Health services in Scotland, Wales and Northern Ireland

There is no single UK NHS employer, because health is devolved. NHS Scotland is run by health boards under the Scottish Government, NHS Wales by health boards and trusts under the Welsh Government, and Northern Ireland has an integrated Health and Social Care (HSC) system covering both health and social care. All four use versions of Agenda for Change, but pay, job sites, pensions and criminal record checks differ.

NHS Scotland

Scotland has 14 territorial NHS boards, each responsible for all health services in its area, plus special boards covering national services such as the Scottish Ambulance Service, NHS 24 and NHS Education for Scotland. There are no trusts, so in a Scottish hospital your employer is the health board.

Scotland negotiated its own two-year Agenda for Change deal: 4.25 per cent for 2025/26 and 3.75 per cent from 1 April 2026, with an inflation guarantee that pays a top-up in March 2027 if average CPI for 2026 exceeds 2.75 per cent. Scottish bands have fewer pay points and higher values than England’s.

Band	Scotland 2026/27	England 2026/27
Band 2	£26,658 to £28,947	£25,272
Band 5	£34,494 to £42,977	£32,073 to £39,043
Band 6	£43,169 to £52,603	£39,959 to £48,117
Band 7	£52,769 to £61,377	£49,387 to £56,515

Scottish taxpayers pay Scottish income tax rates, so at some salaries the take-home gap is smaller than the gross figures suggest. The take-home pay calculator handles both. Jobs are advertised on the NHS Scotland jobs site, and pre-employment checks use Disclosure Scotland and the PVG scheme rather than the DBS.

NHS staff in Scotland belong to the NHS Pension Scheme (Scotland), administered separately, with contribution tiers that start at 5.7 per cent.

NHS Wales

Wales has 7 local health boards, which run hospital, community and primary care services in their areas, and 3 NHS trusts: the Welsh Ambulance Services trust, Velindre (cancer and blood services) and Public Health Wales. Further national functions sit with special health authorities.

Wales uses the same Agenda for Change pay structure as England, and the Welsh Government announced 3.3 per cent for 2026/27, matching England’s award. Jobs are mostly advertised on NHS Jobs or Trac, as in England, and checks use the DBS. Many posts list Welsh language skills as essential or desirable; Welsh language skills in public sector jobs explains the levels. Staff are in the NHS Pension Scheme for England and Wales.

Health and Social Care in Northern Ireland

Northern Ireland runs health and social care as one system. Regional HSC trusts employ hospital staff, community nurses, social workers and care staff, and the Northern Ireland Ambulance Service is a trust in its own right. The Department of Health in Northern Ireland oversees the lot.

Pay follows Agenda for Change, but awards depend on the NI Executive’s budget. For 2026/27 the pay review body recommended 3.3 per cent and the Health Minister wants to pay it, but no confirmed payment date had been announced by mid-October 2026. NI has historically paid awards later than England. Jobs are on the HSC jobs site, checks use AccessNI, and staff join the HSC Pension Scheme, run separately from the English scheme. See public sector jobs in Northern Ireland.

Doctors and other national contracts

Doctors’ pay is devolved too. The 3.5 per cent DDRB award and the resident doctors’ deal accepted in 2026 apply to England. Scotland, Wales and Northern Ireland each decide their own doctors’ awards and have their own contract arrangements, so pay scales for resident doctors and consultants differ between the nations. Medical training is organised separately as well: NHS Education for Scotland, Health Education and Improvement Wales and the Northern Ireland Medical and Dental Training Agency handle training posts in their nations. Check the relevant body’s pay circulars before comparing an offer with English rates. See doctors’ pay in the NHS for England.

Criminal record checks by nation

Nation	Body	Check for most clinical roles	Fee
England and Wales	DBS	Enhanced	£41.00 from 5 October 2026
Scotland	Disclosure Scotland	PVG scheme membership	£59 to join
Northern Ireland	AccessNI	Enhanced	£32

Employers often pay for the check, but some pass the cost on to new starters.

Moving between the four nations

A move from a trust in England to a health board in Scotland or an HSC trust in Northern Ireland changes your employer and usually your pension scheme. The NHS schemes in each nation have arrangements that recognise service across them, but how your benefits link up depends on your scheme, your membership dates and how quickly you join the new scheme, so ask the pension administrators before you move.

Continuous NHS service for annual leave and sick pay is generally recognised across the UK health services under Agenda for Change, though you should confirm it in writing with the new employer. Doctors in training who move between nations change deanery and contract. For the English structure, see how the NHS in England is organised.