Examination of Witnesses (Questions 80-99)
DEPARTMENT OF
HEALTH
2 MARCH 2009
Q80 Mr Burstow: Perhaps calling them
success criteria and having success criteria in that sense did
not really help this at all because you could not use them as
criteria.
Mr Griffin: I think they are.
They are not hard quantifiable ones but they are sensible things
to be looking to say at the end of the day do we think we have
got improvements around these areas. Using whatever information
we can get, anecdotal examples and data, one can test the proposition,
has it delivered against these and by and large it has.
Q81 Mr Davidson: Am I right in thinking
that everybody covered by this exercise got more money?
Mr Nicholson: There were people
who when we looked at their jobs and did the evaluation, their
jobs were priced at a level below what they were currently on.
In those circumstances they got the original pay increase and
then their jobs marked time until 2011.
Q82 Mr Davidson: That is helpful.
You made the point that the lowest paid got more comparatively.
That was part of Government policy anyway, was it not?
Mr Nicholson: Yes.
Q83 Mr Davidson: Again, unlike some
others, I am not entirely clear how all these things mesh together.
Change has often got to be bought in these circumstances or, indeed,
in any circumstances when we are revising things. What I am not
clear about is the extent to which this opportunity of a big slug
of cash coming into the system was used to buy all the changes
that were necessary at the time. I am looking particularly at
paragraphs 2.8, 2.9 and 2.10 where it basically seems to be saying
there that the changes were not made at the time in working practices.
People were put on new scales but they were not put in new structures,
new systems and so on. What I want to clarify is whether or not
it has subsequently cost you additional slugs of money to get
people to work differently or was that initial boost to the system
sufficient to allow you to subsequently make changes?
Mr Nicholson: That was exactly
the way we did it. It would have been remarkable had we managed
both to completely re-organise the Service and the way people
worked and implemented Agenda for Change and the KSF all at the
same time, it simply was not a practical proposition for us. We
thought Agenda for Change essentially was a fantastic baseline
on which to take things forward. If you look at the five years
before Agenda for Change and the five years afterwards, you can
see there the total pay bill for Agenda for Change staff grew
less the five years after than the five years before.
Q84 Mr Davidson: To be fair, that
could be to do with overall falling numbers of staff.
Mr Nicholson: No, we were increasing
at the same time.
Q85 Mr Davidson: If you strip that
out, right, okay.
Mr Nicholson: No, that was absolutely
the case. The percentage increase for staff again was lower in
the last five years than the first five years. There is no indication
we have been throwing lots and lots of money to get more change
out of a system that we put through Agenda for Change.
Mr Griffin: I would support that.
I think the investment brought change, harmonisation and a lot
of goodwill and subsequently we have been able to use that to
drive change.
Q86 Mr Davidson: Let me be clear
then, if you now want to restructure the way in which people in
a particular area are working, you are able to do that without
having to put in additional dollops of cash, is that correct?
Mr Nicholson: That is correct.
Q87 Mr Davidson: Sorry, I am getting
two nods and a stony face and I am not quite sure. Mr Nicholson,
since you are the boss, I want to make sure I have your view of
this.
Mr Nicholson: That is absolutely
the intention. If you ask me, in every single circumstance where
we are implementing change that either extra people or whatever
are not put in, I could not say that, but there is no evidence
that people are putting lots of money into that.
Q88 Mr Davidson: There was specific
mention made in the initial stage of this document about what
the objectives were and one of them was down as breaking down
traditional barriers. What I want to clarify is whether or not
in your view these traditional barriers have entirely been overcome,
they are working in silos and "That's not my job", the
sort of demarcation lines you used to have in the shipyard, all
of which have gone there. Are they still there in the Health Service?
Mr Nicholson: In some organisations
there are still people working in silos more than we would hope.
We have not abolished people working in silos, but there is lots
of anecdotal evidence around which shows ways in which these have
been moved on and we have changed the Service. What we can say,
though, is new jobs as they are created are not part of that process.
