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You want me to do what…? For how much…?

January 22, 2015

By Basket Press

So our great and noble leaders at the Department of Health (DoH) are acting to protect our interests again, provoking an inevitable response. But is it really that simplistic? The actual DoH recommendations document is sizeable and much is about “7day services”, which is a whole other kettle of fish – especially to ward-based nurses who provide, lemme see now, what is it that they do…? Oh yes, 7 day, 24 hour a day services. I am not going to re-visit any discussions about the necessity or otherwise to provide 7 day services.

 
Part of the difficulty is that previous pay and contract negotiations have created as many problems as they solved. Agenda for Change (AfC) introduced some anomalies, such as sick pay being based on pay which had included unsocial hours payments and other elements of people being paid for unsocial hours they haven’t worked, rather than claiming solely for those hours worked as under the old Whitley Council agreements. Now one could make an argument for a certain amount of re-negotiation of some of the more obvious idiocies, but that isn’t what is happening nor what is being suggested. So, is something else at play?

 
We also need to step back and look at how some trusts are treating the existing AfC arrangements. One of the selling points for AfC was that it was supposed to harmonise pay and conditions across different disciplines, simplifying the morass of the Whitley Councils and so reducing the costs of administering payroll and Human Resources systems. That never happened: there were so many “local exemptions” and the like that payroll costs were increased (why, yes, I am married to a payroll person).

 
Since then many trusts have been imposing new “local arrangements”, such as making annual increments at all points, not just the gateway points, dependent on annual appraisals. This is a complete misuse of the whole Knowledge and Skills Framework (KSF) process in order to remove (mostly nurses’) contractual rights (why, yes, I was a KSF manager) and cut the wage bill, while,, at the same time – paradoxically – further increasing the costs of running payrolls. Some have gone further and started changing sick pay arrangements to reduce what is paid to those off sick. And…I could get my wife to write several pieces on how AfC has never been properly implemented and then has been subverted and the increases in associated costs.

 
Then we also have the proposals, which keep surfacing, to move from national pay structures to local pay – based on arguments that it is cheaper to live in, say, Northumberland, than in London so staff in Northumberland should be paid less. While the costs of living may be different, the costs of implementing such a system will add to administration costs: numerous small local negotiations cost more than a single national one, so payroll and HR costs will increase because of added complexities. Additionally, the national ESR (Electronic Staff Records) system will not be able to cope with some of it, so IT costs will increase…

 
To return to the DoH recommendations, reference is made to “Communicating the full package of benefits beyond pay that are on offer to staff (known as ‘Total Reward’)” but without any definition or explanation of what this might mean. Now, given that NHS pension rights have been hammered in recent years by the DoH, how trust worthy is such a suggestion?

 
But what are the actual costs of unsocial hours payments and increments? The DoH say “Unsocial hours pay costs at least £1.8bn for employed non-medical staff a year, and the current system of incremental pay progression within AfC has a cost pressure of over £550m per year.” But without explaining what proportion of the overall NHS staff budget that is…If I wanted to be argumentative I might start drawing comparisons with the cost over-runs on defence projects or the NHS IT schemes…Or the costs of agency staff to fill existing holes: “In 2013-14 NHS Trusts spent approx. £1.2bn on agency staff, and NHS Foundation Trusts spent approx. £1.4bn on agency staff”. I am not knocking agency staff (I did agency work for a couple of years); I’m just using these figures to highlight the money spent on plugging existing gaps, and the implications about how poor current systems are at providing the right numbers of staff in the right places at the right times, and how little leeway there is.

 
And what are the consequences of working shifts? From the Nursing Times on 13/1/15 we have this and from late last year we have this. The links between shift work, especially nights, and depression, cardiac problems and other health issues are well documented, even in management journals. I am sure all of us who have any history of long-term shift work can point to deleterious effects on our health, let alone our family lives (one weekend off a month with my wife was the norm for me for a decade, for example).

 
So we have proposals to reduce staff pay while at the same time asking them to give up more of the rest of their lives and suffer increased ill health into the bargain…On top of other ideas also designed to worsen pay and conditions and parcel off services previously provided by NHS trusts to the private or “not for profit” sectors.

 
Is this actually anything to do with supposed increases in efficiency of service delivery? Or are there other things behind these proposals? Or, as with the implementation of Afc and the like, is this just another DoH SNAFU? Either way it is nonsense.

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