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Published: 05/02/2004, Volume II4, No. 5891 Page 15

Agenda for Change is stalling, so the Royal College of Nursing is campaigning for trusts to give its implementation due importance.But what is causing the delay, asks Mary-Louise Harding

After enjoying a brief moment in the sun in the run-up to union ballots at the end of 2002, Agenda for Change was largely relegated to the wait-andsee policy pile while the 12 pilot sites prepared the ground, and the rest of the country dealt with more pressing targets.

But the Department of Health has admitted the pilots are running late (they were supposed to have fully implemented the new pay scale by December last year), and there are only seven short months to go before national rollout begins.Now it appears that the Royal College of Nursing - which voted overwhelmingly last year to embrace the new pay deal - has decided to 'up the ante'.

RCN general secretary Beverly Malone says the launch of its sixweek advertising campaign in HSJ is the first step in a broader campaign to ensure that Agenda for Change 'gets back on the radar screen'. Although the campaign's essential message is about giving nurse reps time off other duties to prepare for implementation, Ms Malone says the underlying message is about putting the pay modernisation initiative on to the majority of trust agendas. She alleges they are not giving it due importance.

Ms Malone says: 'So much could be remedied if we just prepare.

That is why It is important that nurses are given enough time off to actually do the work they need to do to get ready for Agenda for Change; to get the training That is necessary for them to be both on the panels that are going to be set up; and to do the local evaluation of job descriptions.

'But if everybody's leaving it, if there is just a sleep-fest going on, then it will not happen, and I am afraid that when it does hit there will be mass chaos, ' she adds.

The Modernisation Agency does indeed have an 'initiation' checklist on its website that it recommends trusts follow to ensure that they are prepared for implementation. It ranges from giving union reps 'substantial time and facilities' to perform their key roles in embedding the implementation structure, to appointing a lead director.

However, such preparations, particularly allocating resources for 'backfill' to allow staff time off from operational duties, cannot happen until trusts are clear on central funding, argues Mid-Essex Hospital Services trust director of workforce development Nick Groves.

Mr Groves says the trust has calculated that implementation will cost about£150,000-£200,000 over an 18-month period (over double the current amount in primary care trust allocations). 'We need to know what might be available centrally before we can commit to that spending, ' he says.

Ms Malone says she understands more implementation money was to be made available to English trusts, which have been allocated£70,000 each, compared to£100,000-£400,000 per trust in Scotland.

But the DoH is attempting to quash any speculation. Last week, a spokesperson said: 'With record levels of investment going into the NHS to support service reform, we would question the assumptions [about new funding] that some appear to be making.'

However, Mr Groves also points out - as does Nigel Turner, Royal Free Hampstead trust human resources director and chair of the NHS Confederation HR committee - that progress will be stalled until the other staff unions, such as Unison, hold a second ballot of members on whether to accept the deal based on the pilot reports.

These are expected in March.

So, if an advertising campaign is the first step, what is the endgame if all else fails? Ms Malone will not be drawn specifically on the prospect of union action rearing its head, but the hints are obvious.

'One of the reasons why We are starting in January is to give us plenty of opportunity to start on the next phase. This has to be a campaign between now and October to make sure that it happens, and when this finishes we will regroup and see what we need to do next, ' she says.

'I know there are competing priorities in the inbox. But we have to get [managers] to understand how basic this is to the delivery of their service, to their bottom line, to whether or not they're going to be a successful hospital.

'It is a matter of believing that if you do not have your workforce effectively satisfied and working, and you have this opportunity for pay and career modernisation That is waiting to be implemented, then you're going to have unrest with staff.

'I think that most of us who are chief executives know that the last thing that we want is unrest with staff.'