Examination of Witnesses (Questions 271-279)
DR JONATHAN
FIELDEN, MS
KAREN JENNINGS
AND MR
ALASTAIR HENDERSON
8 JUNE 2006
Q271 Chairman: Good morning. Could I
welcome you to our third session in relation to our inquiry into
workforce planning and ask you to introduce yourselves and your
organisations for the record.
Ms Jennings: Good morning everybody.
My name is Karen Jennings and I am the National Secretary for
Health in UNISON. UNISON is the largest trade union in the Health
Service, representing over 450,000 staff right across the piece,
other than doctors and dentists.
Mr Henderson: I am Alastair Henderson.
I am Deputy Director of NHS Employers, the employers' organisation
for NHS Trusts. I am particularly responsible for pay and negotiations.
Dr Fielden: I am Dr Jonathan Fielden,
a consultant anaesthetist with an interest in intensive care medicine.
I am Deputy Chairman of the Consultants' Committee of the BMA
and also the Chairman of Negotiators.
Q272 Chairman: Thank you for coming
along. Dr Fielden, we are now paying our consultants a lot more
as a result of the 2003 contract. Why have we not seen more improvements
in return for this extra pay?
Dr Fielden: I think you have seen
improvements in return for the extra pay. The hours that consultants
are doing are now properly rewarded and recognised. There are
tools available within the contract to ensure that job planning
allows consultant time to be focused for the best benefit of patients,
and you have the tools to engage consultants at trust level in
the objectives and direction that trusts need to go. There are
other tools there. Some trusts—my own, for example, and
there are many others around the country—are using it very
well and very successfully. Others—and in an organisation
as big as the NHS I suppose you would expect this—are not
using those tools as well as appropriate. Those tools are there
to be used and we are there to help them.
Q273 Chairman: We were told by the
Academy of Medical Royal Colleges that the short-term impact of
the new consultant contract has been to reduce the productivity
of the consultant workforce. You are saying, Dr Fielden, that
that has not happened, certainly in some areas. Do you agree with
that statement?
Dr Fielden: I would not agree
with the statement. Having said that, we would have to ask what
you mean by productivity. You asked the Department what they meant
and they came back with a whole range of productivity measures.
I think the Department has to decide what measure of productivity
it is talking about and then we can come back to answering that
question. The contract was about recognising the workload that
consultants did, appropriately remunerating it and giving the
tools for engagement between employers and employees, and I think
that is what the contract has done and will allow that relationship
to develop.
Q274 Chairman: Mr Henderson, do you
have any comments on this?
Mr Henderson: Yes, indeed. I think
it is important, both with the consultant contract and the Agenda
for Change, to recognise what they can and cannot deliver.
The consultant contract is a contract of employment; Agenda
for Change is a pay system. By themselves they do not result
in improvements to services; they are tools to be used. As such,
I think they can be tools that can either be a hindrance or a
help to organisations making changes. I am pretty clear, both
with the consultant contract and Agenda for Change, that
compared to what we had before they are huge aids to organisations
making changes. Specifically on the consultant contract, my colleague
David Amos, who came to you a couple of weeks ago, described in
what I think was quite a nice way that we now have a currency
and a method for engaging with consultants that we did not have
before, a currency with which we can talk about how their work
is planned, how their work is delivered, and we can talk about
how work needs to be changed, if it does. I think that is now
beginning to happen in the NHS.
Q275 Chairman: Andrew Foster, who
I know has left the post, came here and he said to us that he
believed a lot of organisations put more effort into simply getting
people onto the new system than generating the benefits from it.
Do you think, Mr Henderson, that the implementation of the contract
was rushed?
Mr Henderson: I do not know about
being rushed. I think just on 90% of consultants are now on the
new contract—and remember it was their choice to do that.
I think it is important to recognise that it was not implemented
in a uniform rate or manner across the NHS—and that is probably
not surprising. I think it is true that to start with there was
probably as much attention paid on the process of putting it in
and the process of job planning rather than the content—and,
again, that is not necessarily surprising. There was a huge amount
of activity going on and the transactional job of getting the
new contract in of itself was a major task and organisations did
understandably concentrate on that to start with. In the second/third
round of job planning, we are seeing organisations, now that the
structure and the machinery is in place, concentrating on how
you use the job plans, how you develop them. I think we are seeing
more and more of that.
Q276 Chairman: Are you saying, basically,
that we are seeing more benefits from it now than we were with
the initial implications?
Mr Henderson: Absolutely. I think
that is happening all the time. I think there is a range of examples
of benefits and of ways that it has been used. There are a number
of examples one can find of job plans that now have team job planning
which provides cross-cover across various specialities. That has
happened in anaesthesia, in paediatrics, in radiology. In Plymouth
Hospital, I know they have introduced, through a contract, annualised
hours and team job plans in their colorectal team. That has meant
that they have now not had any cancellations of clinics due to
consultants' annual leave (which was something that used to happen)
and they have 100% utilisation of sessions. Bart's would tell
you that their team job planning has helped them deliver their
A&E targets. Hampshire Partnership Trust, as well, developed
evening services there for consultants. That developed, over time,
through better job planning, through better dialogue between consultants
and managers to sit down and work out how they do that best. That
is going to develop over time.
Q277 Dr Naysmith: Dr Fielden, could
I ask you a question to do with the negotiation stage of the contract.
Andrew Foster told us last week that he wanted to run a pilot
scheme but the BMA refused even to consider it. Is that true?
Dr Fielden: My recollection is
different: that the piloting was refused at higher level.
Q278 Dr Naysmith: Higher level in
the Department of Health?
Dr Fielden: Yes, at either ministerial
level or higher.
Q279 Dr Naysmith: Why would Andrew
Foster say that when he was in charge of the negotiation?
Dr Fielden: I am not sure on that.
From our position, we felt that there may or may not have been
some benefit of piloting, but actually it was better to bring
out the contracts across the board. To our recollection, we did
not refuse piloting.
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