NHS EMPLOYERS’/media/Employers/Documents... · 6 Pay and contract reform NHS Employers continues...

NHS EMPLOYERS’

SUBMISSION TO THE

NHS PAY REVIEW BODY

2017/18

September 2016

2

Contents

Key messages 3 - 7

Section 1 Informing our evidence 8 - 27

Section 2 Modernising Agenda for Change 28 - 37

Section 3 Workforce supply 38 - 48

Section 4 Staff engagement and the NHS Staff Survey 49 - 51

Section 5 Pensions and total reward 52 - 61

Section 6 Staff numbers and pay bill 62 - 69

Annex A

Results from NHS Provider/NHS Employers

workforce survey

70 - 74

Annex B Expected basic pay per FTE increase in

2016/17 through increments by AfC Band

75

Annex B1 Expected basic pay per FTE increase in

2016/17 through increments by staff group

76 - 77

Annex C

Proportion of staff receiving recruitment and retention previa (RRP) by staff group and AfC Band April 2016

78 - 79

Annex C1

Proportion of staff receiving recruitment and retention previa (RRP) by staff group and LETB region April 2016

80 - 81

Annex D

Paybill metrics for Total HCHS non-medical staff

82 - 84

Annex E Percentage of AfC staff on top of their brands 85 - 87

3

Annex F

Time series of non-medical staff by staff group

88 - 90

Annex G1

Non-medical staff by staff group and AfC group and AfC band, September 2015

91

Annex G2

Non-medical staff by region and AfC band, September 2015

92

Annex H

Time series of mean basic pay by staff group 93 - 94

Annex H1

Time series of mean total earnings by staff group

95 - 96

Annex I Advertised vacancies by staff group 97 - 98

Annex I1 Advertised vacancies by region 99 - 100

Annex J Increments and positions within band 101 -104

Annex K Cost impact of the National Living Wage on the NHS paybill

105 - 106

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Key messages

Financial challenge

The NHS continues to face unprecedented financial and service

challenges. The majority of trusts fell into deficit during 2015/16 and the

overall shortfall has now reached over £2.5 billion1, the highest level seen.

The financial settlement for the NHS up to 2020 is extremely challenging,

with employers set ambitious targets to deliver efficiency savings. At the

same time, demand for services continues to rise. Performance indicators

show the service is under great pressure as demands for care increase

and other public services reduce provision.

Concerns about NHS finances link through to pay decisions for NHS staff.

Pay makes up more than two thirds of the budgets for most hospital costs.

Changes in staff costs, above those already planned for, will have a

significant impact on the financial viability and sustainability of NHS

financial plans. Continuing to contain pay costs remains an integral part of

addressing this financial challenge.

This financial position sets a key context for this year’s evidence.

Transformation challenge

A different approach is required to deliver a health and social care system

that is capable of meeting the scale of the financial and sustainability

challenge.

National policy has identified the significant and necessary changes

required to: shift care from hospitals to the community; introduce new

models of care that support the integration of health and social care; and

support a focus on preventing illness and promoting health and wellbeing.

Sustainability and transformation planning (STP) is helping to bridge the

gap between health and social care, with 44 STP footprints charged with

1 Kings Fund (July 2016) Deficits in the NHS 2016

5

delivering plans that deliver transformation of the services provided to local

communities.

It is expected that these transformation plans will improve outcomes for

people accessing services, support greater efficiency and effectiveness in

service delivery and deliver cost savings.

Integrating care across organisations and sectors will lead to

considerations around the current and future workforce. Opportunities to

restructure and create new roles to meet changing needs will need to be

taken to support system integration. This requires a new and integrated

workforce plan to be created (across boundaries).

Workforce challenge

How the NHS plans, trains, regulates, supports, deploys and rewards its

staff will be critical to the delivery of the triple aim identified in the Forward

View.

The results of getting workforce planning wrong are potentially very

significant and will create further system instability in an already

pressurised environment. Financial pressures will not be effectively and

efficiently managed (including those linked to staff shortages, which

historically have translated to higher costs through increases in agency

spend).

Senior policy makers from across the health system have recognised that

a new approach is required to meet the scale of the challenge presented

both now and in the future with regards to workforce.

Employers welcome the development of a national workforce strategy set

against the 5 Year Forward View (5YFV)2 and the creation of clear plans

for service delivery. They will be looking for national actions which enable

greater innovation in ways of working, as well as enhance the broader

reward and employment package for NHS staff.

2 NHS England (October 2014) Five Year Forward Plan

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Pay and contract reform

NHS Employers continues to aim for and seek out opportunities to reform

the Agenda for Change (AfC) pay and conditions. Although some changes

were agreed in 2013, the pay system has not undergone systematic

review since it was introduced in 2004.

It remains the view of employers that the pay system needs to change to

support the NHS to deliver the priorities set out in the 5YFV, address the

quality and efficiency challenges linked to the work on delivering care

across seven-days, meet the changing needs of patients and integrate

new models of care.

Employers are looking where possible for a balanced package of reforms.

Reforms to the pay structure and other terms and conditions would

contribute to and support system wide initiatives, increase capacity and

reduce the costs of agency staffing, but without creating new and

additional cost pressures.

Constructive national discussions with NHS trade unions on pay reform

are ongoing, but progress has been slower than anticipated..

It is unclear whether, within the constraints of both government public

sector pay policy and the current system financial pressures, agreement

around a balanced package of reforms can be reached within this

spending review period.

A reform agreement will not be possible for implementation during

2017/18; therefore any pay award for 2017/18 will be set against current

government public sector pay policy.

Pay award 2017/18

The pay review for 2017/18 will be subject to the government’s public

sector pay policy set out in the 2015 Budget, that increases across the

public sector will be constrained to an average of 1 per cent until 2020/21.

In the absence of an agreement on pay reform, there is consensus

amongst employers in favour of the same percentage increase for all AfC

staff within the 1 per cent cap. Any pay uplift that is not fully funded

through the tariff would create additional financial pressure for employers.

7

There is not sufficient evidence to justify differential pay awards to AfC

staff in 2017/18. The common view is that an envelope of 1 per cent

would not in practice make any differentiation worthwhile and would have

a negative impact on the morale of the workforce. We are not aware of any

labour market challenges at national or local level that would be resolved

by differentiated pay awards.

There are particular recruitment and staff retention challenges facing

employers in the London area which go beyond the level of High Cost

Area Supplement (HCAS) payments. We have been working with trade

union colleagues to raise particular concerns regarding housing and

transport costs with the Mayor of London.

The NHS continues to have a well-regarded package of valuable

employment benefits, including a generous pension scheme. In addition,

we are increasingly seeing that employers in the NHS are broadening their

definition of total reward to include recognition schemes, health and

wellbeing initiatives and training and development programmes, among

others.

Furthermore, employers remain committed to enhancing the package of

measures that they can put in place to recruit, retain, deploy and develop

the NHS workforce in a way which responds to their aspirations and

personal and family priorities.

8

1. Informing our evidence

Introduction

1. We welcome the opportunity to submit our evidence on behalf of healthcare

employers in England for the 2017/18 pay review. We continue to value the

role of the independent NHS Pay Review Body (NHSPRB), in bringing an

expert view to remuneration issues in relation to the NHS workforce.

2. This year, our evidence has been informed by a regular programme of

employer engagement with a full range of NHS organisations, on their

priorities for pay and terms and conditions reform. We have:

had direct discussions with a number of NHS chief executives and HR

directors. In addition we have attended regional HR director network

meetings, and other employer networks throughout the year for further

input.

had substantive discussions with members of the NHS Employers

policy board, and with employer representatives on the NHS Staff

Council

undertaken, in collaboration with NHS Providers, a short online survey

of employer views during July 2016 to complement feedback received

from the various other networks.

3. Last year our evidence was framed within the challenges faced by the NHS

on finance, transformation and workforce. These remain and will become

more intense, complex and urgent over the next few years.

4. The chief executive of NHS England has described3 the current priorities for

the NHS as stabilising finances, implementing the 5YFV and delivering on

STPs. These are the challenges that employers in the NHS will face in the

short and medium term.

3 Speech to the NHS Confederation Conference in June 2016 https://www.england.nhs.uk/2016/06/simon-stevens-

confed-speech/

https://www.england.nhs.uk/2016/06/simon-stevens-confed-speech/

https://www.england.nhs.uk/2016/06/simon-stevens-confed-speech/

9

5. Employer plans have been designed to deliver significant transformational

change to services over the next three to five years. In compiling our

evidence we considered whether a longer term pay deal provides employers

with stability and certainty within the context of the current government

public sector pay policy and the financial pressures facing employers. The

majority of employers said that they would prefer multi-year pay settlements

for staff not already covered by pay agreements. Those in favour of a multi-

year agreement highlighted the stability it offers to employers, giving them

the ability to think strategically and plan ahead with regard to pay costs.

The financial challenge

6. Increases in demand for NHS services continues to outstrip increases in

NHS funding. Acute activity grows each year by around 2.5 per cent while

the pressure on prices increases by up to 3.7 per cent a year.4 In contrast,

NHS funding will grow by a little under 1 per cent each year in this

parliament.5 This creates a gap between funding and demand that needs to

be met through efficiencies to maintain current services.

7. A £22 billion efficiency programme has been outlined and the NHS will be

expected to deliver this by 2020. This includes £8.6 billion worth of hospital

savings made up by productivity improvements of 2 per cent each year.6

This would be a significant step up from the long-run average in the NHS of

around 1 per cent a year and would require a reversal in recent hospital

productivity, which has been reducing for the last three years.7 In the latest

NHS Confederation member survey, 96 per cent of NHS leaders had little or

no confidence the efficiency savings set out in the 5YFV would be possible.

4 NHS England (May 2016), NHS Five Year Forward View: Recap briefing for the Health Select Committee on technical modelling and scenarios

5 Written evidence submitted jointly by the Nuffield Trust, the Health Foundation and The King’s Fund to the Health Select Committee inquiry on the impact of the Spending Review on health and social care (January 2016)

6 NHS England (May 2016), NHS Five Year Forward View: Recap briefing for the Health Select Committee on technical modelling and scenarios

7 Health Foundation (March 2016), A perfect storm: an impossible climate for NHS providers’ finances

10

8. The consequence of not closing the funding gap is increased financial

pressure on local NHS commissioners and providers. Last year, NHS trusts

and foundation trusts ended the year with a combined deficit of £2.45 billion

and 157 of 240 trusts were in deficit. This end-year position would have

been poorer were it not for a non-recurrent £950 million capital to revenue

budget transfer.8 In 2016/17 £1.8 billion of additional funding has been

agreed for providers as part of a Sustainability and Transformation Fund.9

Despite this funding, NHS providers are still forecasting a deficit for this year

of around £550 million, which national bodies are aiming to reduce to £250

million.10

9. Staff costs represent 70 per cent of a typical hospital’s total costs. They are

a key factor in the declining financial position of NHS providers. Between

2011/12 and 2014/15, the share of income spent by acute trusts on staff

rose by 8.1 per cent. The growth in spending on non-permanent staff in

particular has been significant in recent years with a 24 per cent increase,

as a share of total income, between 2012/13 and 2014/15.11 Reports by the

Health Foundation and the National Audit Office identify a strong

association between spending on non-permanent staff and an

organisation’s financial performance. For every percentage point in a trust’s

staff costs accounted for by an agency, their net financial position is likely to

fall by 0.4 per cent of their operating costs.12

10. A cap on agency spending was introduced last year and has been fully

operational since April 2016. This sets a ceiling for each trust on their total

agency expenditure and requires the use of approved framework

agreements to procure all agency staff.13 A new single oversight framework

has been proposed that will enable regulators to mandate NHS

8 National Audit Office (July 2016), Reports on Department of Health, NHS England and NHS Foundation Trusts’ consolidated accounts 2015-16

9 NHS Improvement (March 2016), The Sustainability and Transformation Fund and financial control totals for 2016/17: methodology

10 Letter from Jim Mackey to Chairs and CEO’s of Foundation Trusts and NHS Trusts on 2016/17 Financial Position (June 2016)

11 National Audit Office (December 2015), Sustainability and financial performance of acute hospital trusts

12 Health Foundation and NAO

13 NHS Improvement,(March 2016) Agency rules

11

Improvement to help improve the quality and management of services,

where trusts have exceeded their agency cap by more than 25 per cent.14

Evidence suggests if trusts could achieve 70 per cent compliance with the

rate caps, they could save 20 per cent of their annual locum bill.15

11. During July 2016, national bodies announced a mid-year financial ‘reset’

with the aim of restoring financial discipline and helping to ensure ongoing

financial sustainability for the NHS. This has seen five providers and nine

CCGs placed into a new financial special measures regime, while all

providers and commissioners have agreed financial control totals that

represent minimum levels of financial performance they will be held

accountable for.16 These totals will be maintained while the NHS prepares

for a two-year planning and contracting round for 2017-19, which is due to

be completed by December 2016.

12. The two-year planning round will be supported by a two-year national tariff,

setting national prices until 2019.17 It will not be known until later in the year

what level of efficiency factor will be set in tariff for the next two years,

however it has been reported that there are no plans to set a target above 2

per cent.18 This is in line with the efficiency factor set in this year’s tariff,

which was reduced from a 4 per cent factor for the previous five years.

13. The focus on a two-year planning round, supported by a multi-year tariff, will

aim to support the implementation of STPs, which are intended to receive

the bulk of additional funding committed in the 2015 Spending Review.19

This will depend on how far the deficit in the provider sector has been

eliminated, which is the reason for concern about the carry-over of a deficit

from 2015/16 into this year. The latest temperature check from the

Healthcare Financial Management Association identifies that only 26 per

14 NHS Improvement (June 2026), Single Oversight Framework Consultation (June 2016)

15 Liaison (June 2016), Taking the temperature: A review of NHS agency staff spending in 2015/16

16 NHS England (July 2016), “NHS action to strengthen trusts’ and CCGs’ financial and operational performance for 2016/17”

17 NHS England and NHS Improvement (August 2016), National tariff proposals for 2017/18 and 2018/19 (August 2016)

18 “NHS issues plan for two-year payment tariff” in Public Finance (02 August 16)

19 NHS (December 2015), Delivering the Forward View: NHS planning guidance 2016/17 – 2020/21

12

cent of trusts who reported a deficit in 2015/16 expect to have a surplus in

2016/17 and that 30 per cent of trusts who reported a surplus in 2015/16

expect to have a deficit this year.20

Impact of the National Living Wage

14. The introduction of the statutory National Living Wage (NLW) will not have a

direct impact on the NHS in England during 2017/18 but will have longer

term implications. The NLW was introduced with effect from April 2016 at

£7.20 per hour for employees aged 25 and over. The government’s target is

that this will increase to £9.00 by 2020. AfC rates are currently higher than

the NLW; the lowest pay point with an annual basic pay rate of £15,251 is

equivalent to £7.80 per hour during 2016/17, 8.3 per cent higher than the

government living wage.

15. Assuming that pay increases are in line with public sector pay policy (1 per

cent uplift per year for 2017/18 to 2019/20), we estimate that the NLW is

likely to impact on AfC pay scales from 2018/19. We understand the

additional costs of the NLW will have to be met within the constraints of

public sector pay policy. We estimate the cost of meeting statutory

compliance would add 0.02 percent (circa £10m) to pay bill in 2018/19 rising

to 0.39 per cent (circa £180m) by 2020/21. Annex K provides further

information for these estimates. However, it is not yet known what the

trajectory of the increases will be to the NLW rate post 2016. If the

additional costs of the NLW are to be met within the public sector pay policy,

to maintain an average award of 1% for all staff, other NHS staff earning

above the National Living Wage would be required to receive an award of

less than 1%.

16. As the AfC pay rates do not have age related points, it is unlikely that the

NHS will be able to benefit from using the under 25 rates moving forward.

We understand the additional costs of the NLW will have to be met within

the constraints of public sector pay policy.

20 HFMA (July 2016), NHS financial temperature check

13

17. NHS pay rates are already favourable in comparison to the NMW. The

NMW for workers aged 21 and over is currently £6.30 per hour and is likely

to increase in October 2016. The 2016/17 point 2 hourly rate of £7.80 per

hour during 2016/17 is 23.8 per cent higher than the legal minimum wage

for workers aged 21 and over.

18. In our survey we asked employers about implementation of the NLW and

the challenges and opportunities this presented. A few employers reported

that they were already paying the Living Wage Foundation rates21, which

are voluntary and set at a higher level than the NLW. Other employers (who

will be paying the NLW from 2018/19) said that there were potentially

positive impacts including: opportunities to increase apprenticeships in the

NHS and demonstrate to lower paid staff that the NHS is a fair and

equitable employer.

“The opportunities for meeting the living wage are improved recruitment and

retention for lower banded staff where churn is normally high.

