Increase the NHS Higher Cost Area Supplement (HCAS) and scrap the cap!

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Increase the NHS Higher Cost Area Supplement (HCAS) and scrap the cap!

CEOs of London NHS Trusts

From housing and transport, to food and energy prices, the cost of living has risen significantly in recent years, and low paid workers in high cost areas like London have been among the worst hit.

Over twenty years ago, the High Cost Area Supplement (HCAS) - or London Weighting - was established for NHS staff in London and surrounding areas. It hasn't been reviewed since!

HCAS is divided into three geographical areas: where you work determines the percentage of your salary you'll receive as HCAS on top of your basic pay, up to a predetermined cap.

Inner London Zone (e.g. Hackney and Camden): 20%, capped at £8,466
Outer London Zone (e.g. Ealing or Newham): 15%, capped at £5,941
Fringe (e.g. parts of Essex and Surrey): 5%, capped at £2,198
(2025/26 figures)

In 2022, Sadiq Khan cited research recommending an updated minimum London weighting of £9,600 in inner London and £6,549 in outer London; despite the weekly food shop costing 40% more now than it did in 2020, HCAS hasn't kept the pace.

The value of HCAS is pinched from both sides. Because HCAS payments are capped, many workers do not receive the full value of the supplement. Despite years of low NHS pay rises, increasing numbers of workers are losing out to the cap. On the other hand, continually rising costs in our city are eating in to value of the supplement. In other words, HCAS is flatlining.

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Unite Action Network

To: CEOs of London NHS Trusts
From: [Your Name]

We the undersigned believe that:

(1) The current rates of High Cost Area Supplement (HCAS) should be increased and regularly reviewed in line with the regional cost of living;

(2) The cap must be abolished.

Since its introduction in December 2004, the payment has provided a valuable top-up to address the high cost of living in this part of the country, however HCAS has not reasonably kept pace with rising food, energy, transport or housing costs, and is undermined by a cap on supplements which hasn't risen alongside wage and salary increases.

When HCAS was introduced, it was an acknowledgment that the cost of living in London is higher than in other parts of the country. This is as true now as it was two decades ago, particularly alongside shocks caused by war, global pandemics, and energy crises, however HCAS has not been updated to address this.

In order to make HCAS fit for purpose in ensuring a minimum standard of living for NHS staff in one of the most expensive cities in the world, it must be increased and applied without a cap.