NHS Employers submission to the NHS pay review Body 2015/16
This year the NHS Pay Review Body (NHSPRB) was asked to make observations on the barriers and enablers within the Agenda for Change pay system for delivering healthcare services every day of the week in a financially sustainable way, that is, without increasing the existing spend. Specifically, the NHSPRB was asked to make observations on:
- affordable ‘out of hours’ working arrangements
- any transitional arrangements.
We have now submitted our evidence to the NHSPRB on behalf of employers in the NHS in England. Our evidence takes account of feedback from employer representatives on the NHS Staff Council, our regional HR director networks and of discussions with members of our Policy Board. It has also been informed by the results of a short survey published on our website and the outcome of the HSJ/NHS Employers HR Barometer survey that was published in June 2014.
Our key messages to the NHSPRB include:
- In December 2013 Sir Bruce Keogh, NHS England’s national medical director, set out plans to further develop seven-day care across the NHS over the next three years, based on the findings and recommendations of his forum on NHS services, seven days a week. These plans included ten new clinical standards that describe the standard of urgent and emergency care that all patients should expect. There is evidence of increased mortality rates for people who are admitted to hospitals at the weekend. This presents a clear case for moving towards a seven-day health and care system.
- In many settings, the NHS already provides continuous services over seven days and many staff on Agenda for Change contracts already provide care over seven days a week. There are no contractual barriers in the national agreement to prevent this. Working patterns have always been a matter for local organisations to determine.
- The Francis Report noted that patients feel more vulnerable at weekends, when staff absences and shortages are more noticeable. It is becoming apparent that a five-day service model is no longer fit for purpose in providing safe, efficient care, or in meeting the public’s expectations for standards of care.
- A move towards seven-day services for the NHS will provide better, safer and more responsive services to patients and lead to a more efficient use of NHS resources. Seven-day service provision would potentially enable NHS organisations to make more productive use of high-cost diagnostic equipment and operating theatres, which tend not to be fully utilised at weekends or evenings.
- NHS England’s Five-year forward view, published on 23 October, sets out a vision for how the NHS can continue to provide care within available resources and how, by taking the proposed steps, the future of the NHS can be sustained. It highlights the need to consider how working patterns and pay and terms and conditions can best evolve to fully reward high performance, support job and service redesign. The move towards more seven-day services needs a wider culture change across the NHS, in addition to resolving the financial, workforce and service design challenges.
- Employers have consistently told us that the national pay and terms and conditions of service for all NHS staff, need to continue to adapt in order to make them more affordable and sustainable in the future and better support the challenges facing the NHS in terms of both patient care and affordability. A key challenge is the move towards delivery of patient services over seven days a week. Employers are looking for more flexibility around conditions of service to give them more scope to address their local challenges. In the recent HSJ/NHS Employers HR Barometer survey, over 80 per cent of responders agreed that there was a need for a review of Agenda for Change. Changes to the pay structure and unsocial hours pay enhancements were cited as key areas for reform.
- The quality of services to patients should be consistent throughout the week, so that their care is actively progressed at weekends. In order to do this, service provision at times currently deemed unsocial hours needs to be made more affordable. Employers have told us that the additional costs associated with staff working evenings and weekends through the current unsocial hours enhancements, provide a financial disincentive to providing non-urgent care at some times of the week. In the HR Barometer Survey, 60 per cent of responders said that the Agenda for Change unsocial hour’s provisions needed to be reviewed, while over 26 per cent listed the cost of paying unsocial hours enhancements as being a barrier to implementing more seven-day working.
- There is a consensus among employers that changes are needed to the unsocial hours pay arrangements. In a 24-hour, seven-day service like the NHS, there is a need for more hours in the week to be paid at plain time, and the level of enhancements to be at a lower level for weekend and public holiday working. That said, there is a range of views on exactly how the unsocial hours pay enhancements should be recast to be more supportive of care delivery across the week.
- While outside the direct remit of the NHSPRB, employers have told us that more significant contractual barriers to seven-day service provision remain in the nationally determined medical and dental consultants’ contract. If patient outcomes are to be as good every day of the week, at all times of the day, it is clear that more senior doctors need to be present and working in the hospital more of the time.
Find out more