Downgrading through Restructuring

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2008 Health Care Service Group Conference
14 April 2008

This conference is concerned that many NHS employers are seeking to avoid their obligations under the Agenda for Change agreement by conducting restructurings of their organisations, or sections or departments within them, to deliberately achieve the down-banding or down-grading of staff, particularly those in clinical or therapy or professional specialist or leadership posts.

The government’s funding arrangements in the acute sector of the NHS is causing financial difficulties, in organisations that up to now have delivered balanced year end figures. Some organisations are embarking on short sighted and unsafe Nursing and Allied Health Professionals establishment reviews. Conference believes that in many cases these restructurings not only undermine the AfC process but are resulting in unsafe staffing levels and structures, particularly in specialist areas such as coronary care units, consequently putting patients’ lives at risk.

The reviews carried out on pre-AFC data and pay structures, are being married against AFC banding outcomes. This in itself is a major cause for concern. Individual posts are being identified and although they have been matched or evaluated, consistency checked, assimilated and been paid the identified band, (for the past 3 yrs) they are now earmarked for down grading. This comes about because the national tariff set for acute Trusts does not allow for the incremental progression through the pay band. How can staff provide a quality service be innovative in treatments and improve the patient experience, when they face demotion or redundancy?

AFC has delivered significant improvements in pay and conditions for many staff, particularly low paid workers. For increasing numbers of clinical staff the outlook is not so clear, if every time finances are tight Trusts attack the clinical establishments on wards and departments (which are not rich with numbers and grades to start with). There will be no career development opportunities as the structures are so flat, job satisfaction and morale will hit an all time low. Cutting back on the duties of clinical staff and expecting junior doctors to once again pick up some of the duties that not so long ago Nurses were encouraged to develop, will within a very short time lead to worse standards for patients and increased waiting times. This will erode the very basic ethos of the NHS and make for disastrous performance targets for the government. Quality services need investment and staff that are dedicated motivated and well trained, not demoted, deskilled and disenchanted.

Conference therefore calls upon the Service Group Executive to:

i.use whatever means and pressure it has to ensure the government sets its funding formula at a level that will ensure the integrity of AFC is maintained and that staff who have been fairly and consistently banded are not penalised for developing and delivering quality health care for the local population;

ii.Complete the staffing / establishment review work started by the national nursing sector, to ensure guidelines are in place for safe staffing levels with adequate skill mix to ensure quality services are provided;

iii.mount a sustained campaign against these unsafe staffing levels and to defend career and grade progression for our members faced with this type of action by their employer; on Branches and Regions to undertake a survey of their branches to ascertain the level of re-organisational change which is taking place, with particular attention to nursing, which appears to be the initial focus of trusts’ attention (this information should take into account the existing and proposed staff establishment, the areas which will be effected and research which is being cited as the rationale for change.)