Staffing is the issue keeping NHS leaders awake at night – and which consumes two-thirds of trusts’ spending. The fortnightly The Ward Round newsletter, by HSJ workforce correspondent Annabelle Collins, ensures you are tuned in to the daily pressures on staff, and the wider trends and policies shaping the workforce.
“We have potential for a long, hot summer,” warned Gary Smith, the general secretary of trade union GMB, last week. This was no empty threat – at the time of writing the country’s train and tube services had largely ground to a halt, with further disruption promised if pay demands are not met.
The transport unions are of course not unique; the financial squeeze is being felt acutely by many. Speaking at a Health Select Committee evidence session last month, Royal College of Nursing president Denise Chaffer said she never envisaged a time when nurses would have to turn to food banks to feed themselves and their families.
The next few weeks will surely set the temperature for the NHS – in July the Pay Review Body will report its findings and pay rise recommendations for NHS staff. Unions have warned that if the offer is not judged to be fair, the government should expect an increased number of resignations in search of better pay and conditions, worsening patient care, the prospect of “work to rule” or at worst, a strike.
Expectations were certainly lowered when earlier this year the government indicated it could not afford more than a three per cent rise for agenda for change staff and urged “restraint”.
The Scottish government has already put its cards on the table; last week it announced a one-year pay offer of a five per cent increase for Scottish NHS workers, but unions described this as “disappointing”.
Jim Buchan from the Health Foundation said this was perhaps “just a little hint” when speaking at the NHS Confed/Expo conference last week but described inflation as a “grey cloud looming” over the English pay award this year.
“It’s twenty years or thirty years since this level of inflation has been part of people’s lives. There are plenty of people working in health and social care now who have never seen this level of inflation and what it is doing to take home pay,” Professor Buchan said.
He also stressed the need for pay and reward in NHS and social care to be aligned with national and local workforce strategies, describing the current disconnect between them.
“One of the main policy levers, which is pay, will not be aligned with what is happening in the workforce strategy space,” he said.
Sara Gorton, head of health at Unison, also criticised the absence of a workforce strategy and the “failure to adopt a strategic approach to pay and contracts”. She described how the government’s attitude of seeing how little it can “get away with putting in the funding pot” was starting to affect the health and social care workforce with a risk of “rising industrial tensions within the sector”.
However, Ms Gorton argued the biggest risk was the healthcare workforce deciding to move to other sectors who can “commit” to paying above the real living wage.
Colenzo Jarrett-Thorpe, national officer for health at Unite, told HSJ for the union “all options remain on the table”, including industrial action, if what the Pay Review Body recommends, and the government decides “doesn’t meet our members’ hopes and expectations”.
A healthcare assistant, who is a member of Unite, summed up the situation for many: “When I started in the NHS over twenty years ago, the pay was good and got better after training and time served, ten years to get to the top of band two. My husband, who works in a warehouse, has passed my hourly rate by a third in his fifteen years in post.”
Ethnicity and gender pay gap
And within staff pay there are other important issues – namely the gender and ethnicity pay gaps.
Unlike the gender pay gap, where employer reporting is mandatory, the ethnicity gap is not compulsory, and is “more of a good practice exercise”, according to Habib Naqvi, director of the NHS Race and Health Observatory, who also spoke during the pay discussion at Confed.
In its written evidence to the Pay Review Body the DHSC commited to a review to help “better understand” the ethnicity pay gap.
There is urgency here – as highlighted by a Health Foundation report, giving the example of nurses, of whom 90 per cent are women and 28 per cent reported to be of minority ethnic origin. Its authors argue that action “must be taken” so pay is “equitably structured and applied”.
This inequality in the pay system will – shamefully – involve more than one pay round to address and the pressure is on employers to show staff what they’re worth and address pay gaps internally. But in many pressurised systems this could fall by the wayside.
Of course, pay is not the only factor when it comes to happiness at work, but it is more than enough to light the fuse this summer if the government fails to take this risk seriously.