I’m writing this just before polling day, and within a couple of day we will have a new government and possibly a new health secretary. I won’t be the big dumb and predict who will have won. It’s fair to say, however, that the general turmoil in our politics will continue, and will affect the health and care system. And it’s also fair to say that the policy challenges we face probably won’t look that different in three weeks’ time, whoever has the reins of power.
The in-tray exercise for the new health secretary is a tried and tested classic for comment pieces. So if it ain’t broke...
Here’s what your union will be saying to the new government.
We hope the new government will maintain and invest in the NHS’s longstanding commitment to social partnership working between employers and unions. A widely-admired feature of the NHS, these arrangements survived—if not exactly thrived—under the Coalition and Conservative governments. Partnership led to progress on workplace culture, especially tackling bullying and improving staff experience of system change. They have come back into their own with the workforce crisis and the resulting NHS People Plan. MiP will play its part in the national machinery and our workplace reps will do the same with local employers. Government should encourage trade union membership and participation to help make the NHS the best place to work.
We urge the new government to deliver on the leadership compact between national bodies and providers, and go further to support and train managers and leaders. Accountability of managers should bring support as well as challenge and any proposals for regulating managers need to be proportionate, fair and created through consultation and consensus. An important signal—which I believe employers also want sent—will be parity of value between clinical staff, especially doctors, and other staff such as managers. This is partly a matter of words but also of practical policy. The two tier approach to support staff (e.g. with pay and conditions in wholly-owned subsidiaries) and managerial staff (e.g. with the unfair pensions tax fix) sends all the wrong signals. Treating everyone as part of one team must be a central plank of the People Plan.
Part of the workforce crisis stems from pay. Next year sees the last year of the three-year Agenda for Change pay deal. Health unions, including MiP, are starting to assemble the pay claim for ‘year 4’ in 2021. The 2018 deal was critical in breaking the pay cap and making overdue structural reforms to the pay system. But it must not be seen as a one-off investment: pay rises must continue if we’re to avoid a boom and bust approach to pay. And MiP has outstanding issues with the unjust caps on awards for higher band staff and the failure to shorten the time it takes to reach the top of bands 8 and 9. We also want the NHS to remain a Living Wage employer. Funding a decent settlement in 2021 must be a priority for the new government.
On funding, our members call for a long-term funding settlement for social care as well as the health service. We need a higher-quality debate about the tax base required to provide decent health and care, and improve public services such as housing and education, which are key determinants of people’s health. Managers, with their focus on the needs of the whole system and its workforce, are well placed to inform this debate.
Finally, legislation on the functions and structure of the health service now seems inevitable. NHS England has ‘oven-ready’ proposals. It’s critical that form follows function, but this means being very clear about the functions of the system and what we expect from both integration and devolution. We can then have a proper debate about accountability and consider carefully how the people side of any legislation is managed. What looks good on paper can become worthless if it results in unnecessary or badly-managed organisational change. As a union with wide experience of such reform, we hope the government (and parliamentarians) will draw on our expertise.
We will be robust and constructive in our relations with the new government. In particular, we will be unafraid to speak up for the core principles of the NHS and public service, and will argue workforce’s corner, not least its hardworking, dedicated and skilful managers. .
Jon Restell is chief executive of Managers in Partnership