The letter N Tees NHS sent to all staff: “accept or be fired, but we’re being fair”

I’ve received a copy of a letter North Tees and Hartlepool NHS Trust has sent to all its staff concerning the planned removal of unsocial hours enhancements from sick pay. The Trust has been accused of intimidating staff to force them to accept the new terms, with an RCN spokesman saying “I don’t think I have ever seen a more bullying approach“.

The letter is couched in language that seems eminently reasonable at first glance, but with two seconds’ consideration it is both sinister and bullying – and also bodes very ill for the future. For those who want to read the whole thing, I’ll reproduce it at the end of this post in full, but first I’ll pick out a few ‘highlights’:

We’re consulting with you, but the decision is made

The letter contains several invitations to staff to participate in the process, as well as offering staff 1:1 consultations with managers and laying out the timetable for ‘consultations’ with unions, holding out the possibility that the decision might not yet be a done deal – but with a threat attached:

“Ultimately if this change goes through and staff do not agree, we may dismiss those staff and offer to employ them again under different terms and conditions.”

However, read carefully and the decision is already made, and the change is a fait accompli:

“Staff who do not sign their variation to contract in either category above, will be served notice and issued with a new contract of employment.”

and:

“New staff, promotees, or changes to working practices requested by staff will result in a new contract of employment being issued, which will no longer provide for sickness enhancement payments. The new contact will come into effect on 1 November 2012.”

Not ‘might be’, not ‘if the changes go ahead’, but ‘will be‘ served notice, ‘will come into effect’. Done deal.

It’s against the rules and we don’t care

In the section of the letter that lists the issues being discussed under the national ‘Agenda for Change’ (AfC) negotiations, the Trust says that the discussions are not proceeding quickly enough but explicitly acknowledges that:

“It is likely that each NHS organisation would still need to consult and reach agreement at a local level, on the practical arrangements to deliver any changes agreed nationally.“

And yet, while it pays lip-service to the idea of a consultation, it is pressing ahead with no concern for reaching any kind of agreement on the matter:

“In relation to current consultations regarding this proposed change to AfC terms and conditions, our local staff side representatives have shared that they are not able to enter into any form of consultation and/or negotiations with our Trust without regional authority.

We are advised that regional authorisation relies on national guidance, which appears unwilling to consider changes to, or moves away from, national terms and conditions. This is really unfortunate that our excellent relations with our staff side cannot be replicated this time; and it is important to recognise we respect their views but ask that they do engage in this process.“

In other words: “We acknowledge that we are not allowed to push through a unilateral change and have to negotiate local agreement with unions before implementing any change, but we’re going ahead anyway.”

A sledgehammer to crack a nut

The Trust has over 5,000 staff and a sickness rate of 5%, which it says is one of the highest regionally and nationally. However, no thought or investigation appears to have been made into why it has a higher rate – whether this is to do with working practices, low staffing levels leading to greater fatigue and higher rates of injury or transmitted illness.

Nor has it apparently made any effort to identify whether the rate is caused by a few employees who habitually abuse the process – which, anecdotally, seems likely to be the case based on comments I hear from staff who work at the Trust’s hospitals.

So, rather than use existing HR and disciplinary procedures to deal with a small number of problem employees, the Trust is pressing ahead with a change which will penalise everyone – including the vast majority of staff who are hard-working, who work many additional hours unpaid, and whose dedication can’t be questioned. If one of those staff catches flu from a patient because s/he is run down, or is injured while trying to catch a falling patient, s/he will be financially penalised for the consequences of doing the job properly.

We’re detached from reality, so we’re sure you’ll agree with us

The lack of understanding of real life as faced by ordinary people in the letter is quite staggering – on a par with Frances Maude’s infamous assumption during the petrol-crisis-that-never-was that everyone has a garage to store spare fuel in:

“I understand that this will affect a number of people but I would ask that you remember that absence isn’t something we should all be basing our take home pay on. To be fair to ourselves, our colleagues and in fact the tax payer we should be thinking of attendance at work, not absence, and being paid for what we do not what we don’t do.”

For ordinary people, budgets are tighter than ever at the moment. Two years of pay-freezes for public-sector workers, steep rises in fuel and energy prices and continuing inflation have combined to make most poorer now than we were before the coalition government came to power (unlike the rich, whose increase in wealth has merely accelerated).

Maintained sick-pay if we get ill is not a luxury or a bonus for most, but rather a crucial safety-net that prevents us incurring debt (or more debt) because of an illness or injury outside our control. The smug, self-righteous statement by a highly-paid chief executive, and his certainty of correctness and that we must surely agree with him, beggars belief.

