Full benefits of NHS pay reform unlikely to be realised

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Full benefits of NHS pay reform unlikely to be realised

“Patients will never feel the intended benefits from the biggest NHS pay reform in UK history unless health service leaders secure changes in the working patterns and productivity of more than a million nurses and other staff.” This is the conclusion from recent research by the King’s Fund examining the impact of the NHS pay reform that began in December 2004.

The report, "Realising the Benefits? Assessing the Implementation of Agenda for Change" is the first independent report looking at the impact of the new pay system that has impacted on over one million nurses and other NHS staff. Based on case studies of ten NHS Trusts and interviews with various stakeholders, the report provides useful insight into the effect of the key pay reform up to now.

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In particular, it reveals that the costs of Agenda for Change are more obvious than the benefits which are often hidden or difficult to quantify and says that the longer-term benefits will not be realised unless greater efforts are made to use the new pay system in the way it was intended – to facilitate and reinforce improvements in skills, roles and motivation.

Implementation rushed

Perhaps one reason that the pay system is not operating in the way intended is because of the finding that despite years of negotiation prior to the changes, national implementation of the new pay and career development structure was rushed and has exceeded all cost estimates.

In addition, the report says that for some NHS trust managers, transferring staff to the new system became an end in itself rather than a way to achieve the longer-term benefits of treating patients more quickly and providing a higher quality of care.

Recommendations

For the future, the King’s Fund warns that unless Agenda for Change is properly “embedded”, and the associated knowledge and skills framework becomes fully operational, the full benefits for patients and staff will never be realised.

To help, it makes a number of recommendations:

• Calling for a systematic, independent audit of the cost and impact of Agenda for Change – a list of benefits to be realised in the short, medium and long term was drawn up at the beginning of the process, but there is no evidence that this has been used to assess the progress at NHS trust level, or applied regionally or nationally to track success or failure in achieving intended benefits.
• Strategic Health Authority chief executives must support networking and sharing of “good practice” in their regions to ensure patients feel the full benefits of reform nationwide.
• Managers at trust level need to strengthen their commitment to both the spirit and letter of Agenda for Change to secure full benefits, not just for the workforce but for improved care and increased productivity.
• The need for the accompanying competency-based career structure, the Knowledge and Skills Framework, to be fully implemented so all staff have personal development plans and meaningful appraisals.
• The knowledge and skills framework needs to be kept simple, robust and properly resourced in order to build staff confidence that the system is designed to deliver career improvements.
• Despite the problems, the report does add that most managers favour Agenda for Change over the old system and believe it can help them improve productivity and patient care.

A final word

Report co-author James Buchan states: “Implementation has been rushed with no one body taking responsibility for ensuring all proposed benefits actually become a reality. As things stand, the ability to deliver all the potential benefits to patients is constrained by variations in local management capacity and willingness for following through with the reform’s original objectives. It will require additional effort and support to realise all the benefits envisaged when the new system was designed and agreed.”

Want to know more?

Title: Realising the Benefits? Assessing the implementation of agenda for change, by James Buchan and David Evans, King’s Fund, July 2007.

Availability: The report can be downloaded for free at www.kingsfund.org.uk/media/patients_may.html.