19. Challenges identified by employers include:

an additional financial burden on already tight budgets if no additional

funding is made available, which will need to be borne by other staff to

pay for the NLW and may damage morale. employers told us there is

no evidence of market pressures for Bands 1 - 3 to receive additional

pay and therefore it is not a priority;

the impact on current pay structures – over time compression of pay

scales at bands 1-3 could undermine the pay structure at the bottom of

the pay scale;

a need to re-profile roles to get more productivity from higher levels of

pay;

funding any future increases in the NLW which may be higher than the

general settlement.

21 http://www.livingwage.org.uk/calculation

http://www.livingwage.org.uk/calculation

14

potential labour market issues - employers in other sectors may seem

to be more competitive in relation to basic pay being offered, making it

even more important for the NHS to stress the total reward package.

“The challenge of bringing those in lower bands (1-3) up to the living wage

is if it is funded from the 1 percent – resulting in damage to the morale of

other pay bands who will receive less than 1 percent to pay for it. This will

be perceived as extremely unfair application of government policy.”

Agency/locum spend

20. NHS Improvement’s consolidated guidance22 outlines the rules on the

procurement of agency staff across all groups including doctors, nurses and

all other clinical and non-clinical staff which apply from 1 April 2016. The

rules require compliance against a ceiling set for total agency expenditure,

the use of approved frameworks to procure all agency staff at rates set at or

below the price caps, and introduce a maximum hourly wage rates for

agency workers from 1 July 2016.

21. Almost two thirds of survey respondents indicated that their agency/locum

spend had been lower since the introduction of the price caps, while only a

very small percentage of employers had seen a rise in agency locum spend.

Less than a third of survey respondents believed that the agency cap had

encouraged staff to work for them on a permanent basis.

22. Where permanent recruitment has been successful it has primarily been

with nursing or AHP staff and less so for medical staff and in hard-to-fill

posts.

23. There has also been a positive impact on the numbers working on internal

staff banks. In some cases lack of supply had pushed employers towards

high cost agencies. Despite the caps, individuals may opt to remain with

22.https://www.gov.uk/government/uploads/system/uploads/attachment_data/file/510391/agency_rules__23_March_

2016.pdf

https://www.gov.uk/government/uploads/system/uploads/attachment_data/file/510391/agency_rules__23_March_2016.pdf

https://www.gov.uk/government/uploads/system/uploads/attachment_data/file/510391/agency_rules__23_March_2016.pdf

15

agencies for better rates of pay and the flexibility that agency work offers.

The transformation challenge

24. In our 2015/16 evidence we described the transformational vision that the

5YFV set out for new models of care delivering a better NHS by 2020/21.

The emphasis has now shifted firmly towards delivery and implementation.

25. Many of the plans for transforming services have been designed to deliver

significant change over the next three to five years. In formulating our

evidence we have considered whether a longer term pay deal will provide

employers with some stability and certainty as they plan and deliver

services locally within a similar timeframe.

26. In December 2015 NHS England published planning guidance for 2016/17-

2020/21 to help ensure that health and social care services are built around

the needs of the population.23 The NHS has a clear set of plans and

priorities for 2016/17 and NHS England has described these in a series of

must dos. These include ensuring that by March 2017 25 per cent of the

population will have access to acute hospital services that comply with four

priority clinical standards and reducing excess deaths by increasing the

level of consultant cover and diagnostic services available to patients at

weekends.

27. Every health and care system in England must produce a multi-year STP

showing how local services will evolve and become sustainable over the

next five years and deliver the 5YFV vision of better health, better patient

care and improved NHS efficiency. STPs will offer opportunities to think in

different ways about workforce within a wider strategic plan.

28. Local must do’s in the planning guidance for 2016/17 include restoring the

system to aggregate financial balance, including delivering efficiency

savings, complying with maximum total agency spend and maximum hourly

rates set out by NHS Improvement.

23NHS England (December 2015) Delivering the Forward View: NHS planning guidance 2026/27-2020/21.

16

29. The NHS 5YFV recognises that:

“Healthcare depends on people — nurses, porters, consultants and

receptionists, scientists and therapists and many others. We can design

innovative new care models, but they simply won’t become a reality unless

we have a workforce with the right numbers, skills, values and behaviours to

deliver it.”

Integrating health and social care

30. Integrated care has become an important aspect of healthcare reform over

the past few years. This is a response to challenges faced in both the health

and social care sectors arising from a rapidly ageing population; rising

demand for care; increasing numbers of complex patients with multiple long-

term conditions; moving care from hospitals to primary care; and poorly

coordinated care (for example between community health services and

hospitals and between the NHS social services).

31. This requires investment at a national level to build the capacity and

capability of the workforce to provide integrated care. At a local level it

means a workforce that meets the needs of its citizens and is equipped to

deliver holistic, proactive and integrated care. The aim of this is for

communities to have confidence that local systems are effective and offer

value for money and that individuals are confident that local services are

safe, effective, high quality and accountable.

32. The Cities and Local Government Devolution Act received Royal Assent in

January 2016 providing the legal framework for devolving healthcare

functions to local authorities. The Act provides an additional push towards

integration of health and social care, but not all devolution plans currently

include healthcare. However, integration will feature as part of STPs and

significantly a small number of STP leaders come from local government.

33. It is not yet known what the implication of these changes are for the NHS

workforce. It is clear that there will be no national blueprint and may mean

various different approaches. This supports our general position that there

needs to be more scope in national agreements for employers to tailor the

employment package to meet local operational and organisational needs.

Some employers have suggested that the development of joint working with

local authorities may mean that, in future, pay and conditions changes in

17

both the NHS and local government may need to be considered together. A

set of nationally less prescriptive NHS terms and conditions would help

facilitate local flexibilities.

Employer views

34. We asked employers for their views on the pay and workforce implications

arising from system changes such as new care models and devolution.

35. Respondents consistently highlighted the need for flexibility in pay, contracts

and terms and conditions to allow organisations to address local priorities.

Staff will have to work differently and could be accountable to more than

one organisation. Closer working with the local government employers, will

mean that the barriers that make staff movement difficult between different

employers will need to be considered.

36. The ability to build flexibility and flexible working models into the system

could support employer aspirations of a more diverse workforce. Local

government organisations already have some experience of integrating

NHS staff following the transfer public health functions to local authorities

which could provide a useful source of learning.

37. Employers have told us that responding to the need to work differently

across organisations will present a major training and development

challenge. One outcome might be generically skilled staff across health and

social care.

38. One vanguard site for primary and acute care systems (PACS) said that

experience was beginning to show that common competencies, irrespective

of employer, were emerging which in turn would need a common approach

to job evaluation across organisational boundaries.

“Devolution/STP requires a whole system approach and solutions to the

provision of care. This requires flexibility in the workforce across health and

social care but currently contracts and the law do not allow this to happen

with ease.” Respondent from a clinical commissioning group

39. Respondents also noted the practical difficulties involved, including the

management of pay differentials and the potential of pay inflation where

18

social care staff are currently paid less than their NHS equivalents for

similar work. As one employer explained:

“We are moving towards integration with social care, but the base pay and

pensions differentials are a stumbling block. A jointly recognised staffing

and contractual structure would make the process of integrating teams

much easier – as would transition funding.”

Seven-day services

40. The government has been clear about its intentions on seven-day services.

Transformation of this scale and complexity requires well-trained, well-

motivated, modern and flexible workforce.

41. Many staff already routinely work shift patterns that mean they can be at

work on any day of the week. The national AfC agreement includes no

direct contractual barrier to the provision of seven-day services. However,

there remains a case for some adjustments to the unsocial hours payment

provisions to help make the delivery of seven-day services more sustainable

for the longer term. Such changes ought to be agreed with NHS trade

unions as part of a wider balanced package of pay and contract reform.

42. Employers are committed to the core government objective to ensure

reliable and safe care which all patients should reasonably expect from their

national health service across all days of the week. It will enable timely

access to senior clinical decision making and interventions, enable better

patient outcomes, reduce avoidable mortality and patient harm and improve

the patient experience. It allows for better utilisation of the facilities, more

speedy diagnosis, improved patient flows and reduced delays and waiting

times, as well as avoiding unnecessary admissions.

43. The NHS England NHS Services, Seven Days a Week Forum examined24

the evidence base for seven day services in hospitals. One of the

conclusions of the forum was that ‘there is a large body of evidence

associating timely consultant input to patient care with improved outcomes’.

24 https://www.england.nhs.uk/wp-content/uploads/2013/12/forum-summary-report.pdf

https://www.england.nhs.uk/wp-content/uploads/2013/12/forum-summary-report.pdf

19

It also noted:

variable staffing levels at weekend

the absence of senior decision makers (consultants and other senior

clinical staff);

a lack of consistent specialist services (for example diagnostic) at

weekends;

a lack of availability of specialist community and primary care

services.

44. From the ten produced by the forum, the four clinical standards that have

been prioritised by the government are those which were considered as

being those most likely to tackle the risk of avoidable mortality and harm

across all seven days of the week. The priority standards are:

time to first consultant or senior-decision maker review – seen as

soon as possible but at least within 14 hours of arrival at hospital

diagnostics – seven-day access to x-ray, ultrasound, CT, MRI, echo

cardiology, etc within set timescales

consultant-led intervention – 24 hour access to critical care,

interventional radiology, interventional endoscopy, emergency

general surgery etc

on-going review - all patients with acute and urgent care needs must

be seen and reviewed by a consultant, twice daily, and patients on

general wards once daily, unless it has been determined that this

would not affect the patient's care pathway.

45. We understand that the key requirement is that, by the end of this

parliament, all patients with similar urgent and emergency hospital care

needs will have access to the same level of consultant or senior clinical

decision maker assessment and review, diagnostic tests and treatment,

seven days a week, as described by the four priority standards. Employers

also expect by 2020 to be working towards implementation of all ten

20

standards. This is being pursued through the standard NHS contract and

NHS England's Strategic Transformation Plans25.

46. Achieving the NHS clinical standards will take time and progress will be

achieved by the employment of additional clinical staff and through

continued productivity improvements. The NHS is developing its short and

long-term workforce plans to enable this objective. It will not be achieved by

simply diluting existing staff from Monday to Friday and redeploying them

across the weekend.

The workforce challenge

47. NHS staff are essential to the planning and delivery of efficient, innovative

and effective models of patient care.

48. All of the providers responding to our survey said that they had issues with

the recruitment and retention of staff. The main area of concern was a

national skills shortage, followed by competition from other NHS

organisations, local skills shortages, and the age profile of the workforce.

Pay and reward featured less prominently.

49. Employers described a range of local initiatives to address these difficulties,

including:

local and international recruitment campaigns

social media marketing

making use of local recruitment and retention premia in hard to fill

posts

establishing links with local education providers to improve workforce

growth in hard to fill roles

redesigning roles

25 https://www.england.nhs.uk/ourwork/futurenhs/deliver-forward-view/stp/

https://www.england.nhs.uk/ourwork/futurenhs/deliver-forward-view/stp/

21

widening benefits and promoting the total reward package

promoting staff/career development to aid retention of staff

partnership working with other employers to promote local areas.

50. One employer described their involvement with Health Education England

as part of the Global Health Exchange Scheme to recruit registered nurses

on a three year fixed training contract. The aim is to recruit up to 3,000

registered nurses for England in order to help with the short to medium term

national labour shortage. At the same time they were increasing their

commissioned numbers of undergraduate nurses and expanding their

placement capacity to ensure a future guaranteed supply of registered

nurses.

“We have about 175 nurse vacancies and about 23 consultant vacancies -

therefore we have a major reliance on agency staff. We only have a small

internal bank too, which we are taking steps to increase. We are also

recruiting flexible pools of healthcare assistants. Although we have very

rigorous agency approval processes and monitor it tightly, we have to ‘break

glass’ to make sure our services are safe…the sheer scale of our agency

need has kept costs high”

High host area supplements (HCAS)/ London

issues

51. A small number of employers responded to our survey question on high cost

area supplements.

52. Employers pointed out the retention challenge posed by staff who move

from inner to outer London and the combined impact of increased costs and

a reduced allowance. One employer on the border between inner and outer

London indicated this impacted particularly on their ability to recruit to hard

to fill services.

53. Other comments focused on the value of the supplement. Feedback from

staff at one trust was that it didn’t cover the higher cost of living in London

and the South East. Feedback from other employers suggested that

22

supplements should be flattened out across London - although not at the

expense of a general 1 per cent uplift.

54. Rising accommodation and transport costs have meant there are particular

challenges facing NHS organisations in London with regard to recruitment

and retention. Jobs requiring a car can be more difficult to fill. Further

research is needed on living and transport costs and travel patterns.

“The NHS should look to use HCAS to introduce a differential that better

reflects the higher costs which have increased markedly with house prices”.

55. NHS Employers has been working with trade union colleagues to raise

particular concerns regarding housing and transport costs with the Mayor of

London. . This work has included analysis of the postcodes of more than

100,000 NHS staff between 2010 and 2015 which showed more staff are

moving out of London to live and work. During this time, transport costs rose

by 25 per cent and average house prices rose by 37 per cent. This is

leaving London NHS Trusts struggling to attract and retain key workers

needed to ensure safety for patients.

56. NHS Employers and the London NHS Partnership called for the mayoral

candidates in the 2016 election to help the future of NHS workers with a

commitment to:

work with London’s NHS employers and Transport for London to

review the scope to reduce transport costs for key NHS staff

provide key worker housing and prioritise new housing developments

for NHS workers.

Pay and contract reform

57. Our continued priority has been to seek reform of the national pay and

conditions system. Employer feedback has consistently told us that the AfC

pay system needs change in order to ensure it supports the transformation

agenda and is responsive to quality and efficiency challenges. It also needs

to be responsive to the changing needs of patients and the evolution of new

models of care. Whilst there have been some elements of reform in March

2013, the pay system has not undergone systematic review since it was

introduced in 2004.

23

58. It is important that further pay reform ensures that the NHS continues to

offer a competitive employment package that allows for the recruitment and

retention of the skilled and qualified staff needed; maximising their

contribution and engagement. Reform should aim to contribute to wider

initiatives to reduce the costs of agency staffing and minimise the need to

reduce headcount, without creating new additional cost pressures.

59. Employers’ continue to tell us that their preference is that pay reform is

delivered through agreed changes to the national framework over the next

two years. Our engagement work showed a preference to reform some

priority areas rather than to seek wholesale changes.

60. During 2015/16 there has been constructive discussions with our trade

union partners on the scope for an agreed balanced package of pay

reforms. The initial focus has been on options to revise pay structures with

shorter pay bands and the removal of overlaps between pay bands.

Substantive discussions have not yet been possible on wider conditions of

service issues. Given the current financial and political environment, and the

constraints of public sector pay policies, progress has been slower than

planned and it is now clear that new arrangements will not be introduced

from April 2017 as originally hoped for.

Pay award 2017/18

61. The pay review for 2017/18 will be subject to the government’s public sector

pay policy, set out in the 2015 Budget, that pay increases across the public

sector will be limited to an average of one per cent a year for four years.

62. The NHSPRB has been asked to consider whether or not there is evidence

to justify targeted or differentiated awards within the 1 percent pay

envelope. We have had clear feedback from employers that they have no

evidence available at local level to justify differential pay awards to AfC staff.

The common view is that an envelope of 1 per cent would not in practice

make any differentiation worthwhile and could have a negative impact on

the morale of the workforce.

63. We are not aware of any labour market challenges at national or local level

that would be resolved by differentiated pay awards in

2017/18.Respondents to our survey were asked to rank a series of options

on how they would apply a 1 per cent pay award. The option of giving all

24

staff 1 per cent was the highest ranked with over half of employers selecting

this as their highest choice. The main reasons given making for this choice

were:

1 per cent was insufficient to make significant change

“The amount is too small to make significant impact on recruitment and

retention or a reward scheme. Differentials across types of post could

develop variations in pay scales between different trusts and a

departure from the national pay scales would create a competitive

environment between Trusts and be detrimental to recruitment and

retention.

The effort required to work out alternative local options would be

disproportionate to any gain

“As the pot is so restricted it is hard to justify putting a lot of effort into

anything other than spread by same percentage…effort should go into

finding ways of changing terms and conditions to release cash to spend

on different priorities”

The potential impact on staff motivation and morale for those not

receiving an uplift.

“1 per cent is not a lot of money to work with…about keeping all staff

motivated during a time when we are trying to do things differently and

transform our services

“The pay increase is small and not significant enough to motivate staff

under a performance pay process. Staff at all levels suffer financially so

we believe the fair way would be to award the increase across the

board”

64. The annual uplift is a cost of living increase rather than a reward payment

which should be awarded to all staff.

65. Those respondents who selected other options highlighted using the 1 per

cent to help address recruitment and retention issues, followed by giving

more to lowest paid staff, giving more to high performers and giving more to

staff at the top of their band/grade.

25

66. The prevailing view was to award 1 per cent evenly as employers saw this

as the most equitable option. Although some employers were attracted to

the possibility of making more creative use of the resource locally, there was

a recognition that this would depend on them having sufficiently resourced

and developed performance management systems and overall there

seemed to be little appetite for this at the moment. The effort to attempt

something different within the limit of 1 per cent would be unlikely to resolve

significant supply issues.

