Tuesday, 31 July 2007

According to a Kings Fund Report the Agenda for Change programme designed to increase the pay of one million NHS workers may not increase productivity or improve quality of care for patients.

Agenda for Change introduced new paybands for the vast majority of staff except Senior Management and Doctors. AfC also standardised contracts of employment. The stated aim was to ensure that staff were paid fairly and that it would help deliver fast, modern services.
In their analysis however the Kings Fund found that after years of negotiations, national implementation of the new pay structures was rushed resulting in an overspend of £220 million in 2004/5. They also noted that the lack of proper implementation meant that patients may never feel the intended benefits of the pay reform or that there are few signs it has delivered increased productivity or transformed practice.

It was noted in the report that many Trust’s dealing with a crowded agenda and nationally led pressure for rapid implementation, have seen it as little more than a 'tick box' exercise, rather than as a way to make services more effectively.

One of the other principles was to tie progress through pay scales with personal development and training by way of the NHS Keyskills Framework (appraisals etc). One progresses through gateways on a pay band by providing evidence of work undertaken over the course of the year that matches the criteria that your job has been assessed as requiring. There are quite a few flaws in this though. There are national guidelines issued proving the criteria / basic elements of the job descriptions that just don’t take into account the subtleties of many of the posts. So if you were a Buyer for example who also undertook a great deal of analytical work that fell outside of the general criteria you wouldn’t receive any appreciable financial benefit for your efforts. So rather than push yourself on you are tempted to coast along.

Interestingly it is also incumbent on the manager undertaking assessments and appraisals of staff to inform HR / Payroll if any member of staff should NOT progress up the payband because they hadn’t provided evidence of the required level of knowledge or if the manager felt that they hadn’t met the criteria. Whereas to be effective I would argue that it should be the other way around.

But perhaps the biggest problem was in the original evaluation of jobs that was undertaken at the start of the process. This determined which pay band any given position / job was placed in. This has been hugely controversial. Many of the problems stem from a lack of consistency in the original panels decisions. I am personally aware of a great number of cases where directly comparable posts in neighbouring acute Trusts are now paid on different bands. This actually is working against one of the stated intentions of the programme, that is to make staff retention easier and one of the key concepts of equitability of pay for the same or similar jobs.

I know many staff from a whole array of staff groups who have exercised their right to appeal against the decision of the original panel. Many still haven’t been resolved and are awaiting a final decision more than two years later.

The Agenda for Change and the appraisals system has been over engineered and in its execution disaffection seems to have increased and moral lowered. This is quite a trick as staff, in the main, are getting more cash to take home or to have taken back by HM Treasury.

There are some suspicions in some of the darker corners that say that particular Trust boards leaned on the AfC panels to place jobs in bands lower than they really be in an effort minimise the effects of an increased pay budget. I doubt this but I have heard this from several people from several different Trusts.

It should be so simple. Good staff get more money, bad staff get less until they buck up (with the help of their managers) or get sacked. Would that be so tricky?


Mousie said...

AfC was such a white elephant.

In principle, the idea was genius - a fair day's pay for a fair day's work; dependent on the skills and knowledge needed to do each individual role and the stresses and hardships faced when carrying it out.

Each job was "assessed" individually, at great expense to the tax-payer, ostensibly to grade each role more accurately.

The point of this was meant to be that staff nurses who popped in to work in outpatients departments 9-5, Monday to Friday, to take a couple of blood pressures and hand out a few x-ray forms were paid somewhat less than the staff nurses who were resuscitating neonates, breaking bad news to the mothers of moribund adolescent joy-riders and dealing with drunken louts at midnight on a Friday night in A&E.

The reality was sooooo different. Everyone in each of the previous pay grades was picked up en masse and dumped into the same band on the new scale. It's exactly the same system as before, just rebranded. How very NuLab.

Do you think Tony's favourite bedtime story as a kid was "The Emperor's New Clothes"?

Grendel said...

Thanks for the comment Mousie. I totally agree with what you say. Writing a post about AfC /KSF was difficult for a ‘non-writer’ as there is so much you could say and the temptation to ramble on and on more than I did anyway was almost irresistible.

Coming from a non-medical area we always go the feeling that we were just kind of tacked onto the end of the process as a bit of an afterthought. Which maybe why some of my staff had to wait nearly two years for their appeal to be heard (shocking isn’t it).

I think part of the problem may have stemmed from the fact that the Grading / Assessing people don’t seem to have been given adequate training in the task and were just throw in in at the deep end. That may account for the lack of subtlety in the transfer from the Whitley to the AfC grades.

Not sure about the Emperors New Clothes as now we have Postman Prat and his black and white ‘no longer than 4 hours wait to be seen in A&E unless you move them out and move them back again to start the clock ticking from zero’ target to enjoy.


Mousie said...

The people that were doing the assessing definitely didn't have enough training to equip them for the job in hand. Not that it mattered, because they were all told to toe the party line and ensure that there was as little change from the old system as possible anyway.

Another issue I had with AfC was about the localisation of the assessment / grading process, in that there was never any need to do it individually in each and every hospital. There's little difference between what a staff nurse on an orthopaedic ward in the North East does in comparison with one on a similar ward in the South West. The role of an A&E charge nurse in London is essentially the same as that of one in Edinburgh. Few posts ever really needed to be graded locally.

Nursing experts / leaders could have decided the banding centrally, with less potential for nepotism or other corruption and at far less expense to the tax-payer.

And don't even get me started on the 4 hour targets!