Representativeness of the European social partner organisations: Hospitals – United Kingdom

  • Observatory: EurWORK
  • Topic:
  • Published on: 27 April 2009



About
Country:
United Kingdom
Author:
Helen Newell
Institution:

The aim of this representativeness study is to identify the respective national and supranational actors (i.e. trade unions and employer organisations) in the field of industrial relations in the hospital sector in the United Kingdom. In order to determine their relative importance in the sector’s industrial relations, this study will, in particular, focus on their representational quality as well as on their role in collective bargaining.

1. Sectoral properties

The National Health Service (NHS) is by far the largest employer in the hospital sector in the United Kingdom, although a small number of private companies also run hospitals (data on their employment is not available). Since 1950, the UK economy has grown almost three-fold in real terms, while NHS spending has increased about seven-fold and the NHS share of gross domestic product (GDP) more than doubled to around 7%. The NHS workforce is larger and more heterogeneous than that elsewhere in the public services, and this is reflected in a complex pattern of representation by professional associations and trade unions. At the same time, the NHS has been undergoing rapid and fairly continuous change. Trade unions are critical of the pace of these reforms and complain of inadequate consultation.

Table 1: Main aspects of hospital sector in the UK, 1994 and 2005
  1994 2005**
Number of employers (a) n.a. 230
Aggregate employment* n.a. n.a.
Male employment* n.a. n.a.
Female employment* n.a. n.a.
Aggregate employees 911,390 1,233,363
Male employees n.a. 370,000*
Female employees n.a. 863,363*
Aggregate sectoral employment as a % of total employment in economy n/a n.a.
Aggregate sectoral employees as a % of total number of employees in economy 3.8% 4.5%

Notes: * employees plus self-employed persons and agency workers; ** or most recent data; n.a. = not available

Data relates to 1996; Data relates to 2006

These figures are taken from the NHS Hospital and Community Health Service and General Practice Workforce, but have been amended to exclude general practitioners (GPs), practice nurses, ambulance staff, other practice staff and support to ambulance staff, which do not take place in hospital settings.

Source: The Information Centre: General and Personal Medical Services; Medical and Dental Workforce Census: Non-medical Workforce Census

* Source: Press release: ‘NHS Employers’ response to the Women and Work Commission report, Shaping a Fairer Future’, 27 February 2006. Among non-medical staff, almost 82% are women.

(a) The 1990 NHS and Community Care Act introduced about 450 self-governing hospital, community care and ambulance ‘trusts’ that employed their staff directly. However many employment contracts remained standardised because of the provisions of the Transfer of Undertakings (TUPE) Regulations 1981. It is not possible to readily differentiate between the number of hospital trusts and private hospitals for 1994. The 2005 figures are inclusive of both. The following companies currently provide private hospital care in the UK, but no data is available on employment figures: Abbey Hospitals, Aspen Healthcare Ltd, BMI Healthcare, Capio Healthcare UK Ltd, Classic Hospitals, HCA International Ltd, Nuffield Hospitals, The Hospital Management Trust, Life Healthcare.

2. The sector’s unions and employer associations

This section includes the following trade unions and employer associations:

  • trade unions which are party to sector-related collective bargaining;
  • line with the conceptual remarks outlined in the accompanying briefing note, we understand sector-related collective bargaining as any kind of collective bargaining within the sector, i.e. single-employer bargaining as well as multi-employer bargaining. For the definition of single- and multi-employer bargaining, see 4.2)
  • trade unions which are a member of the sector-related European federation – in this case, the European Federation of Public Service Unions (EPSU);
  • employer associations which are a party to sector-related collective bargaining;
  • employer associations which are a member of the sector-related European employer federation – in this case, the Hospital and Healthcare European Employers’ Association (HOSPEEM).

