Who paved way for NHS regional pay?

Hospital ward NHS bosses in the South West want to introduce regional pay

Like a good fugue the recent parliamentary debate on regional pay in the NHS had more than one major subject.

Its principal theme was stated by Labour: the move towards regional pay deals by a consortium of NHS trusts in the South West was a thoroughly bad thing.

The project exuded "unfairness, irrationality and economic illiteracy", we were told in the warm alto tones of Alison Seabeck (Lab, Plymouth Moor View).

From the government benches came an answering phrase in the rich bourdon of Geoffrey Cox (Con, Torridge and West Devon), who enthusiastically set about embroidering the same theme with his customary eloquence.

It was both "wrong and retrograde", he said, exhibiting a little of that talent for alliteration so admired by Professor Higgins in Alfred Doolittle. And it was "inconceivable" that he could agree to a policy which would further depress incomes in his already low-wage constituency.

Then he deftly introduced the counter subject: it was indeed a dastardly business but it was all Labour's fault.

Who is to blame?

He and his coalition colleagues from the South West went on to perform every conceivable variation on this motif. They were as appalled by the prospect of regional pay as the members opposite but Labour needed to do the decent thing and fess up to the fact that their own reforms had given trusts the power to pursue this option. It was, opined Geoffrey Cox, "cynically opportunistic" of Labour to try to wash their hands of the matter.

Labour insisted this was nonsense. The changes they had introduced had allowed one trust to increase pay in one instance but there had been no pay cuts on their watch.

As much of the ensuing debate seemed to be devoted to who was to blame as to the basic issue itself.

Andrew George (Lib Dem, St Ives) attempted a synthesis of the two themes: regional pay was bad and Labour had let it happen - but perhaps they hadn't really meant to.

Labour were still having none of it, so - unlike a good fugue - the subject and counter subject were not resolved in glorious harmony.

This is the House of Commons, though, so it was a minor miracle that the counterpoint proceeded as well and for as long as it did.

Thatcher's government

But it left the obvious question - how did we reach a situation where NHS trusts can negotiate regional or local pay deals - entirely unanswered.

My quest to get an answer started with the Foundation Trust Network.

They told me it was "complicated", something I'd already got half an inkling of. In broad terms, though, they said trusts had received the theoretical power to vary terms and conditions as long ago as 1990 under the Conservatives. But they claimed it was only after further changes made by Labour that this became a practical proposition.

Next I approached the consortium of South West trusts who are actually trying to implement these freedoms.

The consortium says it is basing its case firmly on the NHS 2006. So the trusts, which are the driving force in this, clearly think they have Labour to thank.

Finally, I sought a ruling from the Department of Health. Surely they could give me a definitive ruling on whether the move was legally sound and - if yes - which piece of legislation made it so.

The department says the powers are enshrined in the NHS and Community Care Act 1990 - a piece of legislation enacted by Margaret Thatcher's government.

'Mature' approach

They directed me to Schedule 2, paragraph 16, where it states: "An NHS trust may pay its staff such remuneration and allowances and employ them on such other terms and conditions as it sees fit".

The department threw no more light on the issue of whether Labour's later reforms had enhanced this. But the whole point of Labour's new foundation trusts was that that they should have more autonomy than their traditional counterparts.

The 1990 Act also stipulates that a trust's freedom to vary pay and conditions must be "in accordance with regulations and any directions given by the Secretary of State".

This would seem to support Ben Bradshaw's (Lab, Exeter) claim at the beginning of his debate on regional pay that "a single word from the minister today and this madness can be stopped".

It's not surprising that Health Minister Anna Soubry instead chose to commend the South West consortium for its "mature" and "responsible" approach.

A government which is seriously considering introducing local pay across the public sector can hardly be expected to censure others proceeding in the same direction.

The truly definitive ruling on all of this would probably involve testing it in the courts, which neither my personal means nor the BBC's licence fee allow for.

But Ben Bradshaw, at least, thinks others may well now do so.

Martyn Oates Article written by Martyn Oates Martyn Oates Political editor, South West

Who paved way for NHS regional pay?

MPs debate which government opened the doors to the proposed regional pay in the NHS.

Read full article


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  • rate this

    Comment number 29.

    elcej : I presume/hope you are not staying in the South-West in the long-term? Take it from the horse's mouth that if regional (lower) pay is forced on us the exodus of highly-qualified and experienced NHS staff will lay waste to the local health service provision. Why stay here when we can have a "better quality of living-ssh" elsewhere? Private healthcare will be no help for major interventions.

  • rate this

    Comment number 28.

    NHS funding is by "payment by results" on a National tariff which is based upon factors including National Pay rates. If Trusts in the SW cut the Pay of staff they will surely see a reduction in the payments they receive. Many National private sector employers pay national rates of pay so why not the NHS & other publicly funded employers?

  • rate this

    Comment number 27.

    All absolutely right, but Unison et al are barking up the wrong tree. Until the per capita funding for the NHS is national and not regional (Cornwall and the southwest are disadvantaged) it's difficult to argue against regional pay. Have a go at the central funding first!

