I Workinn for Patients? by him. How does this increased centralisation reconcile with the Government's apparent wish to distance itself from operational What assurances are there that the costs for increased management information and accountancy will not be diverted from patient care? v The Prime Minister in her foreword says: 'The patients needs will always be paramount.' matters and ena.ble patients to influence services? What direct influence will Community Health Councils have on the ' How realistically will patients be able their Is it an increased choice for GPsl new management to represent interests of the local community? views and the What are the real benefits for patients? Will services be improved I in conurbations? In rural areas? 7. Better Audit Arrangements How will patients be helped to judge 'a better service'? I Will those who cannot afford to travel to a better service be helped What form will a review of quality and effectiveness of care take? How will 'value-for-money' be judged? What are the criteria for a 'better service'? to do so? Will 'a wide range of optional extras' and choice introduce a two- I tier system based on ability to pay? Senior Managers - Proposed New Contracts IN the January 1989 issue of Physiotherapy (page 30) we reported on the Government's proposals to extend the pay and grading arrangements for general and some senior managers to a further group of senior managers. The Department of Health (DOH) circular was to have been published in December 1988, but, at the time of going to press, it has still not appeared. The draft proposals are all we have seen. However, the DOH leaflet from which we gave extracts in the January Journal has been widely circulated. Several physiotherapy senior managers have been approached by their general managers with offers of the new contracts. Senior managers may be asked to choose between their existing pay and conditions and the new salary and conditions including Performance Related Pay. Since if they opt for the new conditions that decision is irrevocable, we are giving below points which members should consider carefully. We emphasise though that no one should make any final decision before the official circular is issued. When it is, we will look at the final details and advise members further. Contracts of Employment Managers accepting the new pay and conditions arrangements will have to accept new contracts, although these are not intended to be short-term contracts (as applied to other general managers) for most individuals currently within the NHS. The nature of the new contracts which will be signed is still unclear but (as stated in the draft circular) they 'will provide specifically for performance to be reviewed under the individual performance review arrange- ments and will specify that unsatisfactory performance may be regarded as grounds for action under the authority's disciplinary and dismissal procedures' (our italics). Thus there is a clear threat of the possibility of dismissal for unsatisfactory performance built into the system. Pay Flat Rate Salary Managers will be offered a flat-rate salary (without increments) based on a 25-point pay spine ranging from €11,790 to €30,220 a year. Within the pay spine, a 12-point pay range is proposed for each management level in Regional Health Authorities, District Health Authorities and Units. The maximum salary which could be offered to any individual represents about 75% of the maximum range point of the next higher management level. Thus, a manager who is accountable to a Unit general manager cannot be offered a salary which is more than 75% of that UGM salary. There will be local pay flexibility which will give general managers in exceptional cases the right to raise the salary for hard-to-fill posts by up to 10% of the authorised level, but it is not intended to apply this to those already in post. The general manager will decide the pay point. Once an individual is placed on this point, there are no further annual increments. The only addition to salary will be Performance Related Pay. But PRP is equivalent to only about one increment on existing scales; slightly less at the top. Note also that PRP is not guaranteed. You could get a payment one year, then nothing for the next three. Performance Related Pay PRP is classified in five categories. There are maximum awards of up to 4%, 3% and 1.5% for bands 1, 2 and 3 respectively with annual quotas of not more than 20% of managers in band 1, and no more than 60% in bands 1 and 2 together. There is a cumulative ceiling over a minimum of five years which could give the most outstanding performer up to 20% additional salary. Managers in bands 4 or 5 will get no merit payment. There are considerable problems with PRP applied to clinical grades. It is dependent on the inclusion of the individual in an Individual Performance Review (IPR) system. IPR relies on the identification of management targets, many of which are put in financial terms. The DOH has already recognised that there is some tension between managerial and clinical responsibilities. At times there will be conflict between budgetary obligations of general managers and clinical care responsibilities of clinical managers. However, the DOH does not appear to have produced any solution to these problems. The quota system for the maximum numb.er of managers who can get into a particular band (eg 20% in band 1) means that there is an arbitrary element about the band in which you are placed. Thus, in one year you could be in band 1 but in band 2 the following year, despite an even better performance, because of the number restriction. It is a pure cost control. PRP is a merit pay system. The experience of many other employers is that merit pay systems, particularly where effective team work is required, can be a source of division and not incentive among members of staff. Appraisal systems, such as IPR, are already in place for many within the NHS, but many other organisations have found that IPR linked to pay is not successful. Pay Increases Managers opting for the new contracts will no longer be covered by the recommen- dations of the Pay Review Body. If in any year, there is a significant increase in pay through the Review Body, managers who have opted for the new contracts will not have the right to opt back again into possibly more favourable salary conditions. The review process for salaries under the new contracts is extremely uncertain. Increases in the flat-rate salary will only come through a decision by the Secretary of State to increase salaries. There is no guarantee that this will be done on an annual basis and certainly no guarantee of what this increase would be. With no incremental payments, individuals who do not perform to a standard to be eligible for PRP, may get no annual increase at all. Although the Government may review salaries in a reasonable way for the first year or so, subsequently there may be political pressure to limit pay, particularly to hold down inflation, with the public sector setting an example. The Review Body process has the advantage that its reports will be published, no matter what the Government decides to do about them. In turn this puts considerable 158 Ptlysiotherapy, March 1989, vol75, no 3
Transcript
I Workinn for Patients? by him. How does this increased centralisation reconcile with the Government's apparent wish to distance itself from operational
What assurances are there that the costs for increased management information and accountancy will not be diverted from patient care?
