Examination of Witnesses (Questions 300-319)
DR JONATHAN
FIELDEN, MS
KAREN JENNINGS
AND MR
ALASTAIR HENDERSON
8 JUNE 2006
Q300 Mike Penning: Is that because
of the difficulty in looking at their job descriptions and fitting
into certain bands, or is it just because of the way that admin
in the NHS has expanded so much over the years and we do not quite
know what pay they should be on?
Ms Jennings: I think it is a combination.
Also I think the panels that were implementing and assimilating
the staff needed additional advice and information about where
to place those staff, so that they were not demonstrating any
bias towards clinical staff and therefore not fully understanding
the role of the admin and clerical staff.
Q301 Mike Penning: Are UNISON happy
with the way the appeals procedure is working for those who have
suffered? I have had correspondence from constituents whose pay
has dropped. Is the appeals procedure working well or are there
teething problems there as well?
Ms Jennings: It appears to be
working well at the moment. We are not getting complaints through.
Because it is done in partnership, I certainly think that the
mechanisms for appeal are much better than they were under the
previous pay and grading system, the clinical trading structure.
I think we have learned a great deal about how to work in partnership
and to ensure that there is a fairer process in place.
Q302 Mike Penning: Mr Henderson,
from the employers' side.
Mr Henderson: The protection is
less than was first thought. It is important to remember that
protection does ensure that nobody's pay drops at all. I mean,
it may stand still but it does not drop. I think Karen is right,
our view is that probably the majority where protection is, is
in admin and clerical roles.
Q303 Mike Penning: And a 4.5% is
something that you see as well? We have heard slightly higher
figures, so I am interested in confirming what you think.
Mr Henderson: Yes, I think that
is about the figures that I am picking up. The estimation was
that it could be up to 9%, but I think it is less than that. It
is running at around 4.5%.
Q304 Dr Taylor: The people who have
been in touch with me have been people in the more senior grades.
Is it fair to say that they would mostly, if we are talking about
nursing, be in the RCN rather than in UNISON. I am talking about
nurse consultants, nurse specialists. A large number of those
I think are on standstill, which is quite hard. I know it is not
as bad as a pay reduction but it is quite hard when your pay suddenly
sticks and other people, who are probably doing not much more
than you, are on an increasing range.
Ms Jennings: UNISON represents
a broad family, including senior nursing staff. We have 240,000
members. I think the important thing to remember is that Agenda
for Change is about an equal value pay system and it has a
rigorous process of determining where individuals are assimilated
to. Our evidence is not necessarily that senior nurses are suffering
more than other groups of staff.
Q305 Dr Taylor: Those who are being
made to standstill were probably being paid too much before, is
that what you are saying?
Ms Jennings: No, I have not said
that. I think if they are standing still then they have been properly
evaluated and are being paid what they should have been paid.
Q306 Dr Taylor: Do you have physios
and occupational therapists?
Ms Jennings: We have occupational
therapists.
Q307 Dr Taylor: Have they been affected?
Ms Jennings: Occupational therapists
have, indeed, been affected. In our submission to the Pay Review
Body evidence, we are concerned that the recruitment and retention
of occupational therapists is very worrying—in fact, I think
they are the second largest occupational group that continue to
have major shortages. There are some concerns for highly skilled
technical staff to go on to gain access to education and training
on occupational therapy. We believe it would be helpful, in that
case, if recruitment and retention premia were utilised to enable
better recruitment of occupational therapists, because they do
not feel they have done as well out of Agenda for Change
as other comparable groups.
Q308 Dr Taylor: Is it, again, the
more senior occupational therapists who feel hard done by?
Ms Jennings: I think it is across.
Q309 Dr Taylor: I think Mike mentioned
pharmacy. What about pathology, the path lab technicians—the
medical laboratory scientific staff?
Ms Jennings: I think there is
still a lot of work to be done on their job profiles. It is a
continuing process, looking at the job evaluation scheme and developing
profiles for those particular schemes. We are trying to look at
a family of job descriptions and profiles which will enable a
better career development and better career structure for those
groups.
Q310 Chairman: Is there any evidence
at all, both Karen Jennings and Alastair Henderson, that Agenda
for Change has been used for cutting costs in any trusts that
may not have spending problems?
