1 Achievements of Agenda for Change
to date
1. 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. Before Agenda for Change there were 12
separate pay structures covering more than 400,000 different job
descriptions across the NHS. Different staff groups were entitled
to different amounts of leave and different length working weeks.
In addition, there was a multitude of allowances ranging from,
for example, 'radiation protection supervisors allowance' to 'authorising
clerks allowance' and a wide variety of shift patterns and on-call
arrangements and payments.[2]
The variety of terms and conditions created barriers to developing
new roles and new ways of team working, designed around patient
care pathways.
2. The NHS is the largest employer in Europe and
it was a significant achievement for it to introduce the new pay
system successfully in a short timescale.[3]
Implementation included training staff in NHS Trusts to participate
in job evaluation panels, through which they matched 90% of around
415,000 jobs to just 463 national profiles (Figure 1).
They also dealt with applications for reviews and amended 1.1
million individuals' payroll details to their new pay points,
deleting all the previous allowances. The new pay arrangements
removed the structural barriers described above.[4]
Figure 1: Under Agenda for Change over 400,000 different roles were rationalised
to just over 35,000
Note: each job may be held by a single individual
or by many thousands.
Source: C&AG's Report, para 1.20
3. Agenda for Change was developed and implemented
in partnership with the NHS trade unions. This led to the development
of constructive relationships between staff representatives and
managers in NHS Trusts, and contributed to the low level of challenge
to the system. Schemes, such as Agenda for Change, which involve
job evaluation, have the potential to undermine staff morale.[5]
However, Healthcare Commission NHS staff surveys show that levels
of job satisfaction stayed broadly stable between 2004 and 2006,
the period over which Agenda for Change was implemented.[6]
4. Increased expenditure on the NHS since 2000 has
resulted in increased numbers of doctors, nurses and other staff,
new buildings and equipment, and more and better drugs. Waiting
times have come down and treatment for certain conditions such
as cancer have improved. The fall in overall productivity over
this period, however, indicates that the improvements may be the
result of extra resources rather than the result of staff working
more efficiently.[7]
5. The Department considers that reductions in the
numbers of posts which have been vacant for more than three months
and falls in expenditure on 'agency' staff are evidence that Agenda
for Change had been successful in helping the NHS to employ sufficient
staff for its needs.[8]
The percentage of nursing posts that were vacant for more than
three months fell from over 2.5% to less than 1% between 31 March
2004 and 31 March 2006.[9]
Figure 2: The number of staff employed under Agenda for Change fell slightly
as deficits were reduced.
Source of staff numbers: Information Centre for
Health and Social Care
Source of gross deficits: NHS (England) Summarised
Accounts 2003-04 to 2007-08
The fall in vacancies may, however, have been due
to other factors, such as a freeze in recruitment as part of the
drive to reduce financial deficits in 2005-06, rather than to
the success of Agenda for Change (Figure 2). The NHS is
spending less of its pay bill on nurses employed through private
employment agencies than in the past, but other factors have contributed
to this apart from Agenda for Change. These include framework
contracts with employment agencies, increased use of NHS 'bank'
staff[10] and a fall
in the demand for nursing due, again, to the financial deficits.[11]
2 Q 100; C&AG's Report, paras 1.4-1.5 Back
3
Qq 3, 58, 79 Back
4
Qq 56, 88 Back
5
Q 90 Back
6
C&AG's Report, para 3.12 Back
7
Qq 14, 25 Back
8
Q 14 Back
9
C&AG's Report, Figure 9 Back
10
Committee of Public Accounts, Twenty-ninth Report of Session 2006-07,
Improving the use of temporary nursing staff in Acute and Foundation
Trusts, HC 1176 Back
11
C&AG's Report, para 3.9 Back
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