v
The Prime Minister in her foreword says: 'The patients needs will always be paramount.'
matters and ena.ble patients to influence services?
What direct influence will Community Health Councils have on the
'
How realistically will patients be able their Is it an increased choice for GPsl
new management to represent interests of the local community?
views and the What are the real benefits for patients? Will services be improved I in conurbations? In rural areas?
7. Better Audit Arrangements How will patients be helped to judge 'a better service'? I Will those who cannot afford to travel to a better service be helped
What form will a review of quality and effectiveness of care take? How will 'value-for-money' be judged?
What are the criteria for a 'better service'?
to do so?
Will 'a wide range of optional extras' and choice introduce a two- I tier system based on ability to pay?
Senior Managers - Proposed New Contracts IN the January 1989 issue of Physiotherapy (page 30) we reported on the Government's proposals to extend the pay and grading arrangements for general and some senior managers to a further group of senior managers.
The Department of Health (DOH) circular was to have been published in December 1988, but, at the time of going to press, it has still not appeared. The draft proposals are all we have seen. However, the DOH leaflet from which we gave extracts in the January Journal has been widely circulated. Several physiotherapy senior managers have been approached by their general managers with offers of the new contracts.
Senior managers may be asked to choose between their existing pay and conditions and the new salary and conditions including Performance Related Pay. Since if they opt for the new conditions that decision is irrevocable, we are giving below points which members should consider carefully. We emphasise though that no one should make any final decision before the official circular is issued. When it is, we will look at the final details and advise members further.
Contracts of Employment Managers accepting the new pay and
conditions arrangements will have to accept new contracts, although these are not intended to be short-term contracts (as applied to other general managers) for most individuals currently within the NHS. The nature of the new contracts which will be signed is still unclear but (as stated in the draft circular) they 'will provide specifically for performance to be reviewed under the individual performance review arrange- ments and will specify that unsatisfactory performance may be regarded as grounds for action under the authority's disciplinary and dismissal procedures' (our italics).
Thus there is a clear threat of the possibility of dismissal for unsatisfactory performance built into the system.
Pay Flat Rate Salary
Managers will be offered a flat-rate salary (without increments) based on a 25-point
pay spine ranging from €11,790 to €30,220 a year. Within the pay spine, a 12-point pay range is proposed for each management level in Regional Health Authorities, District Health Authorities and Units. The maximum salary which could be offered to any individual represents about 75% of the maximum range point of the next higher management level. Thus, a manager who is accountable to a Unit general manager cannot be offered a salary which is more than 75% of that UGM salary. There will be local pay flexibility which will give general managers in exceptional cases the right to raise the salary for hard-to-fill posts by up to 10% of the authorised level, but it is not intended to apply this to those already in post.
The general manager will decide the pay point. Once an individual is placed on this point, there are no further annual increments. The only addition to salary will be Performance Related Pay. But PRP is equivalent to only about one increment on existing scales; slightly less at the top. Note also that PRP is not guaranteed. You could get a payment one year, then nothing for the next three.
Performance Related Pay PRP is classified in five categories. There
are maximum awards of up to 4%, 3% and 1.5% for bands 1, 2 and 3 respectively with annual quotas of not more than 20% of managers in band 1, and no more than 60% in bands 1 and 2 together. There is a cumulative ceiling over a minimum of five years which could give the most outstanding performer up to 20% additional salary. Managers in bands 4 or 5 will get no merit payment.
