DELIVERING AN AGENDA FOR CHANGE

Introduction

The technical work in the four working parties under AfC is all but complete. Amicus MSF has sought to advise members of discussions through briefings and regional or sectional training days. The problem with this process is that much of the talks were ‘work in progress’ and were bound by confidentiality causing written material to be general in nature. In addition, there was a sense amongst members that progress was taking place at a faster pace than was actually happening and as a result they were not being informed.

At this stage there is little further point in describing the various processes taking place in the four working parties save for the terms of the overall agreement which will be put to members on the basis of an all or nothing basis. In stead we now need to inform members about our negotiating agenda and give practical guidance on the process of implementation to ensure that members are not put at a disadvantage.

The delay in AfC caused by awaiting the results of Comprehensive Spending Review was worth the wait. The Secretary of State for Health has won a major victory and he should rightly be congratulated. This extra money is clearly going to be tied to reform and modernisation. It is clear that the Government is seeking a new settlement for NHS staff and the ‘pay cake’ should be larger post AfC than before.

However, there are two key issues for Amicus. Firstly, the balance, between the professions, of the distribution of any immediate extra money put into salaries. Secondly, the balance between immediate money and that tied to reform or modernisation through changes in roles. It is this latter issue which indicates why we should be active agents of reform in order to progress opportunities for our members at all levels. Indeed we already have a good track record on which to build in Healthcare Science (Advanced Practitioner in Cytology or development of MLA role) or Community Nursing (Community Nursery Nurse).

At the same time we should not forget our recent successes in the parallel process of achieving reform of the salary structure through normal bargaining structures or litigation.

• It was the MSF backed case on behalf of Speech and Language Therapists that was largely responsible for the AfC approach because NHS pay was not equality proofed.

• It was our campaign that caused the consolidation of one Discretionary Point into the pay scales for Nurses and Midwives and Professions Allied to Medicine (PAMs).

• We have successfully negotiated for greatly improved salaries in pathology and this year amongst Medical Technical Officers (MTOs).

• We are leading the campaign for the enforcement of the Clinical Grading Criteria for Nurses and Midwives winning a succession of grading claims locally.

• We have co-ordinated initiatives across all the Whitley Councils to improve pay levels tied to recruitment and retention problems and the need to meet targets set within the National Service Frameworks.

And we have not finished yet!

At the same time we should remember why we had talks on modernising NHS pay. The NHS pay system was creaking. It has not kept pace with changes in clinical practice. Employers were eroding clinical grading criteria and the system was facing equal pay challenges particularly in Speech & Language Therapy. Non-Pay Review Body professions were comparatively underpaid. The proof of the new system will be how it tackles all these issue for our members.

An early key issue for members was the Job Evaluation scheme. There was a great deal of resentment about poor pay in the NHS. JE schemes do not deliver better pay in their own right. The objective of this was to produce a transparently fairer, properly evaluated and equality proofed new pay system for the NHS. This resentment was combined with a sense of injustice on the part of non-PRB professions that they were unfavourably treated in comparison with professions covered by a PRB. MSF lead the campaign, including two major lobbies of Parliament, to highlight this issue. Our assertion about relatively poor levels of pay for non-PRB professions is now about to be tested once the JE outcome is fully known.

JE can often give cause to false expectations in many ways. Often members argue for JE when they really want a pay rise. If this is the case, this should be their bargaining demand. By testing the assertions of comparability or equal value with a higher paid occupation a JE scheme often disappoints by disproving or only partly proving this. Members often determine the robustness of a JE by the outcome. If an occupation comes out well it is a ‘good’ scheme or if it comes out badly it is a ‘poor’ scheme. This is only natural. However, we should resist adopting this subjective approach because the scheme is a bespoke one for the NHS partly of our own making. The other way expectations are dashed is that the outcome is not properly financed and all this ends up doing is re-ordering poor levels of pay.

