RepsDirect No 183 - 19 June 2003

Yes. The Staff Side and the Department of Health (DOH) identified benchmark or typical roles in NHS i.e. in this case Health Visitor. The CPHVA via Staff Side then nominated Trusts and postholders where an evaluation could take place.

The steps in the development of a profile are as follows:

• Completion of Job Analysis Questionnaire (JAQ) by postholders(s), usually with the assistance of job analyst(s) to ensure all information included and accurate.
• Evaluation of JAQ(s) by the JEWP profile sub-group ('the profile group').
• Draft profile prepared by 1 profile group member on basis of JAQ and reviewed (sometimes more than once) by whole profile group to ensure consistency of assessment against factor level definitions and other similar profiles.
• Distribution via Staff Side to relevant staff side organisation (i.e. Amicus CPHVA) for comment.
• Consideration of comments by profile group and revision of profile.
• Submission of revised profile to Staff Side for agreement to publish. Possible return to profile group with questions or comments from Staff Side for further review.

Yes. Comments were made by the CPHVA Labour Relations Committee which resulted in an improved outcome.

Profiles are NOT job descriptions and are NOT intended to replace organisational job descriptions. They are NOT person specifications, for recruitment purposes, although they may be helpful in drawing up person specifications in the future. Profiles ARE the outcomes of the evaluation of jobs.

There is no 'bargaining' in the sense you will understand it in this process. We cannot stake a claim for an evaluation outcome and then 'settle' on a compromise position. Any case we made had to be done in the terms of the job evaluation scheme and then accepted by the colleagues undertaking the profiling exercise. Likewise the DOH was not in a position to determine evaluation outcomes.

When Clinical Grading was introduced in 1988 the then HVA argued that all Health Visitors met the criteria for H grade and mounted a campaign to achieve this objective. This was mainly a failure. As a result we missed the opportunity to have specialist Health Visitors graded H except where we made a separate case defacto invalidating our case for this grade for all Health Visitors.

This is untrue. Health Visiting is on Band 6, higher than that of Staff Nurse profiles, and on par with other Specialist Practitioner profiles (School Nurse, District Nursing Sister, Community Psychiatric Nurse and Community Midwife), specialist nurses in the acute sector and specialist or Team Leader roles amongst Allied Health Professionals (Physiotherapy, Radiography, Podiatry, Occupational Therapy and Biomedical Science). The profile is at the same level as the draft profiles for other professions which have a higher educational requirement prior to practice.

A job evaluation scheme (JES) is a tool for comparing the demands of jobs and thus establishing internal relativities within and between job groups. In order to apply a JES tool fairly, it is necessary to apply it consistently, by ensuring that similar job features are evaluated the same, wherever they occur, and that distinguishing job features are evaluated differently. Job features, which are common across a job family, should be reflected by the same factor level assessments.

We have conducted a review of factor level outcomes across specialist practitioner profiles and the question posed is true (see table attached). Health Visitors also come out higher in some factors. Where differences are not sustainable in terms of the factor plan e.g. working conditions we will seek a revision upwards to match levels of the other profiles.  However, we are of the view that these revisions will be insufficient to take the profile into Band 7 and this is why the profile was signed off by Amicus as it had no material effect on pay levels.

This factor is mainly dealing with the depth, rather than breadth of knowledge. The Specialist Practitioner qualification in terms of the JE scheme is at a higher level than that for nurse prescribing. Breadth of knowledge would only count when it is of a sufficient nature to take a factor onto the next level of this factor. Nurse prescribing on its own is insufficient to do this in the same way that under the current Whitley structure it was insufficient to take Health Visitors onto grade H.

The scheme was designed to cover all jobs in the Health Service and has been rigorously tested on jobs ranging from catering assistants to consultant practitioners and including senior managers, in order to ensure that this is the case.

Good job evaluation practice is to work up from level 1 for each factor in order to find the level which best matches the available job information. This is preferred to working down from the top level, because this latter practice leads to over-evaluation and the need to re-evaluate later when it becomes apparent that the initial evaluations are inflated.

Each factor level is intended to reflect a distinct step in demand from the level below and to the level above. This results in a limited number of levels per factor (from 4 to 8) and means that each factor level encompasses a small range of demand, so it is possible for different jobs within a job family to fall at the same factor level, even where small differences in demand can be perceived. So, for example, a specialist practitioner is not always 1 level higher than a practitioner on knowledge, skill and responsibility factors.

Therefore in order to make the case for example under the Communications Factor that Health Visitors should be at the highest level we are seeking to prove that the profession is at the highest levels of complexity not just in nursing but all NHS professions. We were not able to sustain this case and we are sure that you will accept that other professions are at a higher level. 

