The Royal College of Midwives (RCM) is today calling on the Health Secretary Yvette Cooper to urgently resume stalled talks on reforming the NHS pay structure. 

The trade union says every month of delay is pushing more midwives and maternity support workers out of the profession, at a time when services can least afford to lose them. 

The RCM is one of 14 health unions, representing more than 1.2 million NHS staff, who together say reform has stalled following the rapid departure of two health secretaries in succession.  

In April, ministers imposed a 3.3% pay increase for staff on the Agenda for Change (AfC) pay scale, following a pay review body recommendation. That came with a promise to fix longstanding problems with an ageing pay structure and to backdate any improvements to April. Five months on, nothing has changed. 

The RCM says the gap between doctors’ pay and AfC pay has widened sharply in recent years, leaving midwives and MSWs feeling like second-class members of the same NHS team. 

Gill Walton, RCM General Secretary, said: 

“Midwives and maternity support workers have been promised action on pay structure reform for years and they are still waiting. Every month that talks stay stalled is another month in which experienced midwives are weighing up whether it’s worth staying in the profession at all. 

“Our members are consistently seeing their annual pay rises outstripped by the rising cost of living and at a time of severe workforce shortages we should be doing everything we can to hold on to the staff we have. 

“We know from our own members that unsafe staffing levels and poor pay are the two biggest reasons they’re considering leaving.  

“A new Health Secretary gives Government the chance to reset this relationship and get serious, funded talks back on track – not push them further down the road.” 

A recent RCM survey shows three-quarters of maternity staff have considered leaving the profession in the past year. Pay is a critical factor in stopping midwives leaving – particularly those who are most experienced. Analysis shows competitiveness against other graduate professions falls by 29% within ten years of qualifying at roughly the same point many reach the top of Band 6. 

The RCM points to Scotland, where the government negotiates pay directly with unions rather than going through the pay review body. A midwife at the top of Band 6 in Scotland earns £3,673 more than an equivalent colleague in England – evidence, the RCM says, of what direct talks can actually deliver. 

Like 13 of the 14 AfC unions, the RCM will again not take part in this year’s Pay Review Body (PRB) evidence-gathering process. Direct negotiation, not another PRB cycle, is now the only realistic route to structural reform, the unions argue. The delay means the 2027 pay award must now also be settled in the same talks. 

Gill added: 

“We’ve already shown we’re willing to do things differently by stepping back from a Pay Review Body process that isn’t fit for the scale of reform needed. 

“Yvette Cooper is now the one who can fix this. Midwives and maternity support workers have waited years already and they cannot afford to wait any longer.  

“We need her to bring real urgency to the negotiating table, so our members get the pay structure and the recognition they deserve.” 

Notes to editors: 

• The RCM represents almost nine in ten midwives working in the UK, along with maternity support workers, students and midwifery educators, across England, Scotland, Wales and Northern Ireland. 

• RCM survey data (2026): 93% of maternity staff said staffing levels directly affect the safety and quality of care; 75% had considered leaving their role as a midwife, student midwife or maternity support worker in the previous 12 months, mainly citing inadequate staffing (65%) and safety concerns (54%). 

• Analysis based on the 39th Pay Review Body report (2026) shows midwives’ graduate pay advantage over other professions disappears within around ten years of qualifying – a 29% drop in earnings competitiveness, coinciding with the point many reach the top of Band 6. 

• The Agenda for Change pay structure covers more than 1.2 million NHS staff, including nurses, midwives, healthcare assistants, paramedics, porters and allied health professionals. Doctors and dentists are covered by a separate pay review body. 

• The 14 AfC unions are: the Association for Laboratory Medicine, British Association of Occupational Therapists, British Dietetic Association, British Orthoptic Society, Chartered Society of Physiotherapy, GMB, Pharmacists’ Defence Association, Prison Officers Association, Royal College of Midwives, Royal College of Nursing, Royal College of Podiatry, Society of Radiographers, UNISON and Unite.