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NHS trusts forge ahead with apprenticeship plans despite frustrations

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Image: © Monkey Business

NHS Trusts in England are forging ahead with apprenticeships despite ongoing frustrations.

NHS trusts in England are gearing up to spend their levy at a far faster rate than employers outside the health sector and most plan to expand apprenticeship programmes – even though many of them are frustrated by their perceived inflexibility, according to one of the largest ever surveys on the subject.

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The BPP University survey of 175 trusts, which represents over two-thirds of the sector in England, found that virtually all planned to use the Apprenticeship Levy rather than lose it, and that most would spend the majority of funds in the first year compared to less than a fifth (18%) of employers outside the NHS.

Four-fifths of NHS employers plan to expand their number of apprenticeship programmes and almost all plan to offer clinical as well as non-clinical options – 89%, for instance, plan to offer health care support and 85% nursing degree apprenticeships.

However, nine in ten trusts wanted more flexibility in how they spent the levy and none said they were satisfied with the status quo. Large majorities wanted to be able to use the levy pot for in-house training programmes outside of apprenticeships, programme overheads and salary and headcount.

Professor Lynne Gell, Director of Nursing and Healthcare Education at BPP University, said it was gratifying to see so many in the health service embrace apprenticeships with enthusiasm, particularly as those in clinical roles who had little experience of them until recently.

“Not only are NHS employers converting many of their non-clinical training roles into apprenticeships, the vast majority are also exploring programmes in clinical roles, such as nursing apprenticeships, too. Just as importantly, trusts are using the opportunity the levy presents to upskill colleagues who may not have had training opportunities before.”

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In contrast to employers outside the health sector, NHS trusts are focusing most of their levy funds on internal rather than external candidates, with two-fifths saying they will use 80% of the levy on internal apprentices and one in ten saying they will spend all of it on them. Very few plan to reverse the split and spend 80% of the levy on external apprenticeships and 20% on internal hires.

As a result, trusts are targeting a broad range of age groups, with 80% of them saying, for instance, that a fifth of apprenticeships will be aged 16-24 and a fifth will also be in the 51 plus age bracket.

Professor Gell added that the government’s 2.3% apprenticeship target for the public sector is partly responsible for employers’ focusing on existing staff rather external hires, it’s only part of the story. “NHS trusts tend to see apprenticeships not merely as recruitment tools but also as crucial instruments for retention and progression. So it’s not surprising to see health providers tailor programmes to meet the training needs of existing staff.

She also said that it would be foolish to downplay the challenges trusts faced. “The NHS is arguably the most complex organisation in the country. The expectations and pressures placed on it are unlike any other employer. That means that regulatory approval, for instance, can be far more rigorous in the NHS than outside it. It also means that converting existing courses into apprenticeships isn’t always straightforward, particularly where the funding has historically come from elsewhere and the roles are supernumerary.”

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Rejecting the pay deal is ‘deluded’ and ‘unrealistic’, says RCN Negotiator

“Critics who advocate an aggressive rejection of the deal without a credible alternative approach may be deluded about the effectiveness of such a ‘male’ approach. They are also unrealistic.”

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The Royal College of Nursing’s Chief Negotiator claims that members who wish to aggressively reject the proposed NHS pay deal are ‘deluded’ and ‘unrealistic’.

Josie Irwin, the Royal College of Nursing’s (RCN) Chief Negotiator during the recent NHS pay discussions claims that members who wish to ‘aggressively reject’ the NHS pay deal are ‘deluded’ and ‘unrealistic’ about the alternatives.

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The RCN worked alongside fourteen other healthcare unions, including Unison, to negotiate the proposed NHS pay deal with the Government – which members are set to vote on later this month.

With gender pay gaps in the headlines and nursing being a predominantly female profession, the NursingStandard article titled, ‘A ‘male’ style of negotiation would not have delivered a better pay deal‘, argues that an all-female team nor a more aggressive ”male’-style’ of negotiating would have changed the outcome of the negotiations and the deal is the ‘best possible’ in the current economic climate.

Whilst many agree the gender of the team is irrelevant, the style and context of negotiations are certainly paramount.

Ms Irwin admits in the article; “It is not the best they [members] hoped for, but they [members] understand it is probably the best they will get.”

Concluding the article with; “Critics who advocate an aggressive rejection of the deal without a credible alternative approach may be deluded about the effectiveness of such a ‘male’ approach. They are also unrealistic.”

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The RCN warns that if members reject the offer, it is likely that pay recommendations would be made by the NHS Pay Review Body and as the £4.2 billion of extra funding agreed by the Treasury would no longer be available, the offer could revert to the 1% of previous years.