Terms occurring in the factor level definitions (e.g. complex, highly complex, specialised, occasionally, regularly) are defined in the relevant factor guidance notes and in relation to other jobs. For example, practitioner jobs are generally evaluated at level 3 under the Analytical and Judgemental Skills factor as dealing with 'a range of facts or situations'. Specialist practitioner jobs have usually been assessed at level 4 as making judgements 'involving complex facts or situations'. These usages may be different from those, which postholders might apply to their own work. It is therefore not sufficient to say, for example, when commenting on a profile that 'all postholders make highly complex judgements', even though those in question might reasonably use this terminology when describing their work to others.

This is a subjective assessment of factor levels based on the views of the postholders. For example the complexity of a task to a postholder is based on a number of factors e.g. knowledge and skills, experience, levels of supervision. However, there is also an objective measure as defined by the factor plan. 

This has been partly created by compression of the current career structure. Four Whitely grades (E-G) have effectively been squeezed into two Bands (5 & 6) whilst guaranteeing that no nurse is worse off in their basic pay. In fact all nurses gain. It is just that some have gained more than others and this has created the impression that you have been downgraded when in fact this is not the case. It is impossible to create a new pay system based on Job Evaluation whilst maintaining existing differentials. The current grading structure in terms of levels of work differentiation was not sustained by the evaluation outcomes.

Our advice to all members is that if the profile does not fit, do not wear it. If you do not agree with the decision of the matching panel in your Trust to match your job to the Health Visitor profile then you can challenge this decision. You will obviously have to produce evidence that this is the case.

In our view the published Health Visitor Profile  covers the standard role. No successful match can be made for Community Practice Teachers or those undertaking specialist roles unless national profiles can be agreed in these areas. Therefore we are positively encouraging members in this position to go for a local evaluation.  You may like to look at the profile for a Highly Specialist nurse based in the acute sector with which to make an effective comparison.

This is where the present system is fairer and more transparent. Under Whitley, Trusts optimised the grades to meet the salary budget. There are colleagues who undertake specialist roles and do not get a H grade and from our own survey only 50% of CPTs receive a substantive H grade even though they explicitly meet the criteria for this grade. Whilst often we have proved the unfairness of these abuses of the Clinical Grading criteria Trusts retain power to act as final arbiters of our claims and deny our members fair pay. 

Under the Agenda for Change we can mount an evidence based challenge to the Band allocated for a post and ultimately have an independent assessment of the post via the Job Evaluation scheme. Often the basis of the challenge is that roles have evolved or health visitors have taken on leadership roles or they are engaged in developing practice through research and development. This happens as a means to better address the health needs of your clients. How would a Trust under these circumstances defend a position where they are in effect arguing for relatively 'poorer' healthcare provision based on outdated modes of practice?

More excitingly using the Knowledge and Skills Framework we can start defining the competencies required for higher levels of practice and giving members the means to reach these via CPD. The CPHVA needs to show leadership qualities of its own that this is the way forward.

We are certain that if we do this more Health Visitors will be on Band 7 as a proportion of the overall workforce then are presently on H grade.

Blaming Amicus CPHVA for the evaluation is akin to blaming the clinician for the assessment. Let us learn the lesson of clinical grading and do not seek to reach unrealistic goals ending in defeat. Instead we need to use the new pay template to take forward the profession in the way outlined above.

So in addition to the an increase in pay of =A31160 (reduced for those on discretionary points) for those Health Visitors at the top of G (an estimated 80%+), we have secured:

• additional annual leave;
• the elimination of grade mix in district nursing;
• fairer pay in school nursing; and
• a transparent means to move people through the Bands.

We are also confident we can nursery nurses working in the community onto Band 4.

Yes this does not meet everyone's aspirations but is a bit more than the "nothing" described by some colleagues. The talks are not the 'end game' in our campaign for better pay and conditions for Health Visitors.  We can still obtain further gains from this process. In order to achieve these we need avoid infighting, keep our eye on the ball and campaign in the radical tradition of the CPHVA.

For further information contact:

Colin Adkins
Amicus Health Section Research and Policy Officer
020 7505 3167
colin.adkins@amicus-m.org

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3 Amicus reports steady progress on job profiles but much work remains to be done

Amicus will report to Health Sector delegates to the Annual Conference that there has been continuing progress with the production and development of job profiles covering Amicus occupations but much work remains to be done. In some areas we still identify that significant problems remain but we are hopeful that through partnership that these can still be tackled. The conference will also see preparations being made for the second stage of this process - the issuing of guidance on job profiles and the training of Representatives in the Early Implementor and then other Trusts.