Changing times in the NHS

David Bingham
Director of HR, Northern Ireland Department of Health, Social Services & Public Safety

AfC is the most significant development for HR professionals since the profession emerged as a distinct function in the 1970s.

It represents a comprehensive change in all the basic terms and conditions systems and in the way we will do business in the future.

It has been developed with reference to best practice elsewhere, and it should provide a robust basis for employment in the NHS over the next couple of decades. The scheme will transform employment practice in the health service. Although it will take a huge amount of effort to implement, it will give us a more coherent, robust and usable system on which to base our employment practices.

HR professionals’ workloads will be heavy as we move into the implementation of the new scheme. They are the focal point for processing the information and communicating to staff. They will also be the main players in the partnership working with the unions. One important aspect of the system is that it has been designed and implemented on a partnership basis with the unions.

We established a project team nearly two years ago, staffed by HR professions, line managers and trade unionists. They have been taking forward a massive training exercise that has been aimed at raising awareness levels, as well as training a large pool of staff in the matching process.

The main lesson is that you need to plan ahead and ensure that enough resources are available to implement the scheme. We have been clear that AfC must bring tangible benefits to staff, patients and the NHS.

Ultimately it will be judged on whether we are able to recruit and retain an effective workforce.

Dave Prentis
General secretary, Unison

It will take some time before employees fully see the financial and more far-reaching benefits of the new system.

The timetable does not anticipate everyone moving over to the new system until September 2005, and many organisations will even find that challenging.

But about 92 per cent of staff will see an immediate financial gain, as well as being able to move up to higher maximum salaries in their new pay bands.

At least as important is the Knowledge and Skills Framework. This requires that for every post, there is a statement of the knowledge and skills needed, and how these should develop during an individual’s time in post. It is the basis for annual development reviews and access to training and development opportunities.

For thousands of non-registered NHS staff, this is the first time they have had these chances, and the framework holds out the prospect of real career progression.

When we started on AfC, everyone thought they knew what it was they wanted to replace. But the experience of early implementer sites showed that no-one knew the full extent of local variations to terms and conditions, or how far jobs had evolved.

Knowing what you’ve got, who you’ve got and how they are working is essential for implementation. Above all, AfC has been about change, altering traditional relationships and questioning the validity of traditional identities.

So the communication of the AfC’s outcomes have been fraught with the difficulty of asking people to understand it in its own terms, and not by reference to what preceded it.

Andrew Foster
Director of HR, NHS

We are changing the way we work – for example, a barium enema used to be administered by an experienced consultant, but now a radiographer can do it.

We are encouraging work that makes economic sense and better use of the skills we have. Jobs are still being carried out by properly qualified staff – we are just using our resources better.

It has been a huge task for each trust to produce a job description for each person, assess their competencies and then assign a pay band. Now we have a competency-based pay system, where every job is described in terms of the competencies required. There are nine pay bands tied to employees’ ability to do work, rather than the old system, which was based merely on annual pay rises.

When implementing major change, it is vital to run a test project – so often in the NHS we introduce something before having tested it first.
In an organisation the size of the NHS, even a small problem could have huge implications. The areas we evaluated included whether the scheme came within budget, whether it has been positively accepted by staff, and whether it delivers real benefits to patients.

The negotiations between trade unions and local management have been regarded as mutually beneficial. As far as I know, AfC is the biggest pay reform programme the world has ever known.

Agenda for Change: the facts

– Backdated deal to 1 October will increase NHS pay bill by at least 1bn

– NHS minimum wage increased to 5.69 an hour from 4.85

– Starting salary of a newly-registered nurse increases from 17,060 to 18,114, while senior nurses could earn more than 80,000 a year

– About 650 different job descriptions have been negotiated with 17 different unions since 1999

– Ambulance staff receive a pay boost in the region of 10 to 20 per cent, and will now be paid for working unsocial hours

– All staff will benefit from a 10 per cent pay deal over three years from 2003-05

– All staff will benefit from the use of the NHS Knowledge and Skills Framework to support the effective use of training and career progression through the ranks.

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