67. Some employers saw the risk of pay spiral and unnecessary competition if

employers were encouraged to adjust pay locally – though some said that

decisions on local pay could be limited to AfC band 8 and above.

68. Several contributors said that the aim should be to reward as many staff as

possible without rewarding poor performance. Some felt that the uplift was

intended to recognise cost of living increases and was not designed to

provide a reward system. Differentiated pay based on objective

performance measures would be more acceptable to staff than arbitrary

awards.

69. Contributors also noted that there would also be an adverse impact on

morale if all staff were not treated the same which could in turn affect their

willingness to engage with service redesign and transformation work.

70. There is no evidence that further targeted increases to the lowest pay points

are required on labour market grounds. The view is that NHS pay rates and

the wider employment package remain competitive in the labour market,

particularly when compared to some other public sector employers. NHS

rates will be higher than the statutory National Living Wage during 2017/18.

71. We asked employers about whether or not they would prefer a single or

multi-year pay approach. The majority of survey respondents said that they

would prefer multi-year pay settlements for staff not already covered by pay

agreements, highlighting the stability and certainty offered to both staff and

employers who would be able to think strategically and plan ahead with

regard to pay costs.

“Provides stability and certainty… fits with the move towards longer term

planning and settlements with trusts.”

26

“Flexibility within a multi-year deal would allow us a larger pot to invest for

priority staff/care needs in a strategic manner. It would help us manage

positive dialogue with unions, which the normally late 1 per cent deals

limits.”

72. It was, however, recognised by some that a longer term pay settlement

would work best in the context of supporting the transition to a reformed pay

structure rather than to perpetuate the existing arrangements.

73. Others noted the general level of uncertainty post referendum and that in

the current circumstances a single year deal would be preferable as it was

important to retain pay flexibility rather than be locked into a multi-year pay

deal.

“There is significant uncertainty at present and being tied into a multi-year

pay deal may cause more problems than it resolves”

74. We estimate that just over half of all AfC staff will be entitled to a pay

increment in 2016/17 worth between 1 and 6.7 per cent (see Annex J), even

without an increase in the national pay scales. Annex B details the average

basic pay increase by pay band and staff group.26 The average increase is

1.8% (this includes those at the top of the band who do not receive an

increment).

Summary

75. In summary, our extensive programme of employer engagement tells us the

following:

Employers continue to stress the importance of further pay and

contract reform and tell us that meaningful pay reform must be in a

balanced package of changes to include terms and conditions, as

well as pay structure reform.

26 NHS Employers Estimates. Taken from April 2016 ESR Data Warehouse pay bill query of Agenda for

Change staff. scaled to NHS Hospital & Community Health Service (HCHS) monthly workforce statistics

- March 2016, Provisional Statistics

27

Employers support the same percentage increase to be made to all

AfC staff within the average 1 per cent cap. There is some limited

support for a longer term pay agreement to provide certainty and help

planning.

There is no evidence available at national level to justify or support

differential increases in 2017/18. The average 1 per cent envelope is

not enough to make any significant targeting worthwhile. To do so

would be seen as inequitable and potentially damaging to staff

morale and employment relations.

NHS organisations are facing a growing and changing demand for

care, at a time of increasing financial pressure and growing

employment costs. The priority is that available resources should be

used to support improvements to the delivery of patient services, and

the necessity of retaining key staff.

There was no significant support for changes to the HCAS unless

there was additional funding for employers in London. Increases to

the minima and maxima rates should be increased in line with the

headline pay award.

NHS organisations continue to face workforce supply issues in

relation to some of the health professional staff groups. The current

shortage is essentially a supply issue and is not related to pay levels.

A number are included on the Home office’s shortage occupation list.

28

2. Modernising Agenda for

Change

76. Delivering high-quality services and improving outcomes for patients should

be at the core of what the NHS does. In doing this the NHS terms and

conditions can act both as an enabler and a barrier. In an ever changing

healthcare environment, the national pay terms and conditions of service

need to be relevant and supportive of the necessary changes to service

delivery.

77. The pay system has not undergone a systematic review since it was

introduced in 2004, in a very different financial and policy environment than

the NHS today. The current system has in-built challenges that make it

difficult, in certain circumstances, for employers to reward and incentivise

high-quality patient care and deliver seven-day services.

78. In 2015, as part of the 2015/16 pay deal between the government and NHS

trade unions, there was a commitment by staff side organisations to talks

which look at the possibility of further reforms to AfC.

79. Employers continue to raise concerns about affordability and lack of

flexibility in the current system and are increasingly asking for the pay

arrangements to be better aligned to performance and productivity and

where possible to support capacity.

80. Most employers continue to support changes to be delivered through

agreed changes to the national framework. Any changes to the national pay

system must ensure that it remains a competitive employment package that

supports employers to recruit, retain and motivate the highly skilled and

committed workforce that will be needed, whilst maximising their

contribution and engagement.

81. Employee reward should consider not just the level of pay, but the entire

employment package offer. Any direct changes must support employers to

meet legal obligations and to effectively and efficiently allocate resources to

where they are needed most - without creating additional costs.

29

Agenda for Change review

82. The NHS PRB said in the 2015 report:

“We have previously recommended that the AfC pay structure is ready for

review and it seems to us that discussions about unsocial hours definitions

and premia are better taken forward as part of negotiation on the pay

system as whole, with the aim of agreeing a balanced package. Ideally this

should include a review of the length of pay scales, overlapping bands with

shared spine points, progression and improved links between reward and

performance, including incentives for staff at the top of their pay band.”

83. The 2015/16 national pay agreement, directly negotiated by government,

included a commitment from NHS trade unions to review the national

agreement, originally with a view to seeing if agreement on changes could

be reached by April 2016. We would note that the NHS Pay Review Body

subsequently endorsed the need for modernisation of the pay structure and

other conditions in their 29th Report.

84. Employer aims were to:

maximise the contribution of NHS staff and reduce the reliance on

agency staffing

strengthen the AfC agreement on pay progression - building on the

2013 flexibility to link pay progression to locally set performance

requirements.

review generally the need for further reform to the pay system.

85. Since then the parties on the NHS Staff Council have been involved in

active and constructive discussions with an initial focus on exploring the

scope to revise the pay structure and pay progression arrangements.

86. There is a shared aspiration to make the pay structure simpler in a way that

works better for staff and the service without disturbing the underpinning job

evaluation scheme and pay band structure. It is recognised that there will be

a need for some re-structure at the bottom of the current AfC pay scales to

accommodate the NLW pay rates. The parties are looking at how to revise

the pay structure in a way which would limit overlaps between pay bands,

reduce the number of pay points in a given pay band and create more even

spacing between pay points. The group is examining the practical, financial

30

and legal implications of this as well as the options available for transition to

such a structure.

87. It is disappointing that it will not be possible for new arrangements to be

agreed and introduced from April 2017 as was the original aim. Reaching an

agreement on pay and contract reform within the tight constraints of current

public sector pay policy, that meets both employer and trades union

aspirations, has proved difficult. For a final agreement to be reached,

employers will want to see adjustments to some wider terms and conditions

as part of a balanced package of changes.

88. The failure to reach a conclusion on pay reform this year is likely to make

the agreement on transition to a revised pay structure more difficult to

deliver within the government’s spending review period. This is because the

costs of transition would have to be spread over fewer years. Despite the

challenges the parties on the NHS Staff Council are continuing to explore

the possibilities for reaching an agreement on further changes in the longer

term.

Employer views

89. Most of those employers who provided feedback during our engagement

activity said that AfC reform remains a priority if achievable through

negotiation, with an aspiration that this should be delivered within the next

two years and a desire for some stability within the workforce to allow STP’s

to be met.

90. Those arguing for immediate reform cited the need for flexibility arising from

developments in devolution and other system change, including redesign of

services and deployment of staff. One employer commented:

“(AfC)… needs to be the vehicle to help drive change in behaviours and

attitudes locally, regionally and nationally”

91. The cost of the current contract was also another reason quoted in support

of more urgent reform, particularly with the emergence of a more

competitive health and social care sector where price is a key factor in

commissioning decisions.

31

“The pay system means that we are not cost competitive in the market we

operate and this has led to a loss of contracts and a recognition that we are

not able to put in a competitive tender based on our staff pay structures.”

92. Those for whom reform wasn’t a priority argued that there were other

competing pressures for the time and resources necessary to deliver

significant reform. One human resources director commented that there was

a risk in making concessions in minor reforms rather than waiting until

resources were available for more significant change:

“We can achieve these improvements without amending AfC. Renegotiation

will only otherwise lead to a pay pressure we’re unlikely to be able to afford”

93. Most employers were in favour of small scale, incremental change to a

number of priority areas of the contract rather than fundamental reform.

Regardless of their views on the scale and pace of reform, employers were

agreed in their wish for a contract which allowed organisations flexibility to

recruit and retain staff; to deliver their aims and objectives, and to align

performance to organisational needs.

Pay structure reform

94. As a consequence of the government’s target of £9 per hour by 202027,

some action is needed to revise the bottom of the pay structure. By

2020/21 we estimate that AfC Bands 1 and 2 will overlap in their entirety

with the bottom part of Band 3. This degree of compression would leave

employers facing significant challenges as a result of no pay differentiation

between different role levels covered by Bands 1-3. However additional pay

differentiation would inevitably mean increasing cost pressures above and

beyond the cost of meeting statutory compliance. We understand that the

costs of meeting the NLW have to be met from the value of the planned

average 1 per cent increase allowed for within the government’s pay policy.

95. The current pay structure has a number of bands that take up to 9 years to

progress from bottom to top. It is widely considered as good employer

practice to have pay bands that take no longer than 5 years to progress

27 Office for Budget Responsibility (March 2016), Economic and Fiscal outlook:

http://cdn.budgetresponsibility.org.uk/March2016EFO.pdf (footnote, page 64)

http://cdn.budgetresponsibility.org.uk/March2016EFO.pdf

32

through. In some of the lower Bands, 1 – 3, there is a case for fewer pay

progression steps to reflect the fact that the period of competency

development for the roles are shorter.

96. Employers have told us consistently that priority should be given, when it is

affordable, to reduce the degree to which the AfC pay bands overlap with

each other. The overlaps act as a disincentive to promotion and

development, where someone may be earning less than those that they

manage. Having a clear difference in pay between bands will help

encourage staff to seek to take on higher levels of responsibility.

“Current pay arrangements are becoming unaffordable and

unsustainable…and sometimes fail adequately to reward or actively

disincentivise career progression”

“(AfC) does not provide the flexibility to reward and retain staff. There are

limited incentives for staff at the top of their band”

Terms and conditions reform – Increasing workforce capacity

97. The priority for employers are changes which they believe will contribute

towards:

increased workforce capacity and thereby help to reduce agency

spending;

recruitment and retention of staff and improvements in their health

and wellbeing

support in the training and development of staff

greater flexibility of terms and conditions to support future service

changes, for example seven day service provision.

98. Managing sick leave was an area in which employers expressed a particular

interest in exploring opportunities for change. Some employers commented

on the relative generosity of the scheme compared to the private sector,

although others noted that the security of sick pay was valued by staff in the

event of serious illness. There is also recognition that effective management

of sickness absence and an emphasis at local level on the health and

wellbeing agenda is vital in supporting people back to work and preventing

ill-health in the first place.

33

99. Employers are keen to explore the scope for the further extension of plain

time working with particular consideration given to the level of

enhancements that are paid for day-time weekend working.

100. Employers felt there was scope to look at annual leave entitlement, the

rates of entitlement and options for buying and selling leave.

Support for seven day service delivery

101. Employers would like to ensure that the provision for unsocial hours, in

particular the cost dis-incentive for scheduling weekend working, better fits

the needs of patient care over the weekend. This needs to align with

medical terms and conditions in a supportive way, along with the removal of

the consultant opt-out for weekend working.

102. The changes agreed to AfC in 2013 introduced a national framework

underpinned by shared values that allowed employers locally to determine

local variations to pay progression. Employers would like further

consideration to be given to the appropriate balance between national

prescription and local flexibility. Though some employers suggested that

they did not at present have local management capacity to be able to use

additional flexibilities effectively.

103. The Health Foundation report on NHS workforce policy Fit for Purpose

commented on the high level of prescription found in national NHS terms

and conditions relative to other sectors of the economy28.

“The Staff Handbook, which codifies the main AfC contract for non-medical

staff, currently runs to 307 pages in 47 sections and 30 annexes. The

product of detailed national negotiations, it covers everything from pay and

progression to flexible working and career breaks in a level of prescription

which in most other employment contexts would be left to much greater

local discretion.”

28 Health foundation 2016, Fit for purpose? Workforce policy in the English NHS, http://www.health.org.uk/publication/fit-

purpose

http://www.health.org.uk/publication/fit-purpose

http://www.health.org.uk/publication/fit-purpose

34

Ambulance issues

104. The 2015 pay settlement agreed between the Department of Health (DH)

and trades unions included a commitment that ambulance employers would

work with trades unions to address recruitment and retention issues

affecting ambulance paramedics. This was to include consideration of both

job evaluation profiles/appropriate pay bandings for paramedics and

whether evidence supported the application of a recruitment and retention

premia.

105. As part of the 2016 pay review, the NHSPRB considered evidence and

concluded that:

“We do not believe the case has been made to warrant the introduction of a

national recruitment and retention premium (RRP) for paramedics.”29

106. It is acknowledged that there is a shortage in the supply of qualified

paramedics. This is reflected by the inclusion of paramedics on the Home

Office’s occupation shortage list. The opportunities for using and employing

paramedics in a wider range of settings and organisations is contributing to

workforce gaps faced by ambulance employers. This is being addressed

through a number of initiatives, the most important of which is an increase in

the number of training places being coordinated by HEE. Further

information is provided in Section 3.

107. Representatives of ambulance employers, trades unions, commissioners of

ambulance services and other national stakeholders met in June 2016 to

consider how to make more rapid progress on various ambulance workforce

issues. The parties agreed to continue the national dialogue started by the

National Ambulance Partnership Forum to:

review national job profiles for paramedics, using the auspices of the

Job Evaluation Working Group;

identify ways to improve the employee experience and health and

wellbeing of ambulance staff. The parties will consider the

29NHS Pay Review Body twenty ninth report 2016

https://www.gov.uk/government/uploads/system/uploads/attachment_data/file/506030/54488_Cm_9210_NHS_PRB_2016_Web_Accessible_NEW.PDF

35

operational pressures that affect staff experience, issues around

violence ad aggression and perceived bullying and harassment in the

service.

find workable solutions to the challenges facing ambulance staff of

changes to retirement age; and, later to conduct a joint review of the

impact, take up and scope of the recently agreed Early Retirement

Reduction Buy Out scheme to be undertaken before April 2017.

108. NHSPRB recommended that partnership work on considering the national

job profiles and the differentiation between Band 5 and Band 6 roles be

taken forward as a matter of urgency. The parties are giving priority to

concluding the work on ambulance job evaluation profiles. The aim being to:

reach a conclusion to a review of the national job evaluation profiles

for paramedics as quickly as agreed job evaluation processes

allow:

produce guidance and support employers with the job evaluation

process at a local level (job matching):

seek to understand how Job Evaluation Group (JEG)

recommendations for a new profile(s) might impact on paramedic

deployment/roles:

ensure that ambulance commissioners are aware of and

understand the likely financial impact of any proposed changes to

banding in the immediate future and longer term.

109. In February 2016 there were about 12,200 FTE ambulance paramedics

employed in the ambulance service in England. Around 65 per cent were

on Band 5. Some trusts have used local variations on the AfC national

agreement, which has resulted in a number of trusts having higher

proportions of their paramedic staff employed at Band 6

110. An NHS Staff Council technical review of paramedic roles is being

undertaken and has found some evidence of an increase in the levels of

patient diagnosis and treatment. This is being driven by the requirements

of commissioners wishing to see more patients treated at the scene and

reducing transfers to hospital. The initial assessment of the impact on job

weight, in line with AfC job evaluation, indicates that more paramedic

posts will fall into Band 6.

36

111. If any new profiles are agreed, local employers will be responsible locally

for reviewing their paramedic roles to see if jobs match to the new

profile(s).

112. Ambulance employers face the challenge of coping with a potentially

significant increase in workforce costs which will not deliver efficiency

gains. The concern is that commissioners may not be able to find the

additional funding required. Commissioners have been looking to the

ambulance service to become a mobile treatment service which aims to

reduce hospital admissions by treating more patients at the scene. They

may be reluctant to support pay banding changes financially, if this simply

means paying more for the same level(s) of service.

