When David Cameron and Jeremy Hunt talk about seven-day services, anyone would think it is a new concept. Yet thousands of nurses, midwives, healthcare assistants and other NHS staff already work shifts across a 24/7 pattern.
When people go into hospital, their admission day or time should never be a factor in determining how well - or even if - they recover. Unison members would absolutely agree with that, so putting money into ensuring more services are available over seven days is to be welcomed. Of course the NHS should be flexible in meeting patients’ needs but when budgets are tight and demand is growing, any government would be irresponsible to encourage the public to see - and use - the NHS as a 24-hour supermarket.
Throughout this year’s election campaign David Cameron was coy on where the promised £8bn extra funding for the NHS is to come from. Unison and other health unions are concerned this is to be paid for by cutting the wages bill - specifically existing provisions for unsocial hours payments. To put this in context, a nurse’s average pay in the UK is £30,948pa, which includes an average of £3,901 pay for overtime and working unsocial hours. Cutting the unsocial hours premium would make NHS pay unattractive and uncompetitive.
There is clear evidence that working unsocial hours over a long period affects not only family and personal life but also health and wellbeing. Most people would agree that staff working such shifts should be fairly paid for doing so. When the Pay Review Body Board reported in July, it had accepted much of the evidence submitted by unions. It said cutting payments for staff already working seven days would not just hit their take-home pay and damage their goodwill but would also make them less willing to work unsocial hours. It also said moving to a seven-day service would need more resources - ie more staff - and a lack of trained staff was a huge barrier. Making changes without planning for the impact could result in increased agency costs.
Although Jeremy Hunt has said he accepts the PRB report, he expects changes to be made as part of the overall reform of Agenda for Change. At the same time the chancellor has now confirmed to the PRB that the government’s proposed public-sector pay cap of 1% for the next four years is only an increase to the pay bill. This will not deliver even a paltry 1% to all NHS staff each year. Instead this will be “targeted”, with some receiving more than 1% and some less. It’s now apparent that the much-vaunted claim to increase the minimum wage to £9 per hour by 2020 will also have to be funded from this money. This doesn’t leave much to be “targeted” elsewhere - and leaves no room for manoeuvre in any negotiations on contract reform.
We must guard against the government and cash-starved NHS employers taking a one-dimensional approach to seven-day services that is focused on cost and getting more from staff for the same or - as is more likely - less money. We’ve been told the government believes any changes should be “cost neutral”. But if the plan is to have more services running over seven days, with more staff working unsocial hours, the only way this can be achieved is by cutting the unsocial hours premium for existing staff. I doubt many nursing staff would feel terribly “neutral” about this.
This is a complex issue that requires a service specification based on a real understanding of the clinical evidence and likely benefits of change before a workforce model can be developed. Patient safety and health outcomes must be the driving factors in this policy. It must not become a stalking horse to cut the pay of vital and committed NHS staff.
Christine McAnea is head of health at Unison