12 December 2003
NHS finance salaries must not be downgraded under a new pay system due to be implemented next autumn, leading health service accountants told the Healthcare Financial Management Association conference in London last week.
Paul Cummings, who completed his year as chair of the association last week, said early indications on the restructuring of pay scales under Agenda for Change were worrying for accounts staff. Payroll and financial accountancy staff would do particularly poorly, with salaries falling by up to 30%.
There have been suggestions that employers could use the new system's 'recruitment and retention premiums' of up to 30% to make up the shortfall but Cummings said this would barely cover the gap.
Though pay of existing employees would be protected, they would not receive a pay rise. New staff would be paid on the lower scale.
Cummings said the downgrade would be a blow to morale at a time when finance staff would be key players in implementing the new pay system, as well as other reforms such as Patient Choice and payment by results.
'Although we are not a trade union, we will raise this on our members' behalf at the highest level,' he added.
'We are already seeing payroll staff, who have access to the information, voting with their feet,' said Christine Daws, finance director of NHS Wales.
John Allen, NHS Northern Ireland director of finance, said this was beginning to happen in his local health service. 'It is crucial for patients that Agenda for Change is brought in, but it can only be done with a major contribution from our staff.
'Their importance to the exercise is completely contradicted by the value the exercise places on them.'
Richard Douglas, NHS England finance director, promised to help by arranging a meeting between the HFMA and Department of Health officials. 'I do not wish to see anyone's job inappropriately valued,' he added.
Cummings raised the matter in a question-and-answer session with keynote speaker Sir Nigel Crisp. 'This is an issue that has not been visible from where I sit and you have raised it quite properly. Richard [Douglas] will bring you together with the people from the HR directorate and that is the right way to deal with it.'
Douglas promises devolved health spending
More and more health service funding will be devolved to local organisations over the next four years, according to Richard Douglas, NHS England finance director.
Douglas told the conference that the Department of Health would 'top slice' less of the NHS budget.
'At the moment we have quite a large pot of money we call "central budgets" and by 2008 we should be in the position where we have central budgets only for levies and a small number of centrally funded organisations,' he said.
'We have this large pot for specific purposes because we don't believe the system can deliver what's required. I hope by the next couple of years this will be down to next to nothing.'
He added that by 2008, funding allocations for primary care trusts should be announced in June, rather than in the autumn, giving them about a year to plan their spending.
The NHS Bank, administered by chief executives of health service organisations, would take on growing significance, going beyond its initial remit of helping NHS organisations in financial difficulty.
He said: 'There'll be a big shift of responsibility from a national level in the department to the NHS Bank.'
Douglas added that deficits should no longer be an issue by 2008, though he conceded there would always be 'small problems', due to unforeseen circumstances.
'During this period of unprecedented funding growth we should deal with this once and for all and drive financial problems out of the system.'
The NHS accountant should be 'driving' reforms
NHS chief executive Sir Nigel Crisp has challenged health service accountants to become the 'driving force for change and improvement' in the service.
He told the conference that finance staff had played a major role in the improvements in the health service over the past few years but it was now time for them to help the NHS move into the next phase of reform.
He said the service had been through the first phase of top-down performance management and target setting.
'The finance function should be proud of what it has achieved but now is not the time to heave a sigh of relief as we have not yet achieved a turnaround,' he added.
'We must move over the next five years from 80% national initiatives and 20% local initiatives to 20% national and 80% local initiatives.'
This new balance of national and local schemes would be reflected in the NHS priorities and planning framework to be published next summer.
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