Read The Small Print Before Signing

Back in October Jeremy Hunt announced that the 1% pay cap (forced on NHS staff) was finally going to be scraped (1). Six months later we have got news of what that pay deal will be (2). At first the offer seems to be going some way to redress the loss of pay, in real terms, we have suffered with this government’s pay freeze and then pay cap. Since 2010 nurses’ pay has fallen in real terms by 14% plus (3).

At the beginning of March, it was leaked in the Guardian newspaper that the government had drawn a “red line” that this pay offer would come with the condition that we had to give up a day’s annual leave (4). Never has a single MP’s pay rise come with this condition. Naturally there was an outcry against this. NHS staff have worked hard enough over the previous years, especially during last winter, the sheer arrogance of this demand was breath-taking. Strangely, when the pay offer was official announced, at the end of March, gone was the requirement (2). Had this been a crude example of political spin, to make us swallow this pay offer without too many questions?

This pay rise might seem generous at first sight, a pay rise of 6.5%, but a closer look quickly shows that this simply isn’t the case.

Firstly, this pay raise is over three years. We will get 3% this year, 1.7% next year and 1.6% in 2020 (5). The inflation rate was 2.5% in February this year (6) which would mean our pay would rise 0.5% above inflation, not much. But inflation is predicted to be 2.2% in 2019 and 2% in 2020 (7). This would again see our pay increase less than inflation, again a cut in real terms. One pay rise just above inflation in ten years, would MPs tolerate this?

The pay points, on the Agenda for Change (AfC) pay scale, are to be “re-structured” (5). We are told that this is to remove the overlap in Bands (5). If you are on the top pay point of Band 5 you will be earning more than someone who is on the bottom pay point of Band 6 (Though the Band 6 person’s pay will increase yearly pay increments). The pay bands will be reduced to three for Bands 5 to 9, with only two pay points for Bands 2 to 4, and they will not be awarded yearly (5). Ultimately this will see a reduction in yearly pay rises, people will reach the top pay point for their Band quickly, even with pay points not being awarded yearly, and then face the only increase on their pay being a yearly pay rise, which since 2010 has been repeatedly below inflation. Gone will be the yearly pay increases from AfC.

To move onto the next pay point we will have to had completed the following:

•  We completed our yearly appraisal
•  Have no live disciplinary actions on our record
•  Have completed all our mandatory/statutory training
•  And if you’re a line-manager you must have completed all your staff’s appraisals too (5)

And it looks like that these requirements maybe enforced more (5). So if your unit is so busy that you can’t get to your mandatory training, if your manager is too busy to arrange your appraisal, or you are that manager who is too busy to arrange your staffs’ appraisals then you won’t move to the next pay point. So if our workload is too heavy our pay could actually suffer.

There has been much made of that some people will receive a 29% pay rise but in reality most of this 29% isn’t a pay rise but part of the re-structuring of the AfC pay points. Newly qualified nurses will see the biggest pay rises as the lowest pay points on Band 5 will be abolished, making a Band 5 starting salary £24,907, but that is only a 12.5% increase (8), not 29%. Only 1% of NHS staff will see the 29% pay rise through re-structuring of AfC, most of whom are unlikely to be nurses, with 50% of staff only receiving the 3% basic pay rise (9). Many nurses like myself, who are at the top pay point of our Band will only get a pay rise of 0.5% above inflation.

When Hunt announced the scaping of the pay cap, last year, he did say that any pay rise would be linked to productivity (1). We now see what this is. There will be a “focus” on reducing rates of sickness (2) and staff will be “encouraged” to work Bank shifts on top of their contracted hours. I cannot find how the sickness rates will be “reduced”, but I fear that it will entail punishing staff for being ill, i.e. more disciplinary procedures and Official Warnings for staff with raised Bradford Scores (The method used to monitor staff sickness in the NHS [10]). How will staff be “encouraged” to work Bank shifts, again I can’t find anything about this. But how is getting an already overloaded workforce to work on their days off helping with staff retention and nurses work/life balance? How will “encouraging” already overworked staff to work even more hours help reduce sickness rates?

Nursing is facing a recruitment and retention crisis. Last year saw 33,000 nurses leave the NHS, that’s a 20% raise on the number who left in 2012-2013 (11). Last May the RCN found that there were 40,000 empty nurses posts in the NHS, just under 10% of the nursing workforce (12), and since then the government has done nothing to recruitment more nurses. There are even less people applying for nurse training since this government abolished student nurse bursaries. Only published this month, UCAS announced that 14% fewer people have applied for the September 2018 intake of student nurses than did last year, and last year saw a 30% reduction on 2016 (13). Last year, for the first time, more nurses left the NMC (Nursing and Midwifery Council) register of nurses then joined it (14). 1,678 more nurses left the register than joined it, in total 35,363 left the NMC’s register. You have to be registered with the NMC to work as a Registered Nurse, so those 35,363 nurses were lost to the professional, with all their experience.

