Health CommitteeWritten evidence from GMB (ETWP 41)

Executive Summary

GMB welcomes the opportunity to submit evidence to the Health Committee’s inquiry into education, training and workforce planning. We are the third largest trade union in the country and represent 30,000 NHS workers, from nurses and paramedics to ancillary staff.

GMB remains resolutely opposed to the Government’s NHS reforms, which have already begun to destabilise the health service in England.

We fear that the vastly increased scope for privatisation of NHS services, combined with official encouragement of local pay bargaining, threatens to undermine the pay and conditions infrastructure within the NHS. This will have serious implications for workforce standards and planning.

GMB is convinced that breaking-up public coordination of training and development, and shunting all responsibilities down to provider level, will significantly reduce the amount and quality of training available to a large proportion of the healthcare workforce.

We are alarmed by the omission from the Department of Health’s Developing the Healthcare Workforce consultation of any mention of the Knowledge and Skills Framework (KSF). The imminent withdrawal of central funding from the e-KSF is further evidence of the worrying shift in official thinking away from nationally agreed and understood tools and guidelines.

GMB believes that the Secretary of State should not duck his responsibilities for, and to, the NHS workforce. He and his new Commissioning Board should champion the rights of NHS workers to continuing professional development under the NHS Constitution and Agenda for Change.

GMB further recommends that:

A portion of the Multi-Professional Education and Training Budget should continue to be allocated to the existing wider NHS workforce.

The proposed “skills networks” should be placed under a duty to consider the training and development needs of the whole workforce.

If providers are to be made solely responsible for funding the development of their existing workforce, the responsibility must be clearly written into all tenders, budgets and contracts.

We greatly fear that the Government’s NHS reorganisation will badly undermine the healthcare workforce and reduce the ability of that workforce to deliver high-quality patient care. From experience we know that privatisation is no way to raise standards in what is a life-and-death service.

Introduction

1. We have serious concerns with the Government’s plans for healthcare education, training and workforce planning. In our response to the Liberating the NHS white paper, we commented that:

“The dismantling of the national training and development structure in favour of localised training will lead to variations in the provision and quality of training and education, and in many cases, especially in the private sector, no provision at all.”

2. Nothing we have heard since has changed this verdict. We are convinced that by breaking-up public coordination of training and development, and by shunting all responsibilities down to provider level, the Government will significantly reduce the amount and quality of training available to a large proportion of the healthcare workforce.

3. The wider context of organisational turmoil and financial cutbacks cannot be ignored. The NHS is now in the midst of a four-year budget freeze despite the Coalition having previously pledged to increase spending in real terms every year. PCTs are having to set aside £3.44 billion over two years to cover the costs of the Government’s reorganisation. Well over 50,000 planned job cuts have so far been documented. Many of our NHS members find themselves threatened with down-banding under the guise of workforce restructurings, while a short-term, cost-driven slashing of commissioned places across almost all occupations requiring professional training is taking place at the expense of long-term medical needs.

Undermining “Agenda for Change”

4. There are frameworks and funding streams within the current system which have provided long-overdue training and development opportunities for non-clinical staff. GMB does not want them to fall into disuse. We hope that the Committee will acknowledge the importance of the Knowledge and Skills Framework (KSF) and Agenda for Change to ensuring a high-quality, fully staffed and safe NHS; and recognise how the Government’s reforms threaten to undo all the progress made on these measures in recent years.

5. As the Committee will know, the KSF provides a single comprehensive framework on which to base personal development plans, annual reviews and supported learning for all NHS Agenda for Change staff. It is a key driver supporting the NHS Constitution pledge to “provide all staff with personal development, access to appropriate training for their jobs and line management support to succeed”. GMB is pleased that the 2010 NHS Staff Survey for England showed some improvement in KSF implementation, and we hope that the simplified KSF guidance will progress matters further.

6. The present Government at one point acknowledged that the system of pay progression linked to the KSF “provides incentives for staff to acquire and use new skills”.1 We are deeply concerned, however, by the omission of all mention of the KSF from the Department of Health’s Developing the Healthcare Workforce consultation paper. This sends entirely the wrong signals from the Government as to the KSF’s importance for staff training and development. The imminent withdrawal of central funding from the e-KSF is further evidence of the worrying shift in official thinking away from nationally agreed and understood tools and guidelines.

7. We fear that the vastly increased scope for privatisation of NHS services, combined with official encouragement of local pay bargaining, threatens to undermine the pay and conditions infrastructure within the NHS. This will have serious implications for workforce standards and planning. How much of the healthcare sector will in future be covered by national pay determination and the Agenda for Change agreement (including the KSF)? Quite possibly a rapidly diminishing proportion. GMB is opposed to this direction of travel. Agenda for Change is an effective, equality-proofed pay and conditions package which ought not to be marginalised.

