A UNISON guide to influencing the new NHS

This UNISON guide is designed to help members and others exert an influence over decisions to cut or privatise NHS services. It provides information on how to get involved in the work of foundation trusts and clinical commissioning groups, as well as through local authorities and patient and public involvement structures

Download the pdf

Say NO to South West NHS Pay Cartel

The South West NHS Pay Cartel claims that its aims are about ‘about exploring more flexible ways of rewarding and incentivising staff‘ – but the measures being proposed show a very perverse idea of what constitutes reward and incentive. It is clear that the real aim is to enable local NHS Trusts to reduce their pay bill from 68% to 60% which has the net effect of reducing individual earnings by up to 15%.

The cartel is bad for the NHS, bad for patients and bad for all NHS staff across the UK.

The pay cartel will hurt the local economy, compromises patient safety, seriously damages staff morale and creates instability in the workforce at a time when the NHS is going through unprecedented change.

There is no doubt that the formation of the South West cartel is being used a pilot project that will be rolled out to the rest of the country if it is successful. This should concern us all. Other industry sectors throughout the country will be watching in keen anticipation and most probably already looking at ways they can implement similar projects to side step and steam roller over previously agreed national pay and condition negotiation arrangements with the sole intention of cutting wages.

As part of the ongoing campaign against the cartel, local Unions are lobbying Trust meetings:


Trust Board Meeting – 26th September – starting 9:45am
Meet Outside main entrance of Poole Hospital, Longfleet Road, Poole BH15 2JB from 8.30am

Public Council of Governors Meeting – 4th October – 4.30pm
Meeting outside Poole Salvation Army, 2 New Orchard, Poole BH15 1LY at 4.00pm

Download flyer: A4 A5

Trust Board Meeting – 26th September 10am -1pm
Meet outside main entrance of Trust HQ, 11 Shelly road, Boscombe, Bournemouth BH1 4JQ at 08.30am

Public Council of Governors Meeting
7th November 17.00- 19.00
Venue to be confirmed

Download flyer: A4 A5

Please support your local NHS staff in their struggle to fight the cartel’s proposals and send a firm, clear message to the Trust’s Board that this cartel, or any other, is not welcome, not wanted and will be opposed every step of the way.


Download leaflet: A4 A5

1. Reduce APA rates
‘Programmed Activities’ are the basis for contracts for consultants. A standard consultant contract consists of 10 PAs of 4 hours each, resulting in a 40-hour standard work week. Consultants are paid for additional activities in 4-hour APAs. The cartel is proposing to reduce the rates paid for what is effectively consultant overtime.

2. Reduce annual leave
The cartel is considering reducing staff’s holiday entitlement and calculating a saving of £150 per employee for each day’s leave reduced, as well as a saving on the 50% of staff that are typically covered during holidays.

3. Bonus scheme
The cartel is considering incentivising all staff based on cost-savings overall, to exceed the ‘planned surplus’ that each Trust typically aims for and saves for capital projects. To help balance this bonus cost out, measure 4 would be implemented:

4. Clinical Excellence Awards
Trusts typically award CEA points to staff for achieving clinical excellence – a direct benefit to patients. The cartel is valuing these at c£3k per employee – and wants to connect these to ‘desired service activities‘ instead of to clinical excellence. These activities would be more oriented to efficiency than excellence – bad news for patient care.

5. Reduce consultant on-call supplements
Consultants are paid for being on call on-site and off-site. The cartel is considering reducing these rates – expecting them to be equally available for less money.

6. Extra hours
A big one for staff at all levels. The cartel is considering adding 1 hour on top of typical 37.5 hours (AfC) contracts – making already stressed and over-stretched staff work longer for no extra pay, and reducing overtime opportunities that are invaluable to NHS workers facing pay freezes and escalating living costs.

7. Flexible ‘benefits’
This one just represents unbelievable audacity and arrogance. Under this heading, the cartel is considering ‘selling’ stolen annual leave back to staff in return for a reduction in pay!

8. Flex-release (voluntary hours reduction)
The cartel is considering offering staff the option of working 25% fewer hours and receiving 25% less pay – and then only replacing 50% of the lost hours to save cost. The hours lost must surely impact on patient care and increase stress and absence, affecting clinical staffing levels even more, again to the detriment of patients.

