Foundation trusts want to stop clinical excellence awards; slash SPAs for existing and newly appointed consultants; cap pensions for higher earners and remove pensionable items; and freeze increments on incremental pay progression.
These are the provocative proposals of a leaked Foundation Trust Network (FTN) paper, which is part of the influential NHS Confederation. It’s a response to the health secretary Andy Burnham’s commitment, in December, to exploring with unions “whether we could offer frontline staff an employment guarantee locally or regionally in return for flexibility, mobility and sustained pay restraint”.
The leaked paper, obtained by public sector union Unison, seeks to identify areas for savings, warning that NHS funding could be worse that currently predicted. Flexibility and mobility are being sought because of the intention to move up to 40% of activity from secondary care into community services.
Certain proposals within the document are underlined in red. These indicate key priorities including freezing increments on incremental pay progression for two to three years; stopping CEAs; and, reducing SPAs for newly appointed consultants to one “to enable them to develop clinical skills”.
Other non-red line proposals include capping the pensions of those earning over £100,000, and removing pensionable items such as CEAs and London weighting. On programmed activities, foundation trusts are urged to reduce SPAs for existing consultants from 2.5 to 1.5 or 1 if possible.
The FTN also calls for the NHS to make it clear that not every trainee will be offered employment from now on.
Stephen Campion, chief executive of the HCSA, said: “This leaked document shows how the boom years have turned to bust. What we need is a lot more honesty and a lot less secrecy.
“The tragedy of the NHS at the moment is that ministers are fuelling public expectations in the run up to a general election whilst NHS management is trying to figure out which services and staff they must cut to balance the books. In a service that has always depended on trust and goodwill, this paper may well destroy more than money can buy.”
In response to the health secretary’s question on being able to offer staff an employment guarantee, the FTN is non committal. It says: “The group believed that the flexibilities outlined above were now a requirement for managing the fiscal realities but that even with these it would not be possible to give job guarantees.
“In reality many of the factors that will determine the shape of future health and social care services are not under the control of providers but will be determined by commissioning decisions around pathways and competition in service provision.”
The BMA has circulated advice to its local negotiating committees on the FTN paper, describing the proposals as a ‘serious threat to the terms and conditions of service’.
While reassuring LNCs that it is a speculative discussion paper and not policy, the BMA says LNCs should not negotiate on the issues and oppose them where necessary.
On CEAs, the union says: ‘Cutting CEAs would mean a major cut to overall consultant remuneration and will impact on pensions. It must be opposed firmly in all trusts. We suggest that where this is proposed, the LNC should decline to negotiate any changes until they are negotiated nationally.’
On SPAs it says: ‘The 2003 contract makes it clear that consultants should be allocated appropriate SPA time in their job plans to enable them to carry out a range of non-clinical duties. As such a blanket reduction of SPA is inappropriate as job plans must be agreed with individual consultants.’
There are 125 foundation trusts in the NHS, representing about half of all acute trusts.
Read the leaked Foundation Trust Network’s document in full.