Andy Ford, Unite Rep, NHS
There has been a lot of discussion in the press about the formerly obscure NHS Pay Review Body. Government ministers have solemnly declared that they “accept in full” the findings of this so-called independent body. But it is worth looking at why nurses and ambulance workers are so cynical about the PRB.
The NHS unions in England and Wales do not negotiate pay with their employers, the various trusts and the ‘arms-length bodies’ who employ them. Instead, they – and the government – give evidence to the Pay Review Body who then decide on an appropriate ‘award’. The system is different in Scotland, where the joint unions talk directly to the Scottish Health Minister.
The Pay Review Body for England and Wales is nominated by the government, the chair by the Prime Minister and the rest of the committee by the Secretary of State. They get paid £300 a day for their deliberations, and £350 for the Chair. The NHS PRB covers over a million NHS staff and with the other Pay Review Bodies, about two million workers have their pay ‘awarded’ in this artificial manner. Pay Review Bodies now control about £200bn-worth of public sector pay.
PRB has followed government policy
But the PRB is not free to make its own decisions: the government sets the overall remit for pay, which includes a “department spending envelope” but excludes “comparable pay” outside the NHS.
The Pay Review Body was set up in the wake of the defeat of the 1982 Health strike, and it was designed to split the workforce because it only covered nurses and some other professions, excluding ancillary, domestic and scientific staff. Later, in 2004, under the ‘Agenda For Change’ strategy, all NHS workers, except very senior managers, and dentists and doctors, were brought onto one pay scale and within one single set of terms and conditions.
Since then, the PRB has broadly followed government policy on public sector pay. Under Labour, NHS salaries pretty much kept pace with inflation, but since 2010, the Pay Review Body has presided over a catastrophic fall in the real value of NHS wages compared to inflation. Most galling to health workers was the freeze after the 2015 election: when – once the election was over – the pay of MPs and ministers soared. If NHS pay had kept pace with the MPs’ pay, the average nurse or biomedical scientist would be earning about £5,000 a year more.
Adding insult to injury
The Pay Review Body just waved through the awful 2018 three-year deal, which gave the Department of Health a form of performance-related pay, in return for the princely sum of a 3% rise, followed by below inflation rises of 1.6% in Year 2, and 1.5% in Year 3.
To add insult to injury, the Pay Review Body seem to have co-ordinated their ‘award’ for 2022 with the NHS Pension Board, as many NHS staff found that their pay rise mysteriously matched their increased pension contributions and disappeared back into the government coffers. It cannot be a coincidence, because the pay ‘award’ was not a simple percentage rise. It was £1,400 flat rate up to band 5, then for bands 6 and 7 it was 4%, while for the managers’ band 8, it went back to a £1,400 flat rise.
The pension changes followed the same pattern, with bigger increases in contributions for bands 6 and 7, which clawed back a lot of the pay rise, and reductions in contributions for managers which compensated for their lower pay rises. Clearly, the Department of Health can influence both of these supposedly “independent” pay bodies.
The result of the Pay Review Body’s stewardship of our pay has been a huge erosion in its value. Before the present strikes band 2 (£19,000) was becoming almost unrecruitable, and huge holes were opening up in band 3 (£21,000). People were leaving the NHS to work in coffee shops for more money. In band 5 (£22-£25,000), newly qualified nurses, midwives, physiotherapists, biomedical scientists and paramedics were also often forced to look outside the NHS for better pay to cover their student loan debts.
Little better off for greater responsibility
The plain truth is that the NHS pay system is a total mess. As well as low salaries, we also have really narrow gaps between pay bands, which deter staff from going for promotion, as they end up little better off for extra responsibilities. They might even be worse off if they lose allowances for shifts or being on-call.
On the other hand, the performance related pay system means that if a manager passes their five-year performance review, they get a 14% pay rise. But before that, their pay is static for 5 years, added to which, the 2018 pay deal robbed thousands of pounds from ambulance workers because of a different retrospective shift pay system! Well done Pay Review Body!
Until recently, the full-time officials of the major health unions tended to argue that the Pay Review Body, despite its faults, was the best system on offer and the unions therefore gave evidence to it. The obvious point is that they would not entrust their own pay to any such system.
Workers given the minimum government can get away with
Also, a recent study by Unite has shown that in areas like local government that are not covered by a pay review body, have not done significantly worse or better than the NHS. Both sets of workers have basically received the minimum the government feel they can get away with. The difference is that the Pay Review Body can be used as a shield behind which the government shelters, if at any point NHS pay becomes a political issue.
One thing the NHS Pay Review Body does not do is give fair pay to NHS workers. It is not independent. Its members are appointed by the government, which sets its terms of reference. Then the government give ‘evidence’ to it – giving its marching orders – and then after the PRB makes recommendations, the government decide which, if any, of its recommendations to accept. The whole process is a joke, but not a very funny one.
The Health sector of Unite passed a resolution at its conference last year, making it clear that “the NHS Pay Review Body (PRB) as it stands for NHS pay is no longer fit for purpose, if indeed it ever was”, and calling for the PRB to be abolished. That ought to be the policy of all of the NHS unions.
