The UK’s largest nursing union, the Royal College of Nursing (RCN), has overwhelmingly rejected the government’s proposed 3.6% pay increase, warning that strike action could follow unless meaningful negotiations begin before the end of summer.
In what the union described as a “verdict on a broken system”, 91% of participating RCN members voted against the offer during a record-breaking consultation involving more than 170,000 nursing staff across England. Nursing professionals in Wales and Northern Ireland also voted to reject the deal, citing concerns over pay erosion, staffing shortages, and limited career progression opportunities.
RCN General Secretary Nicola Ranger stressed that addressing pay and career development is not merely a matter of fairness but essential for patient safety. “Long-overdue reforms to nursing career progression and the NHS pay structure aren’t just about equity — they are critical for the future of the healthcare system,” she said.
The proposed pay increase, recommended by the NHS Pay Review Body, is scheduled for implementation in August 2025 and will be backdated to April. It applies to staff in England and Wales on Agenda for Change contracts, which cover more than 1 million non-medical NHS employees.
However, union leaders argue the pay award fails to address underlying structural issues within the NHS, including low starting salaries and a lack of clear advancement pathways for nurses. They emphasized that failure to retain experienced staff — at a time when the NHS is facing growing pressures, rising vacancy rates, and increased reports of corridor care — puts patient care at risk.
The RCN has given ministers until the end of the summer to open talks or face the prospect of a formal industrial dispute and a potential strike ballot.
The warning comes amid a broader wave of industrial unrest within the NHS. Just days earlier, junior doctors staged a five-day walkout demanding a 29% pay rise, adding to a series of strikes by doctors, nurses, ambulance crews, and other NHS workers that have led to the cancellation of over 1 million appointments and operations.
A Department of Health and Social Care spokesperson responded, saying: “It’s disappointing that RCN members are dissatisfied with this year’s pay rise. The government is clear that we cannot go further on headline pay, but we are committed to working with the RCN to address their broader concerns.”
As the dispute unfolds, pressure mounts on the government to take decisive action to stabilize the NHS workforce and ensure the sustainability of the public health system.
