terms and conditions could be part of a new GP contract, which is due before the end of this parliament. 

Related Article: Unite ballot sees NHS staff in England reject pay award

A Department of Health and Social Care spokesperson today said it was ‘disappointed’ that RCN members are ‘dissatisfied’ with the pay rise.

‘We hugely value the work of nurses, and through our 10 Year Health Plan, we are rebuilding the NHS for the benefit of patients and staff, and ensuring nursing remains an attractive career choice.

‘This government is clear we can’t move any further on headline pay but will work with the RCN to improve their major concerns, including pay structure reform, concerns on career progression and wider working conditions.’

This is a breaking news story, more to follow.