Item seven: Agenda for Change, changed agenda?

Matter for discussion submitted by the RCN Cumbria Branch

That this meeting of RCN Congress discusses whether Agenda for Change has made a positive contribution to the delivery of patient care

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In January 2009 the National Audit Office said that although Agenda for Change (AfC) in England was expected to achieve specific and measurable benefits there had been no formal assessment of it by the Department of Health or individual trusts.

On Tuesday RCN Congress discussed whether AfC has made a positive contribution to the delivery of patient care. Marie Hannah, Cumbria Branch, said that AfC goals included greater efficiency and effectiveness, the introduction of key skills frameworks (KSFs), fair pay and job evaluations. She said that trusts have not attempted to measure the impact of AfC on productivity or savings.

Many members spoke of their experiences working under AfC - Fraser Westwood, Aberdeen Branch said that there needed to be a dialogue between staff of all levels, Gareth Phillips from Wales said that AfC was largely effective and Judith Durrant, Mid Downs Branch said that AfC had created great opportunities for health care support workers by creating a career framework for a group of people the NHS had not previously invested in. Judith went on to say that training and development for staff still needs to be supported and implemented to allow people to progress through KSF pathways.

Marie closed the discussion saying that we should consider lobbying for an evaluation of organisation's strategic plans in order to understand the impact of AfC.

Background

Agenda for Change (AfC) is the terms and conditions package for NHS staff (excluding doctors and dentists) that was rolled out nationally in December 2004. The goal of the new pay system was to ensure more patients were treated more quickly, and given higher quality care. A further objective was to enable parties to find new ways of working which best deliver the range and quality of services required, in as efficient and effective way as possible, and organised to best meet the needs of patients.

AfC first sought to achieve the harmonisation of numerous sets of NHS terms and conditions. It also incorporates a knowledge and skills framework (KSF) — a national job evaluation scheme and competency based career framework.

The technical exercise of moving people to AfC has virtually finished. Now the focus has moved to how AfC can deliver improvements to patient care, and how the introduction of KSF is intended to deliver a better motivated workforce, delivering more patient focused care.

The Healthcare Commission's annual health care check showed that more trusts in England were achieving an excellent or good rating, and that the number of poor performers had shrunk. Indeed, the then Chief Executive of the NHS Confederation, Steve Barnett, stated: "All sectors of the NHS have improved, with foundation trusts and mental health trusts doing especially well, but we have seen marked improvement from ambulance trusts and PCTs. This reflects the tremendous hard work by all NHS Staff."

In Northern Ireland, the Department of Health, Social Services and Public Safety (DHSSPS) has established an AfC benefits realisation project group to evaluate the 10 UK national success criteria in Northern Ireland.

In 2006 the NHS Employers published a report From pay reform to system improvement: making the most of Agenda for Change, into the wider benefits of AfC, and identified organisations where AfC had supported service improvement and redesign, and workforce development.

In 2007 the King's Fund expressed concerns about the true impact of AfC, stating:: "The danger is that Agenda for Change will not be used as a means to an end of improving patient care, but has become an end in itself - an implementation box ticked, with management focus moving on to the next big challenge".

In January 2009 the National Audit Office said that although AFC in England was expected to achieve specific and measurable benefits there has been no formal assessment of the programme by the Department of Health or individual trusts.