The health secretary's speech to the Kings Fund

Daniel Mortimer

16 / 7 / 2015 3.17pm

Dear Colleague,

I thought you might find it useful to have a summary of the key points from this morning’s statements by the health secretary to the Kings Fund, as well as the broader announcements about pay.

The health secretary outlined the government’s vision for the NHS over the next 25 years. This includes the announcement of NHS Improvement - the name of the new jointly led Monitor-TDA body - and a new independent patient safety investigation service, which will operate on a no-blame basis, similar to the air accident investigation branch. An international ‘buddying’ system was also announced, which will see five NHS trusts working with the Virginia Mason Hospital in Seattle, and a review to develop practical proposals on how new digital innovations in health can be used effectively, to be led by Martha Lane Fox.

At the heart of the health secretary’s speech however, were his plans to reform medical contracts in the NHS to improve seven-day services across the NHS. These reforms will be based upon the reports of the NHS Pay Review Body (NHSPRB) and Doctors’ and Dentists’ Review Body (DDRB), which have also been published this morning. These announcements reflect the work that we have done on your behalf to make the case for contractual reform, especially for medical staff. I am especially grateful to Anne McIntyre, Angela Huxham and David Wherrett, and their respective negotiating teams, for the contribution they have made to making our case to the pay review bodies and government.

I know that you will be particularly interested in the publication of, and government response to, the reports of the NHSPRB and DDRB and have prepared a quick summary of the main findings below.

DDRB report

  • The key principles proposed by the government and NHS Employers are reasonable – to improve patient outcomes across the week and to reward greater responsibility and professional competence. 
  • They found the case for expanded seven-day services in the NHS, in order to address the ‘weekend effect’ on patient outcomes, to be compelling. 
  • The proposals should be viewed as a total package of reform across the two contracts.
  • Changes are required to the antiquated approach for time-served, mainly annual incremental progression in both contracts.
  • The ‘night window’ for out-of-hours work should start at 10pm and that a common definition should be applied across all staff groups.
  • The DDRB supported the proposed approach to the pay package for juniors. Whilst it noted that the rates for unsocial hours and other elements were for the parties to agree, it also noted that total pay for juniors compares favourably with comparator groups and that given the cost-neutral pre-condition for negotiations, that position will continue.
  • Contractual safeguards are needed to ensure that consultants and junior doctors are not expected to work excessive hours, and can maintain a reasonable work-life balance.
  • DDRB considers that removal of the opt-out is important and significant. They stated: “In our view, the current opt-out clause in the consultant contract is not an appropriate provision in an NHS which aspires to continue to improve patient care with genuinely seven-day services, and on that basis, we endorse the case for its removal from the contract.”
  • There is scope for progressing some elements of consultant reform at different speeds, including early removal of the consultant opt-out.
  • The DDRB supports the continuation of national Clinical Excellence Award (CEAs). They believe that given the separation of local CEAs (to be reformed as performance pay, or payments for excellence), the value of national CEAs will need further consideration.
The health secretary has now made further announcements. The government:

  • will be asking the British Medical Association (BMA) to engage with them over the summer. The BMA will need to advise by mid-September if they will work with the government to introduce modernised professional contracts. If they do not agree to consult contract changes, changes will be enforced
  • would be seeking immediate removal of the consultant opt-out and early implementation of new terms for consultants from April 2016
  • wants the introduction of a new juniors’ contract from the August 2016 intake
  • will consult on the removal of the current local CEAs in the autumn, alongside proposals for a reformed national CEA.

Patients and employers want the delivery of the same high quality of care across the entire week, and we welcome today’s report from DDRB as a key step towards achieving our ambition of improved services across the NHS.

To afford and sustain seven-day services, we need to overcome the current obstacles that exist and, as our evidence demonstrated, I firmly believe that the removal of the contractual opt-out for non-emergency work undertaken out of hours is crucial to improving the quality of patient care.

Today’s report sets a clear direction for reform, which is good news for patients and employers , and we now need to work together with our medical colleagues and their trade union, the BMA, to implement the changes the Secretary of State has endorsed.

