Examination of Witnesses (Questions 100-108)
DEPARTMENT OF
HEALTH
2 MARCH 2009
Q100 Nigel Griffiths: Point 2, page
four indicates that the previous practices with different pay
scales, et cetera, was really a dog's breakfast, is that a fair
summary?
Mr Nicholson: It was an extraordinary
byzantine and complex mechanism which involved literally thousands
of different circumstances. It was genuinely the case that only
half a dozen people in the country knew how it all worked. It
was extraordinarily difficult to get change in that environment;
it was incredibly inflexible.
Q101 Nigel Griffiths: How many more
people is the NHS treating now than they were ten years ago?
Mr Nicholson: Currently we treat
over a million people every 30 hours in the NHS, which has probably
gone up by about 30% over the last period.
Q102 Nigel Griffiths: Ms Chapman,
you have clearly got a very distinguished history in HR, Head
of Tesco's HR, Vice President with Pepsi, I think two of the most
successful private sector companies in the world. If you were
now wearing a Pepsi hat or a Tesco hat, what sort of rating out
of ten would you give the Agenda for Change process?
Ms Chapman: Whether you look at
it through the private sector lense or the public sector, the
thing which is extraordinary is there was no disruption to services
whilst all this was going on and it was enabling us to set up
something which has got a very high degree of fairness underneath
it. To have implemented the size and scale of what Mr Nicholson
talked about is extraordinary. Certainly, when I look at the lessons
from the private sector, it is not a surprise to me that there
is still work to do, particularly around things like the KSF because
that now is what you would expect in terms of the next phase of
this Report.
Q103 Nigel Griffiths: I think one
of the criticisms of the NAO Report is really the failure of the
NHS to isolate precisely what the benefits have been and to quantify
them of Agenda for Change. In a presentation to the board of Tesco
and Pepsi, would you expect and would they expect you to be able
to isolate the benefits more than we should expect you to?
Ms Chapman: That is why I summarised
a moment ago that the two overarching benefits we were looking
for were to enable the workforce expansion and enable flexibility.
Would you in the private sector absolutely be able to demonstrate
how many more people you hired in what areas that the Service
required and what did you do to vacancy rates? Those would be
the sorts of metrics which would be looked for. In terms of enabling
flexibility, what you would be looking for is evidence over a
much longer timescale so that the new services which are being
delivered in communities in the acute sector and primary sector
are those being enabled. I think you would have two sets of metrics,
firstly the immediate, were those delivered, yes, in the way that
Michael described and, secondly, we would also be expecting to
come back and look in five years' time, have the new types of
care, as identified in Lord Darzi's report, been delivered? That
is what you would have expected this to enable.
Q104 Mr Davidson: What do you think
is the fairest and unfairest criticism in the NAO Report?
Ms Chapman: I think the fairest
criticism is there is still more to do. There is always a trade
off. If you decide to implement quickly so that you minimise disruption
but absolutely make sure you get the framework in, there is always
more to do. We should not consider that a failure, we should consider
it a feature of the decisions which were taken. Probably the unfairest
piece is when I take a look at the benefits which I see around
the Service, I think that is under-represented by the amount of
evidence which is presented in the Report. If a full diagnosis
was done of the productive time programme so that you could detail
out to what extent were the benefits delivered through Agenda
for Change, I think that would be more helpful for the Committee
to give it full consideration.
Q105 Nigel Griffiths: How much do
you think there is a danger of grievances due to other parts of
change in the NHS being dumped on Agenda for Change?
Ms Chapman: If there were going
to be a lot of grievances dumped on Agenda for Change you would
have known by now. The fact that there have been so few and, as
Michael has already pointed out, the amount of review that was
done locally demonstrates the Agenda for Change process in itself
has been very well accepted, I doubt whether we will see that.
The fact that there is a very high degree of proofing around equal
pay also means we are well protected on that front too.
Q106 Nigel Griffiths: Mr Nicholson,
on the benefits' columns, points 17 to 20, I come to one of my
pet gripes, that is the laggards, those who drag their feet, and
I think Mr Griffith mentioned it, those who do not see the benefits
of putting the resources into making this work. This is where
I think devolution does not work in the Health Service and elsewhere.
I would like to know what more you would do to make sure those
laggards, those health authorities that are failing to adopt and
embrace best practice do not land their local patients with a
second rate service.
Mr Nicholson: There are two or
three things about all of that. You are absolutely right, we need
to make sure that with organisations that are performing poorly,
those issues are addressed by the system. The major way in which
organisations are identified overall as to whether they are performing
is through the Healthcare Commission results and the satisfaction
of staff is part of that. We have a whole series of mechanisms
to identify those organisations and to take them through a process
of them identifying improvements. We performance manage them through
those improvements, we give them improvement targets to deliver
and we make it clear to the leadership of those organisations
that if they do not improve in those circumstances, what the consequences
for them are. Where organisations are not delivering for patients,
that is what we do and we need to do that. Devolution does not
mean giving it all away, devolution means where people can benefit
from local responsibility and power to improve services for patients
they should and where they cannot, we should be as interventionist
as we need to be to protect our patients and the services.
Nigel Griffiths: Thank you.
Chairman: I think Mr Davidson has a supplementary.
Q107 Mr Davidson: One point about
the exercise of the use of external consultants, management consultants
and the like, was there any?
Mr Griffin: I think very few.
This was very much a scheme designed by the Service.
Q108 Mr Davidson: The fact that this
seems to have been pretty successful and the fact that you had
very few external management consultants, do you think these two
points are related in any way?
Mr Nicholson: There is absolutely
no doubt with things like this where the people in the NHS have
the talent, understanding and knowledge to make it happen, we
are really good at doing it. One of the things which came out
of all the turnaround work when we had the financial difficulties
was that for all the money we spent on external management consultants,
the feedback to us was there was somebody in the NHS who knew
how to solve all of these problems, we just did not connect them
properly with the problems. We are learning this, it is something
we have learned out of Agenda for Change, there is huge talent
in the NHS to be able to solve these issues.
Q109 Chairman: Thank you. That concludes
our hearing, which has been very interesting. Of course, this
is not a policy committee, it is a value-for-money committee,
therefore there is one last note I would like to have from you.
I am not sure we have still explored this in enough depth. We
know from paragraph 20 that Agenda for Change was supposed to
deliver net savings of at least £1.3 billion over the first
five years. It is not clear to me, Mr Nicholson, if that has been
achieved at all. I would like you to give me a note, please, at
your leisure so you can explain how those savings have been achieved,
if they have been, and if they have not, they have not.[3]
Mr Nicholson: Can I finally say,
this was the biggest job evaluation and implementation scheme
probably on the planet. It was remarkably successful in the sense
that it delivered some of the benefits described in here. It was
value-for-money for taxpayers because the total cost of it in
terms of increased pay was less over the five years when it was
implemented than it was before and we think when you take all
of the changes in hand and you look at it, we can show we can
deliver £3 billion worth of savings.
Chairman: Thank you. At your leisure
means within two weeks, Mr Nicholson! That concludes our hearing.
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