Resolution: Agenda for Change

This resolution passed.

Members can view a recording of the debate here (part 1) and here (part 2).

Agenda for Change (AfC) is the system of standardised pay, terms and conditions for NHS staff (excluding very senior managers and medical and dental staff). In Northern Ireland, AfC also covers social workers. When implemented in the NHS across the UK in 2004, AfC was the biggest overhaul of pay and terms and conditions of employment in more than 50 years.

A key feature of AfC is its commitment to partnership working through the NHS Staff Council, NHS partnership structures in the devolved nations, and NHS partnership arrangements at regional and local/employer level.

Details of the arrangements are published in the NHS Terms and Conditions of Service Handbook (NHS Employers, 2021), which is periodically reviewed and updated by the NHS Staff Council. The NHS terms and conditions of service were substantially refreshed in 2018, and a new version of the handbook published. A Scotland AfC handbook has also been developed.

AfC is underpinned by a bespoke NHS job evaluation scheme. This is used by NHS organisations to measure the demands of roles and map roles to a pay band. The aim is to ensure the NHS delivers equal pay for work of equal value.

The RCN report NHS Job Evaluation Scheme Agenda for Change: A Guide for RCN Officers and Representatives (RCN, 2020) sets out the key features of the NHS job evaluation scheme. Alongside this report, the RCN published an action checklist for RCN representatives when assessing NHS organisations’ performance on job evaluation to ensure local processes and procedures are fit for practice. This is important as legal cases have determined that AfC can only deliver pay equality where it is implemented correctly.

In 2013, Professor Ian Kessler produced a report on national pay determination in the NHS and evaluated the different components of the UK system, including the NHS Pay Review Body process, the role of the NHS Staff Council, the AfC pay structure, and the complex and supporting relationships between each component (Kessler, 2013). The report states that the AfC pay structure ensures the viability of the national NHS job evaluation scheme, which guarantees equal pay for work of equal value.

A further report published by the Work Foundation (Gulliford et al, 2013) assessed the ten-year history of AfC. The report concluded that AfC is best characterised as an ‘organism or a flexible adaptive system’. The authors’ view was that this is a strength of AfC and one that should sustain it through any change. The report attributed any operational problems more to implementation than the core design of the system. It concluded that “any concerted attempt to dismantle AfC as a national framework would be seriously misplaced” and that, instead, effort would be best expended “on improving and adapting its core provisions”. However, a lack of investment and resource at system and local levels, inconsistency of approach and poor application of the job evaluation scheme, as well as variations across regions and/or countries, have led to concerns that AfC is not fit for purpose.

Reading lists for each agenda item can be found here.

References

NHS Employers (2022) NHS terms and conditions of service handbook, Available at: www.nhsemployers.org/publications/tchandbook (Accessed 20 April 2022)

Royal College of Nursing (2018) NHS job evaluation scheme Agenda for Change: a guide for RCN Officers and Representatives Available at: www.rcn.org.uk/professional-development/publications/pub-007205 (Accessed 20 April 2022)