Healthcare unions have warned that a “dangerous imbalance” between sectors could cause harm to patients.

The Royal College of Nursing and Unite have called on the government to ensure the NHS pay deal is extended to those providing NHS services in social care, the private sector and primary care.

The NHS pay deal, formally accepted by healthcare unions earlier this month, will mean at least a 6.5% increase for the majority of NHS staff in England. Pay negotiations in Scotland, Wales and Northern Ireland are ongoing.

However, thousands of NHS workers employed by social enterprises, general practice, social care, arms-length bodies, independent and charitable providers, have been excluded from the deal because they are indirectly employed by the NHS but still have a direct impact on patient care.

Made to feel like the poor relations.

Colenzo Jarrett-Thorpe, Unite National Officer, said: “Excluding indirectly employed NHS workers from the new pay deal is unjust. It will be a disaster for morale with thousands of low paid NHS workers being made to feel like the poor relations of NHS employees. 

"Regardless of whether an NHS worker is employed by a private company or the NHS, they are still health workers and their contribution to patient’s health must be recognised.”

In a letter to Jeremy Hunt, Janet Davies, Chief Executive and General Secretary of the Royal College of Nursing, said: "“I urge you to consider how to address the pay of all nurses and health care assistants providing NHS services, whoever their employer, so that a gap in pay does not result in workers being drawn away from primary, community and social care services.

”This would include those employed by social enterprises, general practice, social care, arms-length bodies, independent and charitable providers.

"I do believe that without this additional funding, we will see a dangerous imbalance of the workforce, which will significantly harm patients of non-NHS services.

"Many of our members delivering NHS services but not employed by NHS organisations complain that they endure poorer working conditions, loss of career and education opportunities,"

"We recommend the establishment of a new and separate national staff council, negotiating for all nurses and care assistants in health and social care who are not directly employed by an NHS organisation."

The Royal College of Nursing has called for the healthcare sector to be refined as a safety critical industry.

Healthcare should be reframed as a safety critical industry in order to avoid errors and improve patient outcomes, according to written and oral evidence submitted to the Draft Health Services Safety Investigation Bill Committee by the Royal College of Nursing.

Speaking at the Committee hearing earlier today, Dame Professor Donna Kinnair, Director of Nursing, Policy and Practice at the RCN, told MPs and Peers that while the College supports the creation of an independent body to investigate serious patient safety incidents in England, this could only work effectively if healthcare is redefined as a safety critical industry.

Donna said the Bill in its current form places disproportionate emphasis on blaming individuals, and ignores examining the wider context in which mistakes can happen. As well as blaming frontline professionals for system issues beyond their control, this risks investigations failing to root out the true cause of errors, further compromising patient safety.

In light of the 40,000 nurse vacancies in England alone, the RCN has called for nurse staffing levels at the time of an incident to be reported by the HSSIB for every investigation.

In addition the College has called for concerns raised about staff shortages on shift before the incident to be noted by the investigation.

Safe staffing levels should be enshrined in law.

In England, 71 per cent of NHS day shifts in adult acute wards fell outside the recommended nurse to patient ratio (1:8) standard set out in the NICE guidelines. Of those, 26 per cent shifts had more than 14 patients to one nurse. The RCN has previously called for safe staffing levels to be enshrined in law.

The College also raised concerns that healthcare staff who speak out in HSSIB investigations must be guaranteed a genuine safe space in which to discuss errors. It further recommended that findings of investigations be shared with health and care providers both within the NHS and independent sector, in an anonymised and appropriate way.

Speaking at the hearing, Donna Kinnair, Director of Nursing, Policy and Practice at the RCN, said: “The HSSIB will have to tackle those thorny cultural issues such as lack of staff, which people so often say we can do nothing about. It becomes more and more perverse that we tend not to look at the issues that are right in front of us.

“One of the things we are very clear about is we have an understaffed health service. The fewer nurses you have on duty, the worse patient outcomes you have. Nurses deliver 70 per cent of care. We would be working with HSSIB to make sure safe staffing levels are enshrined in law.

“It’s cheaper and easier to deal with the individual, and place the blame on the individual’s head, but this is not the solution. We can make the system safer.”

Nurses are forced to deliver care in unsafe circumstances.

Speaking outside the hearing, Donna said: “To improve patient safety, HSSIB investigations must root out the true cause of errors including systemic failures by Government and agencies. With staffing levels on many shifts below recommended safety guidelines, it is unjust, and potentially misleading to emphasise individual blame when systems and procedures are at fault. 

“Many nurses already struggle in the knowledge they are forced to deliver care in unsafe circumstances, yet their concerns are often ignored. Investigations should note concerns raised prior to incidents, and must take into account inadequate staffing levels.

“Staff should not be held to account for all care that is delivered, irrespective of resources and funding. Appropriate levels of accountability have to exist at all levels, including Government.”

The Health and Social Care Secretary says the pay deal is 'well deserved'.

Jeremy Hunt, the Secretary of State for Health and Social Care, has publicly congratulated NHS staff after they 'overwhelmingly' voted to accept changes to the agenda for change system and a multi-year pay deal.

Since March, 14 healthcare unions have been asking NHS staff whether they want to accept or reject the pay rise, which means a 6.5% increase over three years for over a million hospital cleaners, nurses, security guards, physiotherapists, emergency call handlers, paramedics, midwives, radiographers and other NHS staff across England.

'Overwhelmingly accepted'.

Yesterday, following consultation exercises and online ballots, it was announced that health workers had voted 'overwhelmingly' to accept the deal.

In the statement released by the Department of Health and Social Care, Mr. Hunt said; "This is an incredibly well deserved pay rise for staff who have never worked harder. Salaries will increase between 6.5% and 29%, with some of the biggest increases for the lowest paid.

"I hope this will also go some way to helping us recruit and retain more brilliant staff in our NHS."

.@Jeremy_Hunt's reaction to union members voting to accept an historic NHS pay deal for Agenda for Change staff. pic.twitter.com/ad1eLerxK3

— Department of Health and Social Care (@DHSCgovuk) June 8, 2018

'The issue of NHS pay has been put to bed'.

Janet Davies, Chief Executive and General Secretary of the Royal College of Nursing, said: “After today, the Government cannot assume that the thorny issue of NHS pay has been put to bed. This deal marks a step in the right direction but the bigger leap to truly fair pay still needs to be taken. It does give a genuine pay rise to over one million people from next month and that cannot be underestimated in challenging economic times.

“Ministers knew that the public were behind our members when they turned up the heat last year. Today’s deal would not have been reached without the campaigning efforts of tens of thousands of nursing staff last year and we thank the public for the support shown."