2a Data on the unions

Traditionally, the NHS collective bargaining structure was divided along professional and occupational lines, leading to a profusion of trade unions and staff associations. The pay system itself was, however, reformed – as Agenda for change in 2002 – when the Department of Health (DH) devolved government health departments and NHS employers reached agreement with the 17 recognised trade unions (UK0501105F). A number of different types of trade union operate in the hospital sector. The first group consists of trade unions with relatively homogeneous memberships – comprising workers who are almost exclusively employed in the health services – and with a strong commitment to the professional development of their members. The second group consists of the large ‘general unions’ with significant, but more heterogeneous, health service membership, as well as members across the public and private sectors.

The following tables list and outline the characteristics of the different trade unions.

British Dietetic Association (BDA)
2a.1 Type of membership (voluntary or compulsory) Voluntary
2a.2 Formal demarcation of membership domain BDA is the professional association and trade union representing dietetics.
2a.3 Number of members in the union 5,768 members in total: 178 men and 5,590 women
2a.4 Number of union members in the sector Data is limited for the hospital sector specifically: BDA represents dietetics working in both the public and private sectors, and there are no data available for the hospital sector alone.
2a.5 Female union members as a % of total union membership 97% female membership
2a.6 Density with regard to the union domain (see 2a.2) Dieticians can work in a variety of areas: many work in NHS hospitals, while others work in the community as dieticians, health educators or managers. Although no specific figures are available, as the only professional association for dieticians, BDA is likely to represent the vast majority of employees in this group, whether they are located in hospitals or outside (A).
2a.7 Density of the union with regard to the sector* Although no specific figures are available, as the only professional association for dieticians, BDA is likely to represent the vast majority employees in this group, whether they are located in hospitals or outside (A).
2a.8 Does the union conclude collective agreements? The association can provide evidence to the independent health pay review bodies at national level, although final decisions on pay awards are then made by the government. Through the NHS Staff Council, the trade unions negotiate any variations in core conditions and the interpretation of the national pay agreement. Collective bargaining might also occur locally at trust-level with regard to issues such as working time.
2a.9 Interest affiliation
  • is a member of the Trades Union Congress (TUC).

Note: A = administrative data

British and Irish Orthoptic Society (BIOS)
2a.1 Type of membership (voluntary or compulsory) Voluntary
2a.2 Formal demarcation of membership domain BIOS is the professional association and trade union representing orthoptists.
2a.3 Number of members in the union 1,043 members in total: 38 men, 1,005 women
2a.4 Number of union members in the sector Data is limited for the hospital sector specifically: the majority of BIOS members are employed within the NHS, but may also work in community clinics as well as hospitals, and there are no figures to reflect this breakdown.
2a.5 Female union members as a % of total union membership 96% female membership
2a.6 Density with regard to the union domain (see 2a.2) Although there are no specific figures available, as the only professional association for orthoptists, BIOS is likely to represent the vast majority of employees in this group, whether located in hospitals or outside (A).
2a.7 Density of the union with regard to the sector* Same as previous response (2a.6)
2a.8 Does the union conclude collective agreements? The organisation can provide evidence to the independent health pay review bodies at national level, although final decisions on pay awards are then made by the government. Through the NHS Staff Council, the trade unions negotiate any variations in core conditions and the interpretation of the national pay agreement. Collective bargaining might also occur locally at trust-level with regard to issues such as working time.
2a.9 Interest affiliation
  • is a member of the TUC.

Note: A = administrative data

Chartered Society of Physiotherapy (CSP)
2a.1 Type of membership (voluntary or compulsory) Voluntary
2a.2 Formal demarcation of membership domain CSP is the professional, educational and trade union body for the UK’s chartered physiotherapists, physiotherapy students and assistants.
2a.3 Number of members in the union 35,050 members in total: 4,030 men, 31,020 women
2a.4 Number of union members in the sector Data is limited for the hospital sector specifically: increasingly, CSP members are working outside the hospital setting, with a growing number employed by GP fundholders or primary care trusts. Once again, there are no readily available data on the number currently working within hospitals.
2a.5 Female union members as a % of total union membership 86% female membership
2a.6 Density with regard to the union domain (see 2a.2) As the only professional association for physiotherapists, CSP is likely to represent the vast majority of employees in this group, whether located in hospitals or outside (A).
2a.7 Density of the union with regard to the sector* Same as previous response (2a.6)
2a.8 Does the union conclude collective agreements? The organisation can provide evidence to the independent health pay review bodies at national level, although final decisions on pay awards are then made by the government. Through the NHS Staff Council, the trade unions negotiate any variations in core conditions and the interpretation of the national pay agreement. Collective bargaining might also occur locally at trust-level with regard to issues such as working time.
2a.9 Interest affiliation
  • is a member of the TUC.

