I believe that the information in this article is being made public for the first time.
I’ve written on several occasions about the series of Freedom of Information requests I put in to the 20 NHS Trusts who have joined together in a cartel to try to impose worsened pay, terms and conditions on NHS workers in the South-West of England. A list of the Trusts can be found here. The cartel and the Department of Health have met and colluded, and ministers have approved plans that certainly include pay cuts – and then denied them when they spotlight was turned on them; a U-turn that may well have cost former Health Secretary Andrew Lansley his job.
Devon Partnership NHS Trust was the first to use the ‘commercial interest’ exemption of the FOI Act to try to avoid answering my request for copies of its communications with the ‘Consortium’ (abbreviated to SWC from here on). As answers from the remaining Trusts have started to come in over the last couple of days, without exception each is claiming exemption on one ground or another for not answering. I’m challenging each one, but that means another month-long wait and then, if still no response, a potential wait of months for the Information Commissioners’ office to rule on the validity of the excuse.
I’m prepared to follow that route if need be, because the issue is such an important part of the picture of the government’s assault on the NHS, one of Britain’s greatest political and social achievements. However, asking these kinds of questions, and writing on what I write about, means I’ve started to get to know a wide variety of people in, or simply concerned about, the NHS. And sometimes, people send me pertinent – very pertinent – information.
Today, documents came into my hands which detail the complete list of measures under consideration by the cartel – measures designed to reduce staff incomes and benefits, and which will inevitably impact on services and patient care. As the briefing documents recognise and even look toward – one of the documents even states that intentional ‘service rationalisation‘ may be considered as the next cost-saving measure. So much for David Cameron’s promise that ‘The NHS is safe in our hands‘. As these documents very clearly fall under my FOI request, it’s o wonder the cartel members don’t want to answer it.
The national pay and conditions negotiations currently being conducted under the NHS’ ‘Agenda for Change‘ (AfC) framework contain 4 cost-reduction measures that may or may not be agreed with unions for national implementation. Some of these make sense, and may even meet with approval from a majority of staff.
The cartel’s list of changes under consideration consists of a staggering 28 measures. While the Trust’s press releases and staff communications, as well as statements by the government, insist that both government and the cartel fully respect AfC discussions and principles, the document expressly questions: ‘Do the Agenda for Change principles still stand as those governing the SWC’s approach?‘
So, without question – and has been touched upon in various articles over the last week or so – the idea that the Cartel is not moving away from AfC is laughable. And as Chris Bown, the man leading the cartel boasts, other regions are looking to copy their model – so this is an issue that affects everyone who works in or cares about the NHS, no matter where you live.
And the picture is grim indeed. The cartel claims that its aims are about ‘about exploring more flexible ways of rewarding and incentivising staff‘ – but the measures show a very perverse idea of what constitutes reward and incentive. My wife is a nurse, and she says that whether she and her hard-working colleagues feel appreciated or not is a decisive factor in their ability to cope with the stress, strain and exhaustion that goes hand-in-hand with nursing, and I’m sure the same is true of any health-worker. Those in the South-West must be feeling anything but appreciated at the moment, given what these measures say about their bosses’ attitude toward them.
Here are the 28 measures the cartel is discussing, along with brief explanatory notes where necessary:
1. Reduce APA rates
‘Programmed Activities’ are the basis for contracts for consultants. A standard consultant contract consists of 10 PAs of 4 hours each, resulting in a 40-hour standard work week. Consultants are paid for additional activities in 4-hour APAs. The cartel is proposing to reduce the rates paid for what is effectively consultant overtime.
2. Reduce annual leave
The cartel is considering reducing staff’s holiday entitlement and calculating a saving of £150 per employee for each day’s leave reduced, as well as a saving on the 50% of staff that are typically covered during holidays.
3. Bonus scheme
The cartel is considering incentivising all staff based on cost-savings overall, to exceed the ‘planned surplus’ that each Trust typically aims for and saves for capital projects. To help balance this bonus cost out, measure 4 would be implemented:
4. Clinical Excellence Awards
Trusts typically award CEA points to staff for achieving clinical excellence – a direct benefit to patients. The cartel is valuing these at c£3k per employee – and wants to connect these to ‘desired service activities‘ instead of to clinical excellence. These activities would be more oriented to efficiency than excellence – bad news for patient care.
5. Reduce consultant on-call supplements
Consultants are paid for being on call on-site and off-site. The cartel is considering reducing these rates – expecting them to be equally available for less money.
6. Extra hours
A big one for staff at all levels. The cartel is considering adding 1 hour on top of typical 37.5 hours (AfC) contracts – making already stressed and over-stretched staff work longer for no extra pay, and reducing overtime opportunities that are invaluable to NHS workers facing pay freezes and escalating living costs.
7. Flexible ‘benefits’
This one just represents unbelievable audacity and arrogance. Under this heading, the cartel is considering ‘selling’ stolen annual leave back to staff in return for a reduction in pay!
8. Flex-release (voluntary hours reduction)
The cartel is considering offering staff the option of working 25% fewer hours and receiving 25% less pay – and then only replacing 50% of the lost hours to save cost. The hours lost must surely impact on patient care and increase stress and absence, affecting clinical staffing levels even more, again to the detriment of patients.
9. Reduce/withhold increments
NHS clinical staff are graded in bands based on skills, knowledge and experience. As staff spend longer within a band, they receive annual salary increments to reflect their greater experience and service when it hasn’t yet resulted in moving to a higher band. The cartel is considering reducing these increments – and withholding a percentage of them completely. This means experienced, dedicated staff receiving no reward or recognition of their loyalty and greater experience.
