Tough decisions needed on NHS pay

Dean Royles, chief executive of NHS Employers, explains the effect that issues surrounding patient safety, care quality and seven-day working are having on the difficult decisions around NHS pay.

It is the same every year. The annual planning cycle means that each September, we submit our written evidence to the NHS Pay review bodies – independent bodies that recommend pay awards for NHS staff. They will decide in spring 2014 whether or not to accept our recommendations.

The review body asked us for evidence on the award this year in the light of the Government’s 1% cap on pay. This is by no means a small task. It takes months of trawling through data in order to come up with our recommendations, which will affect hundreds of thousands of staff. It’s a really important part of our work… but I dread it. I know it is not my job to be popular, but it is difficult to become enthused when you know you have a difficult message to tell a workforce of dedicated professionals.

Cost savings

I know NHS staff work incredibly hard. You may have read stories and seen statistics about the rising demand and increasing pressures in the NHS. I really appreciate how difficult it is for staff working in these pressures, which undoubtedly leads to increased absence and affects staff morale.

Like the rest of the public sector, the NHS is not immune to what is going on in the outside world, so cost savings need to be made – £20 billion of efficiency savings, to be exact. In such challenging times, with the increased pressure I would love to be able to recommend pay increases. I am sure many patients would agree that staff do an amazing job and deserve more for their efforts. No matter how I try to phrase our recommendations, the reality is a rather harsh message that cannot be sugar-coated. We can’t have both more staff and pay them more. Something has to give.

We have analysed data such as turnover, recruitment and staff satisfaction surveys, and considered in detail the current financial pressures we are facing. The evidence tells us that it is much better to maintain existing staff numbers and, where possible and appropriate, increase the numbers so there are more staff in clinics and on wards, rather than to give everyone a pay rise. I know many will argue there are other savings to be had, from procurement or drug bills, but these aren’t “either or” options – we have to do all of them.

Patient safety

We also have an uphill struggle to change how we work in the future. The reality is that emergency care for patients is not as good at the weekend as it is during the week. Almost all commentators accept that. Why is it that a patient admitted to hospital with a life-threatening condition mid-week has better outcomes than a patient admitted on a Friday night?

Patient safety has always been at the heart of healthcare. However, it has no doubt received increased focus following recent high-profile reports. The first of those was Robert Francis’s report into the events at Mid Staffordshire HNS Foundation Trust, which said: “The patient must be the first priority in all of what the NHS does. Within available resources, [patients] must receive effective services from caring, compassionate and committed staff working within a common culture, and they must be protected from avoidable harm and any deprivation of their basic rights.”

Don Berwick’s review into patient safety said: “Patient safety should be the ever-present concern of every person working in or affecting NHS-funded care. The quality of patient care should come before all other considerations in leadership and conduct of the NHS, and patient safety is the keystone dimension of quality.”

Finally, the report from the Future Hospital Commission of the Royal College of Physicians – one of the bodies setting the standard for doctors – recommends that we must design hospital services around patients’ needs and to deliver safe, effective and compassionate medical care for those who need it. The report also calls for high-quality care that is sustainable 24 hours a day, seven days a week.

This reinforces why we said in our evidence that, if the pay review bodies do make any recommendations to the Government, they should link this into reforms of the way we work over seven days – including making sure the standard working week includes evenings and weekends. The move towards seven-day working is gathering momentum. Patients want it, employers want it, royal colleges want it and the Government wants it, so the NHS must set about making sure it can work in practice.

Cross-sector approach to pay

But I do not believe we can continue to manage pay by constant freezing. This will store up problems. The history of public-sector pay is one of a pendulum swing; we erode and eat away at pay until it reaches a recruitment crisis and industrial unrest, then pump money in, leading to pay disparities between the public and the private sectors. We have to stop that. We need a cross public-sector approach and political bravery to establish a medium-term plan that will bring us out of a period of pay restraint safely and sensibly. NHS Employers is happy to play its part in that.

I realise that not recommending a pay rise is unpopular. I know pay can have a financial as well as an emotional impact on how staff feel valued. But I also hope they will see our recommendation is in the best interests of protecting the future of the NHS. After all, we all want a sustainable NHS that puts patients at the centre and uses the available taxpayers’ money as wisely as possible. This is a time when doctors must show leadership, as their decade-old contracts are being re-negotiated, to change how services are planned and delivered so that patients’ needs are met every day of the week and at all times, day or night. This will mean changes to how consultants work. It is one of those times when that old adage that managers should “think like patients, but act like taxpayers” makes perfect sense.

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