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https://healthmedia.blog.gov.uk/2022/11/30/nhs-industrial-action-media-fact-sheet-2/

NHS industrial action - media fact sheet

Posted by: , Posted on: - Categories: NHS, Workforce

*Updated 18 January*

This fact sheet sets out the Department of Health and Social Care’s position on industrial action by NHS staff.

 Health and Social Care Secretary Steve Barclay said:

“Patients will understandably be worried by the prospect of further strike action by nurses - the previous two days of nurse strikes saw around 30,000 elective procedures and outpatient appointments cancelled. It is inevitable industrial action will have an impact on patients.

“I have had constructive talks with the Royal College of Nursing and other unions about the 2023/24 pay process and look forward to continuing that dialogue.”

Contents

  1. Pay rise for Agenda for Change staff
  2. Pay process
  3. Contingency plans
  4. Junior doctors
  5. Support for NHS

Q&A 

  1. Pay rise for Agenda for Change Staff

What is the Royal College of Nursing asking for and how much would this cost?

  • The Royal College of Nursing is asking for a pay rise of 5% above RPI inflation.
  • At the time of the RCN ballot result, this equated to a rise of 17.6% using September inflation data.
  • Inflation changes from month to month and using December’s RPI inflation data, this would equate to a pay rise of 18.4%.
  • Uplifting pay for all staff on the Agenda for Change contract by 18.4%, instead of the existing 22/23 award, would cost around an additional £9.4 billion.
  • This is around 6.2% of the total NHS budget (£152.6 billion for 2022/23).
  • Agenda for Change is the system which governs pay across all non-medical NHS staff - including nurses, midwives, ambulance workers, porters and cleaners - covering more than 1 million workers. It aligns pay scales and career progression across all groups, meaning pay rises apply to everyone under this contract.

What are other unions asking for and how much would this cost?

  • Unite, Unison, GMB and other unions have asked for a pay rise above inflation.
  • Each additional 1% of pay for all Agenda for Change staff would cost around £700 million per year.
  • Uplifting pay for the entire AfC workforce by current CPI inflation (10.5% in December), instead of the existing 22/23 award, would cost approximately an additional £4bn. This is 2.6% of the total NHS budget (£152.6 billion for 2022/23).
  • Uplifting pay for the entire AfC workforce by current RPI inflation (13.4% in December), instead of the existing 22/23 award, would cost approximately an additional £6bn. This is 3.9% of the total NHS budget (£152.6 billion for 2022/23).

What is the government offering? 

  • By accepting the independent pay review body recommendations, we have given over one million NHS workers a pay rise of at least £1,400 this year.
  • Newly qualified nurses have had a 5.5% increase and those on the lowest salaries, such as porters and cleaners, are seeing a pay rise of up to 9.3%.
  • This is on top of 3% last year when public sector pay was frozen, and wider government support to help with the cost of living.

How much are nurses paid? 

  • Most nurses have received around a 4-5% pay rise, dependent on where they are in their band, for example:
  • Full-time basic pay for newly qualified nurses starting at the bottom of Band 5 has increased by £1,400, equivalent to 5.5%, to £27,055 from £25,655 last year. This means a newly qualified nurse who works full-time might expect average earnings of over £31,000 a year including typical overtime and unsocial hours payments.
  • A nurse at the top of band 5, which requires at least four years of experience, had a 4.4% increase in basic pay and might expect total earnings over £38,000 a year if they work full-time. This is made up of basic pay of £32,934 plus additional payments including unsocial hours, geographical supplements and overtime. Full-time basic pay for nurses after promotion to the bottom of Band 6 has increased by £1,400, equivalent to 4.3%, to £33,706 from £32,306 last year.
  • With the 4% enhancement, full-time basic pay at the top of Band 6 (for nurses with at least five years’ experience after promotion to Band 6) has increased by £1,561, to £40,588 from £39,027 last year.
  • Nurses also receive a pension contribution worth 20% of their salary.

How much are ambulance workers paid?

  • Most ambulance staff have received a rise of at least 4%, increasing average basic pay per person to around £34,300.
  • On average, ambulance staff have additional earnings worth around 37% of basic pay, covering unsocial hours, geographical supplements and overtime. This takes total earnings to around £47,000 per person.
  • Paramedics who are members of the NHS Pension Scheme also receive a pension contribution worth 20% of their salary.

How much are midwives paid?

  • Most midwives have received an increase of at least 4%.
  • The pay award has increased average basic pay for midwives from around £37,400 in March 2022 to around £38,800.

