It is already clear that where there is competitive tendering to provide NHS services, contracts are almost always awarded to the lowest bidder, regardless of quality. Providing the lowest bid while maximising profits is largely achieved by employing under-trained, cheaper staff, and replacing doctors with nurses, and nurses with auxiliaries (http://www.telegraph.co.uk/health/healthnews/9962195/NHS-reforms-From-today-the-Coalition-has-put-the-NHS-up-for-grabs.html), or reducing the terms and conditions of employment. For example, for cleaners, overtime and weekend premium rates may be stopped, or the number of hours cut back so that the contractor pays lower National Insurance costs.
Within NHS organisations, financial pressures (arising, for instamce from PFI debt) have led to redundancies and poor staffing levels. Apart from the impact on patient care, understaffing leads to intense pressure on staff. The growing privatisation of the NHS means more and more staff are moving from the NHS to the private sector, often with poorer terms and conditions. Those who remain employed by the NHS may have had to re-apply for their job on several occasions, and/or face wage cuts. In addition, there is currently a freeze on NHS pay.
Employment in the NHS
To take just the example of nursing, in 2013, a report by the Royal College of Nursing (“Running the red light“) estimated that the NHS was on the verge of a workforce crisis with, for example, an estimated 20,000 unfilled nursing vacancies across England. Barts Health NHS Trust, coping with the largest Private Finance Initiative debt in the country, provides one snapshot of what this meant. Following a nursing skill mix review in October 2013 the Trust announced that 161 whole time equivalent posts nursing posts were to be cut, and a further 472 posts for nursing and health care assistants were being down banded (i.e. put on a pay grade lower than the one already identified as appropriate for the role they are undertaking).
The effects of down banding are well known – loss of staff morale, eventual loss of pay once an initial period of pay protection has expired, heavier workloads, increased stress, and reduced quality of care provision. These effects are experienced along with long term anxieties about redundancy and career path. Unions point out that if nurses are down banded, they are no long obliged to undertake the duties associated with their previous grade. So nurses in this position are faced with ‘choosing’ between becoming de-skilled or using their skills without having these recognised (either financially or professionally).
Since the coalition government came to power and urged NHS staff to accept pay restraint as a part of seeing the NHS through hard times, nursing pay in England has lagged behind inflation by up to 8% – an average real-terms cut of more than £2,600. And this year (2014), many nurses will not get a pay rise at all. Needless to say, morale is at an all time low, and nurses are finding it difficult to make ends meet.
At the same time, research shows that of all the Trusts that responded to a Freedom of Information request, 50% had offered pay increases of at least £5,000 to one or more of its executive directors. In addition, there were numerous cases where executives received bonuses on top of their salaries – with two chief executives getting bonuses of more than £40,000 or the equivalent of the annual pay of a district nurse or senior sister. http://www.rcn.org.uk/__data/assets/pdf_file/0008/580760/004674.pdf
Moving to the private sector
Staff who are transferred from NHS to non NHS organisations retain their NHS terms and conditions at the time of transfer, at least for a while. However, staff are no longer covered by national negotiating arrangements in the NHS so, for example, they will loose future pay increases agreed for NHS staff. And if they move to another non-NHS organisation after this initial transfer, they become treated as ‘new staff’. New staff – i.e. those not (directly) transferring from the NHS – are not entitled to NHS terms and conditions, or access to the NHS pension scheme.
This means that a two-tier system is developing for staff working in NHS-funded services, with employees who are carrying out similar roles receiving different pay, and terms and conditions. Attempts to redress this unfair situation can lead to a renegotiation of all terms and conditions, which are then downgraded for all staff. (See http://www.unitetheunion.org/uploaded/documents/guidetonhsprivatisation11-10734.pdf)