Amicus MSF will critically examine the outcome of the JE scheme. However, we should adopt an objective and pragmatic approach. Firstly, there will be concerns that dash our aspirations and those that regale against our sensibilities. We should ignore the former and seek to question the latter. Secondly, we use other levers e.g. the Knowledge and Skills Framework to see if we can develop occupations to the place that we envisage they should be, rather than reject AfC. Thirdly, the final fact to consider is that nurses pay will be the central ‘barometer’ for the new pay template. If through JE non-PRB Allied Health Professions even partly improve their standing against their nursing comparators, the likelihood is that salary levels will increase in these areas as reducing nursing pay to those levels would be unacceptable.

Just as critically the JE scheme has covered a lot of ground. The scheme is one of the most complex in existence covering the largest single employer in Western Europe. Sufficient jobs have been analysed to set up a viable template and produce initial modelling.

However, all parties agree that there are significant gaps in the benchmark jobs. The intention is for the benchmark jobs (with associated profiles) to cover over 90 per cent of the workforce. The DoH has under estimated the number/percentage of the workforce they believe are covered.

We are seeking the most comprehensive coverage possible for practical reasons. Staff will not ‘buy-into’ AfC if they do not identify where they fit in the new pay template. Amicus MSF has had a bilateral meeting with DoH Officials where they share some of our concerns and the Secretary of the State for Health. We have been given a commitment to work together to fill agreed gaps.

However, there are a complex range of issues of which we need to respond.

In Healthcare Science, the sheer diversity (particularly in the MTO domain) of the occupations involved is making this practically difficult. If we evaluated every Healthcare Science occupation (60 identified and rising!) at every level we could be facing around 300 evaluations, almost as many evaluated for the rest of the NHS workforce to date. This is impractical.

Let us look at the issues. Many Healthcare Scientists are poorly paid which we have successfully partly addressed through collective bargaining. Many Healthcare Scientists are not appropriately rewarded for ‘value added work’ because they are placed on grades of convenience e.g. MTO. We need these colleagues separately evaluated.

However, in the process of examining gaps in benchmark jobs with OACs and Professional Bodies we need to examine whether a common profile can be fairly adopted across different areas of work but deploying the same competencies. For example do we need a Clinical Scientist Biochemistry and a Clinical Scientist Microbiology profile when a Clinical Scientist Biochemistry/Microbiology may suffice? The same approach could be adopted for MTO grades across a range of disciplines in physiological measurement or in nursing with a staff nurse regardless where they practice.

Amicus MSF has raised our concerns on the Staff Side about the ‘filling the gap’ process. We proposed and it has been agreed to have a ‘clearing house’ system so that Staff Organisations are not working at cross-purposes and that we begin to reach closure on this issue. Amicus MSF is responsible for:

• Healthcare Science (in this case including Pharmacy).
• Psychology, psychotherapy, counselling, therapy, speech and language therapy, sexual health advisors and chaplains.

Our other main group, nursing, is being co-ordinated by the RCN. We have completed our list of nursing gaps following work with CPHVA Professional Officers and a specialist nursing professional body.

The other issues are:

• where roles have in NHS terms recently evolved such as Community Nursery Nurses and ensuring they are evaluated; and/or
• where departments are integrating professionally such as Audiology combining the scientists, audiologists and therapists and ensuring they we evaluate the future rather than the past.

It is accepted that the new Staff Side structure should have some specialist sub-group looking at JE. Otherwise the new pay structure may fall out of date. This was a MSF proposal.

Finally, Early Implementers may throw up non-analysed occupations ‘in the wash’. There is an understanding that Early Implementers must have a commitment to JE to ensure the successful piloting of AfC and contribute to the national benchmarking exercise.

Looking to future needs. There is obviously a need for training for Amicus Officers and lay reps in JE. There is a need for a broad understanding of JE issues but not for detailed knowledge of the operation of the scheme itself as this can simply be read. People are misunderstood if they re-package their existing role or seek to re-interpret criteria in order to end up with a better outcome. Indeed we should actively discourage this approach as it will quickly bring the scheme into disrepute and ultimately those with the 'power' will win out. History will tell us this may not be our members!

