Basic overview of the terrain that health workers defending their terms and conditions is
being fought on; Fighting both their employers, as well as a supine and complicit trade
union bureaucracy. Written by a Solidarity Federation/Anarchist Federation dual carder and
Unison steward working in Healthcare. ---- UK health workers find themselves under the
biggest attack on wages and terms and conditions in living memory. --- The background to
this are the long, slow moves to fragment the public health service into discreet
trusts(1). These trusts are expected to compete on equal footing with other trusts, as
well as private and third sector providers in a regulated marketplace. This has been
rapidly accelerated by the passing of the recent Health and Social Care act 2012(2)
Negotiations to introduce national pay and conditions were introduced in 1999 by the
previous Labour administration and finally came into effect in 2004. This national pay
agreement is known as ?Agenda for Change?. It covers all members of staff excluding
doctors, dentists and very senior managers. Previous to this job banding varied hugely and
was based on the old Whitley Council system (introduced during in 1917 to placate growing
demands for Workers? control of industry and essentially unchanged since then). The NHS as
a whole in England employs just under 1.5 million staff, making it by far the largest
employer in the country.
Agenda for Change introduced an agreement where, at least in theory, job roles are all
banded at a similar level irrespective of their geographical location. Pay is matched to
the job rather than individual.
Within each pay band are a variable amount of spine points, at the end of each year?s
service workers ascend to the next spine point. This proceeds until they have reached the
top of the banding. 3 In addition to this there is the nationally negotiated annual pay
award. Following an on-going commitment introduced in 2010 to freeze public sector pay,
this currently stands at 0% for those earning over ?21k, or a ?250 flat rate rise if
under. Factoring in inflation rises this is essentially a pay cut for nearly every worker
in the NHS. 60% of NHS workers have yet to reach their final salary spine point, so in
reality progression through these is the only thing helping keep wages stagnant, as
opposed to falling, for a majority of workers.
?MARKET FACING PAY? ?PAY MODERNISATION? ?REGIONAL PAY?
As part of the current government?s commitment to austerity, plans were devised for top
down attempts to break national pay agreements. These have been abandoned during the
autumn budget statement in favour of leaving it to the market, though there remains behind
the scenes a hand on the political tiller giving succour to trusts that chose to opt out.
4 A back door for pay flexibility was via the introduction of Foundation trusts under
Labour. Foundation trusts have the theoretical right to opt out of national pay and
conditions, though in practice only Southend University Hospital NHS Foundation Trust
chose to do this. Up till now this remains the only trust currently outside Agenda for
change. There have been attempts by individual trusts to opt out of this agreement,
especially those burdened with crippling PFI debt repayments. These have been defeated at
a local level, mainly due to the threat of employees gravitating towards the competing
local trusts with better terms and conditions, something facilitated by the national
agreement allowing employees to keep accrued salary progression. With this in mind a
consortium of 20 healthcare trusts in the South West, dubbed the ?pay cartel?, got
together to collectively force through the slashing of workers? terms and conditions. 5
In addition to this local agreements have been attacked. North Tees and Hartlepool NHS
Foundation Trust which employs 5500 workers has instigated pay downgrading, with
neighbouring trusts threatening similar action. 6
At the Mid Yorkshire NHS Trust are set to embark on a five day strike over similar plans
to downgrade job roles. 7
NEGOTATIED SURRENDER
Representatives of the approximately 20 trade unions who collectively bargain for workers
within the NHS have been negotiating at length with the pay cartel. As it stands the deal
on the table to ?protect? Agenda for Change in England (Scotland and Wales are not
affected) is:
1) Performance Related Pay to be introduced with exact implementation to be decided
locally. (protected for the lowest paid worker, those in bands 1+2 and first 3 points of
band 3). This is the major, major change here. Speaking to UCU members who have seen
similar performance related pay in some universities, they inform me that this a form of
gatekeeping that unsurprisingly this amounts to a major attack on their ability to earn
this money. Unreasonable expectations or unsuitable criteria to set in place, where it can
actually be logistically impossible to ever proceed up pay points.
Performance related pay is also currently being fought by teaching unions 8, so would
possibly seem to represent the beginnings of a pay model for public sector workers.
2) The removal of preceptorship. This is a pay device that allows newly qualified
registered nurses, midwives and allied health professionals to initially proceed at an
accelerated rate through their pay points.
