Draft plan for London & Eastern High Cost Area Supplement Campaign

Draft plan for London & Eastern High Cost Area Supplement Campaign

This plan was presented to the London & Eastern Health Combine and RISC in January and February. Guys and St Thomas Hospitals Branch proposed the motion for a HCAS campaign that was passed at the RISC.

Introduction

What is the High Cost Area Supplement?

The High Cost Area Supplement (HCAS), sometimes referred to as “London Weighting” is additional payment made to NHS workers who work in London and the surrounding areas. It was implemented as part of Agenda for Change, and was aimed to establish equity among the various forms of additional pay that were implemented across London hospitals.

HCAS is divided in to three areas:

Area	2025/26 pay rate
Inner London	20% subject to a minimum payment of £5,609 and a maximum of £8,466 per annum
Outer London	15% subject to a minimum payment of £4,714 and a maximum of £5,941 per annum.
Fringe	5% subject to a minimum payment of £1,303 and a maximum payment of £2,198 per annum.

The areas it covered are based on the boundaries of old Primary Care Trusts and Strategic Health Authorities, organisations which no longer exist and have been replaced by Integrated Care Boards (ICBs).

Problems with HCAS

Boundaries no longer reflect NHS organisation

HCAS was implemented in 2004, and has not been updated since. It has not been updated to reflect the fact that organisations which its areas applied, to no longer exist. A two decade of NHS cuts, privatisations, mergers and regional and national reorganisations have reshaped the NHS, and meant the boundaries do not reflect the current lay out of services and workplaces.

Barts Trust includes staff at The Royal London Hospital, and Newham Hospital. Royal London is in inner London, while Newham is in Outer London, creating pay inequalities within one NHS organisation.

Does not match rising cost of living

Nor has it not been updated to reflect the rising cost of living, which has risen hugely in London over the past two decades. While 20 years ago there may have been some difference in living costs to justify the different pay areas, now all of London is expensive to live in, and NHS workers either have to pay extortionate rents and struggle to pay their bills, or live on the outskirts of London, with long commutes to work on top of long shifts.

Regions around London have similar cost of living, but are not in HCAS

Surrounding towns and cities have also seen huge rises in the cost of living, and they are completely exempt from HCAS. The rising cost of living necessitates additional pay arrangements for those areas being created to compensate NHS workers for the rising costs there. NHS workers in these towns and cities in London & Eastern, and South Eastern regions have the highest cost of living in the country, but no compensation.

What are Unite’s demands?

Campaigning around the issue of HCAS can mobilise a large swathe of NHS workers, if we have demands which give them something to fight for. 

This necessitates demands to expand coverage of HCAS to surrounding regions, giving those outside its catchment area a reason to join the campaign, and demands to eliminate the inequality present in the current arrangements so workers across London’s boroughs will mobilise.

Draft demands

1. Renew HCAS - raise the HCAS rate, and expand its coverage
2. Redraw the boundaries - One rate for all the London Boroughs
3. Raise the rate, remove the cap - raise the London rate by 10%, remove the salary cap so workers receive all of the additional pay.
4. HCAS for Eastern and South Eastern regions - towns and cities surrounding London and in those regions to have their own HCAS rates

How shall we campaign?

The campaign should be organised through the LE combine, with all branches asked to send delegates to LE Combine meetings so that they are included in campaign planning and can report back on developments and local progress.

The Combines work can be reported back to the RISC, and oversight provided there.

1. Petition

Unite L&E should launch a petition asking NHS workers if they support the demands of the campaign, and if they are willing to take strike action to win these demands.

This can be an online and paper petition. The aim will be to secure 5000 signatures across Unite’s London & Eastern membership over the next two months, and present these signatures to the DOH in an action in March/April.

2. Leafleting

L&E to produce a model leaflet two-sided leaflet containing information about campaign, with space for branches to add their own specific local issues. Branches to be responsible for leafleting and petitioning their members.

3. Meetings

Branches to organise local meetings about the HCAS campaign in February, and L&E to hold a London wide meeting for reps and members in March, to prepare members for balloting on the issue as part of the national pay campaign.

4. Protests

L&E Reps to organise a protest march for HCAS renewal in March. Reps to book the day off, and take part in protest march from a hospital to DOH to deliver signatures and dispute letter. Propose we use St Thomas Hospital as starting point for march. Aim to mobilise 40-50 reps to protest, plus any members who can attend.