One of the things I am sure you have seen when you have been around
hospitals is "We've got a problem in a particular department,
we need another nurse", that is not normally the response
these days, it is what are the skills we need to satisfy the needs
of our patients or the particular service. There is quite a lot
more to do, but there are some good encouraging signs that we
can do it.
Ms Chapman: I think there are
two separate things here. One is we talked about the thousands
of allowances and you talked about working practices, I think
those thousands of allowances distorted working practices because
encouraging people to move when you were asking them potentially
to let go of those was confusing the matter. Has Agenda for Change
solved that? Yes, because you have got a much more transparent
system. Does that mean there are still problems to be solved in
terms of ways of working? Yes, but it is not the pay that is the
barrier, there are other things that need to be addressed which
you will not sort out through pay modernisation.
Q89 Mr Davidson: I think I understand
most of that. Recruitment and retention, to what extent have the
difficulties you face in recruitment and retention been overcome
by this methodology? To what extent would they have been overcome
simply by the additional slug of cash which was being provided
anyway?
Mr Nicholson: Of course, particularly
the Agenda for Change element and those areas, what you described
as the non-professionally qualified areas, there has been competition
for staff. We have increased the number of staff we need, so we
could have found ourselves in a position with bigger vacancies
and bigger problems when you look at the economy as a whole. It
has been remarkably successful at recruiting and retaining staff
for us in that period. When you look at it, we were expanding
at the same time as lots of other parts of the care system were
and the economy was expanding and we have managed to reduce our
vacancy rates, which is no small measure of the implementation
of Agenda for Change.
Q90 Mr Davidson: Can I turn to paragraph
3.10 where mention is made that: "41% of staff thought their
Agenda for Change pay banding was fair in 2006". That means
59% thought it was not fair. Is that a satisfactory situation
or does that tell us that, like Sir Fred Goodwin, some people
are never happy?
Mr Griffin: It is a feature of
job evaluation we reflect on this, that with all this investment
are people remarkably happier immediately afterwards and the answer
is well maybe momentarily, but it soon fades. When there is a
job evaluation change, all the people whose jobs come out with
no change feel, "Well, I'm not getting anything out of this",
those who have been upgraded feel, "Well, it's only right
and proper, it means I've been short-changed before" and
those who have been downgraded are the ones who really feel it.
Job evaluation pay systems do not generate happiness, so I am
not surprised by that figure.
Q91 Mr Davidson: I understand those
three divisions but given the fact that nobody was worse off as
a result of this exercise and the vast majority were better off.
Mr Griffin: Except relatively.
Of course, as you and I know, relativities are very important.
If somebody is seeing a contemporary go up and they stay the same,
they potentially feel aggrieved.
Chairman: I know all about that in my
political career!
Q92 Mr Davidson: Yes, but some deserve
it, do they not! Can I turn to the question of efficiency. Again,
in paragraph 3.18 there is mention here that: "Only 6% of
staff who responded to our survey agreed or strongly agreed with
the statement, `I feel that I am more productive as a result of
this Agenda for Change/Knowledge and Skills Framework"'.
If this was such a wonderful system and really working, surely
more than 6% would have thought they were working more efficiently
than they had been before.
Mr Griffin: Again, not necessarily.
People will not see the sort of changes they have experienced
as attributable to Agenda for Change. If they have been through
other re-organisation in their department and there has been some
sort of restructuring, people will not associate that with Agenda
for Change. If Agenda for Change in the background is facilitating
change happening, people will not necessarily make that association.
The change itself was not brought about overnight, everybody's
job was evaluated as it stood. There were no overnight changes
in jobs, the intention was to get in the job evaluation system,
re-band the jobs as they stood and then, having got it in place,
use it to start bringing about change.
Q93 Mr Davidson: Would it be fair
for me to take from this that the benefits of Agenda for Change
are unknown and unknowable?
Mr Nicholson: No. We know Agenda
for Change delivered all of those things around harmonisation
and simplification, we know they delivered benefits to us in terms
of vacancy rates going down, we know they have achieved a whole
series of benefits in relation to job redesign where it is much
more simple now to design jobs around the needs of individual
patients, so there are all sorts of ways in which we can identify
the benefits of it. Can you put a cash figure against those individuals,
our judgment was it is much better to look at the totality of
the change than just one of the enablers.
