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Pay rise set to be linked to ‘productivity improvements’ in NHS staff contracts


Health secretary Jeremy Hunt has indicated that any future pay rise for nurses and other NHS staff will be dependent on boosting productivity via contractual changes, potentially affecting shift patterns.

The chancellor was not seeking to fund a pay rise above 1% for NHS staff by demanding the health service make further efficiency savings, according to the health secretary.

However, Jeremy Hunt was unable to provide clarity on possible conditions that might be imposed on a wage increase for nurses and others when asked for more detail by MPs yesterday.

Mr Hunt appeared before the Commons health select committee on Tuesday to give an update to MPs on his work as health secretary.

The health secretary recently suggested that chancellor Philip Hammond would be prepared to look at increasing NHS pay, but in return for “productivity improvements”.

“He would like to see some productivity improvements negotiated as part of those contractual changes”

Jeremy Hunt

Yesterday, MPs on the cross-bench committee raised concerns that this could mean looking for further efficiency savings in services “already cut to the bone”.

However, Mr Hunt said this was about contractual arrangements with NHS staff and not making savings in the NHS as a whole.

“What the chancellor has said is that he will consider providing extra money if I am able to secure some productivity improvements in the contractual arrangements that we have with staff members,” said Mr Hunt.

When pressed, he said he did not have any more information from the chancellor about the kind of improvements he would be seeking and this was “really a matter for the negotiations with the unions”.

“He hasn’t given me any more detail than I have given you on this matter,” he told the committee.

“He will consider finding extra funding, so any pay rise wouldn’t – all or in part – have to come out of savings in the rest of the NHS. But he would like to see some productivity improvements negotiated as part of those contractual changes.”

“What he was not saying was that we would expect people to work harder”

Jeremy Hunt

He added: “What he was not saying was that we would expect people to work harder, because I don’t think that is possible at the moment.”

While the pay debate rages, Mr Hunt also confirmed the government was seeking to reclaim up to £100m overpaid in NHS pensions in the past five or six years.

“We are looking to see if we are able to get money back where we have overpaid,” he told the committee, adding later that £62m of the pensions over-payment had been collected to date.

Mr Hunt was quizzed on various pressing issues including spiralling waiting times, staffing shortages and professional regulation in the one-off evidence session with the committee on 31 October.

Safe staffing levels

Key concerns raised by MPs included a lack of nurses and ongoing concerns about safe staffing levels.

“The biggest lack of long-term planning has been around workforce needs”

Jeremy Hunt

Mr Hunt admitted a lack of long-term workforce planning in the NHS had left the health service without enough nurses and under “a lot” of pressure.

“The area where I have felt the biggest lack of long-term planning has been around workforce needs and the failure to understand over many years, really, the lead times needed to increase capacity in the system, because of the time it takes to train new doctors and new nurses,” he said.

“It means that, if we want to improve the NHS, it isn’t just a question of funding – although that is very important – you also need to have the capacity in the system,” he told the committee.

This was why the government had announced a 25% increase in nurse training places, he told the committee.

As reported by Nursing Times earlier in October, the government announced funding would be made available to pay for 5,500 additional clinical placements, though any increase in actual students is dependent on the number of applicants now that the bursary has been scrapped.

If enough people do apply, this placement funding will initially allow the number of student nurses at university to rise from 20,680 this academic year to 25,850 in 2018 – an increase of 25%.

Mr Hunt also suggested to MPs that the so-called “Francis effect” was one of the reasons for high nurse vacancy rates at trusts, with managers increasing their overall establishments.

This was based on the idea that expectations on safety and quality had increased dramatically in recent years, following the inquiry into care failings at Mid Staffordshire Foundation Trust.

“Part of the reason for much higher vacancy rates is because the NHS recognises it needs many more staff than it did a few years ago,” said Mr Hunt.

“In fact, if you look at what the NHS was planning to do with the adult nursing workforce in 2012-13 – they were actually planning to reduce it by just under 5,000 across the NHS,” he said.

“What we have actually done is increased it by around 11,000, which is a good thing,” said the health secretary.

“Putting it very bluntly, happy staff means happy patients”

Jeremy Hunt

He said that since Mid Staffs “pretty much every hospital in the country” had more nurses. “But if you are saying: Do we have enough nurses yet? Then the answer is no,” he added.

“There are still places where we need to improve staffing levels. In a lot of cases, trusts are saying it is not actually about money, it is that they advertise for a post but they can’t actually find anyone qualified to fill that post, which why we’re taking the measure to improve the long-term supply of nurses to the NHS,” he said.

However, he claimed senior nurses in England were not in favour of introducing legislation around safe staffing, like has been done so in Wales, and highlighted instead recently introduced requirements on ward staffing transparency.

On 24 June 2014, NHS Choices began publishing the planned and actual number of nurses on each shift on every inpatient ward in England.

Acute trusts are required to compile a monthly report on staffing to be presented to the trust board each month, which is also uploaded to the NHS Choices site. Each ward must also display information about nurses, midwives and care staff deployed for each shift.

“We looked very carefully about whether we should introduce legal requirements for every ward and every hospital,” said Mr Hunt.

“We had very strong representations from the nursing directors from trusts – up and down the country – that it would be bad thing to do for patients, because that would undermine their clinical autonomy to do the right thing on the ground,” he said.

