Examination of Witnesses (Questions 240-259)
MS SIAN
THOMAS, MR
DAVID AMOS,
MR WARREN
TOWN, PROFESSOR
SIR ALAN
CRAFT AND
MS JOSIE
IRWIN
18 MAY 2006
Q240 Anne Milton: So you feel that
it is being collected elsewhere.
Ms Thomas: I do not know if the
particular point that was raised is collected nationally and it
is not our role to understand why or where that should happen,
but maybe you should ask the question.
Q241 Anne Milton: But you represent
the employers?
Ms Thomas: We do.
Q242 Anne Milton: And employers are
interested in outcomes of data?
Ms Thomas: Yes, for a benchmarking
purpose. Nationally we have not to date—and I am not saying
that we might not in the future—employers at the moment
are not asking us to collection national data from all of them
on service specific issues. We may well do that at some point
but not at the moment.
Chairman: Could we move on to the questions
on Agenda for Change? Charlotte Atkins.
Q243 Charlotte Atkins: From your
earlier comments all of you seem to be quite positive about Agenda
for Change. The Department of Health suggested to us that no professional
group or union coming before the Committee would be critical of
Agenda for Change. Do you have any criticisms at all of the agreement?
Mr Town: I find that a bit difficult
because the Society of Radiographers rejected Agenda for Change
but then took a pragmatic approach to work with it, so saying
that no one would be critical of it is actually not true.
Q244 Charlotte Atkins: Can you give
us the reason for your criticisms then?
Mr Town: The main reason from
our own membership was the increase in the hours from 35 to 37
and a half without any guarantees or additional earnings that
were associated with that increase. That was the main reason for
our members' rejection. What we achieved through discussion with
the Minister was that we would monitor and look at the impact
of Agenda for Change on our members' earnings and if there was
any evidence that there would be a loss we would have to go back
to the Department and talk to them about making good that loss.
That was the agreement we reached with the Minister.
Q245 Charlotte Atkins: Can you define
loss?
Mr Town: Financial loss.
Q246 Charlotte Atkins: Monetary loss
spread over the extra hours?
Mr Town: Yes. Our major concern
at the moment is that although there is a lot of talk about how
the Agenda for Change has been rolled out and it is finished and
it is implemented, it has not—not in radiography, for example.
Only between 8% and 10%, is our estimate, have been matched of
that number and a higher proportion are already appealing. So
we are finding it very difficult at the moment to say that Agenda
for Change is working well and it is difficult to say that it
is not working at all. We can only say that we are still working
our way through, having our members moved on to the terms and
conditions or to be matched or job evaluated under Agenda for
Change.
Q247 Charlotte Atkins: So is radiography
the only area within the allied professions which is problematic?
Mr Town: As far as I am aware.
Ms Irwin: Notwithstanding Warren's
members' concerns about the impact of Agenda for Change on staff
across the NHS I think it has to be said that it is an amazing
achievement that 1.3 million staff have been moved across on to
new terms and conditions in the space of 18 months, and that the
quite high levels of protection which were initially anticipated
have not been realised. The concern might be, as I think Warren
highlighted in an earlier contribution, that the financial difficulties
that the NHS has entered right now may cause some difficulty in
terms of full implementation of the knowledge and skills framework
and the development of competencies and the development of skills
to improve patient care, and there is slight concern that that
may be compromised. But overall I think the contribution that
Andrew Foster made last week was correct in him saying that the
majority of the trade unions would celebrate the introduction
of Agenda for Change, and we do, and it is an enormous logistical
exercise and an enormous achievement in terms of the fact that
it has been achieved through partnership, which has not been achieved
in any other area of the public service so far as I am aware.
Q248 Charlotte Atkins: Is this just
because the vast majority of nurses have seen an increase in pay?
Maybe you could give us an indication of a grade D nurse, what
sort of average rise in pay in percentage terms that nurse would
have achieved?
Ms Irwin: I do not have the figures
in front of me so I have to delve in the depths of my memory,
but I think looking at an average staff nurse moving from grade
D to band 5 we are looking at something of the order of a £3,000
pay increase.
Q249 Charlotte Atkins: Per annum?
Ms Irwin: Per annum. But it is
not just the pay increase itself that is important, it is the
potential to progress, and what Agenda for Change does is introduce
across all staff—not just the nursing staff—longer
pay bands, the potential to progress, the potential for higher
earnings and also, more importantly perhaps, the motivator to
enhance skills and develop and work with other members of staff
in the same sphere.
Q250 Charlotte Atkins: So a staff
nurse getting £3,000 extra a year is really just the starting
point?
Ms Irwin: Yes.
Q251 Charlotte Atkins: They can then
progress to make even bigger increases in pay?
Ms Irwin: Yes, and that goes right
the way up through each of the pay bands and it is applicable
to other groups of staff, not just nursing.
Q252 Charlotte Atkins: Have you had
any complaints about grade compression? Both grade D and grade
E nurses, as I understand, will be assimilated on band 5?
Ms Irwin: There are some localised
concerns which are being played out through requests for reviews
which are allowed through the Agenda for Change process, but we
certainly have not seen any evidence of a real difficulty around
compression. Where there has been compression it is usually local
and generated by the particular management motivation of that
Trust.
