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.

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.

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.

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.

Meet Your Reps: Two of MiP’s most experienced reps, Dave Whatton and Sara Saville from the Black Country ICB, talk about negotiating organisational change and supporting MiP members through turbulent and uncertain times.

“The government miscalculated on all sorts of fronts”, says Sara Gorton, UNISON’s lead negotiator during the recent NHS pay dispute. She tells Matt Ross how a tide of dissatisfaction from workers and strong public support enabled union negotiators to hold their nerve and cut a pay deal that won overwhelming backing from members.

While some thrive on it, many managers hate being on call – unable to relax while waiting for the dreaded call and nervous about taking critical decisions without enough training or support. There has to be a better way, writes Rhys McKenzie.

Decarbonising healthcare will affect everyone working in the NHS. But well-meaning national strategies are struggling to make an impact on the ground. We speak to pioneering surgeon Aneel Bhangu about the barriers to change and ask why NHS staff and unions aren’t more involved in meeting our greatest long-term challenge.

Rhys McKenzie reports on MiP’s first ever Reps’ Day, and explains how MiP’s growing network of workplace reps supports members and boosts the union’s membership and influence.

Staff shortages, plunging morale and shrinking pay packets are pushing more and more board-level NHS managers towards the door. A fair pay award would help to stabilise NHS leadership – just when the service needs it most