The growing demand for efficiency savings in the NHS is stoking desires among NHS organisations to seek further reductions to staff pay, terms and conditions, it has emerged.
Despite a deal between unions and NHS Employers to dilute the national Agenda for Change framework in February, Nursing Times can reveal a growing dissatisfaction with the reward package for NHS staff among employers.
This is being driven by the continual drive to make efficiency savings and the perceived generosity of pay, terms and conditions agreements. Pay accounts for up to 70% of costs for some trusts.
There is speculation the difficulties faced by some organisations could drive them to consider forming new regional groups to break away from Agenda for Change in the longer term.
But unions, fresh out of the talks earlier this year, claim most employers have already failed to implement many of the existing flexibilities that could help save money. They argue trusts should look at the wider service configurations to achieve savings.
A survey of 70 NHS HR directors – carried out by Nursing Times’ sister title Health Service journal in partnership with the NHS Employers organisation – found 95% believed more change was need to pay, terms and conditions. In addition, 81% said they did not feel the agreement reached in February went far enough.
In a sign of their increasing desperation to make savings, 27% of directors said they were planning to cut nursing posts at their organisation. In contrast, a third of HR directors quizzed in the survey admitted they were not confident they had sufficient staffing levels to meet the demand on their services.
In a finding that may differ from the frontline view, 79% of HR directors claimed staff morale in their organisation was “moderate” even after recent health reforms, pay freeze and Francis report. Only 12% rated morale as “poor”.
NHS Employers chief executive Dean Royles said: “There is rising pressure on staff as a result of growing demands on many parts of the service, and employers need to balance the pressure of paying most staff significant pay increments against the need to give job security, while delivering a good service and keeping morale high.
He said trusts faced an “extreme balancing act” on finances. “We can’t keep having more staff and higher pay – something has to give,” he warned.
Thomas Cawston, research director at the right-wing thinktank Reform, said the survey showed there was a “clear need to look beyond the national framework for pay terms and conditions and ask whether hospitals could themselves take a greater lead”.
“There have been a number of organisations looking at the South West Consortium with a great deal of interest and thinking behind closed doors how they could do this themselves. One way that has been discussed is for regional groups to come together to break away,” he said.
But Josie Irwin, head of employment relations at the Royal College of Nursing, said it was wrong for employers to brand Agenda for Change as unaffordable when many of its flexibilities have not been implemented by NHS trusts.
She said: “Employers need to raise their game and step up to the plate. Employers talk about the problems with Agenda for Change but when they are offered the flexibilities they don’t take them.”
Ms Irwin said less than 30 trusts had implemented new changes to the pay framework for staff on-call, which were intended to allow local flexibility for on-call arrangements.
In trying to meet the £20bn efficiency savings target, Ms Irwin said many employers had opted for short-term savings and were “burying their head in the sand”.
She said there was “no way” the RCN would be willing to negotiate Agenda for Change again if employers sought to reduce pay, terms and conditions.
Sara Gorton, senior national officer at Unison, said employers needed to look at alternative options for savings suggesting areas, such as drug purchasing, reducing waste and looking at care pathways that avoided duplication.
She told Nursing Times: “We understand that financial pressures mean trusts are looking to make savings, but they cannot continue to heap the burden onto staff alone.
“Employers cannot expect to attract the best nurses, administrators, paramedics to the NHS and deliver the highest quality if they are going to continually attack their standards of living,” she said.
Ms Gorton added that Unison members were already raising “grave concerns” over quality of care, which could “spiral out of control” as demand on services and savings cuts increase.
“Cutting pay and driving down morale will only make this situation worse,” she said.
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