Mr Henderson: Not that I have
seen at all. I am not sure how, particularly, it might be. There
has been a rigorous process of job evaluation, of putting people
on to new schemes. I have not heard that as a complaint.
Ms Jennings: I think it is a very
interesting question and it is certainly something that was used
in previous pay systems to depress the grades that existed. Generally
speaking, that has not been the case. However, I think there has
been some industrial strife in the ambulance service, in particular,
where it has been felt that a blanket grading of certain staff
has been brought in to depress costs and we are trying to look
at mechanisms to overcome that. I think that is a claim that could
be made there.
Q311 Chairman: Mr Henderson, do you
want to add to that.
Mr Henderson: I think there have
been some anxieties for ambulance staff to have. It is slightly
ironic that ambulance staff overall have done particularly well
out of Agenda for Change. Often in a pay reform it is a
comparative evaluation, that you may have done well but you perhaps
did less well than you thought you ought to have done. With the
allied health professionals, it is an average £3,500 gain
that people were making, and, with nurses, over £4,000 around
each of the grades was the average gain that was being made.
Q312 Chairman: On the issue of Foundation
Trusts, I think in theory they do not have to endorse or take
on board Agenda for Change. Do you feel there is any threat
that that may happen at some stage in the future?
Ms Jennings: When the Foundation
Trusts first came into being, clearly Alan Milburn was making
promises that in the Foundation Trusts' five-year business plan
they would have to include Agenda for Change. It is not
clear that that has to be the case with subsequent secretaries
of state. It certainly is not a requirement within the legislation.
Of course the regulatory body for Foundation Trusts does not have
a mandate over pay and terms and conditions of service. We do
have concerns about the future of the continuing of Agenda
for Change in national bargaining as the roll-out of Foundation
Trust Hospitals takes hold. We have tried to have meetings with
the Foundation Trusts' network, to no avail because they do not
want to meet on a collective basis. That sends early alarm bells
in our collective heads around the future of collective responsibility
around pay and negotiations, and we have examples of some trusts
which are departing already from pay and terms and conditions
of service, particularly, for example, around admin and clerical
staff. That is happening in London in some Foundation Trust Hospitals
where they are having some difficulty recruiting and retaining
their staff.
Q313 Dr Stoate: If we are moving
towards all hospitals being Foundation Hospitals by 2008, which
is the Government's stated aim, then surely Agenda for Change
is theoretically dead, so why bother with it? If all hospitals
become Foundation Hospitals and Foundation Hospitals do not have
to stick to Agenda for Change, then what is the point of
Agenda for Change?
Ms Jennings: The experience under
the Thatcher years was that when trusts were legally allowed to
set their own pay and terms and conditions of service, the vast
majority did stick with the national terms and conditions of service
because it made huge sense not to replicate that negotiating at
a local level. But I do think we did see at that time some maverick
trusts and renegade trusts which did move away. If that begins
to happen, particularly as it becomes more and more competitive,
we are going to see, I think, more industrial relations problems
and differences between staff and how they are trained.
Mr Henderson: I think Foundation
Trusts but all other organisations have the right to do different
terms and conditions and they are legally allowed to. I think
Karen is right, Agenda for Change does provide a framework,
and an attractive framework, but it does provide an awful lot
of flexibilities as well. That was all part of the purpose. I
do not see at the moment much due from foundation or other trusts
to want to do it because they have a system that they can use.
Also, it is not the best use of everybody's time to reinvent wheels
if there is a good framework there.
Q314 Charlotte Atkins: Moving on
to the new Knowledge and Skills Framework provided by Agenda
for Change, we have had glowing reports from various witnesses.
Is it really as good as it seems? I see from the UNISON evidence
that you are calling for the ring-fencing of learning and skills
budgets, so clearly you do have some concerns about the whole
training agenda.