Note: A = administrative data

Managers in Partnership (MiP)
2a.1 Type of membership (voluntary or compulsory) Voluntary
2a.2 Formal demarcation of membership domain This new trade union organisation represents the leaders and managers of the UK’s four health services – the NHS in England, Scotland and Wales and Health and Social Care in Northern Ireland (HSC). Unison, the largest public service union in the UK, and the First Division Association (FDA), the specialist management union, launched MiP in June 2005. MiP is a national branch of Unison and a section of FDA. Members therefore belong to both unions. A management board of senior officers from Unison and FDA agrees on MiP’s overall strategy.
2a.3 Number of members in the union Over 5,000 members
2a.4 Number of union members in the sector No specific data available for MiP
2a.5 Female union members as a % of total union membership Data not available for MiP; FDA has 44% female membership, while Unison has 70% female membership.
2a.6 Density with regard to the union domain (see 2a.2) n.a.
2a.7 Density of the union with regard to the sector* n.a.
2a.8 Does the union conclude collective agreements? The organisation can provide evidence to the independent health pay review bodies at national level, although final decisions on pay awards are then made by the government. Through the NHS Staff Council, the trade unions negotiate any variations in core conditions and the interpretation of the national pay agreement. Collective bargaining might also occur locally at trust-level with regard to issues such as working time.
2a.9 Interest affiliation
  • is not a member of the TUC directly, although Unison and FDA are.

Note: A = administrative data; n.a. = not available

General Trade Union (GMB)
2a.1 Type of membership (voluntary or compulsory) Voluntary
2a.2 Formal demarcation of membership domain GMB is one of the UK’s largest general unions, with members in the NHS, local government, care and education. It also has members in a range of private-sector industries such as engineering, construction, shipbuilding, energy, catering, security, civil air transport, aerospace, defence, clothing, textiles, retail, hotel, chemicals, utilities, offshore, food production and distribution.
2a.3 Number of members in the union 575,892 members in total: 327,512 men, 248,380 women
2a.4 Number of union members in the sector GMB has some 285,000 members in its public services section, which constitutes 48% of its entire membership. There is no breakdown available for the hospital sector alone.
2a.5 Female union members as a % of total union membership 43% female membership
2a.6 Density with regard to the union domain (see 2a.2) n.a.
2a.7 Density of the union with regard to the sector* n.a.
2a.8 Does the union conclude collective agreements? The organisation can provide evidence to the independent health pay review bodies at national level, although final decisions on pay awards are then made by the government. Through the NHS Staff Council, the trade unions negotiate any variations in core conditions and the interpretation of the national pay agreement. Collective bargaining might also occur locally at trust-level with regard to issues such as working time.
2a.9 Interest affiliation GMB is a member of the following organisations:
  • the European Federation of Food, Agriculture and Tourism Trade Unions (EFFAT);
  • the European Federation of Retired and Older People (FERPA);
  • the European Federation of Building and Woodworkers (EFBWW);
  • the European Trade Union Federation Textiles, Clothing and Leather (ETUF:TCL);
  • the European Metalworkers’ Federation (EMF);
  • the European Mine, Chemical and Energy Workers’ Federation (EMCEF);
  • EPSU; 
  • UNI-Europa;
  • the TUC.

