Health unions have voiced concerns after Jeremy Hunt revealed in an interview this week that he wished to overhaul NHS payments for night and weekend work in return for a pay rise above 1%.
The health secretary cited the agreement made following the angry dispute with junior doctors in 2016 as a potential “model” for the more than one million staff on the Agenda for Change contract.
Mr Hunt was speaking in the wake of last week’s budget, in which the chancellor committed to provide “additional funding” for a salary rise after the completion of the current pay review process.
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He told the Commons that he would fund a pay rise for nurses and other staff outside of the normal health service budget if it was recommended next year by the independent NHS pay review body.
But Mr Hammond also indicated that any rise would also be dependent on successful negotiations on updates to the Agenda for Change contract by the government, NHS Employers and unions.
“The biggest area that we have wanted to reform for a long time is the system of increments”
In an interview with Health Service Journal, published on Tuesday, Mr Hunt indicated that this meant staff could see their basic pay increased, but in return to cuts for weekend and nightshift pay.
The health secretary said the government was not aiming to reduce the amount of money paid to NHS staff and said reforming the Agenda for Change contract was not aimed at saving money.
Mr Hunt said he wanted to achieve a “more professional pay structure” in line with government policy on public sector pay generally.
This is likely to include reform of the increment pay structure within Agenda for Change as well as enhancements for the time staff spend working at premium time such as weekends and nightshifts.
Mr Hunt said the contract ultimately agreed with junior doctors “was sensible” and could be a model for a new Agenda for Change contract – with staff who work more weekends getting higher pay.
Out of hours enhancements can substantially increase a worker’s salary, with nurses working on a Sunday getting as much as a 60% uplift in basic pay, while a nightshift can have a 30% premium.
“This isn’t a money saving thing but about moving to modern professional pay structures”
For the lowest paid staff, these rates can be even higher at double time on Sundays and 50% premiums on a weekday nightshift.
The health secretary told Health Service Journal that, across the whole public sector, the government had “been wanting to move towards more professional pay structures”.
“The biggest area that we have wanted to reform for a long time is the system of increments – in particular, payments that simply relate to time served rather than any measurable increase in professional abilities,” he said.
“We have no desire to reduce the total amount paid to the NHS workforce by any such reforms,” he said. “This isn’t a money saving thing but about moving to modern professional pay structures.
“We are still going to have premiums for antisocial hour payments. Funnily enough, the model that we ended up agreeing with the British Medical Association for the junior doctors’ contract is quite a sensible one, which is essentially higher pay for the more weekends you work. We recognise that.”
He added: “I think, to their credit, most unions are very open to these discussions. We are having very productive discussions with Agenda for Change unions… so hopefully those will continue.”
“His intervention has not helped the prospect of a deal on pay in the NHS”
But unions expressed their irritation that the health secretary had gone public with his thoughts on alterations to Agenda for Change, prior to the continuation of negotiations.
However, there also appeared to be differences, with some unions keener to defend the increment system of salary uplift and others more concerned about watering down antisocial hours payments.
A spokesman for the Royal College of Nursing warned that Mr Hunt was “in danger of repeating the junior doctors row if he deploys the same tactics”.
“His priority must be to talk to unions and representatives of the professions, rather than the media,” said the spokesman.
“He provides welcome confirmation on keeping unsocial hours payments, but he appears to be ill-briefed on the increments system. They are not automatic and recognise career progression, not simply time in a post,” he said.
“The RCN will not accept the government’s productivity argument as a condition of a pay rise and we will not support any reduction in terms and conditions,” he added.
The Royal College of Midwives said it appeared that Mr Hunt had “ignored the advice” of unions and others engaged in exploratory negotiations on pay and the Agenda for Change structure.
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“That advice was to explore more and talk less. His intervention has not helped the prospect of a deal on pay,” said Jon Skewes, RCM director for policy, employment relations and communications.
“Last week’s budget was helpful on funding, but the secretary of state, by citing the junior doctor’s dispute, has blundered,” claimed Mr Skewes.
“We regard the Agenda for Change agreement as a most professional contract that is based on equal pay for work of equal value and we will not be prepared to weaken it,” he said.
Mr Skewes acknowledged that the RCM thought the “pay structure could be improved” but it was not prepared to reduce the compensation that midwives and other NHS staff received for providing a service “every day, every night, every weekend, every bank holiday, every Christmas holiday”.
“Mr Hunt would be well advised to address the real terms pay loss our members have suffered over the last seven years. It would be entirely unacceptable to ask midwives and other NHS staff to fund their own pay increase through cutting their terms and conditions,” he added.
As previously reported and confirmed today by the health secretary’s comments, any fresh talks on updates to the Agenda for Change contract by the government, NHS Employers and staff side unions will form part of an ongoing process that is already underway.
Both sides are understood to have previously been discussing potential changes to the contract, including increment pay points and pay bands, with talks ongoing since the industrial action in 2014 amid previous concerns about proposals for seven-day working.
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However, the discussions had stalled due the previous absence of an offer of any new money for pay increases above 1% – a barrier that had seemingly now been lifted.
Meanwhile, as reported earlier this week, RCN campaigners have written an open letter to their leaders, criticising them for an “underwhelming” response to the chancellor’s comments on pay.
Three RCN members, some of whom were at the forefront of pay protests earlier this year, have said the union was too positive in its comments in the wake of the budget on 22 November.
They argued that the RCN must be more “militant” and have called on others to sign their letter asking for the college’s leadership to consider industrial action as its “only response to this budget”.
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The activists questioned what the government hoped to achieve through its “pay structure modernisation talks” on the Agenda for Change contract and called for “transparency” for staff.
Also citing the junior doctor dispute, they said: “Nurses, midwives and all other members of our health professional family should be democratically involved every step of the way, to halt any devastating cuts to key components… and not let the Department of Health walk all over us.”