113. On 14 September the parties agreed to release a new Band 6 Paramedic

profile. The intention is that this will be published, alongside technical

guidance on how existing paramedic job roles should be reviewed against

it and an agreed timetable for this work. It was also agreed that that the

parties will work together to develop a programme of work to identify how

newly qualified paramedics can be better supported as they enter

employment. This work will include consideration of a preceptorship

programme and if appropriate a national role profile for a newly qualified

paramedic at Band 5 level. It is hoped that this programme of work will

support the recruitment and retention of paramedics, generating

consistency across the different ambulance services and enable a better

focus to be put forward on the health and wellbeing of new entrants.

Realising the benefits of pay reform

114. We asked employers how confident they felt in their ability to realise any

future benefits of pay reform. Given the challenges they currently face with

implementing new medical contracts and ongoing service redesign, some

employers said they were looking for simple to implement reforms with

appropriate support at a national level. Any complex changes that would

place their limited local capacity under greater strain would not be

welcomed at the moment when they are having to address the challenges of

the Sustainability and Transformation Plans.

115. Looking back at the 2013 changes to AfC, some employers had welcomed

the additional local flexibilities supported by a national framework of

37

principles. Other employers said they struggled to make effective use of

these local freedoms due to organisational capacity and capability issues.

116. Another concern employers raised was around the cost benefit of any

proposed reform. An employer fear was that cost neutral reforms have a

tendency of costing some employers more locally than others and that they

felt they ended up being left to deal with the financial fallout from these

locally unfunded reforms, the new junior doctors contract being a case in

point. In addition, any transitional costs associated with moving to a new set

of pay, terms and conditions that has to be funded within a cost neutral

envelop means that any benefits can take longer to be realised.

117. A common theme was the variability in the capacity and/or capability of

organisations to fully make the best of local flexibilities. Effective

performance management remains a challenge in some areas so change

needs to be manageable and straightforward. They felt that the message

needs to focus on improving recruitment and retention rather than making

savings.

118. One contributor said:

“There is flexibility within the current national contracts to support

transformation, reward and retention”

119. The lack of resources meant that they were not confident that this could be

achieved at the current time and that contract reform would not increase the

pace. They concluded; “reforming contracts for new starters rather than

existing staff may be a more realistic aim in the current climate”.

38

3. Workforce supply

Changing landscape

120. Effective workforce planning and recruitment has never been more

important in the health sector. The 5YFV acknowledges that new models of

integrated health and social care cannot be delivered unless we have a

workforce with the right numbers, skills, values and behaviours.

121. STPs are helping to bridge the gap between health and social care, with 44

STP footprints leading the way to bring together local health and care

systems, based on community needs, existing working relationships, patient

flows and other related transformation. This shift to place based care will

call for consistent application of pay across STP footprints, reducing pay

related competition amongst providers.

122. The report by Lord Carter30 on efficiency in the NHS identified a range of

areas where the NHS could make efficiency savings. One of the main areas

identified was in the effective deployment of staff. Trusts have been given

challenging targets to generate savings from more effective deployment and

these are being implemented. This is likely to affect both the level of

demand for staff and the way staff work.

123. NHS Employers continues to work with organisations to support the aims of

the 5YFV including staff health and wellbeing, staff engagement and

reducing the use of agency staff.

30 Productivity in NHS Hospitals https://www.gov.uk/government/publications/productivity-in-nhs-hospitals

https://www.gov.uk/government/publications/productivity-in-nhs-hospitals

39

Apprenticeships

124. The apprenticeships landscape is changing considerably over the next year,

with a levy to be placed on large employers from April 2017. The levy will

be payable by employers at 0.5 per cent of their pay bill and will be

calculated, reported and paid through the PAYE process to HMRC. An

employers’ pay bill will be based on the total amount of earnings subject to

Class 1 secondary national insurance contributions (NICs) and will include

any remuneration, such as wages and pension contributions on which NICs

are paid. Employers will be able to access their funds through a new digital

account system, which will allow them to choose a training provider and pay

for apprenticeship training and assessment. Levy funds will only be able to

be used to pay for apprenticeship training and assessment and it will not be

permissible to use them to cover other associated costs for example,

wages, travel costs, organisational infrastructure).

125. Modelling based on the NHS organisations in scope of the levy has

indicated that the cost to the NHS in 2017/18 to be approximately £200

million. In terms of how this relates to individual NHS organisations, for a

large city-based teaching hospital employing 14,000 staff, their levy

contributions would be in the region of £3.29 million per annum. Whilst

apprenticeship use across the NHS has grown considerably in recent years

(by the end of 2015/16, over 17,000 apprenticeship starts had been

delivered across the NHS), the levy is going to place an additional financial

strain on employers.

126. In addition to the levy, apprenticeships targets are also due to be placed on

public sector bodies with more than 250 employees. Government is

currently consulting on the levels of the targets that will be applied to the

public sector but proposals have indicated a minimum of 2.3 per cent

apprenticeship starts each year, to be calculated based on the headcount of

an organisation. If the targets are to be set at this level, this equates to an

annual target for the NHS of approximately 28,000 apprenticeship starts;

this again clearly demonstrates the need to grow the delivery of

apprenticeships.

127. Whilst apprenticeships have long been a valued model for educating and

training the NHS workforce, the direction and speed at which the new policy

40

is being implemented does pose a number of challenges for the NHS. One

of the key drivers behind the reforms has been a wish to drive up

productivity through the delivery of increased numbers of higher and degree

apprenticeships. Whilst this is a desirable aim, which could help employers

to address some of the skills gaps that exist across their workforce, there

are currently a lack of these apprenticeship standards suitable for delivery in

health. This, combined with a lack of organisational infrastructure to support

a large increase in the delivery of apprenticeships and the outsourcing of a

number of NHS services employing the kinds of support staff that would be

suitable for entry level apprenticeships, mean that the direction of this new

policy will represent a significant challenge for provider organisations.

Specific profession shortages

128. Changes to population demand or policy direction can significantly impact

on an organisations to source the staff they need, impacting on their ability

to provide high quality sustainable care.

129. We know that demand can often alter more quickly than we are able to

make changes to the supply of the workforce. The way in which the NHS

operates often means that it is not possible to respond to workforce gaps

through training more people.

130. The Migration Advisory Committee’s (MAC) shortage occupation list,

published by UK Visas and Immigration (UKVI)31, reflects some of the

supply shortages in the NHS and currently includes the following

occupations:

Nurses

Radiographers

Sonographers

*Medical practitioners in consultant radiography, emergency medicine

and old age psychiatry.

Orthotists

Prosthetists

31 *See full list on the UK Visas and Immigration website.

https://www.gov.uk/government/uploads/system/uploads/attachment_data/file/486107/Shortage_Occupation_List_-_November_2015.pdf

41

Paramedics

Social workers children’s family services

Healthcare scientists in neurophysiology and radiotherapy physics.

131. The professions noted in the shortage occupations list correlate to Health

Education England’s (HEE) 2016/17 analysis of commissions which

recognises further expansion is warranted in a small number of areas.

132. Recruitment issues faced by NHS organisations in relation to certain

professional groups is a shortage of supply and these problems cannot be

resolved by levels of pay. There is not another available supply of these

professionals in the UK in relation to those who have already trained and

already employed.

NHS Employer’s nursing supply survey

133. In November 2015, NHS Employers carried out a survey of NHS provider

organisations looking at the issue of supply and demand of the profession.

134. The full survey results32 are available on the NHS Employers. The survey

provided an indication that the shortfall of nurses was widespread across

England, with an approximate gap of 21,200 full-time equivalent (FTE)

nurses against employer demand.

135. The information collected from the nursing supply survey informed our

response to the Migration Advisory Committee (MAC) review of nursing on

the shortage occupation list33. The evidence collected demonstrates that

recruitment challenges are as a result of demand for nurses exceeding the

available supply. Recognition of a national shortage of qualified nurses has

since been reflected by the inclusion on the MAC shortage occupation list34

in October 2015.

32 NHS registered nurse supply and demand survey findings. Report to inform the Migration Advisory Committee (MAC) on the partial

review of the shortage occupation list, December 2015

33 The NHS Employers submission to the Migration Advisory Committee (MAC) call for evidence. Partial review of the shortage

occupation list: Nurses.

34 Shortage Occupation List – November 2015

http://www.nhsemployers.org/~/media/Employers/Publications/Workforce%20Supply/NHS%20registered%20nurse%20supply%20and%20demand%20survey%20findings%20Dec%202015%20FINAL.PDF

http://www.nhsemployers.org/~/media/Employers/Publications/Workforce%20Supply/NHS%20registered%20nurse%20supply%20and%20demand%20survey%20findings%20Dec%202015%20FINAL.PDF

http://www.nhsemployers.org/~/media/Employers/Publications/Workforce%20Supply/The%20NHS%20Employers%20submission%20to%20the%20Migration%20Advisory%20Committee%20Dec%202015.pdf

http://www.nhsemployers.org/~/media/Employers/Publications/Workforce%20Supply/The%20NHS%20Employers%20submission%20to%20the%20Migration%20Advisory%20Committee%20Dec%202015.pdf

https://www.gov.uk/government/publications/tier-2-shortage-occupation-list

42

136. We found no evidence to suggest that the shortage of qualified nurses is

directly linked to levels of pay, or that using additional pay would help

resolve the recruitment or retention problem. Data available on the use of

recruitment and retention premia35 shows that between April 2014 and April

2016 the percentage of all qualified nursing, midwifery and health visiting

staff receiving a recruitment and retention premium fell from 3.1 per cent to

1.0 per cent. This would indicate that employers have not found the use of

pay premia to be effective in resolving the supply problem.

Inclusion of nursing on the shortage occupation

list

137. There is no other available supply of qualified nurses in the UK beyond

those who have trained and are already employed. There are a number of

measures in place to help bridge the nursing supply gap, including return to

practice programmes, increasing nurse training places and a focus on local

action to retain the workforce. For employers, the only way in which to

increase the overall supply in the immediate term is to use overseas

recruitment.

138. The inclusion of nurses on the shortage occupation recognises that a supply

problem exists and is helping to alleviate some of the previous challenges

trying to recruit trained nurse from overseas. Applications for Restricted

Certificates of Sponsorship (RCoS) are now prioritised by the UKVI points

allocation system36 - increasing the likelihood of nursing applications being

granted.

139. It also provides some certainty for the existing overseas nursing workforce

as the requirement to earn £35,000 or more to qualify for permanent

settlement in the UK (indefinite leave to remain) will not apply to individuals

for whom nursing has appeared on the shortage occupation list at any time

during their employment in a nursing role.

35 ESR warehouse data as at April 2014 and April 2016 for all organisations in England except two who do not use

ESR

36 Immigration Rules: Appendix A, Home Office

https://www.gov.uk/guidance/immigration-rules/immigration-rules-appendix-a-attributes

43

Nursing associate role

140. Following the outcomes of the Shape of Caring Review37, HEE are taking

forward proposals to develop a new role of nursing associate. The intension

is that the role will sit between health care assistants and the registered

nursing workforce to help provide high quality care to patients. The new

role will also provide a route for healthcare assistants into the registered

nursing workforce.

141. Test sites will be established with 1000 new students starting their training

in January 2017. Work will be taken forward over the next few months to

identify the knowledge, skills and competencies required for the role

develop a national curriculum. It is expected the wider adoption of the role

will be through an apprenticeship model.

142. The intension is that the new role should not be substitute for registered

nurses but instead should allow nurses to spend additional time using their

more specialist training to focus on clinical duties and take more of a lead in

decisions round a patient’s care.

Reform of the student support system

143. From 1 August 2017, new nursing, midwifery and allied health students will

no longer receive NHS bursaries or have their tuition fees paid by HEE.

Instead, they will have access to the same student loans system as other

students. The government believe the reforms will provide:

more nurses, midwives and allied health professionals for the NHS

a better funding system for health students in England

a sustainable model for universities.

144. The government estimates the reforms could lead to an additional 10,000

nursing, midwifery and allied health professional student places available in

37 https://hee.nhs.uk/our-work/developing-our-workforce/nursing/shape-caring-review

https://hee.nhs.uk/our-work/developing-our-workforce/nursing/shape-caring-review

44

this parliament.

145. If the reforms are successful they have the potential to substantially

increase the supply of non-medical staff in to the NHS workforce. The

feedback received from employers is that there is anxiety in the system

around the reforms and a fear that they could negatively impact on the

number of applications for pre-registration courses from students.

Employers are also keen to ensure geographical spread of courses around

the country.

146. In order to mitigate the risk of the reforms, employers believe the reforms

should be piloted or phased in so the impact can be evaluated.

Temporary staffing solutions and new NHS

Improvement agency rules

147. NHS Improvement have introduced agency rules to help control the amount

of money NHS trusts spend on temporary staffing. In 2014-15 the NHS

spend on agency staffing was £3.3bn which represented 7.6 per cent of

total staffing costs. The rules include the introduction of price caps, wage

caps, the use of approved frameworks to procure temporary staff and

ceilings on total agency spend for each trust.

148. The rules are designed to encourage healthcare professionals currently

working for agencies to work for the NHS on a substantive basis or on NHS

staff banks. The wage caps ensure that agency staff are paid the same on

an hourly basis as substantive staff and therefore aims to reduce the

financial attraction of working for an agency. As the agency rules are

embedded they have the potential to increase the supply of substantive

workers in to the NHS.

Paramedics – supply and demand issues

149. The ambulance services faces a number of service delivery pressures

which impact directly on the supply and demand for staff. The service is

challenged with meeting an increasing demand coupled with a target driven

approach to service performance management. The service faces a

45

challenge, both to recruit and retain sufficient numbers of competent staff to

enable them to meet the service demands.

150. The increase of the state retirement age impacts upon this service as staff

report that it is challenging to meet the physical and emotional demands of

the role as they get older. Sickness absence levels in the service are higher

than those in the wider NHS38. The average sickness absence rate across

the ambulance service for 2015 was 4.71 per cent, which is higher than the

national average of 4.23 per cent. From February 2015 the average across

the ambulance service was 5.03 per cent which has now risen to 5.90 per

cent in February 2016. West Midlands Ambulance Service, one of the 11

pilot organisations on the healthy workforce programme, and who have

invested in several health and wellbeing initiatives for their staff, had the

lowest sickness absence rate in February 2016, with 3.79 per cent, whereas

the highest rate was 6.88 per cent.

151. The most recent staff survey results unfortunately show a continuing pattern

of worse staff experience on health and well-being in the ambulance

service. In areas such as work pressure, work related stress and bullying

and harassment by colleagues ambulance staff have a poorer work

experience than other staff. For example, 48 per cent of ambulance staff

taking time off as a result of work related stress compared to 37 per cent of

staff as a whole. Ambulance staff are also almost twice as likely to report

pressure to work when unwell from managers (44 per cent of those who

attended work when unwell reported pressure from managers in the

ambulance service as compared with 28 per cent outside of the service). 75

per cent of ambulance staff did feel that their organisation took an active

interest in their health and well-being.

152. In terms of bullying and harassment 30 per cent of ambulance staff reported

bullying and harassment from managers and work colleagues in the

ambulance service compared to 25 per cent outside.

153. The above points to a situation where changes within the workplace which

directly affect staff experience could have a significant impact on the

38 Health and Social Care Information Centre, NHS Sickness Absence Rates

46

retention of ambulance staff.

154. Recommendations of where action could be taken:

focus on activities to support the health and wellbeing of ambulance staff

use STPs and integrated services to look at different roles which the

ambulance staff could move to if they were unable to continue in the

ambulance service (this could help with the working longer challenge)

develop new ways of working which enabled cross organisation work,

rotational roles etc. therefore reducing the amount of time staff are

exposed to the pressures and challenges which are an inherent part of

the service delivery

provide support for line management and leadership in the service to

help address some of the issues around staff engagement, bullying and

harassment and more broadly staff experience. Utilise the work from

Professor Michael West to look at the extent to which the ambulance

service implements the key elements for effective staff engagement and

experience. The Staff Engagement Index for Ambulance staff increased

from 3.20 in 2014 to 3.38 in 2015 but remains well below the average for

the service as a whole -3.78. NHS Employers is supporting employers to

address this.

155. The ambulance service has looked at different pay structures as a means to

improve recruitment and retention and work is currently underway to look at

the AfC pay banding for paramedics. However, the evidence presented

above indicates that greater attention to the factors which affect staff

experience rather than an intervention on pay alone could have a much

more positive effect.

Workforce retention programme

156. We know that reducing turnover and improving retention of staff is a key

priority for the NHS. Using employer feedback NHS Employers has created

the opportunity for NHS workforce leads to attend three facilitated

workshops over next 12 months in which they’ll be given the tools and skills

47

to create a sustainable organisational retention plan39. The programme is

free and is funded through NHS Employers various commercial activities.

We initially planned 45 places on the programme. The demand has far

surpassed this, and NHS Employers will now be providing places for 97

NHS trusts across acute, community, mental health, and ambulance service

trusts.

