FTN paper on cutting consultant’s terms & conditions

This is the full text of the Foundation Trust Network (FTN) document leaked to Unison and then run originally in The Guardian:

1. Introduction

In July 2009 FTN undertook a survey of members to examine their priorities for reform of the agenda for change programme. In light of the QIPP programme and the economic realities facing the NHS over the next several years, with a number of member organisations we re-visited the topic of workforce flexibilities as a key part of foundation trust strategies for managing risk and service reconfigurations.

There is now widespread recognition that:  

• Cash will reduce in service (15-20 billion) with no third year commitment from treasury to even flat cash – so the situation could get worse than currently predicted.

• Non-pay costs are rising faster than general inflation and NI contributions at around £500m.

• The commissioning aim will be to take 30-40% activity out of secondary sector.

• There is no allowance in tariff for pay – so real reduction in funding pay bill that will not be made up by using natural wastage.

• Even using full natural wastage only produces 2.9% but will not give the shape of workforce and skill mix required to sustain patient services in new configurations.

• Redundancies are likely to be needed with the best case option being local voluntary agreements.

2. Changes Foundation Trust Employers Wish DH to Pursue

Below is the list of changes foundation trusts want to see to workforce conditions in order to sustain patient services together with an indication of the key priorities (Red Line – note that Hospital Dr has italicised these instead):

• Reform to the need to seek Treasury approval for voluntary redundancy schemes

• Negotiate redundancy payments in 12ths to ensure that the duty to mitigate losses can be implemented if employment achieved quickly in another NHS body. This would create an incentive to move quickly.

Reduce the number of pay points on A4C Bands (Red Line).

• Change Schedule k so that staff members are not able to opt back in to Agenda for Change having accepted local arrangements.

• Freeze increments on incremental pay progression for 2/3 years. Then change increments to two points – one for learners one for experienced staff (Red line).

• Agency staff – refresh the guidance and PASA agreements to drive down unreasonable costs of agency staff. Recognise that some agency (1%) will be needed. DH to review immigration requirements as these have had considerable impact on availability of quality, medical locums.

• Sick pay – 6 months full/6 months half pay unlikely to be able to negotiate change. So, local robust sick management needed. However, change sick pay so that plain rates are paid for sick pay (Red Line).

• Either abolish or extend the time (7am to 10pm) for plain rate payment on basis that many staff chose to work nights (Red line).

• End permanent injury allowance and potentially temporary injury allowance.

• Make clear NHS will not be able to offer employment to every trainee – national review of commissions.

• Tackle regulatory demands for continual expansion of statutory training: plus DH to create more e-learning products.

• Stop clinical excellence awards (Red line).

• New consultants – reduce SPAs for newly appointed consultants to enable them to develop clinical skills – suggested 9/1 (Red Line).

• Existing Consultants – reduce SPAs from 2.5 to 1.5 or 1 (if possible).

• Pensionable items – review all including London rating and CEAs.

• Stop recruitment & retention premium for all staff.

• Cap pensions for higher earners (over £100k: easier to do as part of a whole public sector review of pensions) and look at removal of other pensionable items such as London weighting and CEAs.

3. Agreed Foundation Trust Network Position on Guarantees

In our working group there was some discussion of how FTN should respond on behalf of the foundation trust community to any request for guarantees on jobs. 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 statement below was approved:

“Foundation Trusts do not believe that, in the economic climate and given the system and reconfiguration challenges they are facing, it will be possible to offer any guarantees that compulsory redundancies will not be required. However, all Foundation Trusts will want to fulfil their responsibilities as good employers in supporting staff to find suitable alternative employment in partnership with the local health economy as a whole.”

FTN January 2010

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