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The Time is Now

January 20, 2015

Assiduous readers of this blog should not have been surprised by news that in its recent submission to the NHS Pay Review Body (NHSPRB), the Department of Health (DoH) argues for abolishing – or, at the very least, radically reforming – unsocial hours payments; I predicted it as long ago as August 2013. In its evidence, the Department makes great play of linking the proposals to the long-held goal of seven-day services. Politically, it’s an astute move: the corollary of offering the public something that everyone agrees is A Very Good Thing is that opponents can be written off either as dinosaurs trapped in a time warp, or interest groups who care more about themselves than the people they are paid to serve.

The aggressively pro-patient rhetoric deployed by the DoH bears this out. Their evidence makes repeated references to ‘putting patients first’ and ‘putting patients at the heart of everything the NHS does’. The inference, clearly, is that anyone who dislikes what’s on offer here cannot be ‘putting patients first’ – and by extension cannot hold the selfless values of the true health care professional. How cruelly ironic is it, that at the same time as the DoH trumpets its intention to bring ‘modern employment practice’ to the NHS, it simultaneously relies on an outdated vision of health care workers motivated by duty rather than financial reward?

Beneath all the talk, of course, lies a more chilling truth: the DoH wants to introduce seven-day operation at little or no extra cost, and has decided to make pay reform the mechanism by which this is achieved. Nurses – who, let’s not forget, have always provided seven-day services – have got dragged into it because the DoH does not want our relatively generous unsocial packages to become the benchmark for newly-commissioned services. The solution? Tear up existing agreements and start again – from somewhere less favourable.

In order to make its case, the DoH has appealed to employment models from outside the health service. Unlike the NHS – which continues to revolve around the concept of ‘office hours’ and ‘out-of-hours’ – these take as their starting point the idea that we now live in a 24/7 society. Accordingly, there is no distinction between different hours of the day or days of the week: they’re all the same and there is no reason for any of them to attract premium rates.

The origins of this model lie in consumerism: on the one hand, the public’s demand for unrestricted access to goods and services; on the other, business’s demand for unrestricted access to our wallets, coupled with the desirability of keeping overheads to a minimum. And while the government protests that its motives in importing it into the NHS are to do with patient care pure and simple, suspicions persist that the ‘real’ agenda is one of aligning pay structures with those of the private sector as a way of making NHS services more attractive to private bidders.

The DoH’s evidence to the Pay Review Body does little to dispel these suspicions – indeed the whole document represents a significant raising of the stakes. Tucked away in a letter from the Chief Secretary to the Treasury to the NHSPRB appended to the end of the document is a hugely important sentence. It says ‘It is our intention to take the same approach in 2015 -16 [as we took in 2014-15]. As a result, the NHSPRB will not be asked to make recommendations on a pay award for Agenda for Change staff in the 2015 pay round’. In other words: we’re not going to mess around haggling over pay awards; we’ve already decided. Unless you accept our changes, all you’ll get this year is 1%. Tops.

As alternatives to the current arrangements, the DoH floats six new options. From an opening gambit of scrapping unsocial rates altogether, these range via lowering rates or reducing the number of hours that attract premium payments to a ‘radical’ scheme borrowed from the Automobile Association, that would see ‘pay levels informed by…how flexible the member of staff is to working ‘unsocial’ shift patterns’.

On the face of it, this could be a workable idea – at least it retains elements of incentive combined with fairness. On closer examination though, it merely demonstrates how pathetically little the DoH understands about nurses. The relevant paragraph starts off saying that ‘higher premium pay rates [would be] targeted at those staff whose contracts reflect a flexibility and willingness to work shift patterns which are considered more ‘unsocial’’. OK – so if you did permanent nights, you’d get more, right?

Well maybe not. It turns out that what this really means is ‘i.e. where staff are willing to work any shift within a 24 hour period’. It’s very unclear how policy like this would play out within a majority female workforce, many of whom are restricted in what they can work because of family caring responsibilities that actually save the state money.

But whatever the eventual outcome, the overarching context is that the DoH is looking to do more for less. And while basic rates will undoubtedly rise to compensate for loss of unsocial rates, the ultimate goal remains the reduction or stabilisation of the wages bill. So now, as well as looking at yet another year of miserly, kick-in-the-teeth pay rises, you may even – if the new proposals are implemented – be looking at a pay cut. Unless, that is, you are willing to work lates, earlies and nights in the same week, or – if push comes to shove – content yourself with nothing more than a pat on the back from your Chief Executive and an official ‘NHS hero’ badge. And – incredibly – it doesn’t end there. Because if the Tories win the General Election, they have already (yet another sop to private providers) pledged to make it harder for public sector workers to express their resistance through strike action.

Brothers and sisters: if there was ever a time to stop being complacent, that time is now. With these uniquely punitive, vindictive proposals, the government is, in a single breathtaking stride, pitting NHS staff against NHS patients; holding nurses to ransom over plans to increase private sector involvement in service delivery; and making it much more difficult for us to stop them trampling all over us in future. And the biggest lie of the lot is that it’s about putting patients first. It’s not. It’s about putting profits first. Undemocratically, never voted for by the British public. Over to you, Care Makers.

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