Agenda for Change, introduced 20 years ago, was supposed to put an end to inconsistency and unfairness in how NHS staff are paid. But staff shortages and tight budgets mean many staff are now graded below the level of the work they’re doing. It’s time to modernise the system, says Rhys McKenzie.

Meet Your Reps: Jenny Owen, nurse, MiP health and safety rep and a manager in NHS England’s North West region, talks to Craig Ryan about championing the underdog and why she still needs a “clinical fix”.

Under pressure from political demands and relentless organisational change, many board-level NHS managers are feeling the effects of burnout and contemplating leaving the NHS, according to MiP’s ’Sounding Board’ of senior members and the union’s evidence to the pay review body.

Joining the Scottish health department weeks before the pandemic struck, Caroline Lamb found herself head of NHS Scotland within a year. She talks about the “intense and scary” experience of managing through the Covid crisis, her plans to integrate services and tackle staff shortages and why Scotland needs more money for health and care.

The government wants to attract thousands more staff into the NHS through apprenticeships. But uncertainty over funding, teaching staff and local autonomy could undermine the plans before they get off the ground.

The last party conference season before the general election showed that UK politicians still have to get their heads round what the NHS needs and what it can be expected to deliver.

Meet Your Reps: Prince Obike works at the forefront of change in the NHS while supporting MiP members as a union MiP rep and National Committee member. He talks to us about his incredibly varied career and the real value of management jobs.

As joint chair of the NHS Staff Council, Oonagh Monkhouse negotiates with unions on behalf of hundreds of NHS employers. But she’s also a working manager as director of workforce at the Royal Papworth, the UK’s leading heart and lung hospital. She talks to Matt Ross about boosting staff morale, building management capacity and why it’s important to try walking in someone else’s shoes.

With the relentless upheaval in the NHS, voluntary redundancy may seem like a chance to get out while the going’s good. But not all schemes offer a good deal and government rules and tax policy can eat into your settlement.

Workers from overseas have been part of the health and care family since the NHS began. They are valued and respected colleagues who face many extra challenges in the workplace and beyond. Katia Widlak offers her tips on recruiting, supporting, and retaining your migrant workforce.