9. Reduce/withhold increments
NHS clinical staff are graded in bands based on skills, knowledge and experience. As staff spend longer within a band, they receive annual salary increments to reflect their greater experience and service when it hasn’t yet resulted in moving to a higher band. The cartel is considering reducing these increments – and withholding a percentage of them completely. This means experienced, dedicated staff receiving no reward or recognition of their loyalty and greater experience.

10. Junior medical staff contracts
This one is nothing short of a scam. Junior doctors receive enhancements for anti-social hours and on-call duties. The cartel is thinking of changing the contracts of junior doctors to ‘limited working’ employment contracts that mean most of their hours and activities would be considered education – and would therefore end their access to any enhancements for long, anti-social hours and being available on call when not working. This is expected to result in a 50% saving on around 1000 staff in the cartel’s constituent Trusts.

11. Locum & retired consultant SPA
The cartel wants to end guaranteed SPA (supporting professional activities) time – time which is required for admin, refresher courses etc required for revalidation of professional qualifications and competence.

12. Knowledge and Skills Framework (KSF) reform
Staff are currently rewarded for gaining increased professional skills and knowledge by receiving extra pay reflecting their expertise, to incentivise staff to become more widely competent. This gives employers the advantage of having staff capable of filling more demanding roles when necessary because of staff turnover, sickness etc. The cartel proposes to change this into a ‘KS Performance Framework‘ – in which staff are only paid for gaining knowledge and skills when they are actually using them. This will dis-incentivise staff and reduce the pool of expertise available to care for patients.

13. New consultant roles – direct clinical care
The cartel wants to establish ‘static consultant roles’ where contracts mainly recognise ’DCC’ PA-units (90%), in order to pay less and save money.

14. New employer models – a two-tier workforce
Another massive one – and the title of this section is a direct quote from the document, showing that the cartel is quite prepared to create ’2nd class employees’. This concept means new terms and conditions for staff considered easily replaceable – at rates 20-25% lower. If anyone doesn’t like the lower pay rate, they’re easily replaced.

15. Zero pay inflation (uplift)
The cartel is considering imposing zero ‘cost of living’ increases (except for very low paid staff)

16. Reduced pay levels
The cartel wants to reduce pay, considering that for a typical Trust, a reduction in pay of 1% will save £1.4m.

17. Reduce/eliminate pay protection policy
If re-organisations/restructuring result in staff being moved into jobs with lower banding, their pay from the previous banding is protected for 2-3 years. The cartel wants to remove or reduce this protection, so that staff are deprived of pay if managers decide to move them to different functions.

18. Reduce/remove preceptorship increment fast-track
Staff who take on extra responsibilities for training and mentoring less experienced staff to achieve full competence more quickly are rewarded by receiving in-band increments more rapidly. The cartel is considering removing or reducing this reward structure.

19. Flat-rate sick pay
Sickness pay currently includes anti-social hours rates. The cartel plans to award sick-pay at a flat, reduced rate. This seems to be broadly similar to the AfC measure under discussion.

20. Recruitment and retention premia (RRP)
Some key types of staff are paid at higher rates to prevent losing them. Under this proposal, these improved rates would be terminated as soon as any protections expired.

21. Reduction in working week and income
The cartel is considering imposing a 10% reduction in the working week – and of course reducing pay accordingly. This is expected to save £14m per typical Trust – but cannot possibly be implemented without adverse effects on patient care.

22. Redundancy payments
Current redundancy payments are equivalent on average to 1-2 years of salary costs given typical length of service (plus early retirement financial commitments). It is proposing to reduce these important benefits.

23. Remuneration for extra clinical work
Staff undertake extra clinical work, for example to help reduce waiting lists. This would be reduced/eliminated – again with negative impacts for patients.

24. Unpaid sickness absence (short term)
The cartel is considering making the first 2 days of any sickness absence unpaid. Given that much sickness is the result of injuries sustained at work, stress caused at work and diseases caught at work, this is positively criminal.

