How to Judge Agenda for Change

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How to Judge Agenda for Change

Commentary: Agenda for Change – the New NHS Pay System

For Your Information:
Devil's in the Detail
Radiographers Say "No" to Agenda for Change
UNISON Leaders Recommend Acceptance of Agenda for Change
T&G Health Workers Back Agenda for Change

An agenda for change. Who could be against such a progressive sounding programme? But who is providing the context for which this very complex exercise in national pay restructuring in the NHS can be judged?

The government has set the criteria of Agenda for Change (AfC) being "deliverable and affordable". Are these the most valid and suitable criteria? Who decides whether the exercise is deliverable and affordable?

WDIE is posting a commentary which focuses on the issue of: deliverable and affordable for whom?

One fundamental feature that the government’s context obscures is the very nature of the "affordability" of health care, and within that the remuneration of all who work within the NHS. The health service is paid for out of the national social product, of the value created by workers in Britain. The funding of the NHS can be viewed as a claim on this aggregate social product. The way the government presents the problem of "affordability" obscures that its budget, the collection and disbursement of state funds, is itself a percentage claim on the social product.

"Investment with reform" has been the government’s watchword, which seeks to undermine funding for the health service under the guise of linking it with "modernisation". It is important for health workers to discuss and investigate this issue of the sources and utilisation of state revenues in the health service. This will contribute to lifting the fog from this imposed context of deliverability and affordability. It will strengthen the demand that a modern health service be provided on a par with the level of the productive forces.

Health workers must oppose any use the AfC exercise to sow divisions among different sections, in particular opposing the pressure to accept AfC for the greater good on the pretext that only a minority of health service workers will lose out. In our view, the discussions present an opportunity for health workers to oppose their marginalisation from decision-making and to strengthen their resolve to fight to safeguard the future of the NHS.

The Negotiations So Far

Agenda for Change – the new replacement pay system for the NHS – is now occupying the minds and most of the activity of thousands of health workers and their trade unions throughout Britain. Thousands of health workers are discussing it, training in Job Evaluation and the Knowledge and Skill framework closely associated with the new pay system, whilst Unison and Amicus are consulting with their members prior to a ballot in October in which union members will decide if Agenda for Change will be accepted. The Society of Radiologists have voted to reject Agenda for Change twice, and RCN, RCM, GMB and other unions have accepted.

These national pay negotiations, which have taken nearly seven years, have finally culminated with a review in August this year of the 12 Early Implementer (EI) sites (the twelve NHS organisations in England that have been implementing the Agenda for Change pay system since June 2003). Of the 35,000 jobs in the EI sites only 16,000 had been matched, or evaluated; yet the pay protection was in some cases up to nearly 50% of the workforce. Which in the way "pay protection" works means that these and new staff will receive cuts in pay, either now, or in the future. Sunderland Hospitals were one of the few EI sites to nearly complete all the job matching and job evaluation with 42% of staff losing pay and requiring "pay protection". As a result thousands of staff walked out in lunchtime protests and as a result of this and the work of local union activists the scheme was not implemented at Sunderland. Ambulance staff in and other EI site the North East Ambulance Trust went into dispute with the Trust because they wanted to them to work their breaks without pay. This was not because of rules in the Agenda for Change pay system which said they should have been paid, but because the Trust could not keep within budget having paid for extra holidays in the new pay system. Whilst the ambulance workers eventually won this dispute after threatening to take industrial action unsurprisingly health workers everywhere were calling for a vote No to Agenda for Change.

The Review by the Shadow Staff Council in August faced with this crisis in the new pay system only months before it supposed to go live on December 1 made some changes to the pay system. However, all the changes were negotiated with the government side insisting that the scheme remained "affordable" and within the general budget that is allocated for NHS Trusts. The job evaluation scheme was updated to deal with complaints that it did not evaluate non-clinical jobs correctly. New nationally produced generic profiles were also produced to try and rectify some of the job evaluation results. Changes to overcome those that were losing out with Pay in High Cost Areas and protection for four years and a review of On-Call payments were introduced. But the biggest change was in "decoupling" of the unsocial hours payments from Agenda for Change to be renegotiated, tested and agreed by April 2006 as an "affordable" separate agreement. However, so far there have been no guarantees to the low paid ancillary workers, or night shift nurses that their present unsocial hours will be maintained and in the agreement overtime rates will still be cut by the new pay system in December.