Note: A = administrative data; n.a. = not available

Hospital Consultants and Specialists’ Association (HCSA)
2a.1 Type of membership (voluntary or compulsory) Voluntary
2a.2 Formal demarcation of membership domain HCSA is a professional association and trade union representing and advising senior medical and surgical staff in the UK.
2a.3 Number of members in the union 3,088 members in total: 2,612 men, 476 women
2a.4 Number of union members in the sector HCSA’s membership is not differentiated between NHS Hospital and Community Health Services.
2a.5 Female union members as a % of total union membership 15% female membership
2a.6 Density with regard to the union domain (see 2a.2) There are 32,874 consultants in the NHS, which suggests that HCSA represents less than 10% of the employees (however, this varies across all trusts, and may be up to 50% in some cases). Since all consultants working in private hospitals in the UK are also consultants within the NHS, this means that the union also represents less than 10% of employees within its union domain (A).
2a.7 Density of the union with regard to the sector* Same as previous response (2a.6)
2a.8 Does the union conclude collective agreements? HCSA decided a few years ago that providing evidence to its review body, the Doctors’ and Dentists’ Review Body (DDRB), was a poor use of its time, so it withdrew from the process. Through the NHS Staff Council, the trade unions negotiate any variations in core conditions and the interpretation of the national pay agreement. Collective bargaining might also occur locally at trust-level with regard to issues such as working time.
2a.9 Interest affiliation
  • is a member of the TUC.

Note: A = administrative data

Unison
2a.1 Type of membership (voluntary or compulsory) Voluntary
2a.2 Formal demarcation of membership domain Unison is a large general union based in the public and private sectors. It recruits members in local government, healthcare, the water, gas and electricity industries, further and higher education, schools, transport, the voluntary sector and housing associations, along with police support staff. Within healthcare, its main occupational base is ancillary staff.
2a.3 Number of members in the union
2a.4 Number of union members in the sector Unison’s healthcare service group represents more than 400,000 employees in the NHS and staff employed by private contractors, the voluntary sector and general practitioners.
2a.5 Female union members as a % of total union membership 70% female membership
2a.6 Density with regard to the union domain (see 2a.2) n.a.
2a.7 Density of the union with regard to the sector* n.a.
2a.8 Does the union conclude collective agreements? The organisation can provide evidence to the independent health pay review bodies at national level, although final decisions on pay awards are then made by the government. Through the NHS Staff Council, the trade unions negotiate any variations in core conditions and the interpretation of the national pay agreement. Collective bargaining might also occur locally at trust-level with regard to issues such as working time.
2a.9 Interest affiliation Unison is a member of the following organisations:
  • Union Network International (UNI);
  • the International Metalworkers’ Federation (IMF);
  • the International Textile, Garment and Leather Workers’ Federation (ITGLWF);
  • the International Federation of Chemical, Energy, Mine and General Workers’ Unions (ICEM);
  • the International Federation of Building and Woodworkers (IFBWW);
  • Public Services International (PSI);
  • the International Union of Food, Agricultural, Hotel, Restaurant, Catering, Tobacco and Allied Workers (IUF);
  • the International Transport Workers’ Federation (ITF);
  • EMCEF;
  • the European Transport Workers’ Federation (ETF);
  • EFFAT;
  • EPSU;
  • EMF;
  • EFBWW;
  • Union Network Europa;
  • the TUC.