How much will this pay rise help with the recruitment and retention crisis? Pay isn’t the only reason nurses are leaving the NHS. A report to the House of Commons Select Committee on Health, in January, found that nurses were leaving because of the poor pay, but also because of the high workloads, restricted access to continuing education and feeling undervalued, especially by this government (15). How will a 0.5% above inflation pay rise for half of nurses, and then another two years of below inflation pay rises for all nurses, encourage people to stay in the NHS? It does not address our spiralling workloads, working shifts without a break because we are so busy and poor access to education, it certainly doesn’t show us we are valued by this government. Yes, newly qualified nurses will be paid more but is this enough of an incentive to encourage people to apply for training? Without the bursary, qualified nurses are now looking at £35,000 to £40,000 of student load debt, and more if they train in London (16). Though, if you earn more than £21,000 a year you have to pay back more of your student loan (16), so how much of this increase in newly qualified nurses’ salary be eaten up by student loan repayments?

Most of our unions have already backed this pay deal (2). Janet Davies, RCN chief executive, called this deal, “A significant shift in government policy that has been forced by nurses themselves. That is why we are recommending that you accept this deal.” (17) Sara Gorton, lead negotiator for the health unions, said: "It will go a long way towards making dedicated health staff feel more valued, lift flagging morale and help turn the tide on staffing problems." (2) Danny Mortimer, chief executive of NHS Employers, said this deal will make the NHS a "desirable" employer again (2). Only GMB national officer Kevin Brandstatter called the deal "jam tomorrow", saying "Long-serving, dedicated health service workers have had thousands of pounds swiped from their pay packets since 2010 by the government's cruel and unnecessary pay cap." (2)

Will I vote to accept this pay deal? What choice do I have? If we turn down this deal what is the alternative? The doctors strike in 2016 was bitter and won little concessions, but at least the doctors had us to cover for them. If we strike who will cover for us? No one and patient care will suffer. Also, if we reject this pay deal the government will not offer us the deal we want, they will not restore the pay they have taken from us since 2010, instead they will claim there is no money for any other deal, I am certain. I am so demoralised by my treatment from this government that I am willing to accept as bad a pay deal as this one because I am desperate for any type of pay deal that isn’t another wage cap.

I was right to mistrust this government when they announced they had “scrapped” the pay cap (18), what they are offering in its place is barely any better but what can I do?

"The agreement [this pay deal] reflects public appreciation for just how much they [NHS staff] have done and continue to do," Jeremy Hunt (2), but he has always repeatedly shown his hypocritical attitude NHS staff, he certainly doesn’t value us.

If you want to know how much your pay will or will not increase then check here, at the NHS Pay Calculator.

Drew Payne

Boris Johnson and the Art of the Headline Grab

Boris Johnson has never been shy of grabbing the headlines, he has certainly never knowingly turned away from a photo opportunity. When he was Mayor of London, it sometimes felt like all he did was try and grab the headlines, with one stunt after another.

At the end of January the press revealed that Boris would be demanding an extra £100 million a week funding for the NHS, at a Cabinet Meeting (1). That would have resulted in an extra £5.2 billion a year. Now he was quickly slapped down by both Theresa May and Philip Hammond, the Chancellor (2). Since then Boris does been very quiet on the subject, it obviously didn’t get him the good headlines he was after, but it did highlight this government’s failure to fund the NHS or even look realistically at future NHS funding.

This Government has under funded the NHS since 2010. Since 2010, when the Conservatives came back into Government (In coalition then), they have cut the increase in NHS funding to 1.1% (3), after last year’s autumn budget the NHS yearly increase in funding was increased to 1.2% (4). Previous to 2010 NHS funding was increased by, on average, 4% a year since the NHS was founded. NHS funding increases have been cut by nearly 75% and yet demand has not decreased. A&E attendance in December 2017 was up 3.7% on December 2016 (5), and that was just A&E attendance. All areas of the NHS have seen increases in demand, year on year.

