NHS staff could end up footing the bill for seven-day services

All of the funding options put forward by the Department of Health would involve cuts to unsocial hours payments



When you go into hospital, the day of the week or the time of day you are admitted should never be a factor in determining how well – or even if – you recover. UNISON members would absolutely agree with that. And yes, there is evidence that at the moment these factors can make a significant difference.

So when Jeremy Hunt says he will put money into ensuring more services are available over seven days this is to be welcomed. But there are still serious questions to be asked, and more importantly answered by this government, on funding and implementation.

Will the extension of seven-day services be in areas where clinical evidence shows it will have a positive impact on patients? Or is it also mixed up with a cynical, political soundbite to make the NHS just another commodity in ‘consumer choice’?

Of course the NHS should be flexible in meeting patients’ needs, but at a time when budgets are tight and demand is growing, governments cannot treat, or encourage the public to treat, the NHS as if it were a 24-hour supermarket.

The other critical issue is, of course, funding. Throughout the election campaign and even this week, David Cameron has been very coy on where this £8 billion will come from. UNISON’s concern is that the government plans to pay for this through cutting the existing provisions for paying staff who work unsocial hours.

To put this in context; the average pay of a nurse in the UK is £30,948 per annum. But this includes an average of £3,901 in non basic pay – that is earnings from overtime and unsocial hours. Cutting the unsocial hours premium would make pay in the NHS, including for some very demanding jobs, unattractive and uncompetitive.

Most NHS staff do difficult and demanding jobs and deserve a fair pay and reward system. Yet for the last five years pay has been frozen or capped and as a consequence has fallen by at least 10 per cent in real terms. Now is the time for catch-up but instead we know the government is likely to come after unsocial hours payments and possibly other elements of pay and conditions.

The government view is clear – in its evidence to the PRB, the Department of Health (DoH) stated:

“The way that the week is separated into ‘plain time’ and ‘unsocial hours’ is archaic and out of line with a 24-hours, seven days a week modern NHS service.”

It’s also keen to make comparisons with ‘other similar organisations’ and uses the retail sector as an example (p.11). I’m not convinced patients or the wider public would accept this comparison. I know it’s likely to anger many NHS staff.

All of the options put forward by the DoH would involve cuts to unsocial hours payments. What kind of message would this send to NHS workers at a time when pay restraint is already causing serious financial hardship? If basic pay were to increase significantly this could make it easier to have a discussion about changes as we could then protect overall earnings.

This is unlikely given current government pay policy. But the evidence shows that working unsocial hours over a long period of time not only has an impact on family and personal life but on health and well being too. I think most patients and indeed the public would accept that staff working these kinds of shifts should receive pay that recognises and fairly rewards this.

The government and NHS employers have taken a one dimensional approach to seven-day services focused on cost and getting more from staff for the same or even less money.

In reality this is a complex issue and requires a service specification based on a real understanding of the clinical evidence and the likely benefits of change before any workforce model can be developed. This in turn should determine the professions, levels of seniority and specialisms necessary.

Christina McAnea is head of health at UNISON. Follow her on Twitter

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