How much are porters/cleaners paid?

  • Full-time basic pay for porters and cleaners newly entering at the bottom of Band 2 has increased by £1,724 compared to 2021/22, equivalent to 9.3%, to £20,270 from £18,546 last year.
  • Full-time basic pay at the top of Band 2 (for porters and cleaners with at least two years’ experience) has increased by £1,400, equivalent to 7.0%, to £21,318 from £19,918 last year.

How much do physiotherapists get paid?

  •  Most Physiotherapists have received an increase of at least 4%
  • Full-time basic pay for newly qualified physiotherapists starting at the bottom of Band 5 has increased by £1,400, equivalent to nearly 5.5%, to £27,055 from £25,655 last year
  • Full-time basic pay for physiotherapists after promotion to the bottom of Band 6 has increased by £1,400, equivalent to 4.3%, to £33,706 from £32,306 last year.
  • With the 4% enhancement, full-time basic pay for experienced physiotherapists at the top of Band 6 (with at least five years’ experience after promotion) has increased by £1,561, to £40,588 from £39,027 last year.
  • Physiotherapists who are members of the NHS Pension Scheme also receive a pension contribution worth 20% of their salary.

Is this a fair deal? 

  • We know these are challenging times for everyone, caused by global economic factors, and we have given a fair pay settlement that strikes a careful balance between recognising the vital importance of public sector workers whilst minimising inflationary pressures and managing the country’s debt.
  • The value of the 2022-23 pay settlement was broadly comparable with the private sector where average pay settlements were in the range of 4-6% when the PRBs were making their recommendations.

 

2 Pay process

How is pay decided? 

  • Public sector pay uplifts are determined by the independent pay review bodies (PRBs) who are made up of industry experts.
  • PRBs carefully consider evidence submitted to them from a range of stakeholders, including government and trade unions.  They base their recommendations on several factors including the economic context, cost of living, recruitment and retention, morale, and motivation of NHS staff.

Were the pay review body recommendations made before inflation went up?

  • The NHS Pay Review Body submitted its recommendations to government in June.
  • At the time, published inflation data covered the 12-months to April 2022 and was 9.0% for CPI and 11.1% for RPI. Current CPI inflation is 10.5% and RPI inflation is 13.4% (using December 2022 values).
  • The pay review bodies are made up of industry experts who carefully consider evidence submitted to them from a range of stakeholders, including government and trade unions. They base their recommendations on several factors including, but not limited to, the economic context, cost of living, recruitment and retention, morale, and motivation of NHS staff.

Will the government go back to the negotiation table with unions? 

  • Ahead of the independent pay review body process getting underway for next year, the Health Secretary met several healthcare unions in early January to have an honest, two-way conversation about what is affordable and fair, including wider concerns around pay, conditions and workload.
  • We know these are challenging times for everyone, caused by global economic factors. We want to strike the right balance between what is fair for public sector workers and what the taxpayer – ordinary people across the UK – can afford. We hope the unions will continue to work constructively with us and share the evidence behind their demands too.
  • The independent Pay Review Body process is the established mechanism for determining pay uplifts in the public sector, outside of negotiating multi-year pay and contract reform deals, and we are clear this is the approach the government will be following.

 

3. Contingency plans

What's your advice to the public on strike days?

What are your contingency plans to protect patient safety and mitigate disruption?

  • The government has been working closely with the NHS to put in place contingency plans.
  • The Health and Social Care Secretary has met with ambulance union representatives from Unison, Unite, GMB, and the Association of Ambulance Chief Executives to discuss which services should be exempt from strike action, including life-threatening emergency calls.

Mitigation measures for ambulance strikes 

  • NHS England and NHS trusts have been working with trade unions and professional bodies to agree the safe level of cover during industrial action at a local level. The NHS has tried and tested plans in place to mitigate risks to patient safety and manage disruption.
  • Around 500 military personnel will be drafted in to drive ambulances on strike days, with an additional 100-150 personnel providing logistical support.
  • The NHS is also working with Community First Responders, who are volunteers trained to provide treatment until ambulances arrive.
  • NHS England issued a letter on 16 December outlining contingency plans to ensure minimal disruption to patient care and protect patients on ambulance strike days. This includes:
    • Ensuring measures are in place to enable all ambulances to handover patients no later than 15 minutes after arrival.
    • Free up maximum bed capacity by safely discharging patients, working closely with system partners, in advance of industrial action.
    • Take steps to allow immediate moving of patients who have completed their emergency medical care and are awaiting an inpatient bed out of the emergency department to create space for new patients. This may involve the creation of observation areas and additional beds elsewhere in the hospital.
  • NHS trusts will also scale up winter resilience plans, including:
  • Ensuring System Control Centres can make genuine real-time decisions which spread risk in order to improve patient safety.
  • Establishing 8am-8pm falls response services to support people in the community and prevent avoidable admissions.
  • Continuing to progress urgent community response services to ensure patients are seen in a timely way, with the right support.
  • Maximising the use of existing virtual wards, and continuing to roll out new virtual ward capacity
  • Creating and strengthening Acute Respiratory Infection hubs to improve ‘one stop’ same day assessment of respiratory conditions.