There are considerable problems with PRP applied to clinical grades. It is dependent on the inclusion of the individual in an Individual Performance Review (IPR) system. IPR relies on the identification of management targets, many of which are put in financial terms. The DOH has already recognised that there is some tension between managerial and clinical responsibilities. At times there will be conflict between budgetary obligations of general managers and clinical care
responsibilities of clinical managers. However, the DOH does not appear to have produced any solution to these problems.
The quota system for the maximum numb.er of managers who can get into a particular band (eg 20% in band 1) means that there is an arbitrary element about the band in which you are placed. Thus, in one year you could be in band 1 but in band 2 the following year, despite an even better performance, because of the number restriction. It is a pure cost control.
PRP is a merit pay system. The experience of many other employers is that merit pay systems, particularly where effective team work is required, can be a source of division and not incentive among members of staff. Appraisal systems, such as IPR, are already in place for many within the NHS, but many other organisations have found that IPR linked to pay is not successful.
Pay Increases Managers opting for the new contracts
will no longer be covered by the recommen- dations of the Pay Review Body. If in any year, there is a significant increase in pay through the Review Body, managers who have opted for the new contracts will not have the right to opt back again into possibly more favourable salary conditions.
The review process for salaries under the new contracts is extremely uncertain. Increases in the flat-rate salary will only come through a decision by the Secretary of State to increase salaries. There is no guarantee that this will be done on an annual basis and certainly no guarantee of what this increase would be. With no incremental payments, individuals who do not perform to a standard to be eligible for PRP, may get no annual increase at all.
Although the Government may review salaries in a reasonable way for the first year or so, subsequently there may be political pressure to limit pay, particularly to hold down inflation, with the public sector setting an example.
The Review Body process has the advantage that its reports will be published, no matter what the Government decides to do about them. In turn this puts considerable
158 Ptlysiotherapy, March 1989, vol75, no 3
pressure upon the Government to agree with the objective judgement of an independent panel. For those opting for the new contracts, there will be no independent panel to publish a report or recommendations. It will be left entirely to the view of the Secretary of State and how much money he is able to convince the Treasury to provide.
Salary levels under the new contracts are unlikely to be of major benefit in many cases to either the PAMs or nurses. They may be an advantage'to a few individuals at the top of the career structure but the current PRB managee'salaries have grown significantly ahead of administrative and clerical salaries over the last five years, and therefore could create particular difficulties about gaps between individual managers on the new contracts with similar responsibilities within the same authority. This would limit the extent to which general managers could offer beneficial salaries.
There will undoubtedly be a few individuals who will be offered substantially beneficial salaries and they will have to decide whether or not any other disadvantages tip the balance, and in particular whether the initial benefit will continue to compare favourably in the longer-term with their existing salary structure. For example, before the most recent pay award announcement of 7.7%, one District physiotherapist calculated, that there would only need to be a 6.6% increase in Pay Review Body awards over five years together with increments for her to be worse off under the new arrangements with PRP.
Terms and Conditions The DOH says that conditions of service
for managers under the new contracts 'will be broadly similar to those for existing senior managers'. This appears to include most General Whitley Council agreements and some administrative and clerical agree- ments, but at present there is too little detail to make adequate comparisons. In particular the position on pension rights for female physiotherapists, who currently have the right to retire at 55 as one of the 'special classes', is very unclear. It may be that if a major part of a physiotherapist's working time is taken up by general management responsibilities, then the right to retire at 55 may be lost.
The DOH rejected a proposal from the GWC Staff Side to set up a new Whitley Council for senior and middle managers. It appears that managers on the new contracts would be covered by existing collective bargaining arrangements for terms and
Advice to Members who are Be cautious in making any commitment
now, before the official circular.
0 Compare carefully the terms and conditions of the new contract with your existing terms and conditions.
Do scme calculations to compare your pay now and what it could be over five years under the existing arrangements and under what you are being offered.
conditions apart from pay. However the DOH says that 'there will be discretion for employing authorities to offer other conditions of service subject to guidance from the Department - for example, salary protection arrangements on reorganisation; additional working; remuneration on acting-up'.
Future of Physiotherapy Management
These new arrangements may offer benefits for a few existing postholders and it has been claimed that it may facilitate career progression in general management. It has been suggested for example, that there may be advantages of access to higher level and broader training. However, in the longer term the proposals may lead to pressure for joint management arrangements between other professions in ways which have not been envisaged before, and District physio- therapy posts may be threatened.
