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Agenda for Change, the pay modernisation programme for 1.1 million NHS staff in England, representing a pay bill of £28 billion in 2007-08, was implemented between December 2004 and December 2006. It covered all NHS staff, except doctors, dentists and senior managers, who were subject to separate pay modernisation programmes. Agenda for Change introduced a job evaluation scheme and harmonised employment terms and conditions for the multitude of jobs within the NHS. A key part of the programme is a process for encouraging staff development and improving staff performance known as the Knowledge and Skills Framework.
Agenda for Change was expected to bring about new ways of working which would contribute to improved patient care and to more efficient delivery of services. In its business case to the Treasury, the Department of Health (the Department) predicted that Agenda for Change would bring about total savings of £1.3 billion over the first five years. These were to come from improvements in productivity of 1.1%-1.5% a year, reductions in equal pay claims, reduced use of agency staff and more controllable pay costs.
The Department and NHS Trusts did not establish ways of measuring the effects of Agenda for Change and there is no active benefits realisation plan. The NHS pay bill for the staff employed on Agenda for Change terms and conditions of service has risen by 5.2% a year on average since 2004-05 while productivity fell by 2.5% a year on average between 2001 and 2005. By autumn 2008 (nearly two years after Trusts had completed transferring staff to Agenda for Change terms and conditions and pay rates) only 54% of staff had had a knowledge and skills review.
On the basis of a report by the Comptroller and Auditor General,[1] we took evidence from the NHS and the Department on the benefits resulting from Agenda for Change, and on the implementation of the Knowledge and Skills Framework across the NHS.
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