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.
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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”
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”
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”
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%.
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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”
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.
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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.
Hunt hints that pay rise will be linked to staff contract changes
“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.”
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.
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”
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”.