Nurses and other health professions review body - 22nd report

This page contains a summary of the key recommendations and conclusions by the NHS Employers' pay and negotiations team and the key comments of the Nurses and Other Health Professions Review Body.

Key recommendations

• The review took place against a backdrop of ongoing implementation of Agenda for Change. Implementation is still not complete throughout Great Britain, therefore recommendations concentrate on the level of basic pay award
• A one year only pay award
• From 1 April 2007 an increase of 2.5 per cent to the Agenda for Change pay rates
• The existing minimum and maximum High Cost Area Supplements (HCAS) for Inner London, Outer London and the Fringe increased by 2.5 per cent from 1 April 2007
• Health Departments and other bodies to review timing of key surveys to provide the review body with more timely data
• The review body strongly urges the Health Departments to provide better explanation of projected earnings growth for next year's review
• The review body strongly asks the parties to ensure the KSF is fully implemented and appropriately resourced as soon as possible
• The Health Departments are asked to take a longer term view of training and development when allocating funding
• No proposals have been made to change either the existing coverage of HCAS or to the percentage proportions of basic salary that currently apply
• The review body have asked the parties to jointly undertake further research and consider the need for a national recruitment and retention payment (NRRP) for pharmacists
• The review body do not accept that that the introduction of NRRP would address the general shortage of radiographers

• Summary of key review body comments
• Equal Pay and Related Areas
• Recruitment and Retention
• Recruitment and retention premia (RRP)
• Local pay and high cost area supplements (HCAS)
• Morale, motivation and training
• The funds available to the Health Departments
• Level and structure of pay recommendations

Summary of key review body comments

The review body recommend Health Departments and other relevant bodies review the timing of key surveys to provide more timely data. Health Departments are asked to report back before the beginning of the next review on the feasibility of providing such data.

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Equal Pay and Related Areas

The review body had some concerns about how to meet the requirements in Agenda for Change regarding the interface with pay of staff groups outside their remit groups. It notes the parties are now considering future Pay Negotiating Council pay arrangements. The recommendations have been made solely on evidence received on NOHPRB's remit groups. DDRB and NOHPRB operate independently. The review body is pleased that the NHS Staff Council set up the equality and diversity sub group to conduct an equality impact assessment following implementation of Agenda for Change. The review body noted the European Court of Justice decision in Cadman v HSE in relation to the number of increments. The review body notes that pay progression in Agenda for Change is underpinned by the KSF process and that progression not automatic.

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Recruitment and Retention

Information suggests no overall staffing difficulties, although there are still some difficulties within certain staff groups and regions. Trust managers indicate staffing problems seem to be improving. Wastage rates for NOHPRB remit groups falling. Vacancy rates decreased since last year, although they remain high for some groups such as therapeutic radiography and ambulance staff.

There are some concerns about the quality of the vacancy data collected on behalf of the Health Departments. The review body hopes that the new Electronic Staff Record computer system (ESR), currently being implemented, will provide more robust data, including further information on vacancies.

There are concerns that the fall in vacancy, wastage and turnover rates could be down to job cuts and recruitment freezes due to the current financial pressure facing Trusts. Current improvements in vacancy and wastage rates may not reflect longer term ability to recruit. The review body will need to look at what happens in the future, and see no evidence that appropriate workforce planning is in place.

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Recruitment and retention premia (RRP)

The review body note Amicus' claim for new RRP for pharmacists, as there is a well established private sector labour market for this group of staff. The review body believes the case for an NRRP warrants proper investigation. The review body emphasise the flexibility accorded to local employers to pay local RRPs in accordance with the terms of the Agenda for Change agreement.

The review body notes the Society of Radiographers' proposals for a new RRP for radiographers, and accept the recruitment difficulties for this profession. However, they do not believe that the general shortage will be addressed by the introduction of an RRP. There is no external market for radiographers, and the review body believe wider issues than pay need to be addressed here, such as how to make the profession more attractive with a challenging career path.

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Local pay and high cost area supplements (HCAS)

There was not enough information to consider local pay this year. The review body understand that Agenda for Change needs to be fully implemented before further research carried out. The review body invites parties to provide further evidence next year, including the degree of pay variation that would be appropriate in London.

The review body considered the case for HCAS in South Cambridgeshire. The review body did not receive enough evidence on labour market difficulties but invite the parties to provide further evidence for next year.

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Morale, motivation and training

There were difficulties in obtaining sufficiently robust information this year, and the results are very similar to those for 2004. The 2005 Staff Survey pre-dates the effects on morale of recent developments such as outcomes of Agenda for Change assimilation and NHS funding difficulties. There are concerns over the 2006 survey, and the review body feels it will be less representative due to optional participation of PCTs. The review body is looking forward to the data series from 2007 for the next review.

The review body secretariat will scope with the Health Care Commission how to bring forward the time period during which the NHS Staff Survey is undertaken each year. Evidence from all parties suggests funding pressures resulting in higher workload for staff due to current vacancy freezes. Feedback from staff side suggests that training budgets were 'raided' to help solve current financial difficulties. The review body notes staff side's concerns about the impact these cuts will have on effective implementation of the KSF. The KSF is key to the success of Agenda for Change and the review body urges parties to ensure it is fully implemented as soon as possible.

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The funds available to the Health Departments

Affordability constraints have taken an exceptional prominence this year. The review body is being asked to come to decisions without adequate information and explanations on average earnings growth. The review body strongly urge the Health Departments to ensure better data could be provided for next year on the relationship between Departmental Expenditure Limits and the tariff uplift in England.

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Level and structure of pay recommendations

The Health Departments and NHS Employers emphasised the need for an affordable pay award this year. The review body does not believe the relative position of their remit group should be reduced. The review body had great difficulty understanding the Health Departments' conclusion that a 1.5 per cent pay uplift was the most that could be afforded. The review body felt that any constraints of a pre-determined figure would be a total abdication of the review body's responsibilities.

At the time of making decisions on pay median pay settlements for the economy as a whole was around 3 Per cent. The review body accept affordability concerns and recommend a pay uplift below median level of pay settlements. The review body sought to maintain the relative position of pay structure as far as affordability constraints allow, and recommend an increase of 2.5per cent on Agenda for Change pay rates.

Inflation figures are much higher than a year ago although indices are probably now approaching their peak. Forecasters expect inflation will fall during coming year, and do not anticipate much change in average earnings growth in 2007. Though faster growth in settlements and earnings elsewhere in the economy would point to a higher pay award, on balance, the review body do not believe most recent figures provide ground for a recommendation above current median level of settlements.