More importantly, we need training on the assimilation of occupations onto the new pay scales via the job profiles. How many members have a Job Description, let alone a contemporary one? Hopefully, the job profiles will cover broad sections of our membership particularly those at basic practitioner level e.g. health visitor, biomedical scientist or speech and language therapist thereby drastically reducing workloads for Officers and lay reps. Problems may arise in specialist or diverse roles for which we need to provide proper and additional professional guidance and advice.

On Career and Pay Progression Amicus MSF has moved cautiously on the basis that we want any new system to be demonstrably better and fairer than the proposed system. We have a bad experience of individualised payment system based on notions of performance or competence particularly as practised in the private sector. They lack transparency and often discriminate. Even the NHS has its own discredited system, Discretionary Points. Our campaign against this system has helped to shape the discussions in this area.

At the moment staff progress up the scale to the maximum on an annual basis or by ‘natural progression’. The Treasury is intent on improving public sector performance by using the pay system e.g. look at what has happened in teaching. Amicus MSF believes that the Treasury over-estimates pay as a driver for change or at least a number of other factors are as equally important in healthcare e.g. investment, training and staff involvement.

However, the fact is that the Treasury controls public finances and is seeking to use this leverage across a number of Government departments. We believe that this was the issue the Secretary of State was referring to when he said at the RCN Congress that you ‘get nowt for nowt’. Whether this approach was good politics or not is beside the point as the Staff Side has engaged in developing a competency framework known as the Knowledge and Skills Framework (KSF).

At present the Staff Side does not accept a link between the KSF and movement through the pay scale. However, political purity is a sometimes dishonest approach to take and implicit in the work to date is that the future system will combine natural progression and KSF gateway(s) where a person has to prove their competency to move forward further.

All registered and some non-registered professions or occupations have some form of occupational standards. This will become more consistent with the creation of the Health Professions Council and the restructuring of the Nursing and Midwifery Council. Procedures are being subject to scrutiny by an overarching body the Council for the Regulation of Health Care Professions. The system is also becoming more inclusive with more groups moving into registration. At the same work is continuing in developing the National Occupational Standards (NOSs).

Natural progression does have the advantage of certainty but this is only to a salary ceiling at the top of the scale. This causes frustration as staff have no where else to move. For example 90 per cent plus of Health Visitors are the top of the G grade and have to move into management or education to progress further.

It is a major task to develop a fair, objective and non-discriminatory system that acts as a facilitator of change and improved clinical practice driven by improved professional development and resulting in better pay. The key question is whether the KSF will help liberate the talents and skills of NHS staff and help them progress.

Key to this approach is right of access of NHS staff to Continuing Professional Development (CPD). This has been one of the key arguments put forward by the Staff Side in negotiations. The KSF will deliver greater access to CPD and this is underpinned by HR strategies in some areas e.g. Healthcare Science.

Those who have been involved in the past in the change process in such areas know that it is hard work or often achieved by some kind of osmosis:

• the Advanced Practitioner in Cytology took many months of discussion to introduce;
• Consultant Nurses were introduced often without any proper professional raison d’être;
• School Nurses who have changed practice and improved their competencies are having to fight for fair grading Trust by Trust; and
• our colleagues in the National Association of Theatre Nurses have proposed changes to standardise gradings in theatres and nothing has happened since.

The professional work of Amicus in the NHS will become key in supporting and developing members through their pay scale and beyond. Amicus already has professional support in Community Nursing and Pharmacy. We must seek to expand this capacity in three ways:

• developing professional levies already carried out by the CPHVA and now agreed by the CPNA and GHP;
• integrating with professional bodies e.g. BAAT, BSHT, CHCC, CPHVA, CPNA, GHP, HPA, MPU and SHASTD;
• developing closer links with other professional bodies e.g. IBMS and others in Healthcare Science.

At the same time we must:

• increase our membership density in the areas that we organise (Doctors have clout not only because of what they do but because they are well organised);
• start to restructure our professional and labour relations work along the lines of the document tabled by the Amicus Head of Health.

This latter initiative is not devised to subsume professional autonomy but to provide greater co-ordination to pursue common objectives across clearly defined areas of our membership.

Terms and conditions is likely to be a contentious issue for some Amicus MSF groups particularly in the are of unsocial hours premiums.