Mr Amos: I know, as Josie has
indicated, that a number of specialist E grade nurses are getting
into the band 6 level and that is in recognition of their experience
and skills and what they deliver at a level that is different
from a non-specialist E grade, and I think that is quite a good
example of how compression has been avoided and skills and experience
have been recognised, and the potential for those individuals
to deliver at that level and to take on more responsibility, which
Agenda for Change allows. I just want to make one point about
Josie's recognition of celebration. I think the celebration will
be complete when we look back and say in one to two years' time—and
I ask the Committee to give us time to do this—which is
to demonstrate that we have a return on the investment that is
associated with Agenda for Change. I think that will come in a
number of ways and I am sure you will hear next week. But that
is getting more from the million who have gone through the Agenda
for Change process in terms of them as individuals taking on more
responsibility, either within their classic professional roles
or that have traditionally been dealt with elsewhere, and crucially
how we can now create new roles either at local individual healthcare
organisation level or across local labour markets or even nationally
in order to be able to deal with many of the issues that we have
been discussing this morning. So in order to give a full answer
to your question it is not that we know the answer, but we need
one to two years in order to be able to get that return on investment,
which I know across London and elsewhere staff side, staff themselves
and obviously employing organisations are extremely keen to set
out to achieve.
Ms Thomas: Just a point to illustrate
it. I think your question was about are there any parts of Agenda
for Change that could be improved and David has explained very
well that we need more time and we need to spread the benefits
of Agenda for Change. A very real example, the day before yesterday,
of how Agenda for Change will enable patients to receive better
care, is that we won an award in the NHS for the most popular
graduate scheme and we have moved in a year from being eightieth
for healthcare science engineering and information technology
to being second, beating the world's best employers, and I think
we have to be proud that we have a public service that has the
top graduates of 40 universities that were surveyed, who say that
healthcare is the second most popular career. Okay, we would want
to be number one but I think to move from eightieth to second
in a career like healthcare science where we need those graduates
has to be commended, and we should all really be proud of that.
We certainly are and it is demonstrable evidence that best graduates
going through the system now see a fairer pay system and a better
career framework for them, and I think that is classic evidence
of that.
Q253 Dr Stoate: The Daily Mail
must have missed that headline—I do not remember anything
about that!
Ms Thomas: I will give the Guardian
a plug because the Guardian surveyed 80,000 undergraduate
students in 40 universities.
Q254 Anne Milton: I am having problems
here because I was at the RCN panel last week—and I apologise
for my question being rather broad—but you are painting
a picture that I do not recognise, and I do not think I am alone
around this Committee. Both Sian Thomas and David Amos are painting
a picture and yet we had a lobby from the RCN last week. If it
is all so good why is everybody telling us who is working in the
NHS that it is not very good? I acknowledge that there are some
good things and I think Agenda for Change is a good thing, although
I would have brought junior doctors in on this as well, it has
to be said.
Ms Irwin: Shall I come back in
on that because you are obviously asking your question in the
context of the—
Q255 Mike Penning: It is not just
the RCN.
Ms Irwin: No, the bigger lobby
last week. The question was about Agenda for Change and there
is no doubt across the piece, as I said, that Agenda for Change
is felt to be broadly a good thing by all staff. However, even
the feel good factor about Agenda for Change is beginning to be
tinged by the sorts of difficulties that the NHS has recently
encountered, and it is that which was reflected in the lobbying
activity last week, and a concern that everything that has been
achieved through the implementation of Agenda for Change will
be stymied because of current financial difficulties, so with
the knowledge and skills framework the numbers of appraisals that
might be carried out, the development and training that might
be provided would be cut as a consequence of the financial difficulties,
and therefore the potential unleashed by Agenda for Change would
not be realised. So it is not quite fair to say that that is not
what you have been hearing, what you have been hearing is concerns
about the NHS writ large and not about Agenda for Change.
Mike Penning: No, that is not true.
Q256 Anne Milton: Mr Town is jumping
up and down in his seat—I can feel it!
Mr Town: There are a number of
salient points. The radiographers rejected it but there was a
clear view that the long-term effect of Agenda for Change is a
benefit. That was not an issue; the issue was around the hours,
as I have said, but also about the commitment from the Department
to both fund and support the process of Agenda for Change, and
I think in recent weeks, in recent months, that has also become
an issue, and in many ways it may be that Agenda for Change is
now suffering from project fatigue and that people are beginning
to lose sight of what they are trying to achieve because they
are trying to put so much in place at the same time with so many
competing ideas, so many competing policies. But there is inevitably
a short-term problem—when I say short-term I would go a
bit further than two, I may go as far as five years—because
many of our members who are in radiography, who have already accepted
extended roles before Agenda for Change came in and have used
their opportunities to enhance their earnings are now on protected
salary. That in itself is a major problem because individuals
then do not see any benefit in moving anywhere further whilst
they remain on a protected scale. So if ultra-sonographers have
extended their role and do reporting, if radiographers have extended
their role and do reporting, have increased their earnings, they
are then stuck on a protected salary because they have already
moved on from Agenda for Change as it stands at the moment. That
is part of our evidence to the pay review body for the next period
but it is still a problem and that is part of the issue that we
have seen amongst our own members who have said, "I have
gone through all this, I have worked very hard and now I feel
I have been kicked in the teeth."
Q257 Chairman: The Department of
Health last week told us that the amount of staff on pay protection
is some 4.5%; is that correct?
Mr Town: Overall. Our estimate
at the moment is 40% of radiographic staff that we have had matched.
Q258 Chairman: You do not dispute
it is just 4.5% nationally, as it were?
Mr Town: Nationally, yes.
Q259 Chairman: At this stage?
Mr Town: Yes.
Chairman: Clearly all Agenda for Change
has not been implemented yet. If we move on, Jim Dowd.
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