Agenda for Change, as the deal was known, covered all NHS staff except doctors and some managers, producing a set of pay scales and a training programme that has, to date, helped to head off highly expensive equal pay claims.

It aimed to ensure fair pay and a clear system for career progression, allowing staff to be paid on the basis of the job they do and their skills and knowledge rather than job titles.

But overall “there are few signs as yet that it has delivered increased productivity or transformed practice, and there is evidence that, despite the extra cost, many staff are far from satisfied by the process,” the report says.

“Managers [also] complain that the knowledge and skills framework is too cumbersome and costly to implement.”

“Patients will never feel the intended benefits unless health service leaders secure changes in the working patterns and productivity of more than a million nurses and other staff,” the study warns.

The deal took almost four years to negotiate and more than three years to implement, with some issues, such as an agreement over unsocial hours, still unfinished.

It exceeded cost estimates by hundreds of millions of pounds – by £220m in 2004/05 alone, and possibly by more in later years, the report says.

The latest forecast is that it will have cost £2.2bn to implement. Yet staff recorded lower levels of satisfaction at the end of the exercise than when it started.

The deal has significantly boosted pay, according to findings based on case studies at 10 NHS trusts and interviews with officials, union representatives and managers.

The scales it has introduced will continue to raise pay further even as the growth rate of NHS spending falls, the report says.

Managers at the 10 hospitals said it would take another two to five years to get the long-term benefits for patient care that the deal was meant to bring.

Even then, several cautioned that slower growth and the extra costs of the system meant that “full benefits realisation would be challenging and problematic”.

Without further central government pressure, “opportunities will be lost”, one union official warned.

From:
http://www.ft.com/cms/s/52bc8fa6-3e30-11dc-8f6a-0000779fd2ac.html

The report from the Kings Fund matches Health Direct view of labour’s waste in the NHS.
On March 02, 06 in Why is NHS productivity falling yet Labour claims it could be rising?

The Office for National Statistics started a fierce disagreement over output and productivity in the National Health Service this week as it launched a consultation into the issue. The ONS reported that different techniques could show NHS productivity rose by 1.6 per cent a year between 1999 and 2004 or that it fell by 1.5 per cent a year. Official figures show a decline of close to 1 per cent a year.

A number of labour government assumptions were questioned in the report.

The Department of Health, for example, found that increased use of statins, the drugs used to lower cholesterol, extended and improved patients’ lives so much that NHS output growth should be measured as 0.81 percentage points higher than previously.

If this assumption was included in NHS output, it should not improve the NHS’s productivity substantially because the gains were largely attributable to pharmaceutical companies.

Another problem was the Department of Health’s assumption that patients’ satisfaction at cleaner hospitals has as much weight in its calculations as the NHS’s ability to save lives. Andrew Street, a senior research fellow at the University of York, said there was no “empirical basis for the weights” the department used.