This all has had a knock-on effect on the service the NHS can deliver, it’s now failing at all its mayor targets. The four hour A&E treatment target hadn’t been met since July 2015, the 62 day target from urgent cancer referral to treatment hasn’t been met since 2014 and the 18 week target for referral-to-treatment for elective care hasn’t been met since February 2016 (6). Good quality healthcare is not cheap, and repeatedly providing the NHS with below inflation funding increases has a direct affect on patient care. There are no more “efficiency savings” to be made, the fall in funding cannot be absorbed in any other but by cuts to patient care.

The Government had a chance to at least begin turning around this chronic under funding with November’s Autumn Budget. In the run up to the budget there was active campaigning for more NHS funding, at least £4.6 billion to stop the shortfall in NHS funding (6). Simon Stevens, head of NHS England, called for extra funding too, warning that NHS waiting lists will soar to five million by 2021 if its funding isn’t increased (7). Yet when Philip Hammond announced his budget, in November, the NHS only received an extra £1.6 for the next year (8). Officials at the Treasury have leaked to the press that Philip Hammond was angry at all the campaigning for extra funding, especially that of Simon Stevens, and this is why he didn’t provide all the funding the NHS needs (9). I am left speechless with disgust and anger at his petty and vindictive actions. Instead of listening to the reasoned arguments, he followed his ego. What kind of politician is he? Unfortunately he’s typical for this government.

Boris Johnson’s attempt to grab the headlines pushed a much more important NHS policy story out of the back pages. A cross-party group of ninety MPs wrote a letter to Theresa May calling for a cross-party convention on the future of the NHS and care social and the funding they will need (10). The letter was organised by Sarah Wollaston, Conservative MP and chair of the Commons health committee, Norman Lamb, Libdem MP, and Liz Kendall, Labour MP (11). It was signed by 90 MPs from all parties, a third of them were Conservative MPs (11). This was a golden opportunity for Theresa May to tackle the problems dogging the NHS and to do it with the full support of Parliament. This would have provided cross-party support for raising taxes to fund the NHS. So far the Conservative party has shied away from raising taxes, seeming to fear losing political face doing so, but with cross-party support all parties would have taken the “hit”. This was a political initiative that has been long overdue. But Theresa May, in her usual limp-handshake-way, dismissed this call for cross-party action, saying the government were managing the NHS themselves (12). Another typical failure and missed opportunity by Theresa May, and I’ve lost count of how many there have already been.

70% of Conservative voters, in a recent pole, said that the NHS was their main concern (13), and yet this government constantly ignores the problems of the NHS staring them in the face. Even when their own supporters are worried about it, it still doesn’t appear as a high priority for this government. Theresa May does not seem very bothered about it and rarely comments on the NHS. What have we done to deserve politicians so apathetic and uncaring about the NHS? For so many voters, the NHS still remains such a major concern, but to listen to our politicians you would think that there were no great problems with the NHS, beyond a few people moaning about it.

What can we do to finally make this government take the NHS’s problems seriously? Yet another winter crisis in the NHS certainly hasn’t done that (14).

As for Boris Johnson. During the 2016 EU referendum the Leave campaign, which he was the leading light of, claimed that £350 million a week extra funding would go to the NHS (15). Last month Boris only called for an extra £100 million a week for the NHS. So it seems his concern for the NHS has fallen by over 70%. As I said, what can we do to make these politicians take the NHS seriously?

Drew Payne

When You Just Don’t Understand the Situation

“If you can keep your head, while all around you others are losing theirs, believe you me you don’t understand the situation.”

I don’t know who said it but I do like this quote, except when it comes true. Jane Cummings, NHS England’s chief nurse, has recently shown that she is a living example of this.

The crisis in nursing has further deepened, last week figures from NHS Digital were released that showed last year (2016 to 2017) more nurses left the NHS than joined it (1). Last year 33,500 nurses left the NHS (about 10% of the nursing workforce), 3,000 more than joined, and 20% higher than left in 2012-2013 (1). Some of these nurses have moved into the private sector, to work for nursing agencies and private companies and private hospitals, but an alarming number of nurses have left the profession altogether. Last year saw 1,678 more nurses leave the NMC register than joined it, 35,363 nurses left the register, 27% less nurses joined the register than left it (You have to be registered with the NMC to practice as a Registered Nurse, therefore if you leave it you cannot work as a Registered Nurse) (2).

A closer look at these statistics makes an even more uncomfortable read.

3,000 more nurses left the NHS than joined it (3). This is the biggest gap but not the first, for the last three years more nurses have left than joined the NHS, but last year saw the biggest gap. There’s no evidence that this trend isn’t going to carry on.