Note: n.a. = not available

Unite
2a.1 Type of membership (voluntary or compulsory) Voluntary
2a.2 Formal demarcation of membership domain Unite is the recently formed general trade union, created in 2007 following the merger of Amicus and T&G.
2a.3 Number of members in the union 1,941,610 members in total: 1,508,318 men, 433,292 women
2a.4 Number of union members in the sector The Unite-Amicus section is the third largest trade union in the NHS and represents about 100,000 health sector workers. This includes seven professional associations: the Community Practitioners and Health Visitors’ Association (CPHVA), the Guild of Healthcare Pharmacists (GHP), the Medical Practitioners’ Union (MPU), the Society of Sexual Health Advisors (SSHA), the Hospital Physicists’ Association (HPA), the College of Healthcare Chaplains (CHCC) and the Mental Health Nurses’ Association (MHNA). Its members range across occupations such as allied health professions, healthcare science, the family of psychology, counsellors and psychotherapists, the family of dental professions, audiology, optometrists, opticians and building trades, estates, craft and maintenance. There are no figures available for the hospital sector.
2a.5 Female union members as a % of total union membership 22% female membership
2a.6 Density with regard to the union domain (see 2a.2) n.a.
2a.7 Density of the union with regard to the sector* n.a.
2a.8 Does the union conclude collective agreements? The organisation can provide evidence to the independent health pay review bodies at national level, although final decisions on pay awards are then made by the government. Through the NHS Staff Council, the trade unions negotiate any variations in core conditions and the interpretation of the national pay agreement. Collective bargaining might also occur locally at trust-level with regard to issues such as working time.
2a.9 Interest affiliation Unite is a member of the following organisations:
  • UNI;
  • IMF;
  • ITGLWF;
  • ICEM;
  • IFBWW;
  • PSI;
  • IUF;
  • ITF;
  • EMCEF;
  • ETF;
  • EFFAT;
  • EPSU;
  • EMF;
  • EFBWW;
  • Union Network Europa;
  • the TUC.

Note: n.a. = not available

Royal College of Nursing (RCN)
2a.1 Type of membership (voluntary or compulsory) Voluntary
2a.2 Formal demarcation of membership domain RCN is the largest professional association and trade union for nursing in the UK.
2a.3 Number of members in the union 380,000 members
2a.4 Number of union members in the sector RCN’s membership is also not differentiated between NHS Hospital and Community Health Services. There are 398,335 qualified nurses working in the NHS as a whole and the RCN represents most of these.
2a.5 Female union members as a % of total union membership Although no precise figures are available, more than 90% of nurses are women; therefore, this should be reflected in RCN’s membership figures.
2a.6 Density with regard to the union domain (see 2a.2) There are 398,335 qualified nurses working in the NHS. Even allowing for the number of student nurses, qualified nurses and healthcare support workers in the private sector, this figure suggests that RCN is very dominant in terms of the both the sector and union domains (A).
2a.7 Density of the union with regard to the sector* Same as previous response (2a.6)
2a.8 Does the union conclude collective agreements? The organisation can provide evidence to the independent health pay review bodies at national level, although final decisions on pay awards are then made by the government. Through the NHS Staff Council, the trade unions negotiate any variations in core conditions and the interpretation of the national pay agreement. Collective bargaining might also occur locally at trust-level with regard to issues such as working time.
2a.9 Interest affiliation No affiliation

Note: A = administrative data

Royal College of Midwives (RCM)
2a.1 Type of membership (voluntary or compulsory) Voluntary
2a.2 Formal demarcation of membership domain RCM is the professional association and trade union for midwives.
2a.3 Number of members in the union About 23,000 members
2a.4 Number of union members in the sector RCM represents the vast majority of midwives working in the NHS, but these are not confined to the hospital sector since midwives also work in the community. There are less than 200 independent midwives working outside the NHS.
2a.5 Female union members as a % of total union membership The vast majority of members (over 90%) are women.
2a.6 Density with regard to the union domain (see 2a.2) RCM represents the vast majority of midwives (A).
2a.7 Density of the union with regard to the sector* RCM represents the vast majority of midwives working in the NHS; there are less than 200 independent midwives working outside of the NHS (A).
2a.8 Does the union conclude collective agreements? The organisation can provide evidence to the independent health pay review bodies at national level, although final decisions on pay awards are then made by the government. Through the NHS Staff Council, the trade unions negotiate any variations in core conditions and the interpretation of the national pay agreement. Collective bargaining might also occur locally at trust-level with regard to issues such as working time.
2a.9 Interest affiliation No affiliation