Improving morale and motivation through staff

health and wellbeing

157. The 2009 Boorman review, described the importance of prioritising staff

health and wellbeing in the NHS. A healthier workforce means less

avoidable days off sick, reduced levels of presenteeism and a more efficient

workforce. The review outlined how to achieve a healthier workforce in 20

recommendations along with key actions. NHS Employers has developed a

timeline40 that provides a summary of what has happened nationally as a

result of the review against each of the recommendations. Organisations

can use the tool to track their own progress made against the

recommendations, allowing them to target their health and wellbeing

activities.

NHS England Healthy Workforce Programme

158. The 5YFV made a commitment to ensure the NHS as an employer sets a

national example in the support it offers its own staff to stay healthy. In

September 2015, Simon Stevens announced further plans to support this

commitment, which included a major drive to improve the health and

wellbeing of NHS staff through the healthy workforce programme. 41 NHS

Employers is working with Dame Carol Black, NHS England, Public Health

England and the Social Partnership Forum along with 11 leading NHS

organisations. A core wellbeing offer for staff is being developed and

39 NHS Employers workforce retention workshops

40 Outcomes from the Boorman Review recommendations

41 Healthy workforce programme

http://www.nhsemployers.org/your-workforce/retain-and-improve/retention-checklist/workforce-retention-programme

http://www.nhsemployers.org/your-workforce/retain-and-improve/staff-experience/health-work-and-wellbeing/the-way-to-health-and-wellbeing/outcomes-from-the-boorman-review-recommendations

http://www.nhsemployers.org/your-workforce/retain-and-improve/staff-experience/health-work-and-wellbeing/copy-of-leading-the-way/whats-happening-nationally/nhs-england-healthy-workforce

48

robustly evaluated to assist the NHS in developing staff wellbeing

approaches that have a positive and sustainable impact on staff wellbeing.

159. NHS Employers will continue to work closely with NHS England as this

programme develops, leading on line manager training and board/senior

and clinical leadership, supporting the collective organisations, and sharing

key learning and good practice.

Quality and innovation (CQUIN)

160. In March 2016 NHS England announced a health and wellbeing

commissioning for Quality and Innovation (CQUIN) payment

framework. CQUIN enables commissioners to reward excellence, by linking

a proportion of English healthcare providers' income to the achievement of

local quality improvement goals. The framework aims to embed quality

within commissioner-provider discussions and to create a culture of

continuous quality improvement, with stretching goals agreed in contracts

on an annual basis. It makes a proportion of provider income conditional on

the achievement of ambitious quality improvement goals and innovations

agreed between commissioner and provider, with active clinical

engagement.

161. To achieve the CQUIN, trusts are encouraged to take steps, such as

introducing health and wellbeing initiatives, increasing healthy food choices

on premises and encouraging uptake of front line staff receiving the flu

vaccine. NHS Employers has been providing support, guidance and

resources to organisations including presentations and webinars.

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4. Staff engagement and the

NHS Staff Survey

Staff engagement trends42

162. Levels of staff engagement have improved in 2015 compared to 2014 as

measured by the NHS staff survey. The survey includes an overall indicator

of staff engagement which is measured on a five point scale. In 2015, this

rose from 3.71 to 3.78 and is now at the highest level since the measure

was introduced in 2013. The measure is a composite measure made up of

scores for levels of motivation, involvement and willingness to recommend

the NHS as a place to work.

163. There has also been a notable improvement in the motivation measure

which rose from 3.83 to 3.92. This reflects an improvement in the level of

enthusiasm which staff feel for their job which rose from 69 to 74 per cent.

There was a significant improvement in the percentage of staff that were

willing to recommend the NHS as an employer which rose from 57 to 59 per

cent43.

164. There was also an improvement in the feelings of involvement with the

percentage of staff feeling able to contribute to improvements at work rising

from 68.1 to 69.8 per cent.

165. There were areas where staff remain less satisfied. The NHS scores 3.43

on the measure of the recognition and value of staff by managers and the

42 2015 NHS Staff Survey 2015, Briefing Note: Issues highlighted by the 2015 NHS Staff Survey in England,

http://www.nhsstaffsurveys.com/Caches/Files/20160322_NHS%20Staff%20Survey%202015%20National%20Briefin

g_V2.pdf

43 2015 NHS Staff Survey, National Weighted Data,

http://www.nhsstaffsurveys.com/Caches/Files/20160322%20NHS%20Staff%20Survey%202014-

2015%20Question%20and%20KF%20weighted%20data%20v3.xlsx

http://www.nhsstaffsurveys.com/Caches/Files/20160322_NHS%20Staff%20Survey%202015%20National%20Briefing_V2.pdf


http://www.nhsstaffsurveys.com/Caches/Files/20160322%20NHS%20Staff%20Survey%202014-2015%20Question%20and%20KF%20weighted%20data%20v3.xlsx

http://www.nhsstaffsurveys.com/Caches/Files/20160322%20NHS%20Staff%20Survey%202014-2015%20Question%20and%20KF%20weighted%20data%20v3.xlsx

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organisation. Only 31.3 per cent of staff report good communication in their

organisation.

166. There remains considerable variation between trusts in their staff

engagement levels and this needs to be reduced. There was a particular

improvement in the staff engagement levels in some of the more challenged

organisations. Over twenty five trusts increased their staff engagement

levels significantly in 2015 including many which had had historical

challenges.

Action to improve engagement

167. The NHS has a national framework of Staff Pledges which aims to

encourage NHS organisations to develop local engagement approaches.

NHS Employers is commissioned by the DH to assist employers in this field.

Our website shares case studies and other resources with over 25 trusts

highlighted as examples of good practice. In 2015 NHS Employers

identified:

an increase in employers focussing on staff engagement. In particular

most employers adopted new approaches to staff involvement and

communication with many implementing new methods of seeking staff

feedback in addition to the national staff survey. There was also a

growth in back to the floor and open door exercises when senior leaders

have direct communication with staff on wards

a renewed focus on increasing the capacity of line managers to foster

engagement and at least a dozen trusts have developed specific

programmes in this area. NHS Employers developed resources to

support employers to foster line manager’s role in engagement. This

indicator also improved in the staff survey from 3.67 per cent to 3.72.44

there was a growth in schemes which seek to recognise and reward the

contribution of staff. NHS Employers has identified over seventy such

44 2015 NHS Staff Survey 2015, Briefing Note: Issues highlighted by the 2015 NHS Staff Survey in England,

http://www.nhsstaffsurveys.com/Caches/Files/20160322_NHS%20Staff%20Survey%202015%20National%20Briefin

g_V2.pdf



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schemes. These are mostly in the form of non-monetary awards and are

well received by staff. A small number of organisations have linked

contribution and reward via their performance progression

arrangements.

168. Current pressures on the NHS are a major challenge to sustaining

engagement. It is possible that staff opinion on issues such as pay and

staffing levels could adversely impact on staff engagement over time.

Employers will need to develop their efforts and share ideas and

experiences.

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5. Pensions and total reward

Total reward

Components of total reward in the NHS

169. The NHS continues to have a well-regarded package of valuable

employment benefits, including a generous pension scheme. In addition to

pay and benefits, we are increasingly seeing that employers in the NHS are

broadening their definition of total reward to include recognition schemes,

health and wellbeing initiatives and training and development programmes,

among others.

170. In 2016, NHS Employers surveyed 100 employers on elements of their

approach to reward strategy. In response to requests for examples of

positive local reward initiatives, there was a variety of responses

demonstrating this wider consideration of what comprises reward. However,

the largest response related to recognition schemes/awards, reflecting an

increasing focus on staff engagement.

171. The broader definition of total reward which considers elements outside of

just pay and benefits is also represented through the NHS Employers total

reward engagement network (TREN). TREN is a network facilitated by NHS

Employers, open to NHS organisations engaged in total reward work, it

gives attendees the opportunity to discuss reward related issues and share

knowledge and experience with colleagues. NHS Employers uses the group

to encourage engagement with the total reward agenda and provides a

route to more closely understand strategic reward in the NHS, and enables

the development of relevant products and tools to support reward initiatives.

172. NHS Employers also commissioned the Institute of Employment Studies

(IES) to undertake an evidence review on the relationship between total

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reward and staff engagement45. This review indicated that the broader the

definition of total reward that is adopted, the more significant the potential

impact on employee engagement appears to be.

Total reward strategy in the NHS

173. The IES evidence-based review on the relationship between total reward

and employee engagement reinforces that there is no one-size-fits-all

approach to reward. This suggests that reward strategies should be

designed to meet the unique needs of the employer and their staff.

174. The NHS Employers reward strategy survey explored how strategic total

reward was being used in the NHS. Asked if their organisation had a reward

strategy in place, only 15 per cent stated that they did. However, 51 per cent

of those that did not, noted that one was currently in development.

175. Additionally, a significant proportion commented that although they did not

have a specific reward strategy, they had elements of strategic reward in

other workforce strategies, such as the people or organisational

development strategy, health and wellbeing strategy or recruitment and

retention strategy. 30 of the 100 respondents (the largest proportion) stated

that resources not being available in the organisation was the main reason

for not having a reward strategy.

176. A similar split is reflected by members attending the TREN, with some

employers having a reward strategy, some having embedded it in other

strategies and a large proportion currently in the process of developing a

reward strategy.

177. This indicates that strategic total reward as a concept is being applied, but

integrated more fully with other business approaches, particularly as a

response to specific workforce challenges, such as recruitment or retention.

45http://www.nhsemployers.org/case-studies-and-resources/2016/05/total-reward-and-employee-engagement-an-

evidence-based-review-by-the-ies

http://www.nhsemployers.org/case-studies-and-resources/2016/05/total-reward-and-employee-engagement-an-evidence-based-review-by-the-ies

http://www.nhsemployers.org/case-studies-and-resources/2016/05/total-reward-and-employee-engagement-an-evidence-based-review-by-the-ies

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Reward as a response to workforce challenges

178. The nature of strategic reward attempts to meet some form of business goal

or objective. Our reward strategy survey sought to determine how

employers were using reward to meet specific workforce challenges.

179. The largest response of 54 per cent stated that they were using reward to

meet recruitment and retention issues. Remaining responses were spread

over a variety of different priorities such as temporary staffing, staff

engagement, training and development, recognition, productivity and health

and wellbeing.

180. A quarter of respondents stated they were not using reward to meet specific

workforce challenges, which suggests there could be more focus applied to

ensuring reward return on investment.

Local approaches to reward

181. This increasing focus on using reward to meet workforce challenges is

reflected in some of the local reward initiatives being developed. Our reward

survey and interactions through TREN show an increase in low cost or cost

neutral developments such as recruitment refer a friend schemes,

promotion of buying/selling annual leave, negotiated travel reductions,

money advice services and relocation allowances.

182. The largest local reward initiatives appear to remain salary sacrifice

arrangements, where individuals can sacrifice a proportion of their salary

prior to tax and national insurance in order to receive a tax-free benefit. The

most popular of these are childcare voucher schemes, but our engagement

suggests that these are being used for a wider range of goods and services,

including electronic goods and car lease schemes.

183. Whilst such schemes are attractive to employers due to the low cost of

delivering them, there are challenges to the future delivery of these. The

government intends to review the continued tax-free provision of salary

55

sacrifice arrangements, and has recently published a consultation46 on

salary sacrifice and benefits in kind.

184. Salary sacrifice schemes are only attractive if an individual has enough

income to take advantage of them. The introduction of the living wage

earlier this year has restricted access to salary sacrifice schemes for low

earners. Employers are responsible for ensuring that the living/minimum

wage is paid, and if salary sacrifice schemes take a staff members take

home pay below this threshold then employers are liable to top up the

remainder. This has meant some employers restricting access to these

schemes.

185. The introduction of the 2015 NHS Pension Scheme, as a career average

revalued earnings (CARE) scheme, provides a different interaction with

salary sacrifice than final salary schemes. With a CARE scheme, each year

of pension contributions adds to the final pension, so individuals in a salary

sacrifice scheme would be adding less to their pension than they would

otherwise were they not in a salary sacrifice arrangement. This potentially

reduces the perceived value of salary sacrifice arrangements and/or the

NHS Pension Scheme.

Total reward statements

186. Total reward can only contribute to meeting workforce needs if staff are

aware of them and engage with them. Total reward statements (TRS) are

one way in which NHS organisations can promote benefits that they offer

locally, as well as providing valuable information about the value of

pensions through an annual personalised summary of the benefit package.

187. 2015/16 was the second year of rollout of TRS in the NHS. Information from

the NHS Business Services Authority indicates that a total of 198,351 active

NHS Pension Scheme members accessed their statement during the main

rollout (up to 31 December 2015) in England and Wales. This was an

increase of 26 per cent compared to the previous year.

46 https://www.gov.uk/government/consultations/salary-sacrifice-for-the-provision-of-benefits-in-kind

https://www.gov.uk/government/consultations/salary-sacrifice-for-the-provision-of-benefits-in-kind

56

188. Surveyed feedback on TRS indicates that 83 per cent of employees claimed

to be aware of TRS, compared to 55 per cent in the first year of rollout. 70

per cent of employees who accessed their statement rated their overall

experience of the TRS website as either ‘very’ or ‘fairly’ good. 88 per cent

thought that the element of their statement relating to their membership of

the NHS Pension Scheme was useful.

NHS Pension Scheme

2015 Pension Scheme

189. The 2015 NHS Pension Scheme was launched on 1 April 2015, replacing

the 1995 and 2008 sections (except where individual protection applied).

The 2015 Scheme is a CARE defined benefits scheme which pays a

pension based on the average of a member’s pensionable earnings

throughout their whole career, revalued in line with the Consumer Price

Index plus 1.5 per cent per annum.

190. Normal pension age (the age at which benefits can be claimed without

reduction for early payment) is now linked to the same age as a member is

entitled to claim their state pension. A build-up rate of 1/54th of each year’s

pensionable earnings applies to the new scheme, which is a higher build-up

rate of both the 1995 and 2008 sections of the NHS Pension Scheme.

191. The flexibilities within the 2008 section of the scheme relating to early or late

retirement factors, draw down of pension on partial retirement and return to

the NHS Pension Scheme are retained in the 2015 scheme. There is a new

provision for early retirement reduction buyout (ERRBO), where members

and/or employer can pay additional contributions through ERRBO to

eliminate or lower the amount of reduction that would apply, limited to a

maximum of three years before the member reaches their normal pension

age.

Contribution rates

192. The employer contribution rate for both the 2015 NHS Pension Scheme and

1995/2008 sections of the scheme are set at 14.3 per cent of pensionable

pay. This rate is determined as part of the funding methodology applied by

the scheme actuaries.

57

193. Members of the NHS Pension Scheme provide contributions on a tiered

basis, to produce a total yield to HM Treasury of 9.8 per cent of total

pensionable pay. The employee contribution rates are outlined in the table

below47.

Tiered contribution rates 2015/16 through to 2018/19 for scheme members

Tier Pensionable pay (whole-time equivalent)/earnings used to assess contribution rate

Contribution rate for scheme years 2015/16 through to scheme year 2018/19

1 Up to £15,431.99 5.0 per cent 2 £15,432.00 to £21,477.99 5.6 per cent 3 £21,478.00 to £26,832.99 7.1 per cent 4 £26,824.00 to £47,845.99 9.3 per cent 5 £47,846.00 to £70,630.99 12.5 per cent 6 £70,631.00 to £111,376.99 13.5 per cent 7 £111,377.00 and over 14.5 per cent

194. The nature of tiered contribution rates means that increases to pensionable

pay, such as through pay awards can mean that a pay rise for pension

scheme members could lead to a reduction in take home pay. For example,

the April 2016 pay rise of 1 per cent affected those at the top point of Band

8A in this way. The 1 per cent pay rise took those staff to a salary of

£48,034 per annum. This caused them to cross into contribution tier 5, from

9.3 per cent to 12.5 per cent. This led to an annual pension contribution rise

from £4,423 per annum to £6,004 per annum.

195. With the introduction of the 2015 NHS Pension Scheme, which is a CARE

scheme, it is expected that future changes to the contribution tiers will

‘flatten’ with a long term aspiration of a single contribution tier for all scheme

members. However, whilst there are still members who have a mixture of

47 http://www.nhsbsa.nhs.uk/Pensions/4207.aspx

http://www.nhsbsa.nhs.uk/Pensions/4207.aspx

58

final salary and CARE scheme benefits there is a requirement to maintain a

tiered approach to balance contributions versus received benefits.

Scheme membership

196. The NHS Pension Scheme accounts 2015/16 provide information on

scheme membership for England and Wales, including those that have

chosen to opt out of the scheme during that year. An extract from the

accounts is below48.

