Examination of Witnesses (Questions 760-779)
MS ANNE
RAINSBERRY, MR
JOHN SARGENT
AND MS
TRISH KNIGHT
14 DECEMBER 2006
Q760 Dr Taylor: We have just touched
on SHA services and the MPET budget. I want to try and dig a bit
further into this. In the year 2005-06 we know that the gross
NHS deficit was 1.27 billion and it was reduced to about 500 million
because of SHA surpluses, largely. How did that affect the MPET
budgets in your two areas, thinking of Anne and Trish? Were you
at any time instructed that you had to hold back on the MPET budgets
to allow your SHA to have a big surplus or was that not the case?
Ms Rainsberry: I cannot answer
because I was not in post at the time. I can talk for this year
but not for 2005-06.
Q761 Dr Taylor: Trish, were you about
that year?
Ms Knight: We had discussions
around how to best manage the MPET budget within the financial
envelope that was given to us and the Strategic Health Authority
was very open to trying to maintain the education budget. We are
perhaps fortunate with the Strategic Health Authority but they
were very open to maintaining it at the level we had.
Q762 Dr Taylor: In your area they
were able to maintain it, were they, pretty much?
Ms Knight: Pretty much, yes.
Q763 Dr Taylor: Going on to 2006-07,
the figures we have for London, the total MPET allocation for
2005-06 for the five London SHAs, was 886 million which was 86%
of the total SHA budget. For 2006-07, you are taking a cut of
60 million down to 826 million. How is that going to affect the
workforce and the training?
Ms Rainsberry: As a bit of context
on that, at the beginning of the financial year we knew that there
were discussions in the department obviously about the devolution
of central budgets and MPET is one. We were planning for a reduction
of between 5% and 10%, somewhere in the middle. It ended up being
10.4% for London, which is quite substantial. It is a £96
million reduction for London. We had a number of criteria that
we used in London to make some decisions. First of all, we had
to honour all our legal obligations. Where we had contracts with
education providers, we needed to honour those. We took a decision
that we were not prepared to pull the plug on any programmes where
people were in training. That was not the case throughout the
country but that is the decision that we took in London. We also
did not want to take decisions which would result in other partners
getting in a position where they would have redundancies. That
was our ideal. The amount of money we had to save and the point
at which we had to save it, which was August this year, clearly
made it very difficult so we took some decisions. There was some
activity that we could defer to next year. For some of the infrastructure
costs around the further roll out of MMC and things like that
we agreed with the deanery we could do some things next year rather
than this year. We effectively shifted the costs. In London the
way in which some of the allocations out to trust is not necessarily
equal and we took the opportunity to equalise some of the allocations
across London. Through that, we saved some money. Also, we took
a view on MADEL that typically there was a 1% vacancy factor across
London. We had always funded at 100% rather than 99%. We did things
like that to find the additional money, which we felt were things
that were not going to irrevocably undermine our future direction.
Q764 Dr Taylor: You were able not
to stop any people who were already in training courses?
Ms Rainsberry: Correct. We did
reduce the numbers of future commissions by a small amount.
Q765 Dr Taylor: From what you said,
you think that was not the case across the country. Some people
did have to be cut in training courses?
Ms Rainsberry: My understanding
is that but that would be general discussion I have overheard.
I could not give you an example.
Q766 Dr Taylor: You have had to cut,
for example, healthcare assistants who want to upgrade?
Ms Rainsberry: Yes. We have had
to reduce the amount of funding we put into that. We have talked
to our education providers, trying not to get to closing down
programmes completely, to try to treat this as a short term measure
in order to deliver. A lot depends on what we can deliver in terms
of our financial control target for London and we are obviously
working very hard as a strategic health authority to deliver what
we have said we will deliver so that we do not store up further
problems for next year.
Q767 Dr Taylor: Trish, have you had
the same sort of range of cuts for 2006-07?
Ms Knight: Yes, we have. I can
only really answer for the NMET part of the budget, the non-medical
side. For the NMET part of the budget, we have done much as Anne
illustrated. We have made sure that anything we were contractually
obliged to do through the universities we have maintained. Anything
where it would have been a loss of infrastructure within the universities
if we stopped it, like community nursing training, we have maintained.