Sarah Wollaston

Hunt hints that pay rise will be linked to staff contract changes

Sarah Wollaston, chair of the Commons health select committee on 31 October 2017

“What we did instead was introduce ward by ward transparency, so we make it a requirement that every month every trust has to tell us what their nursing workforce is in every ward in their hospital,” he noted.

“That has directly led to the fact that we have around 18,000 more nurses in the NHS than the NHS was planning in 2012-13,” he claimed.

When it came to safety, he said he recognised that staff wellbeing was part of the picture.

“I recognise there is a link between having patient safety and a motivated workforce,” he said. “Putting it very bluntly, happy staff means happy patients and people who are motivated and happy to come to work are much more able to give a higher standard of care to patients.”

NHS targets

Mr Hunt was also questioned about the fact the NHS was failing to meet waiting time targets in accident and emergency, delayed discharge, GP appointments and the core 18-week target for treatment.

MPs raised the possibility that people could sue the NHS if they were not seen within the promised 18-week timeframe, as it was a right enshrined in the NHS constitution.

“It is a right but I don’t think it is a right that – under the law as it stands – entitles people to sue the NHS if we don’t deliver it,” said Mr Hunt.

“That doesn’t mean to say it is not a very important right and a fundamental part of what the NHS offers and what we want it to offer,” he noted.

The goal is for 92% of people to start treatment within 18 weeks of referral but at the moment it is 89.4%.

Mr Hunt admitted this was “not acceptable” and said the NHS “did not want to go back to the bad old days of people waiting a huge period of time for their knees or hips to be replaced”.

“We have conceded that we are not likely to get back to meeting that target in the currently financial year, but we have been absolutely clear to NHS England that we do expect us to get back to that target and they accept that,” he said.

Professional regulation

Mr Hunt was also asked about the timetable for long-awaited legislation to reform the regulation of health professionals, including nurses and midwives, which would give new powers to bodies like the Nursing and Midwifery Council.

“It is very important for patient safety reasons that we streamline and improve professional regulation”

Jeremy Hunt

He said it was “something we have been wanting to do for a very long time”, however he confirmed there was no set timescale for changing the law.

“We’re keen to get on with it,” he said. “It is particularly difficult with all the Brexit legislation that is going to be happening, but it is very important for patient safety reasons that we streamline and improve professional regulation.”

As part of this process, the Department of Health yesterday launched a consultation asking for views on potential reforms affecting the nine regulatory bodies that oversee fitness to practise, education and other standards.

Once the Promoting professionalism, reforming regulation consultation was complete, the health secretary said “we will take a view on precisely what legislation is needed”.


Readers' comments (16)

  • I find this a little worrying?

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  • Here we go again. Nurses have to be more productive to be worthy of a pay rise. Mr Hunt you need a brain transplant, we can not produce anything more the magicians hat has given up. You need to have the courage of your convictions and pay us more. We will than be happy nurses with happy patients. Opps I forgot we don't have the nurses.

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  • This is very worrying. My guess is that they will target the unsociable hours extra pay by scrapping it completely or reducing it to being between midnight and 5am on Sat/Sun nights only. Reductions in annual leave allowance, maternity allowances, change of pension scheme could also be hit...... So we might get a 2% pay rise but actually loose pay with the contract changes. Plus wouldn't surprise me if they stopped offering permanent contracts and give annual renewal contracts instead so if you get sick they can easily get rid of you.

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  • I expect to see contractual changes similar to those normal outside the NHS. Reduction in holiday and sick pay entitlement, changes to Agenda for Change (or local pay which would turn us against each other and make unions irrelevant)

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  • Those of you old enough like me who remember the knots we were tied into courtesy of the unions,getting the payrises before the pay freeze. Dumping the gmc, in favour of self regulation, leading to calls for a degree and dwindling numbers, over reliance on foreign staff and skilled But unregistered carers. The is no soul left to sell

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  • I thought keeping people alive is productive in itself but okay Jeremy.

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  • I knew there was a catch!

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  • It is deeply concerning that "Pinocchio" Hunt seeks to smear the Francis Effect in lieu of being an adult and accepting responsibility for the dreadful state of affairs revealed by the Francis Report.

    It may be that nurses are focusing on staffing levels as a way of clearly expressing their justified dissatisfaction at the destruction of the NHS in favour of privatisation and reduced taxes (crumbs under the table for most) but the fact remains - this government consistently fails to deliver the NHS that most voters actually want. Hunt is just spreading faecal matter when confronted wth his own woeful inadequacies. Of course what I view as an inadequacy (depleting the NHS) is from a Conservative viewpoint, a success story.

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  • He is a disgrace in all his planning what's he's going to take away from us to give back with other hand, he forgets that that we work over our hours and all the study time we do that we don't get paid for! He has no real concept of how the NHS works and how much it gets for free from it's dedicated staff!

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  • I am so fed up of hearing Jeremy Hunt and the Government blatantly lying through their teeth about the state of the NHS. I have been a nurse for over 30 years and I am really concerned about what the future holds for the NHS , student places are not being filled due to the scrapping of the bursary, the uncertainty of Brexit has meant there is a significant reduction in the numbers of nurses from Europe, staff are constantly under pressure working above and beyond their means to ensure patients receive the care they deserve and yet we are still being told we must do better. Perhaps if Mr Hunt were to experience first hand the daily stresses and pressures faced by nurses and doctors he would appreciate how the current situation is not sustainable.

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