Rallies can be organised locally at NHS Trusts to build support for the campaign

Further protests can be held as the campaign develops; other targets could be:

• Meetings where Wes Streeting is attending
• Labour Party HQ
• NHS Trust offices

5. Ballot

L&E Region to formally open dispute with DOH in March, so that issue can be included on consultative ballots alongside national pay and cuts, and so we can proceed with ballot if other regions do not want to campaign.

Map of HCAS areas:

 

Motions to the L&E RISC - Creating Caseworkers for Unite, timeframe for the 2026/27 Pay award

These were motions proposed to the London & Eastern RISC in September 2025. They were amended and submitted to the Regional Committee, and Health National Industrial Sector Committee respectively.

The first motion proposes creating a case worker system for Unite to support members and regional officers with the increased load of casework, due to the decline in workplace reps in some sectors.

The second motion proposes a timeline for this years NHS pay campaign. Too often the union has waited months for the outcome of the PRB report, rather than taking the initiative and starting ballots as soon as a pay award is not granted in April, as the BMA has succesfully done.

Motion: Invest in caseworkers to support Unite members

Motion on creating Caseworkers for Unite

This RISC notes:

1. Unite has a duty to support its members both collectively through industrial action and campaigns, and individually through supporting their individual employee relations cases.

2. At present there is no system to support members with individual case work; if there is no active branch in a workplace the burden of case work falls entirely on Regional Officers.

3. In a situation where branch organisation is in decline across many sectors, and where Unite offers membership in completely unorganised workplaces, this places a huge burden of work on Regional Officers.

4. This workload prevents RO’s from being able to support members in the workplace and organise campaigns and industrial action, and leads to a poor service for members needing individual support.

This RISC believes:

1. To rectify the situation the union needs to invest in case workers to handle individual cases from workplaces where Unite is recognised, but without functioning branches, or from the unorganised workplaces where it offers individuals membership.

2. By investing in professional caseworkers, Unite will provide a better, more consistent service to members, resulting in member retention and increased subscriptions.

3. This investment will free up officer time which can be better spent supporting branches and taking forward industrial organising campaigns which will grow and strengthen the union, recruiting more members and increasing our strength in areas where the union has declining membership and organisation

This RISC calls on the Unite Executive to:

1. Urgently develop a plan for creating a caseworker department in every Region which can takeover the responsibility for individual casework from Regional Officers

2. Commit to invest the necessary resource to recruit and staff caseworker offices in every region, in proportion to the need for casework support.

3. Contact our sister unions which have caseworkers for advice and guidance on how to organise and structure this new function to provide the best service to members.

Motion: A timeframe for the 2026/27 NHS Pay campaign

The L&E RISC notes:

1. NHS members are set to ballot in September/October over the 2025/26 pay award. Strike action will not be able to take place till November or December.

2. This time frame has been forced upon us by the long delay in initiating the consultative ballot over pay, and the failure to submit a pay claim earlier in the year.

3. Unite Health needs to avoid falling into this situation again for future pay awards as it creates delay and an unnecessarily lengthy pay campaign, putting extra stress on reps energy and resources to maintain the momentum of the campaign.

The L&E RISC believes:

1. Unite Health should initiate a consultative ballot over pay as soon as the government has failed to agree a pay award on April 1st.

2. We cannot keep allowing the government to dictate the time frame and timescale of our pay campaign.

3. Drawn out pay campaigns waste precious time and energy, while the crisis in the NHS and the cuts and privatisations worsen with each month.

4. The BMA has show you can undertake a consultative ballot, and industrial action ballot prior to August, if you begin consulting members in April.

5. There is nothing to stop the union initiating a consultative ballot in April, regardless of the government having issued its formal pay award. Continuing the practice of waiting for the government pay award allows the government to delay our pay campaign, and leads to us wasting precious time.

The L&E RISC calls for:

1. All RISCs to undertake discussions at their Winter/Spring RISC, with the aim of submitting proposals for a 2026/27 pay claim to the Spring 2026 NISC.

2. The Spring 2026 NISC should discuss and agree a pay claim and submit to the government prior to March 2026. This pay claim should be communicated to members in advance of April 1st, and form the basis for our consultative pay ballot.

3. If the government does not agree a pay deal for April 1st which meets the demands of Unite Health members, the union should immediately commence a consultative ballot of members for strike action, with the aim of concluding this consultative ballot by the end of May.

4. Once the consultative ballot is concluded, Unite Health should initiate industrial action ballots, with the aim of concluding these by the end of July 2026.