Ms Jennings: Thank you for that
question. The Knowledge and Skills Framework is like the jewel
in the crown of Agenda for Change. It is inspirational,
in the sense that, for the first time, all staff in the NHS—from
porter right through to consultant and chief executive—have
the right to access to education and training. Alarmingly, in
the Healthcare Commission's report it indicated that less people
this year had professional development plans than last year, so
something is going wrong in terms of that access assessments in
relation to their education and training. Also, because of the
trust debt situation, I know we have had alarming headlines about
redundancies and job cuts, but, when a trust does that, it goes
through the whole system of what you can cut elsewhere. So there
is a whole range of other mechanisms to save money before you
then announce, as well as that, staff redundancies, and the big
chop is in education and training, without a doubt. We are seeing
that right across the country. In fact, we have a letter from
I think the South West London Strategic Health Authority that
has written to all trusts saying there will be no money for NVQ
training, there will be no money for seconding healthcare assistants,
there will be no money for post-registration training—and
we are talking about a large number of trusts. In fact I have
the letter here, so you are very welcome to see that, but it is
saying that there will be no cash allocation to trusts, there
will be no new healthcare assistant secondments, there will be
no new full-time AHP secondments, there will be no funding for
seconding registration students, there will be no funding for
EN conversion, there will be no NVQ funding. If you look at where
staff are being developed at the moment, where the biggest growth
is, where the richest pool for recruitment into professional education
and training is, it is healthcare assistants. UNISON's own healthcare
assistants' surveys have repeatedly shown that 80-90% of healthcare
assistants want to gain access to education and training, want
to develop themselves to a high level, and want to go on to do
nursing, occupational therapy, or whatever it is, ambulance paramedic
training. We are going to cut that source of potential recruitment
which is key to the modernisation of the NHS—absolutely
key—if we have nurses that are shifting up and up-skilling
and therefore needing more hands-on staff. Could I mention, on
this skill-mix element, that the commissioners of education and
training are very tunnelled in their vision about where to access
education and training from. There are no universities that provide
part-time registration training. Now, do you not think that is
bonkers? In a time when the average age of a student nurse is
29 years of age, has children, how on earth can they last on a
course that is full-time? We would like to see—which is
something UNISON has developed with the Open University and NHS
Professionals—a true skills' escalator, where you are providing
education and training to healthcare assistants, enabling them
to gain access to pre-registration programmes and going on part-time
courses—and you find that the attrition rate is way in excess
in full-time courses than part-time courses. We have to ask Strategic
Health Authorities, who commission the education and training,
to start to open up their eyes to better opportunities for that.
It is much more cost-effective. Just think about the money you
are losing all the time.
Q315 Charlotte Atkins: Presumably
you have put this to the Department of Health, have you?
Ms Jennings: We have put this
to the Department of Health.
Q316 Charlotte Atkins: What sort
of response have you had?
Ms Jennings: I wrote to Patricia
Hewitt earlier in the year expressing my concerns about the potential
lack of money for education and training and the answer that I
had to that was that they had not set the budget yet. We have
made numerous approaches to the Department of Health about looking
at widening the opportunity and the access for pre-registration
training and to look to develop part-time courses. There is a
bit of a stranglehold, I think, between the Commission in this
and the higher education institutions.
Q317 Charlotte Atkins: Are the NHS
Employers very much in favour of the UNISON approach here? Presumably
it would increase productivity if you can train the existing workforce
to take on more responsible roles, as encouraged by Agenda
for Change, rather than taking people in who might decide
health is not really their thing and they will leave and hence
you waste all that time.
Mr Henderson: Absolutely. That
is a core part of Agenda for Change since we started. That
is a core part of the KSF and there are good examples of that.
In Dartford and Gravesham there is an example of a ward administrator
who has taken on more roles, in terms of admission of patients,
and is doing that. Developing those people—and Karen is
absolutely right, those people who work in the NHS normally want
to get on and move on—is an entirely sensible thing to do.
I think KSF will be a real benefit in doing that.
Q318 Charlotte Atkins: One thing
that the Committee is a bit concerned about is that the Knowledge
and Skills Framework has not been implemented until after the
job evaluation. Were there any other approaches considered rather
than just doing that process whereby job evaluation happens first
and then the Skills Framework? Surely, the Skills Framework and
the training element of it should have been put in much earlier.
Mr Henderson: I think it is. I
think we now have about 85% of KSF outlines, about 55% of full
KSF. My understanding is that it was really just in part practical
terms that you could not have done that before. There is a cycle
for the KSF which starts coming in from this October. The task
of implementing the whole new job evaluation pay system was pretty
hard. I am not sure whether it would have been possible to do
it altogether, but it is now coming in.
Q319 Charlotte Atkins: Clearly, this
is key to productivity.
Mr Henderson: Absolutely.
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