The largest percentage of those nurses leaving, 51%, were nurses under 40 (3). These are nurses at the beginning of their career. Traditionally, the largest percentage of nurses leaving had been over 55, nurses retiring. This has been a concern because of the drain of skills and experience from losing these nurses. Last year we saw the largest percentage of nurses leaving were ones at the beginning of their careers. Nursing is now so stressful and undervalued that it is driving away nurses at the beginning of their careers.

"We are haemorrhaging nurses at precisely the time when demand has never been higher,” Royal College of Nursing head Janet Davies said: "The government must lift the NHS out of this dangerous and downward spiral.” (3) She added that the government needs to address nurses’ poor pay and lack of support to start filling the huge number of empty nursing posts (3). She hit the nail on the head, unlike our Chief Nurse.

Jane Cummings told the BBC: "We do lose people that need to be encouraged. We're in the process of bringing in lots of nurse ambassadors that are going to be able to talk about what a great role it is, to be able to tell their story, so we can really encourage people to enter the profession and for those in the profession, to stay in it," (3).

She is the professional lead for nursing and midwifery in England (4) and yet she makes a comment as crass and patronising as this one. Nurses are the backbone of healthcare, we are the ones who actually carry out the vast majority of patient care, and the NHS is haemorrhaging nurses. Yet all Jane Cummings can say, in the face of this of all, is that she’s introducing “nurse ambassadors” who will tell everyone what a “great role” nursing is. She plainly ignores all the factors that are stripping the NHS of nurses, and instead she announces a pie-in-the-sky project. As if all we need are people to go around saying how great nursing is and nurses will stop leaving the NHS. What planet is this woman on?

If a “nurse ambassador” turned up at my workplace and told me it was great to be a nurse, I’d reply asking them what they were going to do about our ever increasing workload, all the empty posts in our team (let alone we need more nurses to manage our increasing workload) and what where they going to about the fact that my pay has decreased, in real terms, by 14% since 2010 (5)? If they answer nothing then I’ll demand to know what good are they? But let’s cut out the middle people, if this is all Jane Cummings can offer then I want to know what good is she?

According to NHS England, Jane Cummings was appointed National Lead for emergency care in 2004 and she had been working in management for many years before then (4). It is safe to say that it is many, many years since she worked on the clinical coalface of nursing, and it shows how her patronising response to this latest crisis is. Why is she in such an important role when she cannot offer the leadership needed?

In 2012, Jane Cummings’ salary was £165,000pa (6), and I am sure she has not seen her salary fall the way the clinical nurses have seen our salaries fall, in real terms.

How has Jeremy Hunt reacted to this latest nursing crisis? He is the Minister for Health and Social Care, he is the politician responsible for the NHS.

He has shown his typical complete lack of knowledge about the situation. In reply to the fall in the number of NHS nurses, Hunt said that he will increase student nurses places by 25%, training 5,000 Associate Nurses this year and 7,250 next year, make it easier for Associate Nurses to re-train as Registered Nurses and give nurses first refusal on any “affordable” housing built on former NHS land (7).

At first this may sound great but a quick glance at the figures shows how hollow they are. It takes three years to train a Registered Nurse and two years to train an Associate Nurse, so any extra training places will not give us more nurses now. In three years times how many more nurses will be leaving the NHS than joining it? There seems no evidence that the NHS will stop losing nurses. This Government has abolished bursaries for Student Nurse training, since then there has been a 23% fall in the number of people applying for nurse training (8). Will they be able to find enough appropriate people to fill these extra training posts? Associate Nurses are not a replacement for Registered Nurses, as yet there are no plans for Associate Nurses to be able to give IV drugs.

As for first “dibs” on “affordable” housing, well only on the ones built on former NHS land. You still need a mortgage for an “affordable” home, it’s not social housing, and with nurses’ pay falling in real terms who can we get a mortgage from? And how many “affordable” homes will be built this way? Certainly not enough to house all the nurses, and their families, who need them. This is another patronising and meaningless “bone” thrown at us by Hunt, which does nothing to ease all the problems faced by nurses.

Nursing is in crisis, we are haemorrhaging nurses from the NHS, yet this has been a problem for years and no one in leadership is doing anything meaningful about it. I want to scream “You’ll miss us when you’re gone, when there’s no nurses left you’ll be in trouble!” But with the leadership styles of Jane Cummings and Jeremy Hunt, I don’t think anyone will notice or will they even care, and that makes me so sad.

Drew Payne

Today Would Have Been His Birthday

Today, the 19^th December, would have been my father’s birthday but he died in 2003. He died before Facebook, Twitter, Instagram, Smartphones and Tablets. He only started to use a computer after he retired, discovering the internet after that. His use of emails could be erratic and interesting, to say the least.

