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OPINION

'Attacks on Agenda for Change impact on patient care'

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Cuts to terms and conditions will demotivate and disengage staff, warns the RCN’s Josie Irwin

There are some positive signs that the recent success of the Royal College of Nursing, and other trade unions, in challenging Central Manchester Hospitals Foundation Trust’s attempt to withhold incremental pay rises for staff on the basis of their sickness records, is affecting the appetite to cut terms and conditions. Trusts with plans in the pipeline to introduce similar policies have withdrawn them following the judgement.

However, the threat has not gone away, far from it.  At the same time, other foundation trusts appear to be gearing up for a coordinated attempt to make changes to Agenda for Change locally, including threatening to dismiss and re-engage staff on new terms and conditions if the trade unions do not agree to negotiate. Some trusts are also reducing costs through re-profiling their workforces and implementing down-banding, that is re-grading jobs at a lower band (but still expecting staff to undertake the responsibilities of the former higher grade).  

The harsh reality of a £20bn gap in finances means such proposals are inevitable.  Trade unions recognise that the NHS is experiencing unprecedented austerity and realise that difficult choices have to be made. Employers are impatient to achieve savings to close the gap caused by reduced budgets, galloping inflation and increasing demand for services, and say they cannot wait for national talks to deliver the flexibilities they seek in the AfC package. However, aggressive pursuit of local changes, circumventing trade unions and failing to engage makes achieving a national agreement more difficult. 

“We simply won’t accept that cuts in pay, terms and conditions are inevitable” 

Attacks on terms and conditions leads to poor staff morale and, ultimately, this can impact on the quality of patient care. It need not have been like this. Had the full potential of AfC to underpin effective workforce re-profiling and support more productive ways of working been realised, damaging and demoralising proposals for cuts in working conditions may not have been inevitable.  

And there was still time to act before the scale of the gap in NHS finances became apparent. In 2009 the National Audit Office (NAO) published a report on the implementation and costs of AfC and the Knowledge and Skills Framework in particular. The analysis and findings related to the application of AfC as a whole but there was particular reference to nursing as the largest pay group. The NAO found that few trusts had exploited the opportunity provided by AfC to look at how their services were staffed and to consider how services might be delivered better with different ways of working.

The NHS squandered opportunities to use AfC to support sustainable changes to how nurses work for the benefit of patients.  Avoidable cuts to staff terms and conditions now risk demotivation, disengagement and deterioration in care standards. 

Hindsight is all very well but it doesn’t help deal with the harsh reality of a bleak financial outlook and the threat from “Any Qualified providers”, and high and rising demand for NHS services. However, not only do short-term, knee-jerk attempts to cut costs by reducing terms and conditions have consequences in terms of industrial relations, but also they have a detrimental impact on staff performance. Staff who feel valued perform better and the evidence of the positive impact of good working conditions on patients’ experience is compelling.

The joint NHS trade unions have issued new advice to assist local staff sides facing proposals to change national pay, terms and conditions. This urges trade unions to work together to resist proposals to cut pay, terms and conditions locally and to advocate other more innovative solutions.  While the proposals are inevitable we simply won’t accept that cuts in pay, terms and conditions are also inevitable. 

Josie Irwin is head of employment relations at the Royal College of Nursing

  • 3 Comments

Readers' comments (3)

  • Anonymous

    'The NHS squandered opportunities'

    'Hindsight is all very well'

    'However, not only do short-term, knee-jerk attempts to cut costs .... have consequences'


    Paying staff less, and trying to get more work out of them without providing incentives, stresses staff - and stressed, unhappy or over-worked staff, won't be able to provide such good care as happier, less-pressured, staff could (surely ?).

    I wish people, especially politicians, wouldn't keep spouting this 'we can do more for less' nonsense, as if it were a panacea for all problems - it isn't as if anyone believes that line, is it !

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  • In my opinion and others of my colleagues, the NHS trade unions have become a soft touch for management. So is it any wonder that they leave their members exposed to contractual abuse.

    Employees pay their union subscriptions to be protected from such abuse and l would want them to be saying much more than Josie Irwin appears to be saying.

    If what management is doing is wrong, then they should be hitting them with legal action every step of the way. They certainly take enough from us in subscriptions!!

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  • The NHS has become a feeding ground for managers who's work detracts from patient care. We have so many managers now, who all justify their jobs by producing more and more non clinical work for clinicians. This is a scandal that never seems to hit the headlines. No one actually does the maths to see if the savings brought about by some of the latest initiatives actually cost less than the time and cost being put into them. We need a 'what if we don't?' rule applied to all new interventions that involve work for clinicians. CQC is a culprit - surely the idea was never for clinicians to spend more time gathering evidence than doing care - this by its very nature must have a detrimental impact on care - hardly the goal of a body designed to raise standards.

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