Published: 30/06/2005, Volume II5, No. 5962 Page 34

With many trusts well behind schedule for implementing Agenda for Change, Chris Mahoney finds out how they can get back on track

For an initiative with the word 'agenda' in its title, it is particularly unfortunate that the NHS's massive overhaul in staff pay is slipping behind schedule.

It emerged last month that less than a quarter of NHS organisations had met a key Agenda for Change target: assimilating at least half their staff into the new pay scales by the end of April (news, page 9, 12 May).

The clock started ticking on the 10month implementation period in December and the pay reform is supposed to be fully implemented by the end of September. But Department of Health workforce director Andrew Foster signalled last month that expectations are now lower, talking of organisations' duty to 'have substantial completion' by December.

With staff costs accounting for three quarters of NHS spending, getting Agenda for Change implementation back on track is clearly crucial. But how should those lagging behind seek to catch up?

NHS Employers director of pay modernisation Peter Smith acknowledges that at this stage there is an element of stable doors banging in the wind as horses - or perhaps disgruntled nurses and therapists - disappear over the horizon.

'Clearly people should have started sooner but there are still some things they can do, ' says Peter.

As with any change initiative, leadership is key. 'Organisations' leaders have to give the implementation process a high priority and be seen to do that, ' says Peter. 'They have got to walk the walk as well as talk the talk.' He also emphasises the importance of organisation. 'People tend to forget this, but Agenda for Change relies a lot on sound administrative processes. There is a lot of admin work: ensuring the right people to configure a panel [to match job descriptions to Agenda job profiles] are in the right place at the right time. In the implementation sites [pilot projects] a lot of time was wasted on getting the right people together, having the room booked and ensuring they had access to computers so they could log on to electronic job evaluations.' Mark Dibble, assistant chief executive at Gateshead primary care trust, which was among those to meet the recent target, adds that it is essential to get staff and their representatives on side.

'Fundamentally it is about the working relationship between staff and management. We worked hard before Agenda for Change to show that we valued that relationship.' The job evaluation panels at Gateshead consist of two staff representatives and one manager.

'There has been no sniff of suspicion among staff that management has been trying to railroad them, ' says Mark.

Salford Royal Hospitals trust workforce director Raj Jain agrees that managers and staff representatives have to work together on what is 'a very emotive subject'. His trust, which assimilated around 53 per cent of its staff to the new pay system by the end of March, formed a project group more than two years ago. To ensure staff buy-in, the group included employees and the full-time trade union officer. By early June around 70 per cent of staff had been assimilated.

With large staff groups, such as registered nurses, the trust broke down the job evaluation exercise into grades and established focus groups for each grade drawn from the relevant pool of nurses.

But in an NHS where staff are often hard pressed and facing simultaneous demands on their time, panel members can too often find themselves called back to their day job. Avoiding that is crucial.

Mark says: 'We have blocked out whole weeks in people's diaries to give focus to the work. We have had forward planning to ensure managers can plan for the staff member to be absent.' With implementation taking at least 10 months, Peter says panel selection should also take account of natural staff turnover.

Are people trained up to step into panel members' shoes if they leave?

And there is little point in agreeing flash new pay and conditions for thousands of staff if your payroll department is ill-equipped to deliver those new salaries into employees' bank accounts.

Raj believes that Salford Royal Hospitals trust is fortunate to have an inhouse payroll service with a service manager who has been on the project board since it was established in 2003.

Putting pay well up the agenda two years ago has left Salford and Gateshead among the minority - well placed to meet the original deadline. For others, it is a case of learning from the front-runners.

Agenda for Change tips

Ensure senior managers show their commitment by getting involved, rather than offering vague backing in staff newsletters.

Gain staff confidence by involving union officers in project boards and using focus groups of employees to consider proposed job descriptions.

Allow panel members time for their panel meetings and ensure line managers understand that the job evaluation meetings are sacrosanct.

Ensure panel members have the training they need and that someone is ready to step into their shoes if people leave or are off sick.