THE BLOG

NHS Pay: Something Or Nothing?

13/10/2017 15:19 BST | Updated 13/10/2017 15:19 BST
Bloomberg via Getty Images

In an unscheduled statement in the House of Commons on Tuesday, Secretary of State Jeremy Hunt responded to questions about NHS pay by clarifying that the pay cap had gone. He proffered a 'win-win' arrangement where additional pay would be considered in return for increased productivity.

So is this something or nothing? Any Department of Health footwork that helps pick the Treasury's padlock on the coffers for better NHS funding is to be welcomed. And anything that helps to ring fence new money for pay, doubly so.

But there's a long way to go before the party poppers come out.

Jeremy Hunt's answer was delivered as a statement of fact, yet committed no funds. He has scrapped the pay cap but not given a single penny to any health worker. Anyone who labels this week's statement a victory may wish to remind themselves that we are a long way from the 1 April pay deadline in what can generously be described as uncertain political times. The real test of whether the cap has been lifted will be when NHS staff open their first wage slip after the pay round.

The health secretary's language also suggests that a focus on shortages and retention problems will dominate the next pay review body round. In other words, a settlement that attempts to put right in one year the impact of six years of pay freeze on the workforce. Let me be clear, it can't be done.

There are dangers in directing any available cash at shortages and cherry-picking specific job groups or specialities. The NHS pay system has built-in mechanisms to deal with these issues. These mechanisms have been unused because the pay system has been starved of funds, not because it doesn't work. Another danger is an unhealthy competition between the varied health professions as they scrabble to win the 'most deserving' prize. In other words, a pay round dominated by special pleading rather than action to improve fairness, morale and long-term investment.

References to productivity in the health secretary's speech are open to interpretation. With think tanks, system leaders and now regulators describing the NHS as running at an unsustainable capacity, it's difficult to picture the productivity wands that can be waved. Unless, of course, 'productivity' is merely code for giving pay awards with one hand and cutting terms with the other. Health workers - and voters - would see through this in an instant. It won't wash.

But if 'productivity' means something else, namely investing in a better pay structure, then there really might be a 'win-win'. Unions have promoted an ambitious pay reform agenda for several years. So far the Department of Health has failed to engage with it. This September - frustrated with the lack of impetus - health unions broke with tradition and put the NHS pay 'claim' into the vacuum.

In addition to a decent pay rise, unions are calling for funding to support reform of pay structures. Change is needed in three priority areas.

First, make it quicker and easier to earn the full rate for a job.

Second, restructure the bands for those on the lowest pay (such as porters, cleaners, healthcare assistants and medical secretaries) to prevent the loss of valuable staff to the retail sector.

Third, remove the overlaps between pay bands, which can create an odd situation where a newly promoted person is earning less than someone on a lower grade.

So, if Mr Hunt wants to increase NHS productivity through a better, more efficient reward structure, and if he returns to reliable and meaningful annual pay rises, then health workers could well be looking at a brighter future.

Next April NHS staff must see that the 'value' placed on them and their endeavours is not mere rhetoric. The unions are prepared to reserve judgement for now and offer their best efforts to find a real win-win pay package on behalf of health workers and the public they care for.

All Jeremy Hunt must do now is to persuade the Treasury that this is something worth paying for.

Sara Gorton is head of health at Unison