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The Ward Round: Barclay gains breathing space

Published on: 4 May 2023

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.

The Agenda for Change pay deal is not “a line in the sand”, warned Matthew Taylor, chief executive of the NHS Confederation, after the government confirmed yesterday that all AfC staff would receive the pay uplift first proposed in March.

Although the pay agreement has given health and social care secretary Steve Barclay breathing space (for now) and put an end to a chunk of NHS staff strike action, it is by no means a long-lasting workforce “fix”.

Mr Taylor is clear that, although the deal was welcomed by NHS leaders, it does not allow the NHS or the public to “confidently move on from the threat of future strikes, or from the underlying issues affecting the NHS that led to this activity being felt as necessary in the first place”.

When first announced, the pay uplift came with a host of other non-financial commitments, including exploring measures to ensure safer staffing in hospitals and working with unions to reduce violence against NHS staff. Little further has been said about the timeframe or approach to these, although Mr Barclay’s statement adds vaguely that the Department of Health and Social Care will “continue to engage constructively with unions on workforce changes”.

Meanwhile, stuck in local election purdah for the past few weeks, there has been no further news on the promised NHS long-term workforce plan.

It is now unclear whether it is still subject to substantive disputes within government (ie what to plan and how to pay for it); waiting for a spot in the government’s announcements grid; or stuck in Mr Barclay’s large backlog of things awaiting signoff.

NHS Employers chief Danny Mortimer recently underlined that the plan is an opportunity for government to prove “its commitment to invest in staff numbers and development”. But – with major doubts in government over NHS productivity, and systems/trusts being told to hold down staffing – is this commitment already waining?

Despite Mr Barclay’s claims, staff acceptance of the deal is not a commentary on its fairness, but instead highlights their current financial plight. Extra money in their “summer” pay packet will be desperately welcomed by many, as bills need paying now. Notably, the unions whose staff accepted the deal tend to be among the lowest paid.

Finally the question remains of when the money will hit said pay packets, and who will pay for it? Ministers told unions it would not affect patient care – but that is not a cashable promise, and they avoided the question of who would actually fund it.

Divide and conquer

Meanwhile, the Royal College of Nursing, Unite, the Society of Radiographers and the Royal College of Podiatry remain in conflict with the government, as they rejected the deal (Unite and RCPod’s leaders had not recommended it to their members in the first place). 

The SoR has written to Mr Barclay calling for urgent talks and pledged to press on with a ballot for industrial action if there is “no positive response”. SoR members did not strike this winter, but with 80 per cent of members rejecting the pay offer this could soon change.

Unite has also said it is preparing to ballot for further strike action, and – most significantly – the RCN has said it will press on with an ”aggregated ballot”, which if supported by enough members will enable the union to take strike action across the NHS. 

NHS leaders and ministers might hope that all staff being given the pay rise means they are less likely to go on strike. But with the RCN reportedly gaining a record 3,000 new members last week it is too soon to assume nurses are disenfranchised with their union’s leadership, and unlikely to vote to strike again. That’s before you even consider the doctors.

And there are fears unions could be further divided in the future. The RCN – much to the chagrin of other unions – started by entering into “intensive talks” alone with the government in February and then has consistently called for a separate “pay spine for nurses”.

If they were allowed to break away from AfC, the power of collective bargaining will be considerably weakened, and staff groups divided. Surely, there is strength in numbers, and a collective campaign to reform the ageing AfC contract would be more effective.

Billy Palmer, senior fellow at the Nuffield Trust, has set out an 11-point plan to modernise the contract to make it fit for purpose, including more transparency and the suggestion of “an in-depth but time-limited study on how the existing pay frameworks can be better used to allow greater and fair pay progression”.

But for now, Agenda for Change goes on, there is no serious published plan to recruit and retain more staff, unions and their members are divided, and the threat of further strike action looms.