by Peter Watt
There was a debate yesterday instigated by Labour on the introduction of regional pay into the NHS. Labour’s argument is clear, that by allowing the introduction of regional pay into the NHS the government risks breaking it up. Of particular focus for criticism were the group of twenty trusts in the south west, the south west consortium. They are seeking to opt out of the national agenda for Change framework for pay and conditions as an element of their plans to achieve their required cost reductions. As Andy Burnham said in the debate:
“National pay is part of the glue of a national health service, part of what holds it together, and in turn the NHS is part of what holds our country together.
A one nation service bridging the social and economic divides of our country, uniting east and west, north and south. The N in NHS should be cherished, but instead it is coming under ideological attack.”
Powerful stuff and you may think hard to disagree with. But Labour has some form in this area, in both government and opposition, which makes their position a little tenuous. It may well be that there is a perfectly good reason for this apparent inconsistency but you can be sure that this inconsistency will be exploited by opponents.
First, in government it was Labour that introduced the very flexibilities and freedoms that allow NHS trusts to make decisions that ensure their responsiveness to local needs. And rightly so; as commissioners agree local priorities it was important that the local providers were able to operate flexibly and choose what they did in order to deliver on these priorities.
This didn’t mean an end to national pay and conditions but it did mean that if needed trusts could be flexible. So for instance, if there was a need for one particular service to be expanded in an area where attracting the right staff was difficult, then a trust could respond.
It is the same flexibility that allows service provision to vary from area to area as local decisions are taken. I know that we like to complain about the “postcode lottery” in terms of care, but it is an inevitable, and in many ways welcome, consequence of local decision making.
Second, the NHS is also required to make billions of pounds of efficiency savings, and would have had to under a Labour government. Its staff costs are a huge proportion of its cost base. For Trusts not to be able to look at how they manage staffing budgets is nonsense. Whilst there are clearly many business processes that can be streamlined and procurement improved to reduce costs they simply cannot ignore staffing costs. The alternative to some variation in pay within a national framework is employing less staff or providing fewer services.
Third, Labour in opposition has said that they support regional rates of welfare benefits. The argument being that as local housing and other costs vary hugely from area to area so should the amount of support provided by the taxpayer to those in need of support. So regional welfare rates yes; but regional pay rates no. It simply does not make sense.
At the heart of this argument is a refusal to fully accept the consequences of local decision making. If you think, as pretty much all of the parties say that they do, that decisions are best made locally then there is a consequence to this. It is why there are different approaches to the NHS, student finance and social care between England and the devolved nations.
It is why you can get IVF on the NHS in some areas and not in others. Or more or less library provision from borough to borough. From next Thursday we may well see even more differences in the way that crime is tackled across the country as police and crime commissioners are elected. Personal budgets for the delivery of social care means that care packages vary and free schools and academies are creating different approaches and styles of educational experience in state schools.
In other words there is an inexorable drive for localisation. It is a key part of delivering responsive and efficient services. And as budgets are squeezed then local decision making and accountability can only become more and more important. The age of the one size fits all state monolith is well and truly gone.
Naturally, this creates uncertainties and tensions as people become used to the complexity of arrangements and new relationships. But unless one nation Labour intends to reverse this trend – to remove the NHS trust status that a Labour government introduced; to centralise all decision making on what money should be spent on local health priorities; to close the school academies; scrap personalisation and co-production in the delivery of social care – then Labour need to be honest about the consequences.
And the consequences are clear; the way that public services are delivered, what is delivered, whether or not things are free and in some cases how much people are paid to deliver them will vary from place to place.
Although this does not mean accepting a free for all in pay and conditions in (say) the NHS, it will inevitably mean that local providers will push to set their own rates albeit within a national framework.
And the truth is that Labour knows this even if the party’s speakers in yesterday’s parliamentary debate didn’t make this clear.
Peter Watt was general secretary of the Labour party
Tags: NHS, Peter Watt, regional pay, south west
1000 people maimed by an NHS surgeon.
Lets see, 100K in damages?
100 million in total.
Yep. 1 Surgeon, 1 hospital’s worth of damage.
Socialised medicine for you.
The moment you acknowledge the a London weighting is required then you are acknowledging that a regional pay scheme exists. If you then only restrict it to London, you are being very unfair with workers in other parts of the country. Each region has different costs of living all affected by the amount of industry in the area, the travel infrastructure, access to supermarkets, etc, etc, etc. So those in the Manchester get the same as those in the far Newcastle. This means that those in the NW have less in their pocket after all living costs have been paid for than those in the NE. So those in the NW need a Manchester weighting, as will those in other areas. If that means that the NE has the lowest wages then so be it, someone has to be at the bottom, but that doesn’t mean that they are at the bottom in terms of discretionary spending ability.
The 2nd half of this piece is a classic example of why “choice” is and was such a total nonsense when it comes to public services.
IVF in some areas and not others? Wholly unfair.
Commissioning groups with different priorities? WTF? What priorities could possibly differ that wildly? The answer is of course none at all worth worrying about.
It all adds up to total chaos, unfairness and poor service provision.
Regional Pay is another daft idea intended to accelerate the race to the bottom in wages that the Tories are hell bent on delivering.
Labour is right to oppose it.
So BenM, do you want London weighting to be abolished? That’s a regional pay scheme.
I think you will find that most large private sector companies have the same pay scales in all of the UK apart from London and some parts of the south east. There really is not much difference between the private and public sectors on this issue. Why doesn’t Peter Watt join the Tories?
@ Ben M
Are you being deliberately obtuse ? I suspect so – like most from the looney left.
SadBur MadLad makes a good point. London weighting in the public sector has more to do with the power of London MPs than anything else. The island allowance paid to workers in the Hebrides is trivial by comparison, but the cost of living is much higher. It is true that houses are cheaper, but everything else is much more expensive.
While regional pay might sound superficially attractive, if introduced it would be likely to have a destructive effect on the NHS. Who would choose to work in one of the low-pay areas when they could do the same work for more in one of the higher paid ones? It’s hard enough to attract people to such areas as it is; regional pay would only hurt them further, guaranteeing that the richer areas get richer and the poorer areas get poorer. Not exactly a ‘One Nation’ policy…
Yes, Labour made mistakes in the past, and we are now having to backtrack on some of those. This is an example. There needs to be many more as we extricate ourselves from the many mistakes of the Blair/New Labour era
Institutionalised regional poverty and brain drain away from the very areas that need them most? No thanks.