Agenda for Change has failed to deliver fair pay, according to the majority of over 1,000 respondents to a Nursing Times survey. In the second in our series on AfC five years on, Richard Staines reports on its effects on pay and careers.
EQUAL pay for work of equal value has been the mantra behind Agenda for Change ever since the new NHS pay system was proposed 10 years ago.
So, five years since its roll-out, has AfC really improved nurses’ working lives?
Nursing Times conducted its own poll to find out what frontline nurses thought about the successor to the old Whitley Council arrangements.
Based on a web survey of Nursing Times readers, which attracted more than 1,140 responses, the findings show how a cross section of nurses feel about pay and conditions now the system is well established in many parts of the country.
Although such polls can be criticised for being self-selecting, the findings show that the implementation of AfC has been problematic for some nurses.
Nearly half (48%) thought the system had been a failure and 61% said it had failed to deliver a fair pay deal to NHS staff.
Before AfC, pay was often decided by job title and depended on which organisation and in which area a nurse happened to work.
The overarching aim of the new system was to establish a unified pay system for the NHS. But has it? Nursing Times’ survey reveals that nearly two-thirds (59%) of respondents think they were on the wrong pay band.
Nurses have raised concerns that often jobs were simply banded according to a predetermined profile, which did not necessarily match the job they were doing.
One nurse said: ‘I actually sit on job-matching panels and it appears that the process is being used to ensure jobs are banded according to what managers want rather than what the job should be matched to.
‘A number of job descriptions are resubmitted with minor changes until the expected banding is achieved. This was not what AfC was meant to undertake.’
Another said the process favoured people who were transferred from Whitley pay scales when the AfC process began in 2004.
‘Staff who were involved in the initial process managed to get much higher grades as they knew which key words and phrases to use – someone who has written an article for a national journal and received an invitation to speak at a national conference got an 8a because she spoke nationally on trust issues, and someone who is a treasurer for a national voluntary organisation also benefited. I lost out on a H grade and was banded a 7.’
Respondents also said that the AfC process has meant that nurses are receiving different pay despite having similar roles.
‘[There is a] lack of standardisation. For example, specialist nursing posts requiring similar responsibilities and qualifications vary considerably countrywide,’ one nurse pointed out.
Another reported: ‘Job evaluation [varied] across the country, with different outcomes for the same groups of staff in close geographic locations dependent on the job profiles used to match.’
Some nurses also took issue with the banding structure created as part of the AfC process.
A common complaint was a lack of career progression for nurses on AfC band 5 – the equivalent of the old D grade – where qualified nurses start their careers.
Unfortunately, despite an AfC goal to provide nurses with a way to progress professionally, it seems that nurses may also finish their career on band 5.
A lack of training and managerial incompetence were major barriers reported by the nurses taking part in the survey.
‘The gateways do not lead anywhere. I am top of band 5 and thought a gateway would be available to 6 with extra skills but not so. To train to become a band 6, I have to take a large pay cut,’ said one nurse.
‘Band 5 is broad spectrum and gives no career benefit. Band 6 posts are few and far between and there is lack of career structure,’ said another.
Some called for the creation of a 5A band to reward nurses who had greater skills and experience.
One nurse said: ‘[The biggest problem is] the divisive effect of not creating a band 5A to provide career development aims for the 5s and to give recognition to the established experienced E grades.
‘The conflict and divisions in teams created by the banding all nurses as 5 is unacceptable to me.’
Many who were on the old E grade also felt they were unfairly demoted to the new AfC band 5.
‘The loss of distinction between D and E grade causes problems,’ one nurse said.
Staff on higher grades also reported problems. ‘A nurse specialist role at a London trust will be a 7. The exact same role outside London will be a 6 or even a 5!’ said one respondent.
Another said: ‘Within band 6, there is no differentiation between an F-grade position and what used to be a G grade. People who are not performing still maintain their banding. The job-matching process is completely unfair.’
Nurses also resented many of the managers – themselves on AfC pay scales – who were administering the process.
Some complained that the people who fared best out of the process were non-clinical staff.
‘Management posts are banded higher than clinical and little or no account is taken of experience in the job or of other qualifications from outside the nursing profession which are useful in practice,’ one nurse said.
The changes were often at the expense of experienced clinical staff, the nurse said.
‘It seems as if the “agenda” for AfC was to drive down salaries; the most experienced nurses mostly lost money by the time all the allowances were merged with the pay or reduced.
‘I lost about £2,000 pa and this obviously affected my pension because I was on protected pay so effectively stood still for two to three years.’
Other issues that nurses raised included on-call and overtime payments, which they said varied across the country.
Unions are in negotiations to harmonise on-call payments across the country and a deal for overtime payments was agreed in 2007.
But some nurses said they were not seeing the benefits. ‘My trust doesn’t pay us for on calls,’ said one nurse, who worked on call at least once a week.
Another said: ‘Not every trust is incorporating overtime rulings. The department I work in will not pay nurses who regularly work over and above contracted hours unless funding has been arranged via “extra activity clinics”.
‘Currently, full-time staff are working up to four hours above their contracted hours and receiving time off in lieu as reward. The hospital trust has refused to pay staff overtime – yet under AfC rules, overtime should be paid.’
Some respondents suggested some ways of solving the problems within AfC.
One suggested that a training database, which automatically updated when a course had been completed, would reduce the administrative burden on managers.
This would mean that, once a nurse has completed a course that would allow progression to a higher pay band, there would be no waiting for the paperwork
to be completed.
‘Once you have completed courses, it should be on some sort of database so that you automatically go up in your band as managers don’t seem to have time to this,’ the nurse said.
Another argued that there should be ‘more transparency [and] less room for manipulation by managers aiming to save money’.
Unfortunately, that damage has already been done. Some nurses said they had become so disillusioned by the AfC process that they had left or were considering leaving the profession.
One nurse said: ‘I left the profession as a result of the mess that was our trust and their refusal to see that top level E-grade nurses were worth more than band 5.’
Another said: ‘Once again, nurses have been taken for a ride and this will always happen when you have lambs leading lions. When will nursing leaders show some backbone and really stand up and get a good deal for all NHS staff and not just a few?
‘I’m getting out of this profession before it gets worse. Personally, I feel that NHS staff are fed up with working for nothing but it appears that this has now been compounded by the very people who are supposed to prevent this. What makes it worse is that these people actually think they have done a good job.’
According to the Nursing Times survey, it appears that, instead of creating a system of equal pay for work of equal value, AfC has created a system where they have been some winners – and, unfortunately, many losers.