Mitigation measures for nurse strikes 

  • Operations, appointments and other electives, including cancer treatments, should continue unless there is a clear patient safety reason to reschedule and all reasonable alternatives have been explored.
  • Hospitals will do everything they can to continue planned procedures during periods of industrial action, especially for patients with the greatest clinical need.
  • Realistically, some procedures and appointments will need to be postponed. This is why we’re asking unions to carefully consider the impact on patients. Tackling the Covid backlogs is our absolute priority and the NHS is making strong progress by slashing waits of 18 months by over half in a year and virtually eliminating waits of more than two years.

 

4. Junior doctors

What is the BMA asking for and how much would this cost? 

  •  The BMA is asking for full restoration of junior doctors’ pay to levels equivalent to 2008/2009 based on RPI inflation to April 2022.
  • To restore real terms pay to 2008/09 levels on this basis would cost around £2 billion on top of the existing 22/23 award. This is around 1.3% of the total NHS budget (£152.6bn for 22/23)
  • Each 1% pay award for all junior doctors will broadly cost around £60 million.

 How much do junior doctors get paid?

  • A junior doctor starting training in Foundation Year 1 can expect full-time basic pay of £29,384 in 22/23.  On average, Foundation Year 1 Doctors have additional earnings worth around 31% of basic pay, covering payments for additional activity and unsocial hours payments, resulting in total earnings of around £38,000.
  • A junior doctor progressing into Foundation Year 2 can expect full-time basic pay of £34,012 in 22/23. On average, Foundation Year 2 Doctors have additional earnings worth around 35% of basic pay, covering payments for additional activity and unsocial hours payments, resulting in total earnings of around £46,000.
  • A junior doctor progressing into specialty training can expect a starting basic pay of £40,257 in 22/23. On average, doctors in specialty training have additional earnings worth around 36% of basic pay covering payments for additional activity and unsocial hours payments, resulting in total earnings of around £55,000.
  • The maximum basic pay as a junior doctor depends on the specialty they train in, but once they are qualified, they have opportunity for career advancement into roles in the consultant, Specialty and Associate Specialist, or general practice workforces, potentially earning significantly more.
  • Junior doctors who are also members of the NHS Pension Scheme receive a pension contribution worth 20% of their salary.

Details on the current multi-year pay deal

  • Junior doctors are in a pre-existing multi-year pay and contract reform deal, which ends in March 2023.
  • The junior doctor pay and contract reform deal will see all pay points increase by a cumulative 8.2% between 2019/20 – 2022/23.
  • This deal came alongside an estimated £90 million of additional investment over the four years which:
  • provided the most experienced junior doctors with a higher pay band, recognising that they are often taking decisions and delivering care at near-consultant level. This meant they received a cumulative increase of 24% over the four years. All junior doctors that reach the highest pay point as part of their specialty training will benefit from this.
  • increased allowances for those working the most frequently at weekends.
  • increased rates of pay for night shifts. Shifts between midnight and 4am are paid an additional 37% of the hourly basic rate.
  • created a permanent allowance of £1,000 a year – on top of their usual pay – for junior doctors who work less than full time to recognise the additional costs they face.

 

5. Support for NHS

What are you doing to improve access to emergency care?

  • No-one should have to wait longer than necessary to access urgent and emergency care, which is why we working with the NHS to take action to ease pressures across the system and prepare more extensively for winter than ever before.
  • We are making up to £14.1 billion available for health and social care over the next two years on top of record funding and we’re giving an extra £500 million to speed up hospital discharge and free up beds, ensuring people are only in hospital for as long as they need to be.
  • The NHS is also creating the equivalent of 7,000 more beds this winter – enabling hospitals to treat patients sooner, including by using remote monitoring to provide care at home or in the community.
  • We will publish a recovery plan for emergency care next year.
  • For more information, see the urgent and emergency care factsheet.

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