Details of active scheme membership as at 31 March 2016

Active members at 1 April 2015 1,428,050 Adjustment (see note 1) (5,421) Restated active members at 1April 2015 (see note 2) 1,422,629

New entrants 162,458 Deferred members who re-join in the year 55,030 Re-employed pensioners 415 Retirements (32,874) Leavers with deferred pension rights (110,031) Deaths (792) Active members as at 31 March 2016 1,467,102

48 Source: NHS Pension Scheme Annual Accounts 2015-16

http://www.nhsbsa.nhs.uk/Documents/Pensions/56324_NHS_Pension_Scheme_HC_370_Web_only_(2015-

16_accounts).pdf

Note 1. Member records are updated retrospectively after the year end, after the membership statistics are prepared for the scheme

accounts. This is due to the volume of data required to be uploaded onto the pension administration systems from employers, and

the resolution of any subsequent data errors. An adjustment will be required each year to show a revised opening position to

reconcile to the movements and closing position for the year.

Note 2. The membership data at 31 March 2015 differs from that disclosed in the Report of the Actuary as the data extract provided

to GAD was taken in November 2015, whereas these statistics were taken from a data extract provided in May 2016 and member

data is continually updated after the year end.

http://www.nhsbsa.nhs.uk/Documents/Pensions/56324_NHS_Pension_Scheme_HC_370_Web_only_(2015-16_accounts).pdf

http://www.nhsbsa.nhs.uk/Documents/Pensions/56324_NHS_Pension_Scheme_HC_370_Web_only_(2015-16_accounts).pdf

59

Pension taxation

197. Any NHS employee who has pension benefits above tax thresholds may be

liable to a tax charge. This has the potential to impact the perception of the

NHS pension as a benefit and to impact workforce behaviour.

198. The two thresholds are annual allowance and lifetime allowance. It used to

be the case that few NHS workers were likely to exceed the tax thresholds,

but changes in recent years mean that more staff are likely to be impacted.

199. Annual allowance is the amount of ‘pension savings’ an individual can make

in one year before receiving a tax charge. The annual allowance limit is

currently £40,000 in 2016/17, the same as in 2014/15, reduced from

£50,000 in 2013/14.

200. In April 2016 the tapered annual allowance was introduced. This cuts

pension tax relief for high earners by introducing a tapered annual

allowance of those with adjusted incomes of over £150,000. The rate of

reduction in the annual allowance (from the current maximum of £40,000) is

by £1 for every £2 that the adjusted income exceeds £150,000, up to a

maximum reduction of £30,000 at £210,000 For example at £210,000 the

annual allowance is only £10,000.

201. Lifetime allowance reduced to £1 million, down from £1.25 million in April

2016. The lifetime allowance is the total amount that an individual can have

in their pension savings, during their lifetime, without incurring a tax charge.

202. Defined benefit pension is tested against the lifetime allowance using the

amount of pension and lump sum if relevant. Defined benefit pensions are

multiplied by a factor of 20 and any retirement lump sum is added to the

result.

203. With 46 per cent of the NHS workforce aged 45 or above49 there are a

significant number of staff who are at an age where they are considering

their retirement options. Anecdotally there is a perception that the change in

49 Source Health and Social Care Information Centre, September 2015 provisional statistics

60

public service pensions has led to a less desirable pension scheme, and

this change to pension taxation, among others changes such as prolonged

pay restraint; years of increased pension contribution increases, and

changes to state pension leading to increased National Insurance (NI)

contributions may lead people down the path of some form of retirement or

flexible retirement. This will potentially have an impact on supply and

demand, and associated factors such as staff experience and agency/locum

spend.

204. As high earners contribute more through their higher rate of employee

contributions, if a significant number of high earners opt out of the scheme,

this will have an impact on the average overall yield that is received. The

NHS Pension Scheme is required to deliver an average yield of 9.8 per

cent. When the NHS Pension Scheme valuation exercise is undertaken

(using data from 2016 and taking effect from 2019) this could mean an

increase in employee contribution rates at all levels, including lower bands

(which could potentially impact on the behaviour of other members and

increase the general level of opt out). This has the potential to undermine

the integrity of the scheme should such opt outs continue in significant

numbers.

Changes to state pension

205. On 6 April 2016, the state pension was replaced with a new one for those

that reach state pension age on or after that date. The new state pension

replaced the previous basic and additional state pension. Employees who

contributed to a contracted-out occupational pension scheme, such as the

NHS Pension Scheme, did not receive the additional state pension and paid

a lower rate of NI contributions, along with their employers.

206. The introduction of the new state pension meant the end of contracting-out

and ended the reduction in NI that contracted-out employers and employees

paid. Employers no longer receive the 3.4 per cent NI rebate and now pay

the standard rate of 13.8 per cent of all earnings above the secondary

threshold for all employees. The 1.4 per cent NI rebate for employees also

ended.

207. The removal of the rebate for employees has been another cost pressure

for members of the NHS Pension Scheme and contributes to impact on take

61

home pay. Although not directly related to the NHS Pension Scheme,

individual members may perceive this as a further erosion in the value of the

scheme, particularly following previous years of contribution rises and

change to the 2015 CARE Scheme.

62

6. Staff numbers and paybill 208. Analysis of published NHS statistics provides evidence of the recruitment,

retention and pay bill cost trends that employers are reporting. In addition to

the published statistics, NHS Employers has also undertaken its own

analysis of workforce and payroll data to identify trends not evident in the

published information.

209. Against each of the areas of interest below, more detailed data tables have

been provided in the annexes.

Staff numbers

210. The non-medical workforce grew by 16,697 FTE50,51 or 1.8 percent between

September 2014 and September 2015. This is reflective of employers

increasing capacity to meet increasing demand on the service. Growth was

consistent across all staff groups, with the exception of hotel, property and

estates.

211. The new healthcare workforce statistics includes the inclusion of grade and

AfC band for the first time, as shown in Annex G1. In the longer term this

will help identify shifts in the grade mix by staff group. Figure 1 below shows

the profile of full-time equivalent staff by staff group within each band. This

illustrates how the NHS workforce is spread across the levels of the pay

50 NHS Digital, Healthcare workforce statistics September 2015, http://www.digital.nhs.uk/catalogue/PUB20337/nhs-

staf-sept-2015-summ.xlsx

51 There is an apparent discrepancy between the % change in staff numbers (FTE) between September 2014 and

September 2015 detailed in the NHS Digital figures the 2015/16 Average FTE Growth detailed in Annex D (paybill

metrics). This is because the percentage change detailed in Annex F based on the difference between September

2014 and September 2015, whereas the difference in the DH metrics reflects the difference between the 12-month

averages for the years ending in March 2016. The difference occurs because there is seasonal variation in workforce

numbers. The DH metric figure is used to explain and describe movements in annual paybill costs. In this context,

average workforce levels over the year rather than a snapshot at a particular month are relevant. In addition, the

NHS Digital staff numbers are based on slightly different coverage and staff groupings.

http://www.digital.nhs.uk/catalogue/PUB20337/nhs-staf-sept-2015-summ.xlsx

http://www.digital.nhs.uk/catalogue/PUB20337/nhs-staf-sept-2015-summ.xlsx

63

scale. This is reflective of employers increasing their capacity to meet

increasing demand on the service.

Figure 1 Distribution of non-medical staff by band and staff group

212. The ability to grow the workforce is indicative that at system wide level, the

labour market is sufficiently buoyant to sustain both the replacement of staff

who leave and retire from the NHS, and increase overall workforce capacity.

Annex F provides further detail of workforce growth. Workforce growth at a

staff group level hides the presence of hard to fill roles in some professions

and localities.

64

Vacancies

213. NHS Employers welcome the new NHS Digital publication52 which details

an analysis of vacancies advertised on NHS Jobs. In the longer term this

will assist in providing quantified evidence of the localised recruitment

difficulties that employers inform us of. The new publication also details

numbers of web hits, applications, shortlistings and total appointed. This will

hopefully provide not only an assessment of vacancies, but also the number

and quality of applications.

214. As this publication is in its first year, it is marked as experimental. We are

cautious of over-interpreting this initial publication, because we are aware of

inconsistencies in the way the data is recorded between staff groups and

areas. Once a longer term time series of vacancies data is available, it will

be possible to make an assessment of whether the recruitment position is

easing or becoming more difficult.

215. The table in Annex I shows the numbers of advertised vacancy FTE and

accompanying information during February 2015 to March 2016 by staff

group.

52NHS Digital, NHS Vacancies Statistics England 2015, Provisional, Experimental statistics,

http://digital.nhs.uk/catalogue/PUB20132

http://digital.nhs.uk/catalogue/PUB20132

65

Turnover

216. Figure 2 shows that the number of joiners continues to exceed the number

of leavers, which is consistent with the workforce growth reported. Whilst

the number of leavers is increasing slightly, this has been offset by greater

increases in joiners.53

Figure 2 Non-medical joiners and leavers rates, NHS trusts and CCGs

March 2010 - March 2011


March 2012 - March

2013

March 2013 March - 2014



Non-medical leavers

9.9% 11.4% 10.3% 11.7% 10.7% 10.9%

Non - medical joiners

8.8% 8.3% 9.7% 11.7% 12.0% 12.7%

53 Department of Health Estimates

66

Recruitment and retention premia

217. As shown in Figure 3, the percentage of staff in receipt of recruitment and

retention premia (RRPs) continues to fall, with only 0.8 per cent of non-

medical staff (full-time equivalents) receiving RRPs in April 2016. The full

detail of the percentages of staff in receipt of RRPs by staff group and AfC

band/region can be found in annexes C and C1 respectively.

Figure 3 - Time series of non-medical staff in receipt of RRPs (full-time

equivalents)54

54 NHS Employer Estimates

67

Pay bill metrics

218. The Department of Health (DH) pay bill metrics show that the pay bill for

hospital and community health services (HCHS) non-medical staff grew by

2.3 per cent in 2014/15, while the size of this workforce increased by 2.0

percent. This means there has been a slight (0.3 per cent) increase in the

paybill per full-time equivalent (FTE) growth (the cost per unit of staff). The

increase in staff costs adds pressure on NHS finances.

219. Annex D, from the DH Headline HCHS pay bill metrics, details the

contribution of changes to each of the pay elements to the change in pay bill

per FTE.

220. Incremental progression is one of the pay pressures which contribute to

increased staff costs. Figure 4 shows that 46 per cent of AfC staff will be

entitled to a pay increment in 2016/17 worth on average 3.4 per cent, even

without an increase in the national pay scales. Pay increments are paid in

addition to any annual award.

221. The impact of pay progression is not fully evident in the pay bill per FTE

metric as this cost is offset by other negative pay pressures such as

turnover. Should turnover decrease from current levels, the full costs of

incremental progression will become more apparent.

222. Annex B details the average basic pay increase, per FTE, by pay band and

staff group. This adds a pay pressure of around one per cent to the AfC pay

bill. Annex J below details the incremental pay rises, which staff on each

point can expect to receive over the next 12 months (expressed as £s and

also as a percentage increase to the previous year’s basic pay).

223. Figure 4 shows the percentage of staff on top of their pay band. The

proportion at the top of band 1 is due to the band 2 containing just two

points.

224. Figure 5 shows that the percentage of staff at the top of their band in April

2016 (46 per cent) has decreased slightly from the same figure in 2015 (48

per cent.) Whilst staff reaching the top of their band reduces the rate at

which the basic pay bill increases, it does not contribute to a reduction in

68

pay bill pressure unless staff leave and are replaced by staff lower down the

band.

Figure 4 – Percentage of staff on top of their pay band

AfC Band

Total HCHS non-medical staff

Band 1 81%

Band 2 46%

Band 3 50%

Band 4 50%

Band 5 42%

Band 6 40%

Band 7 48%

Band 8a 46%

Band 8b 47%

Band 8c 45%

Band 8d 46%

Band 9 41%

Grand Total 46%

225. Full details of the proportion of staff at the top of each band, by staff group,

can be found in Annex E

69

Figure 5. Percentage of staff on the top point of their band2010 2011 2012

2013 2014 2015

2010 2011 2012 2013 2014 2015 2016

35 40 45 47 49 48 46

226. Annex J details the incremental pay rises that staff on each point can expect

to receive over the 12 months from April 2016 (expressed as £s and also as

a percentage increase to the previous year’s basic pay).

70

ANNEXES

Annex A. Results from NHS Provider/NHS Employers

Workforce Survey

What would you do if you were free to decide how to apply a 1 per cent pay

awarding 2017/18 (total respondents = 51)

(The chart reflect the sum of rank values - Highest ranked option = 5, 2nd ranked = 4, … , Lowest

Ranked = 1, Not ranked = 0)

72

For remaining remit groups would you prefer the current approach of single

year or a multi-year pay approach? (Total respondents = 51)?

How would you target an annual 1 per cent to support transition to a

reformed AfC contract? (Total respondents = 48)

73

Does AfC reform remain a priority for you? (Total respondents = 48)

Do you have issues with recruitment and retention of staff? (Total

respondents = 50)

74

Please select up to 3 options which reflect your organisations most

significant challenges (total respondents = 50)

What has happened to your organisations overall agency/locum spend

since the introduction of the price caps? (Total respondents = 47)

75

Annex B. Expected basic pay per FTE increase in

2016/17 though increments by AfC band

Band

Average increment

% of basic pay

Band 1 50.91 0.3%

Band 2 205.93 1.2%

Band 3 241.28 1.3%

Band 4 270.70 1.3%

Band 5 496.38 1.9%

Band 6 654.08 2.1%

Band 7 650.22 1.7%

Band 8a 876.53 1.9%

Band 8b 1200.59 2.2%

Band 8c 1400.38 2.2%

Band 8d 1729.52 2.3%

Band 9 2465.43 2.7%

Total HCHS non-medical staff 477.06 1.8%

76

Annex B1. Expected basic pay per FTE increase in

2016/17 though increments by staff group

Staff Group

Average increment % of basic pay

Qualified nursing, midwifery and health visiting staff 562.54 1.8%

Qualified scientific, therapeutic and technical staff 646.05 1.9%

Qualified ambulance staff 559.46 2.0%

Support to clinical staff

Support to ambulance staff 311.85 1.5%

Support to doctors & nursing staff

242.51 1.3%

Support to scientific, therapeutic and technical staff

320.53 1.6%

NHS Infrastructure Support

Central functions 534.82 2.0%

Hotel, property & estates 175.28 0.9%

Senior managers 1545.24 2.4%

Managers 1114.89 2.3%

Total HCHS non-medical staff 477.06 1.8%

Sources

ESR Data Warehouse; Pay Bill Data Extract, 2016

NHS Workforce Statistics - May 2016, Provisional statistics: National and HEE Tables [.xlsx],

http://www.digital.nhs.uk/catalogue/PUB21381/nhs-work-stat-may-2016-nat-hee-tab.xlsx;

NHS Workforce Statistics - April 2016, Provisional statistics: HCHS staff in NHS Support

Organisations and Central Bodies in England, March 2016 [.xlsx],

http://digital.nhs.uk/catalogue/PUB21066/nhs-work-stat-mar-2016-quart-sup-org-tab.xlsx.

http://www.digital.nhs.uk/catalogue/PUB21381/nhs-work-stat-may-2016-nat-hee-tab.xlsx;

http://digital.nhs.uk/catalogue/PUB21066/nhs-work-stat-mar-2016-quart-sup-org-tab.xlsx

77

Notes to Annexes B and B1

Estimates derived from NHS Employers analysis of ESR data warehouse data as at April 2016,

for all organisations in England except two organisations who do not use ESR.

Data cleaning processes are applied to the ESR extracts before use

Staff with an invalid staff group, other staff groups, or with an incorrectly recorded point or band

have been excluded from the analysis

Approximations have been made to match the staff groups used in previous submissions to the

NHS Review Body and those now used in NHS Digital workforce publications following the

consultation carried out on workforce census.