  • rate this

    Comment number 26.

    A recent article by the bbc showed that the southwest region has the third highest house prices (http://news.bbc.co.uk/1/shared/spl/hi/in_depth/uk_house_prices/regions/html/regions.stm)

    If any adjustments should be made for employees in the southwest then these should be upwards! I have lived in Exeter for two years now and the first thing that struck me when I moved here was the house prices!

  • rate this

    Comment number 25.

    Interesting view from Red Carol Ann but given that MPs spend a large part of their time working in London and are paid less than equivalent workers in private or public sectors, regional pay would increase their salaries. I'm assuming RCA wouldn't want that.

  • rate this

    Comment number 24.

    Just because an organisation believes it has the power to do something doesn't mean it has to exercise that power. The trouble is though nine times out of ten, give someone power and they will use it regardless of the consequences.

  • rate this

    Comment number 23.

    When will we start paying MP's Regional pay ?

  • rate this

    Comment number 22.

    20.elcej - ".......other salaries are lower the SW. Why should the NHS be different."

    Because having the public sector paying a bit more forces private employers to pay more if they desire to attract thebest staff - a win-win all round.....

  • rate this

    Comment number 21.

    I trained in Brighton and now work in Cornwall. The only thing cheaper here is the rent. I spend much more than the difference on petrol due to the large rural area I cover and the lack of public transport.
    I do the same job (in fact due to the somewhat backward hospital I work in, it seems a more difficult job) than my friends who stayed in Sussex- I cannot see a reason for being paid less.

  • rate this

    Comment number 20.

    @18. EBlue
    I lived in Oxfordshire 1986-2002.Then moved to Tavistock (Devon). Houses are cheaper.Used cars cheaper. Food similar price & fuel a tad dearer (relevant if you drive a lot). HOWEVER, quality of life is much better (sssh, don't tell anyone).
    Anyway, all this is slightly irrelevant.My original point @13 below is that other salaries are lower the SW. Why should the NHS be different.

  • rate this

    Comment number 19.

    It's a disgrace. It will further impoverish the area and drive out talent. Scrap it now!

  • rate this

    Comment number 18.

    @17 elcej
    'average house price is £210k in SE.., £173k in SW' therefore regional pay is OK...
    It is MORE expensive to live in the SW - house prices are not hugely lower that SE and then add costs of transport, water (highest in UK by far), any commodities that need transporting in, access to cultural events etc (that are all concentrated in the SE). Thank God the sea is free (so far!)

  • rate this

    Comment number 17.

    @14 Ginger Ferrit
    Yes, there is a "London weighting" for many jobs but that doesn't means the cost of living is the same everywhere outside of London.
    FACT: Latest Land Registry stats say average house price is £210k in SouthEast (excl London), £173k in Southwest & £115k in Yorkshire.
    Regional cost of living effects private sector salaries.
    Why should the NHS be different?

  • rate this

    Comment number 16.

    In the SW, due to in-migration of rich wrinkles from the SE we have some of the highest UK house prices. We also pay the highest water bills to provide clean bathing water for holiday-makers. Now the Government tell us we can have the lowest wages.
    Let's ban in-migration and tax holiday-makers as part of the deal.

  • rate this

    Comment number 15.

    I am a public sector worker (not NHS) in the South East.
    Where I grew up houses are about half the price they are where I live, most things about 1/3 less. While I earn just about enough to live I have friends who work in the public sector near where I grew up who have less qualifications than me, are paid a bit less, work less hard, and have a far better lifestyle than I do.

  • rate this

    Comment number 14.


    I was under the impression that NHS pay scales were similar to that of LEA's - dictated to them in that those in Greater London get paid more to reflect the cost of living, those outside get a lower renumeration, which is the same across England.

    Your suggestion could, as stated by Hum Sci, leave people here unable to afford basic living standards. Why would they stay?

  • rate this

    Comment number 13.

    This article should be read in conjunction with today's Office for National Statistics report on (regional) pay. Today's Guardian has a particularly good graphic that shows regional pay.
    If the average salary in the southeast is vastly more than the regions, I don't understand why the NHS should be treated differently.

  • rate this

    Comment number 12.

    Apparently we are all in this together. If this were really the case then MP's would lead by example and first vote for regional pay for themselves. As likely as turkeys voting for christmas

    Idiots the lot of them.

    I know, my constituents live in a deprived area dominated by poorly paid seasonal tourist jobs I'll improve their prospects and stimulate the economy by paying nurses less.

  • rate this

    Comment number 11.

    And, the consortium won’t save money. There’s already huge demand for bank staff in South West because NHS jobs are being cut. The NHS pays agency fees and overnight accommodation for bank staff from outside the area: it’s astronomical, and lucrative. My husband (nurse) is already considering turning private as soon as he has enough experience. Travelling staff = not much continuity of care.

  • rate this

    Comment number 10.

    I can only assume that MPs will also recieve regional pay, o no i forgot everyone else rules dont apply to them. Houses/rents/allowances/taxes even something as simple as decorating. We need to invoke an election as and when we the public feel that we are not being represented and sack those that are failing.


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