Note: A = administrative data

Society of Radiographers
2a.1 Type of membership (voluntary or compulsory) Voluntary
2a.2 Formal demarcation of membership domain The Society of Radiographers represents more than 90% of diagnostic and therapeutic radiographers in the UK.
2a.3 Number of members in the union 16,838 members in total: 2,553 men, 14,285 women
2a.4 Number of union members in the sector There are about 18,000 registered radiographers in the UK. The NHS employs 90% of all radiographers in the UK, the rest are employed in private clinics and industry. The society represents over 90% of all diagnostic and therapeutic radiographers in the UK.
2a.5 Female union members as a % of total union membership 85% female membership
2a.6 Density with regard to the union domain (see 2a.2) There is a significant overlap between the society and the union domain. With 16,838 members out of a possible total of about 18,000 members, there is approximately 90% coverage within both the sector and the domain (A).
2a.7 Density of the union with regard to the sector* Same as previous response (2a.6)
2a.8 Does the union conclude collective agreements? The organisation can provide evidence to the independent health pay review bodies at national level, although final decisions on pay awards are then made by the government. Through the NHS Staff Council, the trade unions negotiate any variations in core conditions and the interpretation of the national pay agreement. Collective bargaining might also occur locally at trust-level with regard to issues such as working time.
2a.9 Interest affiliation The society is a member of the TUC.

Note: A = administrative data

2b Data on the employer associations

The Department of Health is responsible for setting health and social care policy at national level. At local level, however, the NHS is run by health authorities and health trusts. England is divided into 10 Strategic Health Authorities (SHAs). Within each SHA, the NHS is split into various types of trusts that are responsible for running different NHS services. NHS Employers is the body that represents employers on workforce issues, particularly in relation to pay and negotiations, recruitment and planning of the workforce, health and productivity, and employment policy and practice. NHS Employers is a member of the NHS Confederation. The NHS Confederation brings together all the organisations that make up the modern NHS across the UK. It is the only membership body for all types of NHS organisations, with over 92% membership. 

Health provision in the NHS is split between primary care – the first point of professional contact for patients in the community, for example encompassing general practitioners, dentists, opticians and support occupations, along with occupational health, and health education and promotion – and secondary care, specialised treatment, normally carried out in hospitals. NHS hospital services are run and managed by acute and foundation trusts. There are more than 160 acute trusts employing a large proportion of the NHS workforce. Some acute trusts are regional or national centres for more specialised care. Others are attached to universities, but they can also provide services in the community, for example through health centres or clinics. Foundation trusts also run some hospitals. These have more financial and operational freedom than other NHS trusts but remain within the NHS and its performance inspection system. They were first introduced in April 2004, and there are now 67 foundation trusts in England.

2b.1 Type of membership (voluntary vs. compulsory)

Formally, membership is voluntary, but in practice all health trusts are members because it is in their interest to be so.

2b.2 Formal demarcation of membership domain (e.g. SMEs, small-scale crafts/industry, health services, etc.)

As outlined, NHS Employers’ membership domain is limited to employers within the NHS. These take the form of either acute health trusts or foundation trusts.

2b.3 Number of member companies (i.e. the total number of members of the association as a whole)

There are more than 160 acute trusts and 67 foundation trusts.

2b.4 Number of member companies in the sector

Data not available

2b.5 Number of employees working in member companies (i.e. the total number of the association as a whole)

The members of this organisation are the health trusts themselves, which means that the total number of employees is the same as the number of employees working in the hospital sector in the NHS.

2b.6 Number of employees working in member companies in the sector

Data not available

2b.7 Density of the association in terms of companies with regard to their domain (see 2b.2)

NHS employers organise all potential members within their domain (administrative data).

2b.8 Density of the association in terms of companies with regard to the sectorNHS employers organise all potential members within their sector (administrative data).2b.9 Density in terms of employees represented with regard to their domain (see 2b.2)

Data not available

2b.10 Density in terms of employees represented with regard to the sector

Data not available

2b.11 Does the employer association conclude collective agreements?

Data not available

2b.12 For each association, list their affiliation to higher-level national, European and international interest associations (including the cross-sectoral associations).

