The current “staffing crisis” in the NHS has been a major driver behind the new pay deal, with hopes it will boost recruitment and retention of nurses, say those involved in devising the framework.
At a press briefing earlier today, Sara Gorton, chair of NHS Trade Unions and Unison head of health, said the pay agreement had been forged amid “a staffing crisis of daunting magnitude”.
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“We have experienced staff who are leaving in greater number than ever before, we have difficulties in attracting new staff to come and work in the NHS,” she said.
“That means that those people who are left are feeling the strain. They are carrying more work and feeling less valued than ever before,” she said. “Pay is a root cause of all of these factors.”
Royal College of Nursing’s associate director for employment relations, Josie Irwin, said trade union action and widespread protests over pay by frontline staff had been a key factor in securing the deal.
“Frontline staff played a major role across the summer in a summer of protest that has drawn the government’s attention to the impact of low pay on both sickness and retention and inevitably on patients,” she said.
“Our primary objective between the three parties has been the recruitment and retention staff”
Ms Irwin said: “It is pressure from unions that led to the government scrapping the cap in October, which then allowed us to have the conversation that we’ve had about putting together a framework.
“We think [it] will fundamentally go to the heart of the recruitment and retention problem and, more importantly, send a message to all staff in the NHS that they are valued by their employer and by members of the public,” she said.
The RCN negotiator pointed out that nurses were among those who had strived to keep the NHS up and running amid challenging winter pressures and poor weather.
“Over the winter we have seen – not only nursing staff – but the whole of the NHS staff group make a major contribution to keeping the service going,” she said.
“In the period of awful winter weather, we saw nurses and other staff trudging through the snow to ensure their patients were cared for and sleeping in hospitals.”
However, she said nursing in particular had been badly hit by a combination of pay freezes and policy that had “seen some of the traditional supply routes for nursing cut off”.
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She said the proposal on the table would “improve the starting salaries to attract new nurses” and also “reduce the impact of student debt”, as well as enabling nurses to reach the top of pay bands in a shorter time.
While a new pay structure would not – in itself – address other worrying workforce issues, Ms Irwin said she hoped that the agreement would also ensure a greater focus on wellbeing.
“There continue to be huge issues about the working environment, too many staff suffering violence at work and bullying and harassment,” she said.
“But what this framework does is goes beyond pay and commits the Staff Council to understand the impact of some of these issues on staff health and wellbeing and work together to tackle them,” she said.
The agreement includes a commitment to “improve levels of attendance through a focus on staff health and wellbeing at a national and local level”.
“The ambition is that through positive management of sickness absence the NHS will match the best in the public sector,” says the framework document.
It states a work programme will be set up, which will include an assessment of the main factors affecting attendance levels and review of current arrangement to manage sickness absence.
“In the period of awful winter weather, we saw nurses and other staff trudging through the snow”
Meanwhile, the document also suggests there may be scope for offering incentives to staff to do extra shifts.
It says the NHS Staff Council will look at the scope for a “collective framework agreement on bank and agency working”, which will include looking at providing “cost-effective” incentives to encourage staff to work for internal staff banks.
Meanwhile, Danny Mortimer, chief executive of NHS Employers, agreed that boosting recruitment and retention was a key goal.
“Our primary objective between the three parties – the Department of Health and Social Care, trade union colleagues and employers in the NHS – has been the recruitment and retention staff,” he told the briefing.
He said: “We do believe this three-year deal gives us a really important platform to take action in other areas to make sure the NHS becomes again the most desirable employer in the country.”
However, Mr Mortimer admitted that there had been compromises on all sides. “Compromises have had to be made. Not everything the trade unions wanted to achieve has been delivered through the deal and the same stands for the Department of Health and Social Care and for ourselves as employers,” he said.
The agreement includes a commitment to “strengthen and improve the appraisal process”, with how it will work and the standards required to progress through “pay-step points” to be set out in further guidance.
Mr Mortimer said the £4.2bn investment by government had not been calculated on the basis that fewer staff would get pay increases.
However, there was “a clear expectation” there would be “a stronger relationship between discussions about achievement and proficiency” and pay.
But Ms Irwin maintained that a new focus on meeting certain standards would not make it harder for nurses to progress up the pay scale.
“In fact, what the agreement does is strengthen the line manager role in working with their members of staff to give them a proper appraisal with clear objectives,” she said.
“We know there are some areas in the NHS where appraisals still don’t happen,” she said. “It does require work from employers and on our part to ensure that standards are clear. Is it harder? No it won’t be.”
Under the new pay structure, salaries for senior nursing staff at bands 8c, 8d and 9 will continue to include an element of performance-related “re-earnable” pay – a feature of the terms and conditions for these bands since 2013.
However, new guidance has also been promised to ensure “effective and consistent use” of this. In the year after employees reach the top of these pay bands, up to 10% of their basic salary will become “re-earnable”.
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This means senior nurses who perform well will continue to earn their basic salary, but those who do not live up to expectations can see their pay reduced by 5% or 10%.
They can restore their basic salary at the end of the following year by achieving agreed levels of performance.
“Creating an effective link between personal accountability for performance and pay is a key objective of these arrangements, building on the 2013 changes,” states the pay agreement document.
It added that employers will “put in robust monitoring arrangements for the use of annually earned pay”.
Meanwhile, the document promises new provisions in NHS terms and conditions to ensure staff have consistent access to child bereavement leave, enhanced shared parental leave and a national framework for buying and selling leave.
The agreement also includes changes to eligibility for certain payments for those who are injured or become ill because of work, including the fact all new NHS staff appointed from July 2018 onwards will not be able to claim unsocial hours pay during “occupational sick leave”.
“We have experienced staff who are leaving in greater number than ever before”
A period of formal consultation with union members will now begin and this is expected to be concluded by the end of May with the outcome reported by 8 June.
If the agreement is accepted, then pay increases could be available to staff as soon as July this year with pay rises backdated to April 2018.
In addition, if ratified in England, then additional money will also be available to the NHS in Scotland, Wales and Northern Ireland.