NHS deal 'failing' to cut costs

By Nick Triggle Health reporter, BBC News

Nurses are among the staff affected by Agenda for Change

A deal to modernise pay and conditions for a million health service workers in England has failed to make the NHS more cost-efficient, say MPs.

The Public Accounts Committee criticised the Agenda for Change contract, phased in from 2004 to 2006.

It was designed to create a more flexible workforce to improve care and career progression as well as pay.

But the MPs said there was no evidence of progress yet. However, the government said it had been successful.

Agenda for Change covers all NHS staff apart from doctors, dentists and managers who have all had their own new contracts in recent years.

WHAT IS AGENDA FOR CHANGE? Like doctors and dentists, nurses, hospital porters and a range of other health workers have also signed up to a new contract The deal led to an increase in pay of about 10% over the first three years As well as more pay, the contract standardised everything from holiday entitlement to shift patterns The aim was to create a more flexible workforce that would eventually lead to better services designed around the patient

It led to a 10% pay rise on average over the first three years, but in return staff agreed to changes in working practices.

The government wanted to create standardised pay structures, holiday entitlements and shift patterns to make it easier to move people around roles.

It also led to the creation of new positions, such as healthcare assistants, who support nurses, and consultant nurses to take on responsibilities from doctors including prescribing.

But despite this the MPs said there had been no real evidence of savings and increased efficiency.

Progress

Even the fall in vacancy rates that have been trumpeted as a sign of progress was more likely to be linked to post closures than a sign the contract had been effective, the MPs said.

The scale of change in the NHS over the past decade has made it difficult to isolate the impact of individual initiatives Ann Keen Heath Minister

The committee's report said part of the problem was that NHS trusts had not been asked to measure productivity.

But it also highlighted the lack of take-up of knowledge and skills reviews which staff are meant to have every year to help arrange training.

Just over half of staff currently have these meetings annually.

Committee chairman Edward Leigh said he had doubts the promised savings of £1.3bn over five years - the equivalent to between 1.1% to 1.5% each year - could be achieved.

"There is no evidence of the increased productivity and other savings in the NHS that were going to be achieved."

He urged the Department of Health to issue guidance on how the NHS should manage the contract from now on and what targets they should be aiming for.

Policy defended

Dr Peter Carter, general secretary of the Royal College of Nursing, said there was plenty of evidence to show that Agenda for Change had improved the NHS for patients and staff.

He said: "Critics are wrong to speak out after so little time to say the changes have not brought about improvements.

"It is no coincidence that in recent years the Healthcare Commission has rated more and more Trusts excellent or good, or that the 18 week target has been achieved way ahead of schedule."

Health Minister Ann Keen said Agenda for Change had made it easier to define news roles for staff, and pay them accordingly.

She said: "We do not agree with the conclusion that there is no evidence of increased productivity.

"The scale of change in the NHS over the past decade has made it difficult to isolate the impact of individual initiatives such as Agenda for Change and their impact on overall productivity."

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