Offered the New Contracts .Consider whether you think the Pay Review Body system and collective agree- ments outweigh the benefits of the new proposals in the long-term.
.Ask your general manager what advantages there could be or what developments are anticipated in the nature of your job following acceptance of these proposals.
Pay Review Body Report Disappointment THE 1989 Pay Review Body reports were published last month. They recommend for physiotherapists: 0 An increase of 7.7% to 7.8% in basic pay. 0 Increases in allowances of between 6.3% and 7.8%. 0 No changes in internal differentials.
Nurses will receive 6.8% and doctors are to have 8% increases.
The Pay Review Body has also asked both sides to consider resuming grading negotiations, even though it acknowledges that 'the Staff Side's confidence in the Management Side appears to have been severely damaged'.
The Government has accepted the recommendations of the Pay Review Body in full. The increases will be paid from April 1, 1989.
The increases are worth an additional €37.4 million on top of the paybill of €484.2 million for the professions allied to medicine ( PAMs) .
The Government will fully fund most of the pay increases for PAMs, nurses and doctors. It will provide an extra €204 million out of the Government's reserves, in addition to the €510 million cash limit money already given to health authorities.
The increase totals €758 million, leaving a gap of €44 million for UK authorities to find from 'efficiency savings'. Secretary of State, Mr Kenneth Clarke, claims that the €44 million can be found by health authorities without cuts in patient care or departmental budgets.
Mr Phillip Gray, CSP director of industrial relations and PTA Staff Side Secretary, comments:
'The 1989 PRB report is disappointing.
Although the 7.8% increase in pay is only 0.2% lower than last year; it is higher than inflation; is higher than the nurses' increase; and has been funded by the Government without the cuts or staging which we had feared - compared to our expectations, our recruitment problems, and our wealth of well-researched evidence, it is a very disappointing reward from the Review Body.
'The PRB seems to have deliberately sat on the fence this year. The Staff Side presented detailed evidence on the growing problems of the recruitment and retention of physiotherapy and the PAM staff. A total of 10% of physiotherapy posts are vacant or frozen; staff turnover has increased to over 20% per year; 65,% of physiotherapists leaving the NHS for other jobs are going abroad (a net loss abroad each year of experienced staff equivalent t o 25% of the newly qualified staff); demand for physiotherapy staff and the new posts is growing at approximately 4% per year - almost the highest in the NHS; 40% of all qualified physiotherapists in the UK under the age of 65 are either not working or not working in the NHS.
'A substantial pay increase is not the only solution, but it would go a long way toward retaining or attracting back physiotherapists. The Management Side's evidence? It didn't have any hard evidence. The PRB reports the Management Side's assertion that in view of what it saw as a broadly satisfactory recruitment and retention position, it concluded that the real value of the existing remuneration levels should be maintained - and that is what the PRB has done.
'We are also deeply concerned about the unjustifiable gap that has appeared between PAM salaries and nurses as a result of last
year's regrading exercise and report for nurses. Their final increase in the total pay bill was 17.9% (with wide variations in payments to individuals). Physiotherapists got an increase of 8.5% in the pay bill (including London supplements) last year. We asked the Review Body this year to remove the pay gap. All it has done is close it by 1%.
'The PRB says that if we complete a grading exercise next year, "it will be understood that it does not necessarily imply a range of an increase of a similar order to the range we recommended for nursing staff last year". It is trying to encourage us to go back to a grading review, yet the report also states that the Management Side had told it that even if the grading exercise for helpers had been agreed, it would have argued that this did not deserve an increase in salaries and relativities. That gives the rest of us little confidence, particularly after the appalling way in which the Management Side behaved over the negotiations last year.
'The Staff Side is not going back into grading negotiations at the moment, but before we reconsider the position, we would need a guarantee from the Management Side that it will argue for increased pay for PAMs from grading and will put forward some additional money - otherwise we could waste yet more time in negotiations, only to find that it argues to the PRB that pay for the new grades should be the same as for the old grades. There is a big gap in trust which the Management Side is going to have to bridge.
'It is a disappointing report, even though it is once again likely to be better than the 1989 increase for non-Review Body staff. We will be seeking an early meeting with the Review Body to discuss the report and prepare ourselves for next year's evidence.'