He came of age during the Second World War, which left a very formative impression on him. For him it brought great freedoms, as a teenager he was given so many adult responsibilities, many of the adults were away at war so he was needed to fill their shoes, going from boy to man almost overnight, and he loved it. His stories about that time were always filled the pride that that was the best time of his life.

He lived his life in a world that was so different from ours now, not just new technology but a whole different world of attitudes. When my parents married, in 1952, the only divorce you could get was for adultery, being gay could land you in prison, terminating a pregnancy was illegal, if your parents weren’t married you wouldn’t be automatically recognised as your father’s child, attitudes to any sex outside of marriage were almost medieval; and racism, sexism, homophobia and prejudice toward the disabled were just perfectly acceptable “values”.

The world I live in is a world away from the one my father grow up in, yet it is also within living memory. The world has changed so much since I was born, but it is unrecognisable from the world that my father grew up in, and I am so grateful for that.

My father lived through so much change in his life but I still wonder what he’d make of our social media. Part of me feels a sinking feeling of how he’d have over shared on it, tagging me into all his posts, did I really need to know what he had for breakfast and that he discussed his constipation with his GP, again, and I can hear him complaining, “How can I say anything in only 140 characters, what fool thought that was a good idea?”

Tom Payne, my father, a man who lived through the world that changed.

Drew Payne

Just More Number Crunching

We’ve had the Equality Act since 2010 (1) and for many LGBT people it has been a game changer. It requires that anyone providing a service for the general public, including healthcare providers, does not discriminate who they provide that service to, no more “We don’t serve your sort in here, this is a family establishment.” In October 2017, NHS England has only just waken up to the fact the Equality Act also applies to the NHS, and in response they have released their latest initiative.

They announced that they want all patients’ sexuality recorded, with their other demographic details (2). So at every face to face encounter with a patient with doctors and nurses and all healthcare professionals have to ask patients what their sexuality is, if it does not already state so on their demographies. Patients do have the opinion to decline to answer.

But this is NHS England’s only response to the Equality Act, to gather data on patients’ sexuality, nothing more. We’ve had several studies, in recent years, about the poor treatment LGBT patients have received from the NHS, there have also been studies into what an unfriendly working environment for LGBT staff the NHS is.

Back in 2007, Stonewall published their study Being the Gay One (3), on the homophobia faced by staff working in health and social care, it was more than an uncomfortable read. Since then they have published four different studies on the experience of LGBT patients in the NHS (4, 5, 6, 7) and all of them have highlighted the negative and homophobic experiences they have received, with many LGBT patients unwilling to be open about their sexuality for fear of homophobic treatment from healthcare professionals.

In 2015 Stonewall published Unhealthy Attitudes (8), their report into a survey of LGBT healthcare staff. The findings of this report showed so little had changed since 2007, and Stonewall’s first report (3). Unhealthy Attitudes found that 25% people surveyed had been the victims of homophobic abuse at work. Last year a BMA study found that 70% of LGBT doctors had experienced homophobia at work, and three quarters of them had never reported it out of fear of reprisals (9). Last year we had the unpleasant sight of NHS England itself going to the High Court to win the right not to fund the HIV preventative drug PrEP (10).

Yet we also have areas of good practice and there are resources out there for NHS Trusts that want to turn around this situation. In 2012 Stonewall published Sexual Orientation, A guide for the NHS (11), which is full of practical advice for combatting homophobia in healthcare. Back in 2009, the Department of Health produced Sexual Orientation: A practical guide for the NHS (12), which was designed to help reduce the healthcare inequalities faced by LGBT people.

We already have a lot of evidence about the homophobic treatment many LBGT people have received at the hands of the NHS, NHS Choices acknowledged the problem back in 2012 (13), there is also guidance on how to reverse this, and yet all NHS England can think to do to combat healthcare homophobia is to ask patients what their sexuality is. A third of gay and bisexual men are not open about their sexuality to their GPs (7) and half of Lesbians and bisexual women (5). Why isn’t NHS England launching a high profile initiative to tackle homophobia in the NHS and to make it a welcoming place to LGBT people? Why isn’t NHS England ensuring that the NHS complies with the Equality Act? Instead all they can do is collect data on LGBT people. So typical of NHS England, too little and much so late.

But why should nurses, be concerned about this? How can we say we are providing open and non-judgemental nursing care when so many LGBT people are afraid of being open about themselves in front of us?

(This was originally written for the Nursing Standard)

Drew Payne