25. Reduce sick-pay entitlement
The proposal is to reduce sick pay for new staff and long term benefits from 6 months full pay and 6 months half pay after 5 years’ service to 3 months of each. Again, in the context of work-incurred illness, stress and injury, this is deplorable.

26. Supporting Professional Activities (SPAs)
The cartel wants to reduce time spent on SPA activity by consultants.

27. Temporary staffing rates 10% reduction
The cartel proposes to reduce the rate paid to temporary staff by at least 10%.

28. Reduce unsocial hours allowances
Health workers often have no choice but to work late shifts, night shifts, weekends, bank holidays etc, as the need for patient care doesn’t stop outside office hours. These shifts impact heavily on family life and often on health. The cartel is considering reducing the financial recognition of the dedication of staff and the adverse effects of unsocial and variable hours.

Reproduced, with permission, from the blog of skwalker1964 See also:

The smoking gun: govt involved in formation of SW NHS pay cartel ‘national pilot project’

By just how much is the SW pay cartel planning to cut NHS staff pay?

Poole NHS Trust breaks own legal advice to dodge FOI request

The 28 measures the South-West pay cartel is considering against staff

Lobby Against South West NHS Pay Cartel

Download flyer: PDF JPG

Please support a lobby of Dorset Healthcare University Foundation Trust against the South West NHS Pay Cartel on Thursday 6th September at 3.30pm during their AGM.

NHS Trusts across the South West have joined together and contributed an opening ante of £10,000 for a ‘war chest’ to attack national bargaining and introduce regional pay. The once ‘secret’ proposals make it clear that each Trust wants to reduce their pay bill from 68% to 60% which has the net effect of reducing individual earnings by up to 15%.

It is no coincidence that this is happening in the South West as general union membership density is low with many unorganised workplaces. If we allow this to happen in the South West it will happen everywhere else! We are posing great resistance towards the Cartel and it’s proposals which threaten to undermine the current national negotiations and we are looking to extend our campaign.

Please feel free to circulate this event to any other relevant groups who could lend their support to prevent the dismantling of the NHS and collective bargaining.

Sign this petition to say NO WAY to Postcode Pay!

UNISON demo outside Poole Hospital

Several hundred delegates from the UNISON conference being held at the BIC in Bournemouth attended a lunchtime flash demo, on June 21st, outside Poole General Hospital in protest against the South West Pay NHS Cartel.

Sixteen NHS trusts in the South West have banded together in a bid to make “radical” changes to staff pay, terms and conditions outside of the national Agenda for Change agreement. Each trust paid £10,000 to join this cartel.

The consortium of trusts is considering a suite of proposals to reduce workforce costs by 8 per cent across the region.

A leaked document drawn up by this consortium reveals that, if a deal cannot be reached, trusts may consider dismissing staff and rehiring them on the new terms in order to force through the changes.

Plans include changes to working hours, annual leave entitlements and pay. The consortium also intends to look at “attractive, performance-driven approaches” to pay and conditions.

Poole NHS trust is a “key player” in setting up the cartel as its chief executive, Chris Bown, is chair of its steering group.

Unison say the plans will “damage patient care and drive down pay”, and threatens the future of on-going national negotiations between unions and government representatives on changes to Agenda for Change.

Unison South West state: “We believe the cartel’s approach is simply a cost cutting exercise which will affect the quality of services.”

“The consequences for the region will be disastrous; skilled health workers will be driven out of the region, taking money out of the local economy, deepening the healthcare postcode lottery.”

Unison head of health Christina McAnea, said: “The setting up of this pay cartel is a crude attempt to drive down wages, which in turn will damage the quality of patient care in all 16 trusts.

“The cartel will lead to shortages of key staff who will vote with their feet and move to hospitals where the pay is better and patients will be the ones who suffer.”

She added: “Cutting wages of hospital workers will also have a knock-on effect on already depressed economies in the South West. Health workers are already suffering from a two year pay freeze and this further assault on their pay and conditions will hit morale as well as their spending power.”

“We do not want rogue employers threatening to undermine the stability of national pay bargaining and Agenda for Change. It is not too late for those 16 trusts to do the right thing by their patients and staff and drop this damaging and divisive plan.”

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Sources: UNISONHealth Sources Journal Nursing TimesRCN

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