'We'll struggle to meet pay caps on staff' say trust directors

Half of respondents to HSJ’s survey of hospital trust directors believe their organisations will struggle to meet the planned pay caps for nursing and medical staff.

Detailed responses from over 60 hospital trust directors suggest that around half of hospitals could fail to implement capped hourly rates for band 5 nurses, staff grade doctors and for consultants.

For each of these staff categories, just over half of respondents said their organisations were either “unlikely” or “uncertain” to meet Monitor’s planned second “ratchet” of cap rates scheduled to be imposed on February 1 next year.

Monitor’s consultation on its plans for implementing the cap closed earlier this month. The regulator has said it wants to introduce the first of three ratchets of the hourly price caps on November 23 – the beginning of the week in which Chancellor George Osborne will announce the outcome of his spending review which is expected to demand greater action against perceived waste in the NHS.

For consultants and nurses, caps are planned to start at 100 per cent over the maximum pay rate for establishment staff, with junior doctor rates starting at 150 per cent. Under Monitor’s proposals, rates will then reduce again to 75 per cent and 100 per cent in February before being brought down to a blanket maximum 55 percent premium from April 1.

Out of the medical and clinical staff categories suggested, respondents were most optimistic about their ability to meet the February cap rate for band three clinical support staff and for junior doctors – although the proportion of those either certain or cautiously optimistic they could meet cap rates for these staff was still less than half.

Announcing plans to the introduce caps last month the Department of Health said the measures would reduce the NHS’s £3bn agency and temporary staffing bill by £1bn over three years.

However, that figure is not reflected in Monitor’s impact assessment of the proposed caps. The assessment warns that medics may not be prepared to work for rates substantially below what they are currently able to command. For that reason the regulator believes that a number of organisations may need to breach the cap rates to maintain safe staffing levels. It therefore anticipates annual savings nearer £200m.

HSJ’s survey also reveals that for nursing and clinical support grades, around one in 10 organisations are already paying rates below the level of the second planned ratchet, suggesting there may be a danger that in some areas, the capping regime could lead to increased rather than decreased costs for some staff groups.