The Shadow Council then recommended acceptance of Agenda for Change because those that lose out are on average below the target of 8% and Agenda for Change is "deliverable and affordable".

Deliverable and Affordable for Whom?

The question of the pay system in the NHS is not a question of whether it is "deliverable and affordable". Deliverable and affordable to whom?

According to this conception of "deliverable and affordable" big business can make lots of money out of the NHS through the Private Finance Initiative (PFI) and by the big drug companies. These costs are underwritten by the government and guaranteed. In the case of the PFI and other contracts payments are guaranteed and inflation proofed for 30-40 years even if the hospital closes. According to this conception, of "deliverable and affordable" the NHS cannot provide health care at the highest level and cannot train enough doctors and nurses for the NHS let alone helping poorer countries. Instead vital health resources and especial human resources are plundered from poorer countries whilst military spending especially for wars of occupation are underwritten and guaranteed.

On the other hand the pay system of the health workers is not underwritten and guaranteed. Health workers who are the vital resource of the NHS have to accept that in their pay system some will gain and others will lose, whilst the lowest paid are still below the poverty levels acceptable in most European countries. And will their pay system be protected and inflation proofed for 30-40 years! The answer is that under this conception of "deliverable and affordable" it will not. Then who decides what deliverable and is affordable? The rich and government vote for their own large pay hikes whilst they decide what is "deliverable and affordable" for everyone else.

Most health workers will say that regardless of who gains not one person should lose out, but more than that in modern times no one should condemned to low pay. What this reflects is a different conception of the worth of health workers to that of the government and big business. For one thing health workers do not discriminate between "clinical" and "non-clinical", or men and women. They consider them all part of the health care team. Their conception is that a million health workers, which include all the support staff, provide a vital service for the people and for the economy. If the economy cannot provide for health workers and other public service workers then what use is such an economy and whose interests does it serve?

A modern conception of society is that not only should the economy serve the interests of those who live and work in it but that it is they that are best place to set their own worth. This conception of what is "deliverable and affordable" would ensure that the most vital human and material resources of society, both in production and in services, in looking after and caring for society and the environment would be addressed first. Everything that is parasitic and worthless would be discarded.

This situation points to the need for health workers to use their discussions, to get together to discuss how a truly modern society and economy can be built in which health care is provided at the highest level with a modern pay system in which they decide what they are worth. This must be a society in which the workers decide not only their worth but also the whole direction of the economy so that the needs of the people can be put in first place.

This week a Unison conference will decide the union's policy on the new pay structure for NHS staff, Agenda for Change. Geoff Martin* says he is not sure he can back a deal which will benefit some - but penalise others

The Guardian, October 5, 2004

After more than five and half years the discussions around a new pay structure for more than 1 million NHS staff - Agenda for Change - is finally reaching end game.

The first talks around the new deal were kicked off by a fresh-faced Alan Milburn as far back as February 1999. Since then a millennium has come and gone and NHS trade union stewards have accumulated shelf loads of guidance and briefings on what is probably the most complicated set of pay negotiations ever entered into.

This week activists from Unison, the biggest of the healthcare unions, will gather in London to consider all the evidence and to make a recommendation in a membership ballot on Agenda for Change which will be done and dusted well in time for Christmas.

If the government had had their way the package would have been bundled through by now. It was resistance from rank and file health trade unionists, who wanted a closer look at the proposals in action, which led to the setting up of a dozen Early Implementer Trust's up and down the UK. It was a wise move as the results coming back in showed that anything up to 30% of staff could end up as losers under the deal if there weren't radical changes.

A period of intense negotiations over the summer led to one of the most contentious areas, payments for working antisocial hours, being decoupled from Agenda for Change but only for a year. Next autumn it will have to be resolved once and for all. No doubt this was a short-term victory but suspicion remains that the employers will come back for their pound of flesh once the rest of the machinery is in place.

Some groups of workers have already come out against Agenda for Change. Unison's white-collar section and the Society of Radiographers have both pointed out that their members will end up with a longer working week and justifiably ask what's modern and family friendly about that? Professional and technical staff and therapists are also set to end up working longer hours and that's one of the key reasons why the union Amicus is making no recommendation in their ballot and is giving their members the equivalent of a free vote.