You can access a more detailed summary of the pay review body reports from our latest news section, where you will also find links to the full reports.

Key findings in the NHSPRB report

  • The Agenda for Change (AfC) pay system was not viewed as a barrier to the delivery of seven-day services.
  • More work is needed to understand how future services would be delivered, the workforce implications and the transitional arrangements to a new way of working.
  • Contract reform should work for staff and patients and that any reform of premium pay should not be done in isolation, but as part of a wider package of reform.
  • NHS premium pay rates are not out of line with comparator industries, but that there is a case for some adjustments to the unsocial hours for which plain time would apply. For example, evening plain time extending from 8pm to 10pm. It was noted that some sectors had also extended plain-time working to include Saturday working.
  • Reform of unsocial hours payments should be considered as part of the wider review of the AfC pay, terms and conditions, which would include reform of incremental pay progression so that the link between pay and performance is strengthened. 
The health secretary has now announced that the government:
  • is inviting the trade unions to enter into formal negotiations with NHS Employers to agree a balanced package of affordable proposals in line with the earlier pay deal agreement, to begin implementation from April 2016
  • will continue to examine pay reforms and modernise the terms and conditions of public sector workers including renewed focus on reforming pay progression
  • wants negotiations to be built on the 2013 agreement for AfC pay progression and fully remove the practice of automatic annual incremental progression from the NHS pay system.
We will continue to speak with our trade union colleagues, to ensure we work in partnership to progress pay and contract reforms. Although we recognise that the recent announcement from the government of continued public sector pay restraint is likely to make talks more difficult, we hope trade unions will continue working with us in partnership to achieve the reforms necessary to improve patient care across the NHS. 

We do suspect that the 1 per cent per year public sector pay restraint budget announcement is intended to be a cap of 1 per cent on total pay increases (ie. includes incremental pay costs), and the pay review body will be asked how this should be applied. We are currently working with Treasury and the Department of Health to get further details and will communicate with you once more is known.

Other health announcements today

Rose report

There were also some further announcements today that you will be interested in. Lord Rose’s report on NHS leadership, Better leadership for tomorrow was published and the government has accepted all 19 of his recommendations in principle, including moving responsibility for the NHS Leadership Academy from NHS England to Health Education England. We will be looking in more detail at the recommendations and their impact on the NHS workforce and will keep you updated.

Raising concerns and speaking up

The government announced today that every NHS trust is to have local whistleblowing guardians and a national officer at CQC for whistleblowing will also be created. They also published their full report Learning not blaming: The government response to the Freedom to Speak Up consultation, the Public Administration Select Committee report Investigating Clinical Incidents in the NHS, and the Morecambe Bay investigation. The responses to the consultation provided much information, which the Department of Health will now use to inform key actions for the relevant national bodies over the coming weeks, to provide additional guidance to support implementation at a local level. 

We will be updating our latest news page shortly with a key summary of the report, but I have highlighted a couple of the key actions below:
  • Removing the Nursing and Midwifery Council’s current responsibility for statutory supervision in the United Kingdom, moving to a model of professional supervision similar to that of other health professionals. 
  • A full-scale review into current maternity services and provision across the country, which started earlier this year, led by Baroness Cumberlege.

Today’s announcements highlight the scale of workforce reform that lies before us and sets out a clear timescale for implementing those reforms. There has always been support from across the NHS for the need for contracts that keep pace with the needs of employers and the services they provide. We now need to work in partnership with the health trade unions to make this a reality and are already planning talks to take this forward.

I hope that you have found this information useful and I will continue to update you as the situation develops. If you have any feedback on the above issues or ideas for how we could support you more in this area, then please feel free to contact me at

With best wishes

Daniel Mortimer
Chief Executive

Latest Tweets

Why Register?

Great reasons to register with NHS Employers

  • A personalised website
    Manage your profile and select topics of interest to you
  • Access your dashboard
    Bookmark useful content to help you quickly find what you're looking for
  • Get involved
    Contribute to our Talking Points discussions, comment on and rate our webpages
  • Keep up to date
    Receive the latest newsletters and media summaries

Sounds great, what next?

Register Now

Not now, I will register later

Log In