3) An agreement to accept strict sickness absence policies and the removal of any payments
associated anti-social hour?s rate. This will inordinately affect all care giving staff,
who are of course expected to provide a round the clock, 365 days a year service.
4) Staff on bands 8c, 8d and 9 to be placed on a ?spot salary?. This translates as ?pay as
low as they think the market can bear?. Whilst these are management roles with the power
to hire and fire and instigate structural change, they are also the pay bands responsible
for deciding on pay and conditions. From a pragmatic point of view and being clear about
the role of the market in this, opting them out of a national agreement is unlikely to
engender a desire to fight for agenda for change if they themselves are already opted out
of it.
Out of these 20 trade unions (number of healthcare workers they represent in brackets),
GMB (30,000) and Unite (100,000) have the rejected the deal out of hand. Unite have
explicitly said they are preparing for industrial action in the event of any opting out of
Agenda for Change. Other unions have said they intend to accept them, but most including
Unison (400,000) and Royal College of Nursing (380,000) are consulting their members with
guidance to accept the measures. 9
These moves show that a majority of health trade bureaucracies to be utterly complicit in
what amounts to a managed decline of a workers? T&Cs. The industrial relations equivalent
of, ?we had to destroy the village in order to save it?. Even on their own terms Unison
states that by agreeing with these proposals may still result in trusts continuing to seek
to leave the national agreement.
?While there is no guarantee that agreeing to these proposals will hold 100% of trusts in
England to AfC, the Health SGE believes these would hold the majority and will be
consulting branches to get better information on this.? 10
However with guarantees for unions to have a consultative role in any job re-gradings, and
to being involved with local performance related pay structures, the union will retain its
primary representative function. When push comes to shove, this is the fundamental bottom
line for unions. That is the right to represent workers, including the right to a
?consultative role? even if that consultation leads to poor outcomes for their members. In
fact we can see how important this role is, how it sees actions by its members as
secondary to its own from in this passage, taken from the accompanying Unison consultation
briefing (italics by author):
?Over the last year, a number of NHS trusts in England have tried to ?break away? from
Agenda for Change. Members in these trusts have had to organise, campaign and take
industrial action to try and stop the employers reducing terms and conditions and moving
to local contracts. If members reject these proposals it is likely that the number of
these attacks would increase significantly, requiring more members to take action to
defend their conditions.? 11
Of course Unison sells the removal of hard, fought T&Cs as a victory. If it can pass these
changes it will accept them as the least worse option rather than risk the unpredictable
nature of a demobilised rank and file organising initiative, that will be either sclerotic
through underuse or even worse from their view point, has the potential to not be under
the full control of the union. Unison made its playbook clear during the recent pensions'
dispute. Even with a mandate it did not risk anything more than tokenistic one day strike
action. 12
So these moves are a clear attempt to gauge exactly how much the membership will take. Any
union member in a branch organised enough to arrange this consultation would be advised to
reject this slow erosion of T&Cs and stress the need to lay officers and fellow workers of
the need for sustained industrial action to defeat them. If your trade union branch
recommends these measures then it makes clear the need for all workers, clinical or
administrative, on all kinds of contracts to organise and meet and organise outside the
union where necessary.
The fight continues.
1.http://libcom.org/library/driving-nhs-market
2.http://www.legislation.gov.uk/ukpga/2012/7/contents/enacted
3.http://www.nhscareers.nhs.uk/working-in-the-nhs/pay-and-benefits/agenda-for-change-pay-rates/
4.http://www.ome.uk.com/Document/Default.aspx?DocumentUid=43EE7D69-8575-4572-9976-B5E0B31B39C8
5.https://skwalker1964.wordpress.com/2012/09/12/explosive-exclusive-how-the-south-west-nhs-pay-cartel-plans-to-reward-incentivise-staff/
6.www.gazettelive.co.uk/news/teesside-news/2012/10/26/north-tees-and-hartlepool-nhs-foundation-trust-staff-in-protest-84229-32108121/
7.http://www.socialistworker.co.uk/art.php?id=30413
8.http://www.teachers.org.uk/node/17337
9.http://www.unison.org.uk/healthcare/a4c/consultation.asp
10.http://www.unison.org.uk/acrobat/UNISON_Briefing_AfC_proposals.pdf
11.http://www.unison.org.uk/acrobat/AfC_FAQs.pdf
12.http://libcom.org/blog/fight-our-lives-analysis-uk-pensions-disputes-31102012
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