A drop in the bucket

In many ways, this is the scariest aspect of the whole thing – and I don’t think it’s been mentioned in the media coverage so far. The Trust says it needs to save £40 million. The amount that will be saved by removing unsocial hours enhancements from staff pay is… £500,000. One 80th of the target amount.

For 1/80 of the amount it says it needs to save, the Trust is prepared to impose a measure that will penalise all its staff, even the most hard-working and diligent. For 1/80, it is prepared to break the rules on local variations which it acknowledges are in place, by imposing a local measure without the agreement of unions and staff. For 1/80, it is prepared to resort – at the very beginning of the process – to the supposedly last-resort measure of dismissing and re-engaging staff.

In its letter, the Trust claims to be committed to working with unions on future measures:

“We do understand and agree that all other matters, which staff side are working with us on, will continue with the partnership arrangements we have always enjoyed.”

But if the Trust is prepared to ride roughshod over any idea of partnership at the very outset, over an issue which will contribute just 1.25% to its savings target, then the promise isn’t worth the ink it used to print it – and unions will be fools if they trust the Trust not to repeat the same measures any time it can’t get immediate agreement to whatever it wants to do.

The full text of the letter follows. If you have the stomach for it, please read through it. But whether you do or not, it’s perfectly clear that NHS staff are just a whipping post for unrealistic government demands and measures, and the bullying tactics of Trust managers who have become willing ‘capos‘ eager to please and satisfy insatiable politicians rather than standing alongside health-workers to fight for the good of the NHS, the patients who rely on it and the staff they rely on. It’s also perfectly clear, from the mention of ‘any qualified provider’, that the government introduced this competitive provision into health legislation specifically to drive down wages and employment in this vital public sector.

The letter

Dear colleague

Our £40m challenge – proposed changes to sickness enhancements

As you know I wrote to you on 1 November 2011 to tell you about the serious financial challenges we were facing and asking you for your ideas about how to save money or bring in additional income to help us through this very difficult period.

We have considered each and every one of your suggestions. Some of them have been easier to make happen than others but we still very much value your ideas so please keep them coming.

However, one theme came up over and over again and that was in relation to the payment of sickness enhancements. Under the present Agenda for Change terms and conditions people who are off sick on a weekend or a bank holiday or during unsocial hours still receive their unsocial hours payments, at the enhanced rate, even though they were not available for work. In effect what we end up with is a “double whammy”. We pay someone additional money for actually not being at work and we often have to pay colleagues overtime or bring agency staff in to cover – costing us even more money – when people take time off sick over these times.

Many staff told us that they thought this was unfair, that it must cost the trust a lot of money and it puts additional strain on wards and departments for the people who are still at work. They’re right. It does cost us a lot of money.

You might be surprised to hear that our trust has one of the worst sickness rates in the region, and in fact in the country, (an average of 5%, but this masks the huge variation in wards and departments where some sickness rates are next to zero and others are as high as 10 or 11%).

Paul Garvin                            Alan Foster
Chairman                              Chief Executive

Sickness rates of all NHS Foundation Trusts in the North East

These figures are for the three months from April to June for 2012

The sickness costs detailed below show how much the Trust has paid out to staff on sick leave, these do not include the additional costs that are also incurred on overtime, bank or agency for backfill:

2010/11                             £5,808,600.50
2011/12                             £5,777,482.83
2012 (April to August)     £2,540,239.39

That is a lot of money and a lot of jobs. The cost of sickness enhancement payments over the same time is:

2010/11                             £406,818
2011/12                             £432,961
2012 (April to August)     £217,479

Again, a lot of money and a pressure which gives us very little alterative than to look at cutting posts to be able to pay for it.

If the sickness enhancements for this year continue at their current rate, then we will be paying around £500,000. In other words just under 20 Band 5 posts or just above 30 Band 2 posts.

National discussions

Sickness enhancements are part of the national Agenda for Change terms and conditions. This means there would have to be national negotiations and discussions to change them for everyone working in the NHS. We know national discussions are taking place and have been for around two years. However, those discussions have not yet reached an agreement, as other matters are also being considered and we feel we can no longer wait for those discussions to conclude. It looks like the earliest any agreement can be reached is 9 November 2012, but we need to consult now on the proposal to remove sickness enhancements if we are to realise
these savings from next year.

I think we all want to work in an organisation which rewards attendance, not absence, so I asked
director of human resources and education/company secretary, Clare Curran to see if it was
possible for us to change this part of the terms and conditions, and this is what I am writing to
you about today.

Clare and her team have carried out a number of discussion groups, visited directorates and carried out a survey to try and find out what everyone in the organisation thinks of this idea. Although not everyone has replied, of those that did, around two thirds suggested this was something we should change. Following that exercise we now feel we can go ahead and start the process for consulting both you and our recognised trade unions with a view to removing the sickness enhancements payment.