78

Annex C. Proportion of staff receiving recruitment and retention premia (RRP) (either

general or long term) by staff group and AfC band – April 2016

Band Total HCHS

non-medical staff

Qualified nursing,

midwifery and health visiting

staff

Qualified scientific,

therapeutic and technical staff

Qualified ambulance

staff


Support to ambulance

staff

Support to doctors &

nursing staff

Support to scientific,

therapeutic and technical

staff

Band 1 0.0% 0.0% 0.0% 0.0%

Band 2 0.1% 0.0% 0.4% 0.0% 0.1% 0.0%

Band 3 0.6% 0.0% 0.2% 0.0% 0.8% 0.2%

Band 4 1.4% 0.0% 0.6% 0.0% 1.9% 0.7% 0.4%

Band 5 0.8% 0.8% 0.5% 0.0% 0.2% 0.5% 1.2%

Band 6 1.0% 1.2% 0.9% 0.2% 0.4% 0.4% 0.4%

Band 7 1.2% 1.2% 1.6% 6.4% 0.0% 0.5% 0.0%

Band 8a 1.0% 1.3% 1.1% 0.0% 0.7% 1.4%

Band 8b 0.9% 1.0% 0.8% 2.7% 0.0% 0.0%

Band 8c 1.6% 1.4% 0.8% 0.0% 0.0% 0.0%

Band 8d 1.8% 1.1% 0.9% 0.0% 0.0% 0.0%

Band 9 3.2% 0.0% 1.4%

Grand Total 0.8% 1.0% 1.0% 0.4% 0.4% 0.5% 0.3%

79

Annex C (continued)

Band

Total HCHS non-

medical staff


Central functions

Hotel, property and

estates

Senior managers

Managers

Band 1 0.0% 0.0% 0.0%

Band 2 0.1% 0.1% 0.2% 0.0% 0.0%

Band 3 0.6% 0.3% 1.1% 0.0%

Band 4 1.4% 0.4% 15.9% 0.0%

Band 5 0.8% 0.5% 13.0% 0.0% 0.5%

Band 6 1.0% 0.8% 5.4% 0.0% 0.5%

Band 7 1.2% 0.5% 2.5% 0.0% 0.6%

Band 8a 1.0% 0.8% 6.6% 0.2% 0.8%

Band 8b 0.9% 1.1% 0.0% 0.4% 1.0%

Band 8c 1.6% 2.8% 1.4% 2.3%

Band 8d 1.8% 2.9% 1.8% 2.4%

Band 9 3.2% 4.2% 2.9% 5.2%

Grand Total 0.8% 0.5% 2.5% 1.2% 1.1%

80

Annex C1. Proportion of staff receiving recruitment and retention premia (RRP) (either

general or long term) by staff group and LETB region – April 2016

Region/ LETB Region

Total HCHS non-medical

staff

Qualified nursing,

midwifery and health

visiting staff



staff

Qualified ambulance

staff



staff

Support to doctors &

nursing staff



staff

Nort

h North East 0.1% 0.0% 0.2% 0.0% 0.0% 0.2% 0.0%

North West 0.4% 0.2% 0.7% 0.1% 2.9% 0.2% 0.1%

Yorkshire and Humber 0.2% 0.2% 0.3% 0.1% 0.0% 0.1% 0.1%

Mid

lands

and E

ast

East Midlands 0.3% 0.3% 0.4% 0.0% 0.0% 0.2% 0.2%

West Midlands 0.5% 0.4% 0.4% 0.0% 0.0% 0.2% 0.9%

East of England 2.4% 4.4% 3.0% 0.0% 0.6% 0.6% 0.3%

Lond

on

North Central and East London 0.8% 0.8% 1.1% 0.0% 0.2% 0.4%

North West London 0.8% 0.4% 0.4% 2.3% 0.0% 0.5% 0.1%

South London 0.9% 0.9% 1.1% 0.0% 0.7% 0.6%

South

Kent Surrey and Sussex 1.4% 1.5% 2.4% 0.0% 0.0% 0.8% 0.2%

Thames Valley 1.7% 2.6% 1.7% 0.0% 0.2% 0.9% 0.0%

Wessex 1.6% 3.1% 1.1% 0.0% 0.0% 0.1% 0.7%

South West 0.3% 0.0% 0.5% 0.0% 0.0% 0.0% 0.0%

Special Health Authorities 2.5% 3.5% 0.3% 19.0% 0.1%

Grand Total 0.8% 1.0% 1.0% 0.4% 0.4% 0.5% 0.3%

81

Annex C1 (continued)

Region/ LETB Region

Total HCHS non-medical

staff


Central functions

Hotel, property

and estates

Senior managers

Managers

Nort

h North East 0.1% 0.0% 0.8% 0.3% 0.0%

North West 0.4% 0.3% 1.9% 0.1% 0.2%

Yorkshire and Humber 0.2% 0.1% 0.5% 1.7% 0.5%

Mid

lands

and E

ast

East Midlands 0.3% 0.1% 1.0% 0.5% 0.4%

West Midlands 0.5% 0.4% 2.0% 0.8% 0.4%

East of England 2.4% 0.7% 4.7% 2.2% 1.4%

Lond

on

North Central and East London 0.8% 1.0% 6.6% 1.3% 0.7%

North West London 0.8% 0.6% 11.9% 1.1% 0.5%

South London 0.9% 1.5% 0.5% 0.9% 1.8%

South

Kent Surrey and Sussex 1.4% 0.7% 3.5% 1.6% 1.0%

Thames Valley 1.7% 1.2% 4.4% 1.7% 2.6%

Wessex 1.6% 0.1% 4.6% 0.9% 0.7%

South West 0.3% 0.3% 3.1% 1.0% 0.3%

Special Health Authorities 2.5% 0.5% 2.5% 3.0% 3.1%

Grand Total 0.8% 0.5% 2.5% 1.2% 1.1%

82

Annex D. Paybill metrics for Total HCHS non-medical staff55

Paybill metric/change versus previous year

2009/10 2010/11 2011/12 2012/1

3 2013/14 2014/15 2015/16

Headline Pay Award 2.40% 2.20% 0.30% 0.30% 1.00% 0.40% 0.50%

Basic Pay per FTE Drift 1.00% 1.10% 0.80% 0.50% -0.50% -0.30% -0.20%

Staff Group Mix Impact 0.10% -0.20% -0.10% 0.00% -0.20% -0.10% -0.10%

Excluding Staff Group Mix Impact 1.00% 1.40% 1.00% 0.50% -0.30% -0.20% -0.10%

Basic Earnings per FTE Growth 3.40% 3.40% 1.20% 0.80% 0.50% -0.30% 0.80%

Additional Earnings per FTE Drift Impact

-0.50% -0.50% 0.00% 0.10% -0.50% -0.10% -0.10%

Staff Group Mix Impact -0.10% 0.00% 0.10% 0.00% 0.00% 0.00% 0.00%

Excluding Staff Group Mix Impact -0.40% -0.50% 0.00% 0.10% -0.60% -0.10% -0.10%

Additional Earnings per FTE Growth

-0.80% -0.50% 1.40% 1.80% -3.90% 2.50% -4.10%

55 Department of Health, HCHS Paybill Metrics and Paybill driver quantifications, August 2016

83

Annex D (continued)

Paybill metric/change versus previous year

2009/10 2010/11 2011/12 2012/13 2013/14 2014/15 2015/16

Total Earnings per FTE Drift 0.50% 0.70% 0.90% 0.60% -1.00% -0.40% -0.20%



Earnings per FTE Growth 2.90% 2.90% 1.20% 0.90% 0.00% 0.00% 0.20%

Pensions Contributions Drift Impact 0.00% 0.00% 0.00% -0.10% 0.30% -0.10% 0.20%

National Insurance Contributions Drift Impact

0.00% 0.10% 0.10% 0.00% -0.10% -0.10% -0.10%

Total On-Costs per FTE Drift Impact

0.00% 0.10% 0.10% -0.10% 0.20% -0.20% 0.10%

Staff Group Mix Impact 0.00% 0.00% 0.00% 0.00% 0.00% 0.00% 0.00%

Excluding Staff Group Mix Impact 0.00% 0.10% 0.10% -0.10% 0.20% -0.20% 0.10%

Employer On-Costs per FTE Growth 2.70% 3.50% 1.70% 0.60% 1.20% -0.90% 0.80%

Paybill per FTE Drift 0.50% 0.70% 0.90% 0.60% -0.80% -0.60% -0.20%



Paybill per FTE Growth 2.90% 3.00% 1.30% 0.90% 0.20% -0.10% 0.30%

Average FTE Growth 4.60% 0.80% -1.90% -0.40% 0.60% 2.00% 2.00%

Aggregate Paybill Growth 7.60% 3.80% -0.70% 0.40% 0.80% 1.90% 2.30%

84

Notes to Annex D

Derived from DH's Estimated Headline HCHS Paybill Metrics (see separate notes on the construction of this data set).

Headline Pay Award reflects the impact of, usually, annual central pay awards which are typically headline uplift applied to pay scales. If uplifts differ

across staff groups, it reflects a weighted

average.

Basic Pay per FTE Drift gives the growth in basic pay per FTE after allowing for the impact of the Basic Pay Settlement. This captures the effects of pay

progression & increment mix, pay band mix and staff group mix.

Employer On-Cost per FTE Drift Impact gives the combined effect of the National Insurance and Pensions Contribution per FTE Drift Impacts. It reflects

the impact of changing on-cost patterns on Paybill per FTE Growth.

Paybill per FTE Drift gives the growth in Paybill per FTE after allowing for the impact of the Basic Pay Settlement. This captures the effects of changes in

workforce mix, additional earnings patterns and on-cost patterns.

The driver quantifications excluding the Staff Group Mix Impact show the residual impact of the driver after allowing for changes in the mix of staff across

the broad staff groups used in HSCIC

publications.

Average FTE Growth compares the average numbers of FTEs over the period, assessed using monthly snapshots, to the average numbers of FTEs over

the equivalent period the previous

year.

85

Annex E. Percentage of AfC staff on top of their bands

Band Total HCHS

non-medical staff

Qualified nursing,

midwifery and health visiting

staff



staff

Qualified ambulance

staff



staff

Support to doctors and

nursing staff



staff

Band 1 81% 95% 69% 65%

Band 2 46% 71% 36% 37% 45% 45%

Band 3 50% 82% 46% 43% 53% 47%

Band 4 50% 7% 45% 40% 26% 58% 45%

Band 5 42% 46% 25% 42% 73% 34% 36%

Band 6 40% 43% 38% 29% 38% 34% 14%

Band 7 48% 51% 49% 48% 45% 34% 41%

Band 8a 46% 46% 54% 52% 35% 44%

Band 8b 47% 47% 62% 34% 45% 50%

Band 8c 45% 38% 63% 38% 39% 52%

Band 8d 46% 29% 72% 30% 30% 52%

Band 9 41% 22% 66%

Grand Total 46% 46% 42% 39% 42% 49% 43%

86

Band Total HCHS

non-medical staff


Central functions

Hotel, property and estates

Senior managers

Managers

Band 1 81% 60% 84%

Band 2 46% 45% 59% 76% 21%

Band 3 50% 41% 58% 43%

Band 4 50% 43% 60% 37%

Band 5 42% 36% 48% 28% 33%

Band 6 40% 32% 42% 38% 30%

Band 7 48% 33% 47% 26% 36%

Band 8a 46% 33% 49% 38% 40%

Band 8b 47% 31% 42% 41% 42%

Band 8c 45% 30% 42% 39%

Band 8d 46% 39% 43% 36%

Band 9 41% 41% 39% 36%

Grand Total 46% 38% 67% 41% 38%

87

Notes to Annex E

Sources

ESR Data Warehouse;

NHS Workforce Statistics - May 2016, Provisional statistics: National and HEE Tables [.xlsx], http://www.digital.nhs.uk/catalogue/PUB21381/nhs-work-

stat-may-2016-nat-hee-tab.xlsx;

NHS Workforce Statistics - April 2016, Provisional statistics: HCHS staff in NHS Support Organisations and Central Bodies in England, March 2016

[.xlsx], http://digital.nhs.uk/catalogue/PUB21066/nhs-work-stat-mar-2016-quart-sup-org-tab.xlsx. to Annex E

Estimates derived from NHS Employers analysis of ESR data warehouse data as at April 2016, for all organisations in England except two organisations

who do not use ESR.

Data cleaning processes are applied to the ESR extracts before use

Staff with an invalid staff group, other staff groups, or with an incorrectly recorded point or band have been excluded from the analysis

Approximations have been made to match the staff groups used in previous submissions to the NHS Review Body and those now used in NHS Digital

workforce publications following the consultation carried out on workforce census.

http://www.digital.nhs.uk/catalogue/PUB21381/nhs-work-stat-may-2016-nat-hee-tab.xlsx

http://www.digital.nhs.uk/catalogue/PUB21381/nhs-work-stat-may-2016-nat-hee-tab.xlsx

http://digital.nhs.uk/catalogue/PUB21066/nhs-work-stat-mar-2016-quart-sup-org-tab.xlsx

88

Annex F. Time series of non-medical staff by staff group

Non-Medical Staff Groups (includes non-

AfC staff)

All Non-

Medical

staff

Nurses,

midwives

and health

visitors

Nurses and

health

visitors

Midwives

Scientific,

therapeutic and

technical staff

Ambulance staff

FTE

2009 923,401 299,075 280,114 18,960 121,241 16,987

2010 931,859 300,971 281,483 19,488 124,090 17,441

2011 910,108 298,315 278,437 19,879 124,864 17,596

2012 891,126 292,902 272,686 20,216 123,529 17,514

2013 902,791 296,673 276,137 20,537 126,129 17,537

2014 920,846 301,237 280,399 20,838 127,680 17,437

2015 937,543 303,746 282,813 20,934 129,653 17,880

Change from 2014

Number 16,697 2,509 2,413 96 1,973 443

% 1.80% 0.80% 0.90% 0.50% 1.50% 2.50%

89

Annex F (continued)

Non-Medical Staff Groups (includes non-

AfC staff)

All Non-Medical

staff

Support to

clinical staff

Support to …

NHS Infra-

structure Support

Cen

tral fu

nctio

ns

Ho

tel, p

rop

erty

an

d

esta

tes

Sen

ior m

an

ag

ers

Man

ag

ers

am

bu

lance s

taff

docto

rs, n

urs

es

and m

idw

ives

scie

ntific

,

thera

peutic

an

d

technic

al s

taff

Other HCHS staff or those

with unknown classification

FTE

2009 923,401 286,746 12,926 224,129 49,691 199,352 100,079 57,468 12,516 29,290 4,322

2010 931,859 290,883 13,290 226,185 51,408 198,475 101,809 57,312 11,715 27,640 3,734

2011 910,108 282,894 12,807 219,444 50,644 186,440 94,875 55,542 10,685 25,337 3,756

2012 891,126 276,360 12,107 215,026 49,227 180,821 92,014 54,106 10,342 24,360 3,610

2013 902,791 282,486 12,714 219,965 49,807 179,966 91,657 53,915 9,984 24,410 3,612

2014 920,846 292,927 13,406 226,913 52,608 181,564 94,072 52,555 10,468 24,469 4,007

2015 937,543 302,630 14,611 233,918 54,101 183,633 95,884 52,146 10,584 25,020 4,091

Change from 2014

Number 16,697 9,704 1,205 7,006 1,493 2,069 1,811 -409 115 551 84

% 1.80% 3.30% 9.00% 3.10% 2.80% 1.10% 1.90% -0.80% 1.10% 2.30% 2.10%

90

Notes to Annexes F and G

Following the recent consultation by NHS Digital into the publication of NHS workforce statistics in England56, a number of developments have been implemented to the way non-medical staff are counted in time for the annual publication of staff numbers. Because of these changes, these statistics are currently classed as experimental. Key developments are:

Only paid staff are counted.

A new category for Very Senior Managers has been defined.

Inclusion of nurses undertaking additional training in the nurse statistics.

Staff with mismatched AfC bands and occupation codes (staff groups) have been re-categorised according to their job role.

Staff groups have been redefined.

Headcount and FTE staff numbers for support organisations and central bodies considered to be outside the NHS, such as Health Education England, National Institute for Health and Care Excellence, NHS Blood and Transplant and NHS England, are published separately to those of NHS CCGs and trusts.

Because of these and other changes, the staff number publications are no longer equivalent to the annual workforce censuses used in previous submissions to the Review Body. In addition, as headcount for support organisations and central bodies is published separately to that of NHS CCGs and trusts, we have not included aggregate headcount in the table in Annex F due to the small risk of double counting those staff with assignments at both types of organisations. We have also not included staff from organisations in the independent sector, as most of these staff will be on different terms and conditions.

