The Department of Health and Social Care in England has told the NHS Pay Review Body it cannot afford an Agenda for Change pay award of more than 2.5% in 2026-27. The below-inflation figure is condemned as derisory by a nursing union. But the government says a higher pay rise for staff on Agenda for Change contracts would risk planned health service improvements and put staffing expansions out of reach. Unions say the government’s submission shows why the pay review system should be scrapped in favour of direct negotiations, a model in place in Scotland.