Let us start on the basis on the basis of apparently contradictory bargaining objectives for the Union:

• Amicus MSF is committed to protecting levels of earnings for our members.
• Amicus MSF believes that those staff that work over and above their contractual hours should receive proper compensation or time-off in-lieu.
• Amicus MSF believes that those staff that work unsocial hours should receive compensation at a premium.
• Amicus MSF supports the strict implementation of the Working Time Directive as a Health and Safety instrument.
• Amicus MSF supports efforts to reduce the length of the contractual working week as a socially useful objective as opposed to a means of increasing the number of hours worked at a premium.

The long-hours culture is a British disease. We have the longest working hours (particularly male workers) of any country in the European Union. The average length of working time has gone up in the last decade. These hours are worked in order to supplement some of the poorest levels of pay in Northern Europe.

At the same demands for increased service coverage are increasing – "the 24/7 society". This is one of the visions within the NHS Plan.

Overtime is a contradictory phenomenon. It is justified by increased service or output demands. However, all economic evidence points to the fact that reducing levels of overtime increases productivity. Similarly, unsocial hours are less productive and bad for the health of staff. This is apart from issues relating to working safely or accurately when working a long and/or unsocial shift. Yet at the same time these working patterns result in premium rates of pay or put crudely employers pay more for less.

It has been shown that sometimes overtime gets systemised and work expands to fill the available time. Some employers in private sector companies engaged in manufacturing have boosted basic rates of pay, slashed overtime without any detrimental effect on output levels. This concept is difficult to apply to a service sector, let alone healthcare. However, it may be applicable in the area of non-emergency process work. But 24/7 implies cover at all times when the levels of emergency work are outside the control of those working in providing the service. At the same time staff numbers, because of poor pay, are insufficient to provide a reasonable pattern of work to deliver 24/7 hence long hours are worked by some.

On these premises there is a basis for a way forward. However, staff are naturally resistant or fearful of change particularly when the current arrangements ‘delivers for them’ even if this involves work patterns that Amicus MSF cannot condone. Maintenance of the status quo of long hours also maintains the culture of low wages.

Amicus MSF needs to take a lead and have confidence that we break such working practices and move to a more virtuous position whilst protecting salaries. The starting point therefore will be hopefully improved levels of basic pay. This will make pay more transparent and hopefully attract graduate staff to work in the NHS reducing the average length of working time across affected areas.

At the same time productivity can be increased by the optimisation of the use of staff particularly in process areas through the use of shift systems. In his speech to the RCN, the Secretary of State indicated that productivity improvements would result in salary gains. Flexibility and bridging clinically unnecessary demarcations through passing work back down the ‘skills escalator’ under supervision would increase the optimisation of more skilled staff leading to further productivity improvements.

The present proposals from the DoH on unsocial hours do not form the basis of an agreement and will result in some departments unable to obtain sufficient numbers of staff to provide cover. Amicus MSF has tabled an alternative proposal which we believe can facilitate change whilst protecting members salaries. Our approach is supported by other staff side organisations and a proposal to management has been tabled. We want work to pay not working the system to pay.

The length of the standard contractual working week also poses problems for us not as a matter of principle but as a matter of balance. Equalisation of the length of the working week is likely to be based on the length of the nurses (37.5 hours). Harmonisation on hours is a key objective in creating single status in the NHS, which we support even though we are unlikely to benefit.

Indeed some Amicus MSF groups (Speech and Language Therapy) presently work less than 37.5 hours and this therefore will be a diminution in their terms and conditions of employment. However at the same time we recognise that many professional groups work over and above their contractual hours so in reality they will be no worse off. For example the last CPHVA Omnibus Survey of 500 Health Visitors revealed that they work an extra 9.26 hours per month unpaid. Amicus MSF is opposed to unpaid overtime or extra hours without time-off-in-lieu (TOIL).

Harmonisation on hours is an expensive cost item as it effectively increases the hourly rates of pay (e.g. a reduction from 40 hours to 37.5 hours increases the hourly rate by just over 6 per cent). However, we believe that if increased investment, Agenda for Change, Improving Working Lives and recruitment and retention strategies start to deliver in terms of the NHS Plan targets for staff increases we should be in a position to argue for a shorter working week for all health staff.