8. In a paper submitted jointly by GMB and fellow NHS unions to the NHS Pay Review Body in September 2011, Dr Ian Kessler of Green Templeton College, Oxford, set out the advantages of national pay determination. Among other things, he found that:

“In combination with the infrastructure established by Agenda for Change a ‘level playing field’ is set for pay conditions which prevent a ‘race to the bottom’ or ‘the top’. The agreement makes provision for payment to address occupation and local labour market needs.”

“[T]he transparency and consistency of the arrangements have facilitated staff mobility, especially amongst the registered part of the workforce, so crucial to the functioning of a national service.”

Kesler goes on to highlight the dangers of a shift to local pay bargaining. He warns that:

“[L]ocal pay might well discourage skills development where trusts feel they can buy in skills developed elsewhere”.

“National pay determination is deeply embedded in the NHS, with high transactional, relational, and pay bill costs likely to be generated in a period of financial constraint if attempts are made to uproot it”.

9. In our submission the NHS staff side called on the NHS Pay Review Body to consider the impact of the NHS reforms on pay determination within the NHS and the long-term implications for the workforce, including as regards industrial relations, equal and fair pay outcomes, transparent pay setting, recruitment and retention.

10. The Chancellor in his Autumn Statement prolonged the period of public-sector pay “restraint” by another two years, without any consideration of its effects on workforce planning or standards. The NHS Pay Review Body process is being unduly constrained by these unfair and inappropriate diktats.

“Developing the Healthcare Workforce”

11. The Department of Health’s Developing the Healthcare Workforce consultation paper promises “increased autonomy” for healthcare providers, with employer-run “skills networks” inheriting many of the workforce functions of Strategic Health Authorities. With the dismantling of public coordination of training and development, we fear that future investment in the workforce will be patchy at best. The Government says it will promote development opportunities for the wider workforce by means of apprenticeships and the work of Skills for Health. In reality, however, there are only a few thousand apprenticeships on offer within the NHS, and the Government is actually committed to significantly reducing its funding of Skills for Health.

12. The Committee seeks views on “the implications of a more diverse provider market within the NHS”. GMB contends that the obvious parallel to draw is with the heavily marketised social-care sector. The Centre for Workforce Intelligence recently observed that “workforce development is less well-resourced and led in adult social care when compared with the NHS”.2 The low pay and status of care workers stand in sharp contrast to the high levels of responsibility, trust and skill this workforce is required to show. The root cause is obvious: care is a mostly privatized sector. Profit-centered providers in need of public money to service their debts and amass profits off-shore are not likely to invest in workforce development. Conditions of employment in social care barely meet minimum standards. The NHS goes down this road at its peril.

13. GMB is opposed to the deepening privatization of the NHS and we intend closely to monitor the treatment of NHS workers and patients at Hinchingbrooke hospital following its outsourcing to Circle.

14. We agree with the Department that all providers (both NHS and non-NHS) should have a duty to consult, to provide data, and to cooperate around training and development. But the proposed duties on providers outlined in Developing the Healthcare Workforce only go so far. GMB is clear that if providers are to be solely responsible for funding the development of their existing workforce, the responsibility will have to be clearly written into tenders, budgets and contracts. If it isn’t budgeted for, in most cases it won’t happen.

Standards for Healthcare Assistants

15. The wider healthcare team is essential to the quality of patient experience. GMB wishes to place on record here that we look forward to engaging with Skills for Health and Skills for Care in their development of the standards for healthcare support workers and social care workers. In our view the standards ought to include entitlements to professional development. We also believe that the employer, not the low-paid employee, should cover any fee related to the new voluntary register(s).

Conclusion

16. GMB is convinced that breaking-up public coordination of training and development, and shunting all responsibilities down to provider level, will significantly reduce the amount and quality of training available to a large proportion of the healthcare workforce. We believe that the Secretary of State should not duck his responsibilities for, and to, the NHS workforce. He and his new Commissioning Board should instead champion the rights of NHS workers to continuing professional development under the NHS Constitution and Agenda for Change.

17. GMB further recommends that:

A portion of the Multi-Professional Education and Training Budget should continue to be allocated to the existing wider NHS workforce.

The proposed “skills networks” should be placed under a duty to consider the training and development needs of the whole workforce.

If providers are to be made solely responsible for funding the development of their existing workforce, the responsibility must be clearly written into all tenders, budgets and contracts.

18. GMB is adamant that privatisation is no way to raise standards of patient care in what is a life-and-death service. GMB has vast experience of the deleterious effects of privatisation on workforce investment and service standards—not least in the NHS’s sister service, the adult social care sector, where private providers have eroded conditions of employment to the point where they barely meet minimum standards. We greatly fear that the Government’s NHS reorganisation will badly undermine the healthcare workforce and reduce the ability of that workforce to deliver high-quality patient care.

December 2011

1 Simon Burns, Hansard, House of Commons written answers, 10 February 2011.

2 CfWI, Workforce Risks and Opportunities, August 2011.

Prepared 22nd May 2012