The NHS Confederation is affiliated to HOSPEEM.

3. Inter-associational relationships

3.1. Unions covered by this study whose domains overlap

Although several general unions represent members within the NHS, they tend to have their own distinctive membership base. For example, Unison represents over 70,000 members working in ancillary and maintenance jobs within the UK. The largest group within this sector consists of cleaning staff. There is a small overlap between the domains of the general unions and the professional associations. Unison, for instance, represents some nurses, midwives, health visitors and healthcare assistants, as well as the groups listed above.

3.2. Do rivalries and competition exist among the unions, concerning the right to conclude collective agreements and to be consulted in public policy formulation and implementation?

All of the trade union organisations have the right to present evidence to the pay review bodies, and they tend to cooperate as evidenced by their joint action in campaigning alliances.

3.3. If yes, are certain unions excluded from these rights?

No

3.4. Same question for employer associations as 3.1

Not applicable

3.5. Same question for employer associations as 3.2

Not applicable

3.6. Same question for employer associations as 3.3

Not applicable

4. The system of collective bargaining

National pay scales for medical staff employed within the NHS are determined by ministers, on the basis of recommendations of review bodies. Independent health pay review bodies – such as the NHS pay review body and the DDRB – make recommendations to government on pay awards for doctors, dentists, nursing health professionals and support staff. A separate review body – the Senior Salaries Review Body – makes recommendations on the pay of very senior (board-level) managers working for SHAs, primary care trusts and ambulance trusts. NHS Employers, unions and professional associations submit evidence to the review bodies. Final decisions on pay awards are then made by the government.

The NHS Staff Council oversees the operation of the pay system and has responsibility for NHS-wide terms and conditions of service. Its membership includes representatives of the health service, the UK health departments in each of the UK countries, and representatives of the NHS joint unions. The council also has overall responsibility for the ‘Agenda for change’ pay system. Its remit includes: maintenance of the new pay system; negotiations of any variations in core conditions; and interpretation of the national agreement.

4.1. Sector’s rate of collective bargaining coverage

The pay rates set by the review body do not apply to those working in the private sector, but will cover the vast majority of workers in this sector who are employed by the NHS.

4.2. Relative importance of multi-employer agreements and of single-employer agreements as a percentage of the total number of employees covered

See previous comments in relation to Section 4 above and the centralised nature of the pay determination system.

4.2.1. Is there a practice of extending multi-employer agreements to employers who are not affiliated to the signatory employer associations?

No, as the system already embraces all NHS employees, this is unnecessary.

4.2.2. If there is a practice of extending collective agreements, is this practice pervasive or rather limited and exceptional?

Not applicable

4.3. Sector-related multi-employer wage agreements* valid in 2005 (or most recent data)

The Health Secretary has accepted the 2007 pay review body recommendations for NHS staff and GPs. The recommendations from the pay review bodies were as follows The Nurses and Other Health Professionals Review Body recommended a 2.5% increase on all pay points. The DDRB proposed a flat rate increase of GBP 1,000 (about €1,100 as at 5 April 2009) for all hospital consultants, staff and associate specialists, and salaried dentists; hospital doctors and dentists in training would receive a yearly increase of GBP 650 (€713). The Secretary of State also proposed increasing very senior managers’ pay in line with the average percentage increase given to consultants. To meet the Chancellor’s public sector pay limit, pay rises for most NHS staff will be granted in stages, with a 1.5% being paid from 1 April and the remainder being paid from 1 November.

