Below are some most interesting comments from HR directors in response to the joint survey by HSJ and NHS Employers:

Do you think the changes to Agenda for Change went far enough?

“We need to make Agenda for Change far more affordable for employers, otherwise trusts will look to move away from national terms and conditions. Far more wide-reaching reform is needed.”

“The financial challenge and 24/7 working means the framework is now out of date. We need to be able to afford more staff to deal with the work pressure rather than pay some a lot of money, such as bank holiday working.”

“When calculated for our Trust, they save a seventy-seventh of the financial challenge this year.”

Are more changes needed to pay, terms and conditions?

“Yes yes yes. Is someone at national level going to have some courage re this? There has never been a better time to do this − the public are expecting it.”

“Doctors pay, terms and conditions − some of the national and local agreements are a waste of resources and immoral.”

“The employment package with the NHS remains very attractive and this is not always appreciated by staff within the institution. It is questionable whether it is in fact affordable.”

“We need to meet the economic pressures and cannot with the current pay constraints.”

“Clinical Excellence Awards need to go; payment for absence is too high and is a disincentive; annual leave reduction could be considered for new staff.”