Such as a demand should unify all staff organisations as we will be starting from the same point. In addition, if we seek more extended protection (see next section) for this aspect of the salary package we can ameliorate this negative aspect of the negotiations.

Whilst we are committed to harmonisation on hours we are also equally committed to our bargaining items. These are:

• improved family friendly arrangements: maternity leave, paternity leave, carers leave, support for childcare and flexible working.
• improved facilities for trade union activities: back-fill time off, meeting facilities and time, access to IT, printers etc.
• improved arrangements on the use of vehicles for work purposes: mileage allowances, lease car arrangements and parking facilities.

There is a potential problem in this area. However, with sufficient investment in pay this may be kept to a minimum.

The present proposal is protection for salaries, terms and conditions for a period of eighteen months. Whether this is eighteen months from completion of AfC or when AfC is introduced and whether the Early Implementers will have a longer periods has not yet been determined.

Some groups have better arrangements mainly negotiated when Section 48 of the General Whitley Council agreement was terminated. In one case it is asserted that this is lifetime protection.

There are two issues, firstly an interpretation of whether such agreements apply in the context of the implementation of AfC. Secondly, the effect of such agreements, if they apply, on fair or equal pay.

Most of the local agreements refer to organisational change e.g. trust or departmental merger or re-organisation. It is unlikely therefore that such agreements do apply under the AfC. The DoH will reasonably argue that AfC is an all of nothing agreement and salary protection is part of this. Staff cannot agree to accept any salary gains but seek to protect salaries for the losers under localised agreements.

If staff did seek to apply local agreements it may be shown that male dominated professions have greater protection than female dominated professions or visa versa and therefore it is indirectly sex discriminatory (in Northern Ireland this case can be made on religious or political orientation grounds). The same arguments may be made on national grounds where devolved government in the Scottish Parliament or Welsh or Northern Ireland Assemblies has reached more beneficial agreements.

Amicus MSF also believes that there is no reason why the service cannot handle different periods of protection for different parts of the salary package (see section above on Working week).

Amicus MSF is likely to make significant advances on the inclusion of our members in coverage by the Pay Review Body (PRB). This will accord the same status for these groups as those professions presently covered by the PRB. This will significantly increase the influence of Amicus on the staff side structures of the central pay spine.

There is confusion over some MTO groups but we have successfully argued that the generic title Healthcare Scientist should apply. There are unresolved differences on Chaplains and Sexual Health Advisors even though the Nurses and Midwives PRB determine the pay of most of this latter group. These issues will not be addressed until full negotiations take place.

Amicus MSF needs to now work out how we submit our evidence to an extended PRB. Presently we have ‘rights’ of submission via the CPHVA who have extended this facility to raise issues relating to our other nursing membership. Amicus MSF also contributes to the collective evidence from the staff sides of the Nursing and Midwifery and PAMs councils. This year these bodies are collaborating on common sections of evidence for the first time ever.

• Amicus MSF needs to ensure that more jobs are benchmarked and that the job profiles reflect the roles of the vast majority of our members.
• Amicus MSF must develop a training programme for Reps focusing on assimilating jobs onto the new pay template via the use of job profiles.
• Amicus MSF will seek to improve its professional capacity either by using professional levies or working with and hopefully integrating with a range of professional bodies.
• Amicus MSF needs to obtain agreement on common payments for working unsocial hours in the face of contradictory bargaining objectives.
• Amicus MSF needs to agree proper procedures for TOIL or overtime particularly where members face a longer contractual working week.
• Amicus MSF will argue for a shorter working week.
• Amicus MSF is seeking improved time-off facilities for trade union activities and improved arrangements for staff who use vehicles for working in the community.
• Amicus MSF is seeking extended salary protection arrangements starting from when AfC has been implemented across the service and for aspects of the salary package.
• Amicus MSF needs to boost its research capacity in order to reflect expanded coverage of our members by the PRB.
• Amicus MSF needs to verify applications for Early Implementers.