Nursing staff ‘relying on credit cards for basic living costs’, warns union

Nursing staff and other NHS colleagues on lower Agenda for Change pay bands are being forced to rely on credit cards to fund basic living expenses because of poor pay, a survey has found.

In findings published by the union Unison, NHS staff also reported taking on additional shifts to help cover their bills.

The survey, Pay up for NHS staff, was first conducted in 2025 and had more than 200,000 respondents. Unison has now received a further 3,160 responses from staff across the NHS, including nurses, technicians and senior managers.

As well as relying on credit cards, those on lower bands (1 to 4) – which covers nursing support workers and nursing associates – reported being unable to claim salary sacrifice schemes to help manage outgoings such as childcare and car parking charges.

This is because employment laws strictly prohibit salary sacrifice and deduction schemes if the reduction takes a worker’s cash earnings below the National Minimum Wage (NMW).

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For more senior level staff, Unison said there were concerns around pay being ‘eroded significantly’ over time, with many ‘forced’ to pick up overtime.

Unison has urged government ministers to ‘modernise’ the NHS pay system in the highly anticipated 10-year NHS workforce plan.

It stressed that 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’.

Unison head of health Helga Pile said the report ‘paints a worrying picture’ of a ‘demoralised workforce’.

She said: ‘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.’

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

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‘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.’

This comes as thee stark findings of Nursing in Practice’s General practice nurse pay: A salary survey of the profession 2026 report revealed that general practice nurses (GPNs) are earning thousands of pounds less than their NHS Agenda for Change counterparts.

It spotlighted that around a third of GPNs did not receive a pay rise for 2025/26 and that 32% are looking to quit the profession in the next 12 months, largely because of pay and feeling undervalued.

Additionally, only 5% of GPNs are being offered above statutory maternity pay and how just 32% are receiving above statutory sick pay.

Earlier this year, NHS England (NHSE) said it ‘expects’ general practice contractors to implement a 3.5% pay rise to practice nurses and other salaried staff following an uplift to the global sum.

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The global sum for GP practices in England increased from £123.34 to £130.07 per patient from 1 April.

The Department of Health and Social Care (DHSC) confirmed to Nursing in Practice that this meant salaried GPNs would be entitled to a 3.5% pay rise for 2026/27.

However, it is typically down to GP practices to pass on pay rises to practice staff following an uplift to the pay element of the GP contract and many GPNs report that they miss out.