10. Junior medical staff contracts
This one is nothing short of a scam. Junior doctors receive enhancements for anti-social hours and on-call duties. The cartel is thinking of changing the contracts of junior doctors to ‘limited working’ employment contracts that mean most of their hours and activities would be considered education – and would therefore end their access to any enhancements for long, anti-social hours and being available on call when not working. This is expected to result in a 50% saving on around 1000 staff in the cartel’s constituent Trusts.
11. Locum & retired consultant SPA
The cartel wants to end guaranteed SPA (supporting professional activities) time – time which is required for admin, refresher courses etc required for revalidation of professional qualifications and competence.
12. Knowledge and Skills Framework (KSF) reform
Staff are currently rewarded for gaining increased professional skills and knowledge by receiving extra pay reflecting their expertise, to incentivise staff to become more widely competent. This gives employers the advantage of having staff capable of filling more demanding roles when necessary because of staff turnover, sickness etc. The cartel proposes to change this into a ‘KS Performance Framework‘ – in which staff are only paid for gaining knowledge and skills when they are actually using them. This will dis-incentivise staff and reduce the pool of expertise available to care for patients.
13. New consultant roles – direct clinical care
The cartel wants to establish ‘static consultant roles’ where contracts mainly recognise ‘DCC’ PA-units (90%), in order to pay less and save money.
14. New employer models – a two-tier workforce
Another massive one – and the title of this section is a direct quote from the document, showing that the cartel is quite prepared to create ‘2nd class employees’. This concept means new terms and conditions for staff considered easily replaceable – at rates 20-25% lower. If anyone doesn’t like the lower pay rate, they’re easily replaced.
15. Zero pay inflation (uplift)
The cartel is considering imposing zero ‘cost of living’ increases (except for very low paid staff)
16. Reduced pay levels
The cartel wants to reduce pay, considering that for a typical Trust, a reduction in pay of 1% will save £1.4m.
17. Reduce/eliminate pay protection policy
If re-organisations/restructuring result in staff being moved into jobs with lower banding, their pay from the previous banding is protected for 2-3 years. The cartel wants to remove or reduce this protection, so that staff are deprived of pay if managers decide to move them to different functions.
18. Reduce/remove preceptorship increment fast-track
Staff who take on extra responsibilities for training and mentoring less experienced staff to achieve full competence more quickly are rewarded by receiving in-band increments more rapidly. The cartel is considering removing or reducing this reward structure.
19. Flat-rate sick pay
Sickness pay currently includes anti-social hours rates. The cartel plans to award sick-pay at a flat, reduced rate. This seems to be broadly similar to the AfC measure under discussion.
20. Recruitment and retention premia (RRP)
Some key types of staff are paid at higher rates to prevent losing them. Under this proposal, these improved rates would be terminated as soon as any protections expired.
21. Reduction in working week and income
The cartel is considering imposing a 10% reduction in the working week – and of course reducing pay accordingly. This is expected to save £14m per typical Trust – but cannot possibly be implemented without adverse effects on patient care.
22. Redundancy payments
Current redundancy payments are equivalent on average to 1-2 years of salary costs given typical length of service (plus early retirement financial commitments). It is proposing to reduce these important benefits.
23. Remuneration for extra clinical work
Staff undertake extra clinical work, for example to help reduce waiting lists. This would be reduced/eliminated – again with negative impacts for patients.
24. Unpaid sickness absence (short term)
The cartel is considering making the first 2 days of any sickness absence unpaid. Given that much sickness is the result of injuries sustained at work, stress caused at work and diseases caught at work, this is positively criminal.
25. Reduce sick-pay entitlement
The proposal is to reduce sick pay for new staff and long term benefits from 6 months full pay and 6 months half pay after 5 years’ service to 3 months of each. Again, in the context of work-incurred illness, stress and injury, this is deplorable.
26. Supporting Professional Activities (SPAs)
The cartel wants to reduce time spent on SPA activity by consultants.
27. Temporary staffing rates 10% reduction
The cartel proposes to reduce the rate paid to temporary staff by at least 10%.
28. Reduce unsocial hours allowances
Health workers often have no choice but to work late shifts, night shifts, weekends, bank holidays etc, as the need for patient care doesn’t stop outside office hours. These shifts impact heavily on family life and often on health. The cartel is considering reducing the financial recognition of the dedication of staff and the adverse effects of unsocial and variable hours.
Without question, these measures under consideration – which would still be secret but for a brave and nobly-intentioned informant – demonstrate clearly that the cartel, far from being about rewarding and incentivising staff and honouring the Agenda for Change principles and negotiations, is intent on creating a situation in which staff can be attacked wantonly and are corralled into a situation in which they have no choice but to submit.
The protests of the cartel executives and PR representatives, and the claims of the government that the ‘consortium’ is not about reducing pay and conditions, are now not only recognised as so much transparent and mendacious hogwash, but proven to be such.
If we do not fight this, it represents the future for health-workers and an inevitable decline in patient care for all of us, as Trusts copy the SWC model. And that’s before the cartel begins its stated ‘phase two’ of ‘service rationalisations’.
Spread the word – tell everyone you know, and write to your MPs and the Shadow Health team to tell them you expect, no demand that they raise the profile of this issue, combat these measures during this Parliament, and give an absolute commitment to reversing them as soon as the coalition is out of office. Please.
EDIT 13 Sep 17.11 – there is a Unison petition on the government’s e-petition site against regionally-variable pay. Please sign and publicise: