NHS reform programme threatened by pay disputes

A series of bitter disputes involving the pay of more than a million health service staff is threatening to derail the Government's reforms.

Doctors, nurses and other staff have deep misgivings on proposed changes to working practices and pay offers, worth up to 50 per cent for some staff, and could reject the deals.

Ministers are desperate to secure agreement with staff whose co-operation is critical if the Government is to keep its promises to cut NHS waiting times and improve standards of care. Although the NHS budget is due for the biggest sustained rise in its history over the next three years, the success of the Government's plans depends on the willingness of staff to achieve the huge increases in productivity that are required.

Negotiations with hospital consultants are deadlocked after the senior doctors rejected a pay deal worth an average 15 per cent pay rise over three years in November because of anger at what they described as a "target-driven culture" and excessive management control.

A furious Alan Milburn, the Secretary of State for Health, ruled out reopening negotiations with the British Medical Association, which had backed the deal, and invited NHS trusts to reach local agreements with their consultants to "pay most to those who do most" for the NHS. But there has been no progress since January and no trust has announced that a deal has been achieved, according to the NHS Confederation, representing NHS managers.

The BMA said there was a "groundswell of anger" among consultants and several regions had called for a ballot on industrial action. Paul Miller, chairman of the BMA's consultants committee, said there was "implacable opposition" to local deals tied to targets.

Initial delight over a pay deal for family doctors worth an average of 33 per cent over three years, announced last month, turned rapidly sour when detailed calculations showed as many as seven out of ten GPs could be losers.

The BMA wants to negotiate an indefinite extension to the three-year "transitional" guarantee that no practice would lose under the next contract but the Government has ruled out the cost of £300m to £600m. The BMA has postponed a ballot on the proposed GPs' contract but insiders say it is likely to be rejected unless the guarantee is backed with extra cash.

A complex three-year pay deal for nurses and other healthcare staff, announced in November, ran into trouble after many staff found they would be eligible for rises of only 3.2 per cent a year over three years, worth 10 per cent in all, plus an extra 2.5 per cent at the end of the three years under a reform package that offers extra pay for extra work.

The public service union Unison, representing the biggest group of NHS staff, could reject the so-called Agenda for Change at a special health conference next week, where left-wingers will be taking a hard line. Activists are concerned that nurses and carers will not be properly rewarded for working unsocial hours.

Geoff Martin, London convener of Unison, said health workers were being asked to accept a pay cut in real terms. "No one should underestimate the level of anger at the sharp end of the health service," he said. The union's health group executive has voted to recommend acceptance of the 10 per cent pay offer over three years, but called for a trial of the Agenda for Change scheme at 12 NHS trusts.