Agenda for Change's backers counterclaim by pointing to an uplift for the lowest paid and a minimum wage of £11,135 per annum. Branch activists have pointed out to me that the bulk of the lowest paid in the health service work for private contractors and that most aren't covered by the deal.

So as decision time looms there's a mountain of detail to weigh up. Some key players involved in the process have told me that what's now on offer is the best that can be achieved through negotiation, which begs the question of how much more we might get for health workers if we flexed a bit of industrial muscle.

If I was still working as a hospital porter I might, conceivably, have been an Agenda for Change beneficiary. But I am still not sure that I could vote yes for a deal which leaves other members of the healthcare team on the losing side.

* Geoff Martin is Unison's London convenor

Report by Society of Radiographers – 01/10/04

Society members have voted to reject Agenda for Change for a second time.

The result of the ballot, announced on Friday, 1 October, shows that 83 per cent of members against the proposals and 17 per cent voted to accept them.

A total of 11, 398 members of the Society voted, representing 67 per cent of the people eligible to vote.

How you voted in detail

Number of ballot papers distributed		17,050
Number of papers returned		11,398
Number of invalid papers (blank/spoilt)		13
Thus, number of valid votes counted		11,385
Number voting ‘No’ to reject Agenda for Change		9413
Number voting ‘Yes’ to accept Agenda for Change		1972

Electoral Reform Services, an independent administrator of elections, held the ballot on behalf of the Society.

Members have voted a second time to reject AfC. Negotiations are being held with the Department of Health on 8 October to discuss issues such as the increase in hours and the payment of the recruitment and retention premia.

The Society is organising a rally in London to protest against the unfair treatment of members. Trafalgar Square has been provisionally booked for 13 November. Further details about this event will distributed shortly.

"This further refusal to accept the proposals will put pressure on the Department of Health to address the key issues that radiographers find unacceptable," said Ann Pollard, the Society’s President.

"No one wants us to take industrial action, least of all the government, but they must understand that issues such as increased working hours for no additional pay is unacceptable to our members. The failure of the government to address this has led to a total lack of confidence in the system and continuing misgivings over the unsatisfactory on-call and emergency duty payments, as well as a structure that does not allow staff to progress smoothly through the profession," she continued.

"We are expecting significant concessions."

Unison Press Release – 08/09/2004

UNISON health leaders today decided to recommend acceptance of the new pay and gradings package in the NHS - Agenda for Change. The union’s health service group executive will now put that recommendation to a special conference of health delegates on 7 October, followed by a ballot of more than 450,000 UNISON health members.

UNISON General Secretary Dave Prentis said:

"This is a historic decision - it’s been five years in the making and the service group executive today has given the membership a clear steer.

"A special health conference and a ballot of the entire health membership will decide. But the job has been made easier by a recent change to the plans which de-coupled unsocial hours from the package. We wanted to make sure that those on the lowest pay would not lose out the most.

"The agreed new minimum wage of £11,135 a year is also a great step forward."

Agenda for Change will affect 1 million staff working in the NHS across every occupation and is designed to tackle the inequalities and demarcations rife across the whole of the NHS. It is also designed to modernise what was an extremely outdated and antiquated pay system.

From the start UNISON expressed grave concerns about arrangements covering unsocial hours in particular.

UNISON will be holding a special conference in London on 7 October. The conference will decide whether to recommend acceptance of the package to its 450,000 health members in a ballot to be held later that month.

T&GWU Press Release – 6 Sep 2004

The Transport and General Workers' Union will be recommending that its members in the health service vote "yes" to Agenda for Change, following a vote at a conference of T&G health workers today. Agenda for Change is a major overhaul of NHS pay structures, and workers will be voting on whether to accept the package between September 20 and October 18, 2004.

Tom Douras, T&G lead officer for the health service, said:

"Following long and protracted negotiations with the Department of Health, this package represents the best deal that could be negotiated. The package is a big improvement compared to it at the start of the process.

"By taking a firm stance on unsocial and on-call provisions, the T&G has managed to gain a review of those issues and members will be balloted on those points separately.

"This is a major step forward for our members in the NHS. We will be fighting particularly hard in the processes that follow to ensure that all our members are being taken forward with the changes."