I understand that this will affect a number of people but I would ask that you remember that absence isn’t something we should all be basing our take home pay on. To be fair to ourselves, our colleagues and in fact the tax payer we should be thinking of attendance at work, not absence, and being paid for what we do not what we don’t do.

Next steps

This change applies to all staff on Agenda for Change terms and conditions, however many have never and will never work unsocial hours, so this change has no impact upon them whatsoever. Every member of staff affected will be asked to meet and have a face-to-face meeting with a manager. This is designed to seek their views and talk about how this might affect them personally.

I have added some more information below and tried to answer questions I think will arise. However if you need any more information please speak to your line manager, or contact extension 4939 in human resources. Further information is also available on the HR sharepoint pages.

I hope you will accept the change and work with us, to help us save these costs.

Yours sincerely

Alan Foster
Chief executive

Our proposal

This proposed change does not impact on staff who have never worked unsocial hours, either now or in the past. However, all staff on agenda for change terms and conditions will need to sign a variation to their contract.
Staff who have received unsocial hours payments in the last 12 months will be asked to sign a variation and change to their terms and conditions of employment relating to sickness enhancements.

Staff who do not sign their variation to contract in either category above, will be served notice and issued with a new contract of employment. New staff, promotees, or changes to working practices requested by staff will result in a new contract of employment being issued, which will no longer provide for sickness
enhancement payments. The new contract will come into effect on 1 November 2012.

How will it work?

We are asking all staff to agree to this change. Ultimately if this change goes through and staff do not agree, we may dismiss those staff and offer to employ them again under different terms and conditions.

New staff, promoted staff or staff whose jobs have changed

All staff who are new to the trust, have been promoted or whose jobs have changed will automatically be given a contract which does not include the payment of sickness enhancements.

What will that section of the new contract say?

The current Agenda for Change paragraph 14.4 says;

The definition of full pay will include regularly paid supplements, including any recruitment and retention premia, payments for work outside normal hours and high cost areas supplements. Sick pay is calculated on the basis of what the individual would have received had he/she been at work. This would be based on the previous three months at work or any other reference period that may be locally agreed. Local partnerships can
use virtual rotas showing what hours the employee would have worked in a reference period had he or she been at work.

We propose to replace this with:

Full pay in this agreement is pay which is in line with the appropriate pay point in the relevant pay circular, which the member of staff is in receipt of at the time of absence from work. No enhancements to pay will be paid when staff are absent from work.

Is this legal?

We respect all legal requirementsto make any such changes and will abide by these throughout the whole process. At a time of change the law requires employers to follow strict processes and we have done this. We have also shared all information with our recognised trade unions, and hope they will engage with us to reach an agreement.

a) What is happening nationally?

Employer representatives on the NHS Staff Council are increasingly making representations that greater flexibilities are needed to the national Agenda for Change (AfC) pay and conditions to help employers address the unprecedented efficiency and quality challenges they are facing and ensure the NHS is competitive in the any qualified provider (AQP) environment. Unfortunately, due to the ongoing national review of the NHS Pension scheme and other national matters, discussions about changes to AfC terms and conditions of service have taken longer than expected and we understand the trade unions have commenced a process of consultation with their membership regarding the need for change and possible flexibilities. The trade unions indicated they would share the outcome of their consultation in September/October 2012, however, following the national Staff Council meetings no decisions have been made and the next meeting is to take place in November 2012. We feet we are left with no option but to seek a local change to our contracts of employment.
The current proposals being discussed nationally and awaiting decisions are:

i. Incremental progression: Introduce an explicit requirement that progression through all pay points, within pay bands, is conditional upon employees meeting locally determined performance standards in line with a new set of national principles. Make pay progression at the top end of each pay band (starting at the first overlapping pay point) non-consolidated. Allow employers locally to have alternative payment arrangements for senior posts within Agenda for Change, for example, spot salaries.

Remove the link between accelerated pay progression and “preceptorship” at the bottom of pay band 5. New starters to Band 5 would only be eligible for one incremental increase in the first year, rather than the current two, bringing this in line with the rest of the pay system.

ii. Sick Pay: The proposal on pay during sickness absence would be to only pay the basic salary. It would not include any other allowances or payments linked to working patterns or additional work commitments eg, unsocial hours payments.

iii. Workforce re-profiling and job evaluation: Good practice principles are proposed to be developed collectively on workforce re-profiling, this will be designed^to support organisations undertaking this process. It is likely that each NHS organisation would still need to consult and reach agreement at a local level, on the practical arrangements to deliver any changes agreed nationally.

Discussions with our own staff side

In relation to current consultations regarding this proposed change to AfC terms and conditions, our local staff side representatives have shared that they are not able to enter into any form of consultation and/or negotiations with our Trust without regional authority.

