Lansley pushes for lower paid NHS staff in poorer areas

Regional pay bargaining supported by internal Department of Health document.

The Observer reports today that the health secretary, Andrew Lansley, is planning to introduce regional pay bargaining into the NHS, meaning that staff in poorer areas will be paid less than those in London and the south east. Astonishingly, the only proposed exception to the new policy would be already highly-paid managerial staff working to deliver Lansley's unpopular reforms to the health service.

Defending the special arrangements, the Department of Health argues that they are necessary in order to:

Attract and retain high-calibre leaders and staff responsible for transforming delivery.

The department fails to explain why such measures are only needed to attract staff responsible for transforming delivery, and not also to attract staff in other important roles in the NHS such as doctors, nurses, hospital porters, cleaners and paramedics.

The move by the health minister comes in response to a wider government programme to introduce regional pay bargaining into all parts of the public sector. In his budget last month, George Osborne announced:

We're also looking to see whether we can make public sector pay more responsive to local pay rates. It is something the last Government introduced into the Court Service. London weighting already exists across the public sector. Indeed, the Opposition have proposed the interesting idea of regional benefit rates.

So we should see what we can do to make our public services more responsive, and help our private sector to grow and create jobs in all parts of the country. We've asked the independent Pay Review bodies to look at the issue. Today, we publish the evidence that the Treasury are submitting to them. And some departments will have the option of moving to more local pay for those civil servants whose pay freezes end this year.

Responding to the news, Labour's shadow health secretary Andy Burnham told the paper:

National pay is part of what underpins a truly national health service. Labour will defend it, as it is fair to staff, helps control costs and brings stability to the system.

It is often harder to work on the NHS front line in more deprived parts of the country and yet this government wants to pay those staff less and reinforce the north-south divide. It will infuriate NHS staff to see senior managers arguing for one rule for themselves, and another for staff. They are seeking to insulate themselves from these changes, while driving down pay for thousands of front-line staff across the country

Regional pay bargaining is particularly controversial in the health service due to its status as the largest single employer (verging on monopsony) of health professionals in the UK. Without the opportunity to take their labour elsewhere, employees are unable to ensure through normal market forces that the wage they are paid is competitive.

Arguing in favour of regional pay, the departmental document suggests:

Setting a national basic pay rate at a "minimum level necessary" and paying additional supplements in particular geographical zones.

It says: "Current rates of pay in the NHS do vary geographically, but significantly less so than the pay of comparable staff in the private sector. The introduction of more sensitive market-facing pay would therefore enable more efficient and effective use of NHS funds."

It further argues that "where the NHS pay premium is relatively high there is the potential for private sector enterprise to be crowded out with adverse impact on the prospects for local economic growth."

Andrew Lansley. Photograph: Getty Images

Alex Hern is a technology reporter for the Guardian. He was formerly staff writer at the New Statesman. You should follow Alex on Twitter.

Photo: Getty
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Who will win in Stoke-on-Trent?

Labour are the favourites, but they could fall victim to a shock in the Midlands constituency.  

The resignation of Tristram Hunt as MP for Stoke-on-Central has triggered a by-election in the safe Labour seat of Stoke on Trent Central. That had Westminster speculating about the possibility of a victory for Ukip, which only intensified once Paul Nuttall, the party’s leader, was installed as the candidate.

If Nuttall’s message that the Labour Party has lost touch with its small-town and post-industrial heartlands is going to pay dividends at the ballot box, there can hardly be a better set of circumstances than this: the sitting MP has quit to take up a well-paid job in London, and although  the overwhelming majority of Labour MPs voted to block Brexit, the well-advertised divisions in that party over the vote should help Ukip.

But Labour started with a solid lead – it is always more useful to talk about percentages, not raw vote totals – of 16 points in 2015, with the two parties of the right effectively tied in second and third place. Just 33 votes separated Ukip in second from the third-placed Conservatives.

There was a possible – but narrow – path to victory for Ukip that involved swallowing up the Conservative vote, while Labour shed votes in three directions: to the Liberal Democrats, to Ukip, and to abstention.

But as I wrote at the start of the contest, Ukip were, in my view, overwritten in their chances of winning the seat. We talk a lot about Labour’s problem appealing to “aspirational” voters in Westminster, but less covered, and equally important, is Ukip’s aspiration problem.

For some people, a vote for Ukip is effectively a declaration that you live in a dump. You can have an interesting debate about whether it was particularly sympathetic of Ken Clarke to brand that party’s voters as “elderly male people who have had disappointing lives”, but that view is not just confined to pro-European Conservatives. A great number of people, in Stoke and elsewhere, who are sympathetic to Ukip’s positions on immigration, international development and the European Union also think that voting Ukip is for losers.

That always made making inroads into the Conservative vote harder than it looks. At the risk of looking very, very foolish in six days time, I found it difficult to imagine why Tory voters in Hanley would take the risk of voting Ukip. As I wrote when Nuttall announced his candidacy, the Conservatives were, in my view, a bigger threat to Labour than Ukip.

Under Theresa May, almost every move the party has made has been designed around making inroads into the Ukip vote and that part of the Labour vote that is sympathetic to Ukip. If the polls are to be believed, she’s succeeding nationally, though even on current polling, the Conservatives wouldn’t have enough to take Stoke on Trent Central.

Now Theresa May has made a visit to the constituency. Well, seeing as the government has a comfortable majority in the House of Commons, it’s not as if the Prime Minister needs to find time to visit the seat, particularly when there is another, easier battle down the road in the shape of the West Midlands mayoral election.

But one thing is certain: the Conservatives wouldn’t be sending May down if they thought that they were going to do worse than they did in 2015.

Parties can be wrong of course. The Conservatives knew that they had found a vulnerable spot in the last election as far as a Labour deal with the SNP was concerned. They thought that vulnerable spot was worth 15 to 20 seats. They gained 27 from the Liberal Democrats and a further eight from Labour.  Labour knew they would underperform public expectations and thought they’d end up with around 260 to 280 seats. They ended up with 232.

Nevertheless, Theresa May wouldn’t be coming down to Stoke if CCHQ thought that four days later, her party was going to finish fourth. And if the Conservatives don’t collapse, anyone betting on Ukip is liable to lose their shirt. 

Stephen Bush is special correspondent at the New Statesman. His daily briefing, Morning Call, provides a quick and essential guide to British politics.