The boss of a social enterprise that delivers NHS community nursing services has called it a “betrayal” that his staff are being denied a government-funded bonus payment.
Registered nurse Andrew Burnell has been chief executive of City Health Care Partnership, a community interest company (CIC) that provides NHS services, for 13 years.
“It just seems unjust because they didn’t work any less hard or committed to the cause and to patient care”
He told Nursing Times that he would have to find £3.7m in his existing budget to fund the bonus for his health workers, so that they did not miss out.
The government has been facing escalating pressure to address confusion and inequalities around eligibility and funding for the NHS pay deal in England, which came into force this month.
There are two elements to the deal – a consolidated average 5% pay rise for 2023-24 and a one-off bonus for 2022-23 of between £1,655 (8.2%) for band 1 to £3,789 (3.5%) for the top of band 9.
It has come to light that only Agenda for Change (AfC) staff directly employed by the NHS are eligible for the non-consolidated bonus that is covered by central funding.
This means other organisations that deliver NHS services and employ nurses on AfC aligned contracts – known as dynamic AfC contracts – are being placed in the position of denying their staff the bonus or covering the costs themselves.
Mr Burnell said he had around 1,800 staff on dynamic AfC contracts, most of whom were community nurses.
He described their omission from the bonus scheme – which in part was rolled out to recognise the extra pressure on staff as a result of the Covid-19 pandemic – as a “kick in the teeth”.
“I think after Covid, people have really taken it quite badly,” Mr Burnell told Nursing Times.
“Our services weren’t shut over that period of time, we carried on as if it was normal service.
“And when you’ve then got your current government saying, ‘we are going to give you a lump sum as a thank you for Covid, but we’re not giving it to anybody who works in a CIC’, to most nurses on the front line means that the government doesn’t respect them or it feels a bit of a betrayal, really.
“I think that’s what I’m getting fed back from staff who find it disgusting that they are considered every other day as being a partner and a part of that wider NHS.”
He noted that City Health Care Partnership – previously part of NHS Hull – only became a CIC, in 2010, because it was encouraged to by the policies at that time.
The CIC, which provides more than 50 services in Hull, the East Riding of Yorkshire, Knowsley and St Helens, employs around 2,000 staff and describes itself as “part of the NHS family”.
Like other CICs – also known as social enterprises – it has a contract to provide NHS services and is a ‘not-for-profit’ organisation, investing profits into services, staff and the communities it works in.
Nationally, around 40% of all community nursing staff were now working in CICs, according to Mr Burnell.
“So, there’s potentially 40% of that community workforce that the government is saying you’re not worthy of the lump sum, you don’t do a comparative job like our colleagues in NHS trusts – that’s the way [staff] interpret it,” he said.
He added: “It just seems unjust because they didn’t work any less hard or committed to the cause and to patient care.
“And quite a number of them became quite unwell during that time as well, but carried on. I just I think it’s short sighted.”
“Health visitors and other community nurses have been very aggrieved that they’ve not been able to get the payment”
Having spent around 26 years working in the community himself, Mr Burnell said it had always been the “Cinderella service” and that this needed to change.
In terms of the 5% consolidated uplift from the NHS pay deal, Mr Burnell said it was “our expectation” that this would be covered through the organisation’s contract with the NHS.
The situation at City Health Care Partnership reflects the national picture, leading Queen’s Nurse Reuben Collings to launch a petition on the issue.
It calls on the Department of Health and Social Care to “fully fund the 2022 non-consolidated pay award for organisations providing NHS funded services to enable them to pay their staff this award, to maintain parity of esteem and recognise the work of all colleagues working to deliver NHS funded services”.
The petition set up by Mr Collings had received more than 16,000 signatures at the time of writing.
Colenzo Jarrett-Thorpe, national officer for health at the union Unite, which hosts the Community Practitioners & Health Visitors Association, said, under the current policy, health visitors and school nurses on dynamic AfC contracts, as well as bank staff working in the NHS, were excluded from the bonus scheme.
Mr Jarrett-Thorpe said this “flies in the face of what we were told when we had these negotiations, that it would be fully funded”.
While some employers, like City Health Care Partnership, have agreed to fund the bonus themselves, others cannot pay it, he said.
“Health visitors and other community nurses have been very aggrieved that they’ve not been able to get the payment,” he told Nursing Times.
“But we’re working with them and to try and see what we can do to make sure as many people get that payment as possible.”
Unite members rejected the pay deal when they were balloted on it and Mr Jarrett-Thorpe said his union was planning further industrial action.
“We’ll be campaigning to make sure our members who are nurses, health visitors, community nursery nurses and school nurses, who are working in non-NHS employers who don’t get what they should be getting, get that and any more that we manage to negotiate,” he said.
The Royal College of Nursing (RCN) has also weighed in on the matter with a letter to health and social care secretary Steve Barclay.
In the letter, the college claimed that, as well as the bonus, some dynamic AfC staff and bank workers were missing out on the consolidated pay award for 2023-24.
RCN general secretary and chief executive Pat Cullen wrote: “RCN members employed as bank workers by NHS employers and those engaged on dynamic Agenda for Change terms and conditions by NHS providers have been informed they will not receive the lump sum payments in respect of 22-23 and/or the consolidated increase in respect of 23-24.
“Although the RCN has not been informed why, I understand this is due to funding,” she said.
“Our members are petitioning the government directly on this point and we will be working with the independent health provider network and the NHS Confederation and others to resolve this situation as was the case in 2018.
“If this situation is not resolved, it will create a two-tier system for staff engaged on Agenda for Change terms and conditions and will do nothing to quell industrial unrest regarding pay,” said Ms Cullen.
“It will also serve to increase reliance on agencies as encouraging workers to use bank systems, some of which operate well to quell agency costs, will only reduce further,” she added.
Meanwhile, Social Enterprise UK – a membership body for social enterprises – is also supporting the fight on behalf of the CICs and similar organisations that deliver NHS services.
Dan Gregory, director at Social Enterprise UK, said: “Social enterprises form a vital part of the NHS family, delivering health and care services all over the country while reinvesting profits in local communities.”
He added: “We don’t believe the government nor the unions would want thousands of hard pressed staff to be treated as second class citizens, at a time of significant vacancies and fragile morale.”
The Department of Health and Social Care declined to comment but directed Nursing Times to guidance on the pay deal.
This confirmed that central funding would only be provided to cover the non-consolidated bonus for staff “directly employed by NHS organisations (for example, permanent and fixed term contracts) as set out in Annex 1 of the handbook on Agenda for Change terms”.
Whereas for the consolidated award, the guidance said that “NHS funding to social enterprises, community interest companies, charities and other similar services will be uplifted through their usual funding routes”.
NHS trusts and integrated care boards have been told to “urgently” look at their finances for covering the 2023-24 pay awards and to only request additional funding if necessary.