Q94 Chairman: The question I want
to ask you, arising from Mr Davidson's question, and this is from
paragraphs 3.5 and 3.12, is if NHS pay overall in real terms for
all your staff has increased over the period by 5%—quite
a lot—why has job satisfaction not increased?
Mr Nicholson: Because job satisfaction
is not just a function of pay, job satisfaction relates to a whole
series of issues: the way you are managed; the nature of the job
you do; the pressures that are put on you; the quality of the
leadership that you have in a particular organisation, there are
all sorts of factors which relate to that.
Q95 Chairman: Which is absolutely
right, but what has Agenda for Change achieved then?
Mr Griffin: Whilst the staff survey
may not reveal the changes, when you see vacancies falling, staff
turnover going down and the number of people applying to come
into the NHS, all of that says that in part is a measure of the
Agenda for Change.
Q96 Mr Davidson: Surely it says there
is a recession.
Mr Griffin: Not when this data
was collected. The recession is about six months old, we have
been operating Agenda for Change for the last five years.
Ms Chapman: Looking at the staff
survey results last year, which obviously related to the year
before, it is also worth pointing out that almost half of all
the measures improved. There is evidence that there are a number
of things, as Mr Nicholson described, which are going on alongside
pay which is impacting and is being fed back by staff. If the
overall measures of this were to enable expansion and also enable
flexibility, then there are specific things in terms of both of
those where there is evidence.
Q97 Nigel Griffiths: I used to serve
on a local health council and ten years ago if you accompanied
me to one of my advice sessions, then once a week somebody would
hobble in waiting for a hip replacement operation or complaining
of a wife or a husband left on a hospital trolley for eight or
12 hours or during the winter would come to me complaining that
an urgent operation had been cancelled. I now get no such complaints,
in fact in the past two months I have not had one constituent
raise with me a problem with the National Health Service. How
much of that is due to Agenda for Change?
Mr Nicholson: It is an important
element of it. All of those things you have just described would
have been extraordinarily more difficult to do, if not impossible,
without Agenda for Change. If you take the hip replacement, we
have designed a whole new set of jobs around diagnostics to get
the patients in earlier and we have designed jobs for people to
go out to see the patient in their houses to make sure they are
fit and well before they come in. The issue you raised around
waiting on trolleys, again there are jobs we have designed around
diagnostics and the way we operate that. Operating theatres are
often an issue for cancellation and the development of technicians
in hospitals again have all been jobs which have come out of the
Agenda for Change process. That has made a significant impact
on all of the things you have just described.
Q98 Nigel Griffiths: On Friday a
young trainee consultant came to see me accompanying some other
consultant with an immigration problem and he told me in passing
that he and his colleague worked 12-hour shifts at the moment
and they are intensive, they are working just about flat out,
but his father, in his generation, had a strict 36-hour shift
but slept for large chunks of the time. How has the Office for
National Statistics been able to measure whether the father or
son was more productive?
Mr Nicholson: That is part of
the issue. That is a good example about the intensity of the work
that we do and we know, for example, patients in hospitals now
are much sicker than they used to be. When people are admitted
to hospital now they are normally extraordinarily sick and require
intensive services when they are in there, that is not reflected
in the way productivity is described. When an individual patient
now is diagnosed for cancer, that is not the view of one surgeon,
it is the view of a multi-disciplinary team of oncologists, surgeons,
radiologists and pathologists all working together which improves
quality but is not reflected in those productivity figures.
Q99 Nigel Griffiths: Following Mr
Davidson's question, how much has the pay boost helped in you
being able to recruit up to 80,000 more nurses net?
Mr Nicholson: You can see whether
it is nurses where the vacancy rates have gone down considerably,
that has been a considerable part of the improvements in pay and
conditions of nursing staff in that, whether it is consultant
medical staff, medical staff or even whether it is GPs, we have
significantly reduced the vacancies of all of those. The pay modernisation
has made a major impact in making that a reality because other
people compete for their skills as well as us.
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