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Trusts desire fresh squeeze on Agenda for Change

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.



Nursing Times will be hosting a twitchat to discuss these proposals at 1pm on Wednesday 5 June. To join in, follow #NTtwitchat and make sure this hashtag appears in allyour tweets.



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Readers' comments (41)

  • So much to say. So little space.

    Bottom line...unless we are prepared to meet such proposed measures with unified, targeted and effective industrial action, then NHS Employers will make their savings through staff redundancies and cuts to the pay and conditions of those remaining.

    However, as we have done nothing thus far, I don't expect that to change.

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  • Get rid of the numerous managers and have one . They are the ones on large salaries, Health boards could save a lot .Too many adninistrators and not enough hands on nurses

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  • Careful what you wish for in getting rid of managers and administrators. That paperwork will still need doing and plenty already complain about what needs doing now.

    The employers appear to see pay and conditions as an easy target in a recession with increasing unemployment. Changing practice on the wards to make efficiency savings is too difficult by comparison.

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  • Definitely too many organ grinders in ivory towers saying wards are overstaffed though strangely enough never enough staff for proper nursing care, so for once lets get rid of all useless jobs for the boys management and invest in the staff on the ward floor, then there would be no need for anymore Stafford hospital scandals. However this will never happen as management are convinced that by reducing staff morale and conditions and staff they will have more money to spend on patient care. Wake up call keep getting rid of the nurses and treating them like dirt will not improve the care the patients receive only make it worse. As long as the hospital is making money that is all they are concerned about.

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  • Anonymous | 3-Jun-2013 2:07 pm

    Given that the managers and administrators are mostly responsible for the generation paperwork in the first instance, I see no problem in getting rid of them and the paperwork too.

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  • michael stone

    I'm not willing to argue that managers are unnecessary.

    But I am willing to argue that either the people at the top are paid by the size of the organisation, or they aren't: I've got a cynical expectation that when top managers downsize organisations, they will themsleves end up being paid more despite the overall wage bill going down - if the goverment chucks more cash in, and the wage bill goes up, I'd bet those same managers also got paid more. One or the other, please (although I would prefer more equality of wages, anyway).

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  • Does this possible pay reduction affect medical staff as well?

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  • tinkerbell

    this is like chinese water torture, drip, drip. Get on with it, get rid of us all and then realise what a mistake to make. As usual no foresight.

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  • tinkerbell

    what about more staff to do the job and less managers?

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  • "Hospital chiefs to consider drafting in police to help with nurse shortage
    Police could be drafted in to alleviate a nursing shortage at a chronically understaffed hospital under plans to be discussed by NHS chiefs."

    By Hayley Dixon
    3:35PM BST 03 Jun 2013

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  • Anonymous | 3-Jun-2013 5:58 pm

    Another silly non-story from the torygraph which appears to be speculative trouble causing. By the look of the moronic comments following the article, it appears to have been quite successful. Job done.

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  • michael stone | 3-Jun-2013 3:49 pm

    "I'm not willing to argue that managers are unnecessary."

    Any organisational structure does indeed require managers. However, the NHS is overrun by numerous unnecessary management layers.
    I used to be answerable to two managers in my department. Now there are five, doing exactly the same job previously done effectively by two. Each manager has their own little feifdom and generates their own little checklists, audit sheets and paper trails which we have to complete to justify their existence. They are bringing the NHS to its knees and we need to get rid of them.

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  • We do need to differentiate between managers and "administrators" Admin staff are front line and make the wheels run smoothly, booking appointments, typing letters to communicate with other professionals ,getting operating lists together, making sure results are in notes and seen by the right person, answering phone calls, there isn't enough space to enumerate the many roles, but they are vital to support clinicians to do their work, it's a team. When they are cut, efficiency is even more reduced and clinical staff spend more of their time on admin rather than being clinically involved with patients.

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  • Anonymous | 3-Jun-2013 6:31 pm

    Fair point.

    However, not all admin staff are frontline. And each unnecessary layer of management comes with unnecessary admin input, which doesn't aid in reducing the load of clinical staff. It is also worth pointing out that some managers refer to themselves as "Administrators" and use the term in their job description. Not always so easy to differentiate.

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  • If only the government would look at cutting NHS management instead of leaving them to decide on savings - they are never going to cut their own posts - far from it they will appoint more staff to support their 'made up jobs'. I too have changed from two managers to 5 with all the work they bring to justify their jobs. Today we have been given notice of formal consultation on restructuring. Make that fait au compli - downgrading and a handful of clinicians taken out of front line work to manage it to justify getting people to do the same job on less pay.

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  • tinkerbell

    I could do with a fresh squeeze.

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  • In my Trust we were told at a senior nurse meeting that the next saving will be made by cutting [possibly stopping] unsocial hours pay.
    Just where do they anticipate finding staff for weekends, bank holidays and nights.

    Back in 1987 rumours of this started national industrial action....

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  • We are a SERVICE INDUSTRY - so of course a large percentage of costs relate to staffing! Cut the staff - and cut the level of service if you want.

    No one has asked me about my morale - it's definitely not "moderate", not even "poor" -it's absolutely rock bottom. If my pay and conditions are cut any further I don't think I can take it, so working anywhere else would be a luxury! Nursing is a responsible career, and the way we treat people makes a hugh difference to their recovery, but we can't keep on doing it with the relentless pressure on pay, and the negative way the NHS is portrayed in the media. The NHS is being brought to it's knees - a very sad sight!

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  • We are a SERVICE INDUSTRY - so of course a large percentage of costs relate to staffing! Cut the staff - and cut the level of service if you want.

    No one has asked me about my morale - it's definitely not "moderate", not even "poor" -it's absolutely rock bottom. If my pay and conditions are cut any further I don't think I can take it, so working anywhere else would be a luxury! Nursing is a responsible career, and the way we treat people makes a hugh difference to their recovery, but we can't keep on doing it with the relentless pressure on pay, and the negative way the NHS is portrayed in the media. The NHS is being brought to it's knees - a very sad sight!

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  • Re: Anonymous 04 June 9.47 am

    I work in the community, so no unsocial hours. However, I agree with you 100% - in what other job would you expect people to work unsocial hours without financial recompense? NHS management must be out of it's mind if it thinks people are willing to have their home and social life wrecked for no extra pay. Don't get me wrong, most people who do have to work shifts know what they are taking on, and are dedicated to their work, but it's unfair to expect them to work weekends, nights, shifts, Bank Holidays without extra reward. I choose to work in the community precisely because I value my free time with my family.

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