National Health Service pay reforms ratified by union members

By the end of May 2003, membership ballots conducted by trade unions confirmed widespread, but conditional, support for an agreement on the radical reform of pay and conditions of employment covering most staff in the UK's National Health Service.

After negotiations on the government’s Agenda for change proposals for the National Health Service (NHS) (UK0201172F) were concluded successfully at the end of 2002 (UK0303104F), all health service trade unions embarked on an extensive process of membership consultation and internal debate culminating in a series of membership ballots. The nature of the debate and the outcome of the ballots, however, varied between the trade unions.

First, trade unions with a relatively homogeneous membership - employed almost exclusively in the health services - and with a strong commitment to the professional development of their members, achieved very high levels of support for the agreement and a high participation rate in the ballots. The largest and most influential trade union in this category, the Royal College of Nursing, with 345,000 members, achieved an 88% vote in support of the agreement, with 32% of members voting. The Chartered Society of Physiotherapy achieved a positive vote of 86%, with a remarkable turn-out of more than 70%, and the Royal College of Midwives achieved a positive vote of 93%. In contrast to these results, members of the Society of Radiographers, representing 16,000 diagnostic imaging and radiotherapy specialists, voted against the agreement by the narrowest of margins (51%). This negative vote may have arisen from members’ frustration with chronic recruitment and retention problems caused by relatively low pay, and anger that the agreement would lead eventually to an increase in the standard working week by 2.5 hours.

Second, the large 'general unions' with significant - but more heterogeneous - health service membership, and 'ideologically-oriented' internal political systems, anticipated difficulties in achieving a positive vote in support of the agreement. The solution adopted by Unison, the largest public services union, was to take a two-stage approach to the ratification of the agreement. The leadership recommended that members should support the proposition that the new pay system should be tested in the 12 'early implementers' sites identified in the agreement, 'so that problems can be identified and resolved, where necessary, through further negotiation'. On the basis of this experience, a second ballot would be held in 2004 to decide whether the new system should then be implemented throughout the rest of the health service. Of the 22% of Unison members who voted, more than 80% supported the recommendation of the leadership.

Two other large general unions, Amicus-MSF and the Transport and General Workers’ Union, adopted a similar two-stage procedure and received strong support for their participation in the initial implementation phase of the agreement. In contrast, the leadership of the GMB general union supported the agreement without reservation, arguing that it offered the prospects of better pay, conditions and career progression for health service support workers. This position was endorsed by 86% of the members voting in the ballot.

A meeting of the central negotiating group - comprising the trade unions, government health departments and representatives of NHS employers - which negotiated the agreement, was to be held on 11 June. Given the immense amount of preparatory work undertaken by all of the parties, it is almost certain that the meeting will decide to proceed with the early implementation phase of the agreement. This would allow more than 1 million NHS staff to receive a 3.2% increase in basic pay, backdated to April 2003 - the first part of an agreed (minimum) pay increase of 10% over three years.

Apart from the technical and organisational complexity involved in the implementation of the comprehensive package of reforms, trade unions, employers and government have to resolve major disagreements on wider issues of health service reform. In particular, the government is committed to introducing 'foundation hospitals'. It argues that the creation of non-profit public interest bodies, with closer ties with local communities, would offer frontline hospital staff greater independence from central government controls and more freedom to develop innovative policies.

All of the health service trade unions oppose these plans. At a meeting of health service unions affiliated to the Trades Union Congress (TUC) held on 2 May 2003, the TUC general secretary elect, Brendan Barber, argued that the proposals 'have provoked powerful fears that a coherent NHS will be undermined by the injection of more market processes that will exacerbate rather than diminish inequalities in health provision'. He noted also that almost no consultation with trade unions had taken place. The government may be forced to delay or abandon its plans for foundation hospitals in the face of widespread opposition. Nonetheless, the serious conflict with trade unions that they have generated, as well as the additional pressures that they would place on managers who feel overwhelmed by an unending series of reforms, do not, according to commentators, provide an ideal context for the implementation of the health service agreement, which requires an active commitment to social partnership.

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