We had to stop all secondment of people into training, the HCAs
or the OT assistant who wants to go and do their training, which
is a real shame, but that is how we have managed the cut. It does
raise an issue though that what we have cut is the salary support
to trainees. Maybe one of the solutions to the problem around
the education budget is that whole issue of how we support people
who are in training. We should examine it in great detail. It
is a very complex area because trainees are supported in a lot
of different ways but it needs a complete re-examination. That
is my belief and it could enable the MPET budget to stretch further.
Q768 Dr Taylor: We are right to interpret
this as the lower grade you are in the staff hierarchy the worse
these cuts affect you?
Ms Knight: Yes.
Ms Rainsberry: The reason for
that is because of the way the MPET budget is made up. We have
different levels of flexibility with different parts of the budget
and therefore where we have the maximum flexibility is in the
work around new roles. When you get into this urgent situation
inevitably that is something that is going to be most vulnerable.
Ms Knight: The pot of money that
is totally cut is the one that was supporting the National Vocational
Qualifications. That has gone completely. We have managed to support
them for this last year but we will not be able to support them
next year and that is hitting the most vulnerable, lowest paid
group.
Q769 Dr Taylor: We did get the Secretary
of State to admit that this could only be a short term policy
but we could not tie her down to how long "short term"
was. How long do you think this could go on without seriously
affecting the future?
Ms Knight: It will affect it next
year from my point of view.
Q770 Dr Taylor: We have already had
it 2005-06 and 2006-07 so if it goes on to 2007-08 it is a disaster?
Ms Knight: "Disaster"
is perhaps strong but it is storing up problems for the future
in that we do not have the funds to develop the workforce that
needs developing.
Ms Rainsberry: It has been a very
positive move this week that the operating framework for the NHS
has been published earlier than ever I can remember it being published.
I think that does give us much greater certainty within which
to plan.
Q771 Dr Taylor: You trust that it
will not change?
Ms Rainsberry: I do not want to
get cynical, but I hope that that is the case. In London we want
to get to a position where we are able to invest in these programmes
again next year. We are not able to say to the Committee that
is what we will be able to do because we have just started our
planning round, but that is certainly our intention. That is what
we would like to see.
Q772 Dr Taylor: You have had it earlier
than usual?
Ms Rainsberry: Yes.
Q773 Sandra Gidley: You said there
had been cuts to learning support. I was not quite sure whether
that was cuts in numbers or the support packages that individuals
had reduced in some way. Are you able to clarify that?
Ms Knight: It is the support packages.
There are quite a lot of trainees, particularly within the health
care scientists group. Their salary is supported while they are
training and it is that area that I think needs examination because
it is inequitable at the moment. Different people get different
amounts and it suggests that we should look at a much more flat
rate for those people. This year we tried to rationalise it a
bit but we have not made a sea change, which is what I think we
need.
Q774 Chairman: You spoke about vocational
training. Is this going to impact on the agenda for change?
Ms Knight: I am not quite sure.
I am not an HR expert. I presume that if an individual member
of staff was going to go through an agenda for change gateway
and they requested vocational training and were unable to get
it, that would be a problem.
Q775 Chairman: They would not go
through Agenda for Change? Presumably they would not get the requisite
increase in salary?
Ms Rainsberry: It links to the
knowledge and skills framework and obviously progression through
the pay bands on Agenda for Change is to do with the acquisition
of additional knowledge and skills.
Q776 Chairman: If somebody has agreed
their individual training package under agenda for change, are
we saying it is potentially going to be disrupted?
Ms Rainsberry: Potentially, it
shifts the burden onto individual employers to try and meet that
obligation to those staff.
Q777 Chairman: Meet the increase
in salary or meet the training?
Ms Rainsberry: The training.
Q778 Chairman: Could we see a situation
where you could get the increase in salary without the training
or the qualification?
Ms Rainsberry: That is not the
premise on which Agenda for Change operates.
Q779 Chairman: I know it is not but
I am wondering if this has a negative impact on that premise.
Ms Knight: I do not know. I would
expect not.
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