The staff organisations (unions and professional associations) with national recognition for the purposes of pay review are as follows: Unison; RCN; RCM; Amicus including MSF, AEEU and the Electronic and Engineering Staff Association (EESA); GMB; the Transport and General Workers’ Union (T&G); the Union of Shop, Distributive and Allied Workers (USDAW); CSP; the Community and District Nursing Association (CDNA); the Society of Radiographers; the Federation of Clinical Scientists (FCS); the British Association of Occupational Therapists (BAOT); the Union of Construction Allied Trades and Technicians (UCATT); BIOS; the Society of Chiropodists and Podiatrists (Feet for Life); and BDA. The employer representatives include the employer representatives’ chair and representatives of the UK health departments, the NHS Confederation, the Ambulance Service Association, and other employer representatives, including a primary care representative, a health authority or health board nominee, as well as a representative of the NHS Foundation Trusts. The pay review body recommendations cover more than 60 different groups of employees.

5. Formulation and implementation of sector-specific public policies

5.1. Are the sector’s employer associations and unions usually consulted by the authorities in sector-specific matters?

The sector’s employer associations and trade unions are only consulted through the usual channels of public consultation. For example, the government aims to strengthen the ability of local communities to influence what health and social care services are provided and how they are run. To help achieve this aim, legislation is currently before parliament to establish Local Involvement Networks (LINks) across England. LINks will be made up of individuals and groups from across the community. The government has invited views and comments on these regulations establishing these bodies (see also the comments on campaigning alliances in the final section of this report).

5.2. Do tripartite bodies dealing with sector-specific issues exist?

In the NHS, a new Partnership Agreement has been reached between the Department of Health, NHS Employers and the NHS trade unions (2007). This agreement established a tripartite Social Partnership Forum (SPF), which meets monthly and consists of five Department of Health representatives, five employer representatives and eight NHS trade union representatives. While the arrangement is for the SPF the apply to national arrangements, the Secretary of State for Health has recommended that the principles of partnership be replicated at regional and local levels and has encouraged local employers and SHAs to review their existing arrangements against the partnership agreement.

Table 2: Sector-specific public policies*
Name of body and scope of activity Bipartite/tripartite Origin: agreement/statutory Unions with representatives Employer associations with representatives
SPF . SPF’s role is to discuss, debate and involve partners in the development and implementation of the workforce implications of policy. Its work currently covers 5 specific areas: workforce planning; partnership working; knowledge and skills framework relaunch; staff security; and the NHS staff survey. Tripartite Social partnership agreement Representatives from: RCN; GMB; Amicus; RCM; the Society of Radiographers; the British Medical Association (BMA); the Society of Chiropodists and Podiatrists; CSP; BIOS; CDNA; BDA; FCS; T&G; the BAOT; and the Ambulance Service Association NHS Employers
         

Note: * Sector-specific policies specifically target and affect the sector under consideration.

6. Statutory regulations of representativeness

6.1. In the case of the unions, do statutory regulations exist which establish criteria of representativeness which a union must meet, so as to be entitled to conclude collective agreements?

No – however, statutory trade union recognition legislation passed in 1999 does refer to the definition of bargaining units in terms of employers’ (de)recognition decisions (UK0007183F).

6.2. In the case of the unions, do statutory regulations exist which establish criteria of representativeness which a union must meet, so as to be entitled to be consulted in matters of public policy and to participate in tripartite bodies?

No

6.3. Are elections for a certain representational body (e.g. works councils) established as criteria for union representativeness?

No

6.4. Same question for employer associations as 6.1

Not applicable

6.5. Same question for employer associations as 6.2

Not applicable

6.6. Are elections for a certain representational body established as criteria for the representativeness of employer associations? If yes, please report the most recent outcome for the sector.

Not applicable

7. Commentary

Trade union density is high in the NHS, including in the hospital sector, and there is also a large number of unions. However, the trade unions tend to work cooperatively. This can be seen, for example, in the case of the NHS Together campaign – an alliance where 16 different NHS employee organisations and health service unions, along with the TUC, have come together to lobby on NHS reform. The alliance argues that financial deficits in health trusts are resulting in job losses and cuts to health services. It is also critical of the pace of NHS reform and the imposition of change without adequate and meaningful consultation. The alliance argues that the NHS is changing too quickly, with far too little involvement of staff and their representatives and no real chance to assess the real impact of the changes.

Helen Newell, IRRU, University of Warwick

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