56 NHS Digital, Outcomes from the NHS Hospital and Community Health Service in England workforce statistics proposed developments consultation,

http://www.digital.nhs.uk/media/20076/Outcomes-from-the-NHS-HCHS-in-England-workforce-statistics-

consultation/doc/Outcomes_from_the_NHS_HCHS_in_England_workforce_statistics_consultation.docx

http://www.hscic.gov.uk/media/20076/Outcomes-from-the-NHS-HCHS-in-England-workforce-statistics-consultation/doc/Outcomes_from_the_NHS_HCHS_in_England_workforce_statistics_consultation.docx

http://www.hscic.gov.uk/media/20076/Outcomes-from-the-NHS-HCHS-in-England-workforce-statistics-consultation/doc/Outcomes_from_the_NHS_HCHS_in_England_workforce_statistics_consultation.docx

91

Annex G1. Non-medical staff by staff group and AfC band, September 2015

AfC Band/Grade Nurses, midwives

and health visitors Nurses and

health visitors Midwives

Ambulance staff

Scientific, therapeutic and technical staff

Band 1 7.00 7.00 0.00 0.00 0.00

Band 2 8.00 8.00 0.00 0.00 7.89

Band 3 4.50 4.50 0.00 0.00 57.44

Band 4 273.61 270.69 2.92 2694.57 5193.55

Band 5 141028.02 138885.91 2142.10 9861.54 28209.38

Band 6 96949.95 82571.09 14378.86 4265.55 42377.68

Band 7 49520.13 45449.35 4070.78 857.14 32119.01

Band 8a 10008.77 9839.72 169.05 128.50 12545.55

Band 8b 2549.96 2517.36 32.60 36.43 4406.23

Band 8c 1021.94 1004.94 17.00 17.60 2158.32

Band 8d 269.04 269.04 0.00 11.00 950.31

Band 9 83.67 83.67 0.00 0.00 278.13

AfC (Total) 301724.59 280911.27 20813.32 17872.33 128303.49

Very Senior Manager

0.00 0.00 0.00 0.00 0.00

Unknown Grade 2021.90 1901.30 120.60 8.01 1349.57

Grand Total 303746.49 282812.57 20933.92 17880.34 129653.06

92

Annex G2. Non-medical staff by region and AfC band, September 2015

AfC Band/Grade North Midlands and East South London

Special Health

Authorities and other

statutory bodies

Grand Total

Band 1 10,215.76 6,590.06 6,762.61 1,300.56 1,165.90 26,034.90

Band 2 52,585.66 43,343.08 36,028.31 15,543.52 1,449.27 148,949.84

Band 3 42,408.52 31,121.48 28,331.35 17,493.92 3,063.41 122,418.69

Band 4 24,975.17 22,457.56 17,887.08 13,928.58 2,898.12 82,146.51

Band 5 69,626.78 56,340.50 47,849.08 33,413.76 3,260.31 210,490.43

Band 6 50,598.93 45,891.29 38,120.72 29,087.69 4,028.06 167,726.68

Band 7 30,066.13 25,095.20 21,521.74 20,570.85 4,469.23 101,723.16

Band 8a 9,815.39 8,237.90 6,802.28 7,638.70 3,190.86 35,685.13

Band 8b 3,727.98 3,447.17 2,940.91 3,161.55 2,092.06 15,369.66

Band 8c 1,873.50 1,771.27 1,570.58 1,819.56 1,419.84 8,454.75

Band 8d 922.85 970.80 740.93 865.55 967.52 4,467.65

Band 9 271.14 300.59 251.06 386.08 495.32 1,704.19

AfC (Total) 297,087.82 245,566.92 208,806.65 145,210.32 28,499.90 925,171.61

Very Senior

Manager

530.89 491.95 396.42 331.75 358.88 2,109.90

Unknown Grade 2,494.65 5,598.87 2,067.50 1,136.11 3,055.79 14,352.92

Grand Total 300,113.36 251,657.74 211,270.58 146,678.18 31,914.58 941,634.43

93

Annex H. Time series of mean basic pay by staff group

Staff Group

Mean basic pay per full-time equivalent during 12 month period ending in March (£)

2009 2010 2011 2012 2013 2014 2015 2016

Total HCHS non-medical staff 24,125 24,984 25,919 26,283 26,537 26,720 26,699 26,837

Qualified nursing, midwifery and health

visiting staff 28,028 29,111 30,122 30,390 30,544 30,782 30,712 31,000

Qualified health visitors 32,528 33,485 34,308 34,388 34,298 34,177 33,661 33,652

Qualified midwives 30,219 31,402 32,338 32,348 32,325 32,511 32,389 32,655

Total qualified scientific, therapeutic

and technical staff 31,913 32,984 34,081 34,308 34,402 34,524 34,462 34,652

Qualified allied health professions 31,015 32,000 33,041 33,258 33,333 33,491 33,285 33,463

Qualified healthcare scientists 32,041 33,343 34,558 34,944 35,183 35,429 36,006 36,204

Other qualified scientific, therapeutic


Qualified ambulance staff 24,665 25,540 26,219 26,396 26,570 26,872 26,960 27,175

Support to clinical staff 16,652 17,211 17,867 18,224 18,483 18,605 18,575 18,437

94

Staff Group

Mean basic pay per full-time equivalent during 12 month period ending in March (£)

2009 2010 2011 2012 2013 2014 2015 2016

Support to doctors and nursing staff 16,505 17,027 17,649 17,999 18,279 18,408 18,361 18,617

Support to scientific, therapeutic and

technical staff 17,220 17,947 18,741 19,089 19,248 19,382 19,415 17,426

Support to ambulance staff 17,229 17,683 18,303 18,803 19,103 19,066 18,998 19,377

NHS infrastructure support 24,588 25,612 26,696 27,053 27,500 27,864 28,189 28,639

Central functions 21,687 22,650 23,763 24,260 24,653 24,854 25,000 25,509

Hotel, property and estates 15,433 15,913 16,522 16,860 17,142 17,278 17,268 17,656

Senior managers 66,205 68,138 71,845 74,045 75,329 77,506 78,595 78,381

Managers 42,445 43,954 46,164 46,871 47,544 48,648 48,819 48,401

95

Annex H1. Time series of mean total earnings by staff group

Staff Group

Mean total earnings per person during the 12 month period ending in March (£)

2009 2010 2011 2012 2013 2014 2015 2016

Total HCHS non-medical staff 24,017 24,770 25,566 25,940 26,263 26,338 26,448 26,581

Qualified nursing, midwifery and health

visiting staff 28,384 29,412 30,174 30,439 30,657 30,917 31,050 31,169

Qualified health visitors 27,126 27,936 28,576 28,803 29,063 29,190 29,190 29,092

Qualified midwives 29,145 30,257 30,816 30,846 31,001 31,211 31,298 31,382

Total qualified scientific, therapeutic and

technical staff 30,311 31,219 32,025 32,182 32,242 32,225 32,245 32,209

Qualified allied health professions 28,152 28,983 29,773 29,863 29,984 30,162 30,093 30,162

Qualified healthcare scientists 34,617 35,837 36,679 37,027 36,938 36,870 37,282 37,049

Other qualified scientific, therapeutic


Qualified ambulance staff 35,651 36,044 35,831 35,881 36,310 36,300 36,602 36,526

96

Staff Group

Mean total earnings per person during the 12 month period ending in March (£)

2009 2010 2011 2012 2013 2014 2015 2016

Support to clinical staff 16,052 16,594 17,158 17,520 17,819 18,003 18,139 18,343

Support to doctors and nursing staff 15,921 16,416 16,946 17,293 17,610 17,812 17,927 18,139

Support to scientific, therapeutic and

technical staff 15,492 16,191 16,896 17,258 17,452 17,610 17,794 17,988

Support to ambulance staff 20,520 21,233 21,665 22,325 22,794 22,630 22,827 23,092

NHS infrastructure support 24,310 25,134 26,325 26,754 27,392 27,205 27,568 27,896

Central functions 20,548 21,430 22,669 23,143 23,764 23,815 24,111 24,510

Hotel, property and estates 16,056 16,121 16,485 16,722 16,882 16,886 16,927 17,232

Senior managers 66,889 68,738 73,443 76,498 78,689 75,619 75,494 74,879

Managers 42,143 43,581 46,490 47,728 48,957 48,691 49,037 48,498

NHS Digital, NHS Staff Earnings Estimates to March 2016 - Provisional statistics: Tables [.xlsx],

http://digital.nhs.uk/catalogue/PUB20971/nhs-staff-earn-mar-16-tables.xlsx

http://digital.nhs.uk/catalogue/PUB20971/nhs-staff-earn-mar-16-tables.xlsx

97

Sources for Annexes H and H1

Annex I. Advertised vacancies by staff group

Staff Group

Numbers Ratio of Total advertised vacancy FTE

Total web

hits

Total

applications

Total

shortlisted

Total

advertised

vacancy

FTE

Total

appointed

Total

web

hits

Total

applications

Total

shortlisted

Total

advertised

vacancy

FTE

Total

appointed

All National

Workforce Data Set

(NWD) Staff Groups -

Non-Medical (excl

students) 177,172,529 3,750,371 856,808 278,648 56,533 635.83 13.46 3.07 1.00 0.20

Additional Clinical

Services 20,236,896 917,260 203,483 31,068 10,514 651.37 29.52 6.55 1.00 0.34

Additional Professional

Scientific and

Technical 9,511,202 120,891 32,088 11,672 2,381 814.86 10.36 2.75 1.00 0.20

98

Staff Group


Total web

hits

Total

applications

Total

shortlisted

Total

advertised

vacancy

FTE

Total

appointed

Total

web

hits

Total

applications

Total

shortlisted

Total

advertised

vacancy

FTE

Total

appointed

Administrative and

Clerical 57,534,757 1,779,742 313,483 74,970 17,983 767.44 23.74 4.18 1.00 0.24

Allied Health

Professionals 22,680,226 232,598 65,607 32,314 5,830 701.86 7.20 2.03 1.00 0.18

Estates and Ancillary 6,161,272 158,982 39,066 7,806 2,362 789.34 20.37 5.00 1.00 0.30

Healthcare Scientists 4,510,962 70,794 11,695 6,435 1,083 700.97 11.00 1.82 1.00 0.17

Nursing and Midwifery

Registered 56,537,214 470,104 191,386 114,382 16,380 494.28 4.11 1.67 1.00 0.14

99

Annex I1. Advertised vacancies by region

Region

Health

Education

England Area


Total web

hits

Total

applications

Total

short-

listed

Total

advertised

vacancy

FTE

Total

appointed

Total

web hits

Total

applica

tions

Total

short-

listed

Total

advertised

vacancy

FTE

Total

appointed

All National Workforce Data

Set (NWD) Staff Groups -

Non-Medical (excl students) 177,172,529 3,750,371 856,808 278,648 56,533 635.83 13.46 3.07 1.00 0.20

North North East 7,177,197 190,291 55,027 9,573 2,472 750 19.88 5.75 1.00 0.26

North West 20,494,274 470,793 84,273 32,528 5,450 630 14.47 2.59 1.00 0.17

Yorkshire and the

Humber 15,579,793 367,480 97,932 20,970 7,261 743 17.52 4.67 1.00 0.35

Midlands

and East

East Midlands 12,443,576 243,387 67,397 17,971 4,812 692 13.54 3.75 1.00 0.27

West Midlands 16,853,484 417,896 124,723 24,693 10,169 683 16.92 5.05 1.00 0.41

East of England 16,331,313 281,729 72,223 27,464 4,600 595 10.26 2.63 1.00 0.17

100

Region

Health

Education

England Area


Total web

hits

Total

applications

Total

short-

listed

Total

advertised

vacancy

FTE

Total

appointed

Total

web hits

Total

applica

tions

Total

short-

listed

Total

advertised

vacancy

FTE

Total

appointed

London North Central and

East London 13,097,245 305,586 45,242 21,633 2,583 605 14.13 2.09 1.00 0.12

North West

London 10,183,307 241,163 31,278 17,487 737 582 13.79 1.79 1.00 0.04

South London 10,335,792 274,632 38,234 15,095 2,512 685 18.19 2.53 1.00 0.17

South Kent, Surrey and

Sussex 15,084,500 252,599 62,193 28,223 4,058 534 8.95 2.20 1.00 0.14

Thames Valley 7,866,956 101,596 17,909 12,823 1,288 614 7.92 1.40 1.00 0.10

Wessex 8,826,844 133,991 38,125 15,401 2,176 573 8.70 2.48 1.00 0.14

South West 14,165,205 252,281 78,318 20,183 5,258 702 12.50 3.88 1.00 0.26

Special Health Authorities and

other statutory bodies 8,733,043 216,947 43,934 14,603 3,157 598 14.86 3.01 1.00 0.22

101

Annex J - Increments and positions within band

Band/

Point

Band 1 Band 2 Band 3 Band 4 Band 5 Band 6

Basic

Pay

per

FTE (£)

Increment Basic

Pay

per

FTE (£)

Increment Basic

Pay

per

FTE (£)

Increment Basic

Pay

per

FTE (£)

Increment Basic

Pay

per

FTE (£)

Increment Basic

Pay

per

FTE (£)

Increment

£ % £ % £ % £ % £ % £ %

2 15,251 265 1.7% 15,251 265 1.7%

3 15,516 - 15,516 428 2.8%

4 15,944 428 2.7%

5 16,372 428 2.6%

6 16,800 551 3.3% 16,800 551 3.3%

7 17,351 627 3.6% 17,351 627 3.6%

8 17,978 - 17,978 174 1.0%

9 18,152 501 2.8%

10 18,653 564 3.0%

11 19,217 438 2.3% 19,217 438 2.3%

12 19,655 - 19,655 693 3.5%

13 20,348 704 3.5%

14 21,052 640 3.0%

15 21,692 217 1.0%

16 21,909 549 2.5% 21,909 549 2.5%

17 22,458 - 22,458 905 4.0%

18 23,363 941 4.0%

19 24,304 994 4.1%

20 25,298 1,004 4.0%

21 26,302 1,059 4.0% 26,302 1,059 4.0%

22 27,361 1,101 4.0% 27,361 1,101 4.0%

23 28,462 - 28,462 871 3.1%

102

Band/

Point

Band 1 Band 2 Band 3 Band 4 Band 5 Band 6

Basic

Pay

per

FTE (£)

Increment Basic

Pay

per

FTE (£)

Increment Basic

Pay

per

FTE (£)

Increment Basic

Pay

per

FTE (£)

Increment Basic

Pay

per

FTE (£)

Increment Basic

Pay

per

FTE (£)

Increment

£ % £ % £ % £ % £ % £ %

24 29,333 1,024 3.5%

25 30,357 1,026 3.4%

26 31,383 1,024 3.3%

27 32,407 1,153 3.6%

28 33,560 1,665 5.0%

29 35,225

103

Annex J (continued)

Band/

Point

Band 7 Band 8a Band 8b Band 8c Band 8d Band 9

Basic

Pay

per

FTE (£)

Increment Basic

Pay

per

FTE (£)

Increment Basic

Pay

per

FTE (£)

Increment Basic

Pay

per

FTE (£)

Increment Basic

Pay

per

FTE (£)

Increment Basic

Pay

per

FTE (£)

Increment

£ % £ % £ % £ % £ % £ %

28 33,560 1,665 5.0%

29 35,225 1,025 2.9%

30 36,250 1,153 3.2%

31 37,403 1,280 3.4%

32 38,683 1,345 3.5%

33 40,028 1,345 3.4% 40,028 1,345 3.4%

34 41,373 - 41,373 1,665 4.0%

35 43,038 1,665 3.9%

36 44,703 1,922 4.3%

37 46,625 1,409 3.0% 46,625 1,409 3.0%

38 48,034 - 48,034 2,433 5.1%

39 50,467 2,818 5.6%

40 53,285 2,819 5.3%

41 56,104 1,536 2.7% 56,104 1,536 2.7%

42 57,640 - 57,640 1,966 3.4%

43 59,606 2,791 4.7%

44 62,397 4,185 6.7%

45 66,582 1,902 2.9% 66,582 1,902 2.9%

46 68,484 - 68,484 2,854 4.2%

47 71,338 3,487 4.9%

104

Band/

Point

Band 7 Band 8a Band 8b Band 8c Band 8d Band 9

Basic

Pay

per

FTE (£)

Increment Basic

Pay

per

FTE (£)

Increment Basic

Pay

per

FTE (£)

Increment Basic

Pay

per

FTE (£)

Increment Basic

Pay

per

FTE (£)

Increment Basic

Pay

per

FTE (£)

Increment

£ % £ % £ % £ % £ % £ %

48 74,825 3,804 5.1%

49 78,629 3,805 4.8% 78,629 3,805 4.8%

50 82,434 - 82,434 3,956 4.8%

51 86,390 4,147 4.8%

52 90,537 4,346 4.8%

53 94,883 4,554 4.8%

54 99,437 -

105

Annex K - Cost impact of the National Living Wage (NLW) on the NHS paybill

The precise cost impact of the national living wage on the NHS paybill is dependent on a number of factors – workforce growth,

incremental drift, future NHS pay awards, and the rate at which the national living wage increases each year. In order to give a

broad indication of the possible cost, NHS Employers has made some neutral assumptions on these points.

Assumptions

Workforce growth -16/17 workforce size is maintained over period Incremental drift – current distribution of workforce across pay points remains constant

Future NHS pay awards – Average 1% public sector pay policy is applied until 19/20. Award for 20/21 is unknown.

Cost estimates include both the in-year additional cost of the increasing value of the living wage, and the recurrent cost of living wage increases made in previous years.

106

Rate at which the national living wage is assumed to increase each year:

Financial Year

NLW

actual/

forecast

rates (£)

Forecast

growth in

average

earnings

Cumulative

Forecast

growth in

average

earnings

Share of

Cumulative

Wider

economy

profile

NLW

forecasts

Equivalent

AfC

Annual

Salary (£)

2016/17 7.20 0% 7.20 14,079

2017/18

3.60% 3.60% 24% 7.64 14,931

2018/19 3.50% 7.23% 49% 8.08 15,790

2019/20 3.40% 10.87% 73% 8.52 16,699

2020/21 9.00 3.60% 14.86% 100% 9.00 17,598

NHS EMPLOYERS’/media/Employers/Documents... · 6 Pay and contract reform NHS Employers continues...

Documents

Transcript of NHS EMPLOYERS’/media/Employers/Documents... · 6 Pay and contract reform NHS Employers continues...