We are advised that regional authorisation relies on national guidance, which appears unwilling to consider changes to, or moves away from, national terms and conditions.

This is really unfortunate that our excellent relations with our staff side cannot be replicated this time; and it is important to recognise we respect their views but ask that they do engage in this process. We do understand and agree that all other matters, which staff side are working with us on, will continue with the partnership arrangements we have always enjoyed.

How many members of staff are affected?

The Trust has identified the following staff groups impacted by this change, they are:

Manual 599
Clerical 999
Professional 2083
Managerial 135
Technical 167
Apprentices/Trainees 96
Other 976

It is important to note this is not a redundancy situation even though the Trust is required by law to complete a HR1 form and provide key data. This is a variation and could be a dismissal and re-engagement, and we hope and expect not to have to terminate members of staffs contract.

Why do we need to do this now?

As presented in our £40 million challenge paper, the documents sharing the outcome of the staff ideas, and the development of all these has enabled the Trust to achieve the savings required in 2011/12. We are now struggling to achieve our CIP for 2012/13, and we must start to secure savings for future years. Invest to save is key in all we do. The sickness enhancement changes will support this philosophy and provide recurrent
savings for the next financial year. The more we can achieve in this way, the less we have to focus upon savings via staff reductions. We do not want to start reducing staffing levels, but without achieving recurrent savings the Trust may have to consider this.

What will these changes mean for all of us?

Benefits for employees:

• Reduced stress and improved morale due to reduced sick leave from other
colleagues
• Sense of equity and fairness amongst all staff
• Financial savings will help reduce the likelihood of redundancies
• Increased awareness of health and wellbeing – eg, staff support, occupational health, staff benefits

Benefits for the trust:

• Recalibrates the purpose of ‘unsocial hours’ payments as premium pay for
working late at night, early in the morning or weekends
• Financial savings as indicated above
• Increased competitive edge through the reduction in the overall pay bill
• Reduction in sickness absence rates
• Reduction in overtime payments to backfill sickness absence
• Reduction in bank and agency spend

Benefits for patient care:

• Better quality of care through higher attendance levels, reduced use of flexi bank and agency workers/locums
• Better continuity of care
• Opportunity for re-investment of savings into improving patient/clinical care

Benefits for line managers:

• Reduction in last minute shift changes
• Increase staff morale due to perceived fairness

Agenda for Change

Agenda for Change was the most radical overhaul of the NHS pay system since 1948.
A key aim was to modernise the NHS pay system and create fair, harmonised conditions
of service – equal pay for work of equal value.

The principles, which underpinned the production of Agenda for Change, stand the test
of time. Set out below are these principles, which on reflection do not appear to need
modifying for today’s challenge. That said, they have not been fulfilled or delivered the
expected flexibilities. Their application therefore needs to be reassessed in the light of
experience and the challenges ahead.

Agenda for Change principles

Pay system which leads to more patients being treated, more quickly end higher quality
Assist new ways of working – promoting efficiency and effectiveness, meeting needs of patients
Achieving a quality workforce with the right numbers, right skills and diversity, organised in the right way
Improve recruitment retention and morale
Improve all aspects of equal opportunities and diversity
Meet equal pay for equal value
Implement new pay system within the management, financial and service constraints March 2003

We want to maintain these principles but the sickness enhancements payments clearly sit outside of these principles. (SKW’s note – sickness enhancements clearly sit WITHIN the principle of ‘equal pay for equal value’ across the entire nation, rather than some regions receiving less)

Equalities Impact Assessment

The proposals in the business case for change are based on principles of fairness and non-discrimination together with the legal requirements of equal pay for work of equal value.

The revised terms and conditions being proposed will be applied, as appropriate, to all employees on agenda for change contracts regardless of Equality Act 2010 protected characteristics or level in the organisation.
The Trust is required to conduct an Equality Impact Assessment and in doing so, consider the direct and indirect equality impacts of these proposals. The Trust will be required to mitigate any impact where it is possible and reasonable to do so.

Consultation Process

3 October 2012

Formal announcement to the recognised Trade Unions, this will include the sending of
the HR1, Business Case and associated data, thus informing the trade unions of
intentions surrounding the proposed removal of sickness enhancements

— Announce to staff the proposal to consult and send a letter and business case explaining the process, and offer briefing meetings to explain the proposals
— Send off the HR1 form to the Insolvency Service

8 October 2012, 11.00am, University Hospital of North Tees initial consultation meeting with trade unions.

10 October 2012, 1.00pm, University Hospital of Hartlepool, consultation meeting with trade unions.

Other dates to be agreed thereafter.

October 2012 onwards, staff briefings and 1:1 consultation meetings to explain proposals, briefing sessions by managers, specific sessions for staff also to be held.