Many, including its own members, have raised concerns over the sub-inflation deal and the union has been heavily criticised on social media for its pro-deal agenda.

A spokesperson for the RCN said: “We make no apology for defending this hard-won deal in very strong terms. Every single member of the RCN will see their pay rise by considerably more than in recent years and that should not be forgotten.”

You can view the proposed changes to the agenda for change pay scales.

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Are Unions still valued in the modern workplace?

What price do you put on even remaining in the country to do the job you’ve worked so hard to get?

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It’s fair to say trade unions are something many people know about and use, but very rarely understand.

As a young NHS worker, I vividly remember the words of considered importance my mother gave me on the first day I started work (a long, long time ago) “Join a union,” She said, “Doesn’t matter which one, they will protect you.” Essentially, this is the general expectation of what a union does – stick up for the workers during tough times – but is that a role they are fulfilling? Do the nuances of UK employment law; the difficulties of the negotiation negate they apparent lack of observable progress?

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“In any industrial negotiation the work starts months, even years, before reaching the negotiating table.” Josie Irwin, Associate Director of Employment Relations at the RCN, believes a lot of the good work that happens behind the scenes goes largely unnoticed by the general public. “In 2015, we took a strategic decision to work together with all fourteen trade unions represented in the NHS to get our members out of austerity. To achieve this, trade unions employ a wide range of techniques to influence government policy, from direct lobbying to securing media coverage. But what unites all these elements is they rely on members getting involved – it is members’ voices that carry the most impact, whether meeting MPs or [being] quoted in the national media.”

It wasn’t until the mid-1800s that trade unions had any real power.

In 1820, a sixty thousand-strong mob went on general strike for a week – later referred to as the Radical War or Scottish Insurrection. They downed tools in defiance of the high unemployment, unfair working conditions and unresponsive Government, at a time of national civil and economic unrest in the aftermath of the Napoleonic Wars.

Much of the Nineteenth Century is littered with instances of fractious industrial tensions; of trade unions becoming more organised, well funded and powerful. For men. Women, on the other hand, were largely excluded from the unions, both in membership, formation and in fact its hierarchies until late in the Twentieth century. There is evidence of challenges to the male-dominated world, largely due to the tenacity groups of reformers like the Women’s Protective and Provident League (WPPL), but it wasn’t until the 1875 West Yorkshire weavers’ strike that women played a central role in unionism. Symbiotic to the development of unionism is the way in which the Labour Party and in part, Socialisms’ ontogenesis, unfolded in the UK.

Very much a grassroots party, Labour came into being through the political ambitions of trade unionists understanding their ability to affect real change came from within the walls of power. Political manoeuvring became a prominent tool of protest during the first half of the Twentieth century, with trade unions offering strong support to the war effort by cutting back on restrictive practices during the Great War, for the good of the nation. Even so, the introduction of the Munitions of War Act 1915 saw strike action and lock-outs forbidden with swift interventions to quell any trouble. In spite of this increasing Government macro management, union membership increased from 4.1 million to 8.3 million by 1920 and the TUC (Trades Union Congress) saw numbers swell with 77% associated to the Congress.

Looking back, it feels like nothing has ever really changed and if you look a little deeper, it really hasn’t.

Margaret Thatcher’s iron grip on unionism lead to mass unrest, strikes up and down the country – most famously the year-long Miners strike of 1984/5 – and mass unemployment. Thatchers’ capitalist ideology saw unions as a barrier to economic growth and so imposed laws to further restrict their powers; powers which she felt had blighted both the Wilson and Callaghan (Labour) government that had preceded her.

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The Miners strike became very much a war of attrition, each side fighting for what they felt was right. For Miners’ Union leader Arthur Scargill and the miners that was financial stability – coal pit closures were rife in the 70s and 80s as the seams dried up and work was hard to come by. While the Tory-led Government wanted to bring the country out of a paralysing economic downturn.

The narrative of the unions continues to be that of protecting the proletariat from the tyranny of their capitalist overlords. A tad histrionic maybe, but when you consider the Government implemented the Trade Union Act in 2016 leading to a TUC-led investigation on it’s effects to members in terms of work/life balance, it’s clear even today, that trade unions and Government are at loggerheads over pay and conditions. You only have to look at the recent junior doctors pay dispute and the response by Jeremy Hunt or even the nurses pay rise to see that the role of the unions is perilous and fraught with frustration. But due to this perceived lack of results or underachievement, is it any wonder then that the average person on the street views trade unions as somewhat feckless, lazy organisations doing only the bare minimum for its membership.