Physiotherapy, March 1989, vol75, no 3 1 59
Salary Scales
April 7, 7988 April 1, 1989 % If) (El Increase
Physiotherapists In the NHS
Physiotherapist 8,000 8,360 8,730 9,110 9,510
Senior II 9,510 9,980
10,450 10,920 1 1,390
Senior I 1 1,930 1 1,935 12,480 13,025
Superintendent IV 1 1,390 1 1,935 12,480 13,025
Superintendent 111 13,025 13,390 13,755 14,120
Superintendent II 14,120 14,615 15,110 15,605
Superintendent I 15,605 16,145 16,685 17,225
District II 17,225 17,825 18,425 19,025
District I 19,025 1 9,700
8,620 9,010 9,410 9,820
10,250
10,250 10,755 1 1,260 1 1,765 12,270
12,270 12,855 13,440 14,025
12,270 12,855 13,440 14,025
14,025 14,425 14,825 15,225
15,225 15,755 16,285 16,815
16,815 17,395 17,975 18,555
18,555 19,200 19,845 20,490
20,490 21,200
7.8 7.8 7.8 7.8 7.8
7.8 7.8 7.8 7.7 7.7
7.7 7.7 7.7 7.7
7.7 7.7 7.7 7.7
7.7 7.7 7.8 7.8
7.8 7.8 7.8 7.8
7.8 7.7 7.7 7.7
7.7 7.7 7.7 7.7
7.7 7.7
London supplements: 5% of Pay (rnax f 532) 5% (rnax €568)
2% % of pa; (rnax €266) 2 % % (rnax f 284)
Physiotherapy teachers and helpers
Student teacher 8,360 8,730 9,110 9,510
Teacher 14,100 1 4,705 15,310 15,915
Senior teacher 15,310 15.91 5 16,520 17,125
Principal II 15.91 5 1 6,520 17,125 17,680
Principal 1 17,125 17,680 18,235 18,790
Principal 24+ 18,790 19,345 19,900 20,455
9,010 9,410 9,820
10,250
15,195 15,845 16,495 17,145
16,495 17,145 17,795 18,445
17,145 17,795 18,445 19,045
18,445 19,045 19,645 20,245
20,245 20,845 21,445 22,045
7.8 7.8 7.8 7.8
7.8 7.8 7.7 7.7
7.7 7.7 7.7 7.7
7.7 7.7 7.7 7.7
7.7 7.7 7.7 7.7
7.7 7.8 7.8 7.8
April 1, 1988 April 1, 1989 % IN Increase lf)
Helper (under supervision) age 18 5,130 5,530 7.8
age 19 or over 5,340 5,755 7.8 5,520 5,950 7.8 5,700 6,145 7.8 5,890 6,345 7.7 6,090 6,560 7.7 6,300 6,790 7.8
Other Allowances: New rate ( f ) Standby - Regional secure unit 755
overnight 6.45 weekend 9.55 public holiday 12.80 Student training 1,190
790 395 'On-call' -
overnia h t 3.40
public holiday 12.80 Student training 1,190 790 395 'On-call' -
overnia h t 3.40 weekend 4.90 public holiday 6'45 Designated District
Lecture fee 12.40 physiotherapist 345
Sparkling A trip t o Congress '89 in Harrogate is definitely worth the journey not only for the excellent conference programme, but t o discover the delights of the beautiful spa town itself.
Harrogate is surrounded by the picturesque Yorkshire dales with many places of beauty and historical interest nearby. Knaresborough, an ancient market town, is less than five miles away. Fountains Abbey, Ripley Castle and Newby Hall are all within easy travelling distance.
The town itself is known for the beauty of its parks and gardens and has earned the reputation of 'England's Floral Town'. Harrogate is noted for its tree-lined boulevards, graceful Victorian architecture and excellent shopping facilities.
Dining out in Harrogate is a delight for gourmets. Betty's Tea Rooms have a worldwide reputation for their excellent teas and Yorkshire curd cakes (a regional delicacy). The Drum and Monkey pub and restaurant, famous for its seafood, is also worth a visit.
Reminders of the town's regal past are the Royal Pump Rooms museum which houses an original sulphur well. The Royal Baths Assembly Rooms have Turkish baths still in operation, as well as a modern solarium, and superb sauna facilities.
For sport enthusiasts Harrogate has three 18-hole golf courses, two swimming pools, tennis courts and a dry skiing slope.
Those who are used to more leisurely activity can visit the three-screen Odeon Cinema.
But remember there is an excellent social programme already arranged for Congress '89 which is far too good to be missed! With all this on offer isn't it time you made a date for Harrogate?
