The nurses' and doctors' pay settlement was supposed to clear the way for the government to wheel out its plans for the proposed new NHS pay system.
Instead, it seems to have muddied the waters. As well as raising questions about funding, the settlement varies the way different groups of staff are treated, which could sow the seeds of industrial unrest.
And ministerial suggestions that the new system will be performance-related, coupled with the trailing of a new grading system for nurses, have already led to accusations that the government is failing to show signs of 'joined- up thinking'.
Health authorities and trusts have been offered guidance on official thinking by NHS chief executive Sir Alan Langlands in a letter outlining ministers' response to the review body reports and plans for modernising the pay system.
He makes it clear that senior managers and other staff whose salaries are not covered by review bodies cannot expect to get the same increases as nurses or professions allied to medicine, who are seen as a 'special case'.
The prospect of a lower award for senior managers, administrators, ancillary workers, scientists and others - while not unexpected - has already given rise to howls of outrage.
Trade union MSF protests that the 12 per cent increase for newly qualified nurses will mean a D-grade nurse starting on a salary almost twice that of a graduate trainee scientific officer.
MSF head of health Roger Kline says it is a 'complete disgrace' that there will be a starting salary of£7,476 for trainee scientists with a BSc, while a D-grade nurse will get£14,400 from April.
Doctors are already up in arms because, for the first time in a decade, they are to get less than nurses.
It has also now become clear that the junior doctors' pay award will lead to a basic salary considerably less than the£26,000 quoted in the Department of Health press notice announcing details of the settlement.
The discrepancy was spotted by the British Medical Association junior doctors' committee, which pointed out that the official figure includes 32 hours' overtime a week and that the true basic salary for 40 hours is£16,700.
The DoH says gamely that both figures are correct. 'It is appropriate to include additional duty hours because they are payable to almost all junior doctors. They make up 40 per cent of annual salary.'
A spokesperson adds: 'We are quoting the top of the range and the BMA is quoting the bottom. We didn't intend to mislead anyone.'
But junior doctors' committee chair Andrew Hobart has written to health secretary Frank Dobson demanding an apology - without which, he warns, junior doctors may withdraw co-operation from the NHS.
This does not augur well for the start of talks on the new NHS pay system, on which government proposals are expected before the end of February.
In his letter, Sir Alan offers four basic principles the government wants to see in a new pay system (see box).
It also takes further the outline for a new grading system for nurses announced by Mr Dobson when he gave evidence to the Commons health select committee inquiry into NHS staffing.
Sir Alan says the aim is to create 'three broad, flexible tiers'. One grade for qualified nurses would broadly equate to D and E grades. A 'higher tier of expert nurses and clinical managers' would take in F-I grades.
Above that would be the proposed 'nurse consultant' posts which prime minister Tony Blair announced at last year's NHS 50th anniversary conference.
That idea and the proposed new grading system were both announced without consultation with managers or health unions taking part in the preliminary discussions on the future structure of the NHS pay system.
Pay and Workforce Research director John Northrop interprets Sir Alan's letter, and the hints dropped by ministers and their advisers, as indicating that the government is working on a pay spine for nurses rather than a single pay spine based on competencies for different groups.
But his view is not shared by NHS Confederation human resources chair Andrew Foster, who sees dealing with nurses' grading as a useful starting point for the new pay system.
He points out: 'One of the things that the new pay system must address is the issue of equal-pay claims.'
The Royal College of Nursing has a series of equal-value claims lined up for industrial tribunals in London and Carlisle, in which senior nurses are comparing themselves with doctors.
To avoid similar claims tearing a hole in any new pay system, it is widely accepted that it will have to be 'equal-pay proof'.
Mr Foster says a pay spine for nurses, with separate pay spines for other staff, would not meet that test.
Doctors, despite their 'extreme' position of claiming that they cannot be compared with anyone, would have to fit in, too.
So to avoid senior midwives, for example, seeking equal pay with obstetricians 'you have to have a system that can address those tensions'.
Mr Foster believes, nevertheless, that there will be consensus over much of the pay reform, with the real area of difficulty remaining the annual pay mechanisms.
The review bodies themselves flagged up a number of issues that they want the proposed pay system to address, such as nurse grading and career progression.
The nurses' body rapped trusts over the knuckles both for failing to increase leads and allowances last year, and for their response to the discretionary awards system for senior nurses - none of the nurses' unions knows of a single nurse who is receiving discretionary points.
RCN employment director Stephen Griffin says there is now a pressing need to think about whether significant progress can be made on pay reform, and not only because of the issues affecting nurses directly.
He believes the gap between the new salary of a D-grade nurse and the trainee scientific officer is 'symptomatic of the problems that the current pay arrangements generate'.
No comments yet