Writing in the Guardian, an anonymous trade union employee blows the whistle on the inner workings of their organisation telling a disturbing (and somewhat one-sided) story of alleged membership fee wastage, underwork – they point out the article was written at their desk  – and a lack of fresh ideas. With all the signs of an employee burnt out but reluctant to leave the obvious benefits of being paid ‘money for old rope’ their words are alarming: “When potential members ask me why they should join, I give them the usual spiel but what I’m really thinking is: “Join our rivals, they are cheaper and care more about you than we do.”” Interestingly, this was borne out in part when contacting four of the main healthcare unions for their right to reply. Only two, the RCN and Unison initially responded, asking what was needed. Only one, the RCN, managed to email a comment after a week of waiting for management sign-off.

One of the main obstacles preventing unions is the rise in individual-rights based employment law.

An article written in the Industrial Law Journal by O’Sullivan et al (2015) finds this somewhat hampers the union’s ability to negotiate using tried and tested collective bargaining methods. However, they go on to highlight the unions concede that the new laws can be used positively to support and protect vulnerable groups of workers. Added to this, at some point down the years, unionism became a commodity. On forums all over the internet, union members discuss the value of their membership in terms of money – A is cheaper than B and you get XYZ as well – but does that miss the point of having representation? Many articles exist for student nurses and qualified staff alike comparing the value of each union against each other: Unionism boiled down to determine its price per pound of flesh – fairly ironic.

What price do you put on even remaining in the country to do the job you’ve worked so hard to get?


Unions appear, by and large, to be the only ones doing more than voicing concern for the ever-dwindling NHS workforce. RCN general secretary, Janet Davies is quoted as saying European expat staff play an integral part in the skill mix of hospital wards all over the UK. “With 40,000 nursing vacancies in England alone after years of poor workforce planning,” She said, “We cannot afford to lose EU nurses too.” Over a fifth of EU nationals have left the country as a direct result of Brexit and the uncertainty they face over the longevity of their stay in the UK. Equally, as more and more young workers bounce between a cafe job here and a zero hour contract there, never has there been a time for trade unions to have the powers to level the playing field.

And yet they are continually viewed in a negative light, the victims of a well-orchestrated narrative. Or are they?

There is always more they could do to improve their standing. Millennials, for all their perceived faults, are in fact a different breed to the hairy-armed activists we remember from university, full of bluster about saving the planet, tofu and recycling. The kids of today can see the troubles ahead of them but rather than band together like the old days and ‘march in solidarity’ which they see just doesn’t work anymore, they instead choose different careers, travel more and look to overcome their issues in spite of authority. Trade unions need to be smart, rebrand their messages and allow new members to consider the benefits of working with a union behind them, supporting their ambition and providing opportunities for betterment.

So, do unions have a place in today’s workforce?

Absolutely, but with that comes new challenges which require new thinking and new energy. This new generation is at peace with the real world application of robots taking their jobs. They are already fostering new avenues of wealth creation and more cohesively working towards a better future. Two-way communication is key to unions surviving this latest workforce re-enablement, but if current experience serves as their narrative, unions will make themselves extinct long before Government legislate them out of existence.

A union is only as powerful as its members.

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Unison start balloting members over proposed pay deal

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Unison has started to balloting members over the proposed NHS pay deal.

Unison has started to ask its members in England if the union should accept the first “significant pay rise” in 7 years.

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All healthcare unions involved in the negotiations, with the exception of GMB, have recommended their members accept the pay deal. However, many have raised concerns over a further sub-inflation rise, changes to unsociable hours payments for ambulance and support staff, removal of agenda for change sick enhancements and changes to the incrementation system.


Can I vote? To be eligible to vote you must hold an active Unison membership and be employed by an NHS trust in England.

Should I vote? Absolutely, a union is only as powerful as its membership. This is a democratic process that involves you and your future.

How should I vote? We cannot tell you how you should vote, you should weigh up your individual circumstances. You can take a look at the proposed Agenda for Change pay scales or use the pay calculator to find out the effect the rise would have on your salary. But, we encourage you to do your own research.

How to vote: Eligible members can vote here.

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It says I am not eligible. You should contact Unison directly on 0800 0857857 as soon as possible.


Sara Gorton, UNISON head of health, said about the proposed pay deal: “Seven years of pay freezes and wage increases well below the cost of living have meant significant financial hardship for health staff and their families. It’s also created headaches for employers as they struggled to attract new recruits and hold onto experienced staff.

“The agreement means an end at last to the government’s self-defeating and unfair one per cent pay cap. It won’t solve every problem in the NHS, but would go a long way towards making dedicated health staff feel more valued, lift flagging morale, and help turn the tide on employers’ staffing problems.

“If health workers accept the offer, everyone’s wages will go further, and the lowest paid would get a significant income boost. Starting salaries for nurses, midwives and other health professionals would also become more attractive to people considering a career in the NHS.”

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