Review of Agenda for Change in NHS Scotland – Equality Impact Assessment

Screening

Policy Aim

As part of the 2023/24 pay deal, Scottish Government committed to a review of Agenda for Change (AfC). The review was conducted on collaboration with Scottish Government, Health Trade Unions (Staff Side) and NHSScotland Employers.

The Cabinet Secretary set out the following principles for the review of Agenda for Change as agreed as part of this pay deal:

• Make NHSScotland an employer of choice for health and other staff;
• Recognise the value of staff and professional roles;
• Improve outcomes for the public;
• Develop a modern and responsive pay, progression and reward system that meets the needs of NHSScotland and its staff;
• Ensure no financial detriment to staff, and;
• The remit and timescales will be fully agreed to ensure the work is undertaken and completed by an agreed date.

The review was to deliver in the context of NHSScotland principles around sustainability and value and was evidence-based. The review ensured that solutions address staff shortages through positive change, that is fit for purpose, demonstrates good practice, is equality proofed and all staff are treated fairly and consistently.

Whilst there is a focus on addressing staff shortages across the AfC workforce, the review aims to deliver a positive change which will be:

• Fit for purpose;
• Exemplar;
• Equality proofed, and;
• Available to all.

Background

While this EQIA includes the strands included within the Agenda for Change Review which was agreed in partnership with Staff Side and Employers, only the Reduced Working Week demonstrates a policy change. The remaining areas are either not within scope of policy amendments or are current policy that is being applied and has not changed.

• Review of Band 5 Job Profiles is being progressed within the provisions of the existing nationally negotiated and agreed UK Job Evaluation Policy which has been the subject of a separate equality assessment;
• Protected Learning Time already has existing guidance, and this work adds to that guidance within the NHSScotland Personal Development and Planning Review PIN Policy; and
• Pay and Reward is a scope for future pay negotiations and is subject to the Equality Act 2010.

This is a working document and will be amended, where there are any changes to policy.

The Staff Side cohort that engaged in the review was comprised of representatives from seven Health Unions that represent approximately 95,000 members, an estimated 55% of the total AfC workforce in Scotland (Annex 1). Together, these unions represent ambulance workers, nurses, midwives, cleaners, medical secretaries, Allied Health Professionals, porters and a host of other NHS staff within the AfC workforce. As Staff Side representatives regularly engage with their membership, they are acutely aware of key priorities and concerns and ensure members views are accurately reflected during the review process.

NHSScotland Employers fully engaged in the review, representing 14 regional NHS Boards, seven Special NHS Boards and one public health body. All NHS Boards are accountable to Scottish Ministers.

On the basis that these policies and processes and associated supporting documents set the standard for employment practice for all NHS Boards in Scotland to follow, an overall EQIA was deemed appropriate for the four Agenda for Change Working Groups. It is also currently practice within Boards to ensure that there is equality of treatment for all of their workforce both in line with the protected characteristic provisions but also on a broader basis taking into account any individual contractual provisions or working arrangements e.g part-time workers. Local equality monitoring arrangement are also in place. Further detail in respect of this aspect are detailed below within the section “Extent/Level of EQIA Required” (page 9).

Working Groups

The working groups as part of the review were as follows:

Work Group 1 – Review of Band 5 Job Profiles

A working group was charged with conducting a review of Band 5 Nursing Roles for AfC staff working in NHSScotland. Following on from preparatory work undertaken throughout 2023, this Working Group has:

Designed a process (consistent with the existing NHSScotland Job Evaluation system) for the delivery of a bespoke banding review for AfC Band 5 Nursing staff; and;

Overseen the development of a digital portal for the submission and consideration of applications as part of this review.

Band 5 Nurses who wished to apply for their current role to be re-evaluated were able to access this digital portal from 17 June 2024. Confirmation of the closing date for applications will be communicated separately.

Further details can be found via NHS Circular PCS(AFC)2024/3 published on 4 June 2024.

The review was undertaken in partnership with a mandate and remit agreed by the Scottish Terms and Conditions Committee (STAC) and conducted on a ‘Once for Scotland’ national basis to ensure consistency of any implementation of recommendations across all NHS boards in Scotland with any increased responsibility properly rewarded.

Lessons Learned

A paper was presented to STAC that summarised lessons learned as a result of the review of Band 5 Nursing exercise. There were learning points and required actions which may be helpful for NHS Employers or Staff Side to consider in the future should it be the case that it is considered that “role growth” has occurred:

1) The requirement to clearly identify, map and evidence the additional roles/responsibilities/learning requirements of the post(s);

2) The requirement to validate the mapping through member contact/ surveys/ employer engagement and confirmation using existing Job Descriptions;

3) The requirement to compare the ‘change points’ against the relevant national profiles; and

4) Consideration of the presentation of a case locally or nationally.

Work Group 2 - Protected Learning Time

A working group was established to consider the learning time for professional groups of AfC staff and was compliant with responsibilities as set out in the National Health Services (Scotland) Act 1978 at section 12II as revised through Section 4 of the Health and Care (Staffing) (Scotland) Act 2019. This states:

“In complying with the duty imposed by section 12IA, every Health Board and the Agency must ensure that its employees receive - (a)such training as it considers appropriate and relevant for the purposes set out in section 12IA(1)(a) and (b), and (b)such time and resources as it considers adequate to undertake such training.”

The recommendations made by this group will support the recruitment and retention of staff, their development and wellbeing, and have due regard to the need of health boards to manage the day-to-day deployment of staff in line with existing and future service provision responsibilities. Implementation of this review will require that the predicted absence allowance is reviewed and/or adjusted to reflect the impact at team level, ensuring adherence to agreed paid protected learning time for staff.

The working group developed a policy in partnership and approved by STAC at their meeting of 22 November 2023.All changes made within this guidance will be adopted within the refreshed Once for Scotland policy being developed.

Details on the agreed policy can be found via NHS Circular PCS(AFC)2024/1 re-issued on 12 July 2024 to include clarification around the Two-Tier Workforce.

These provisions were effective from 1 April 2024, and implementation of this work is ongoing.

Work Group 3 – Pay and Reward

The pay and reward working group was established to explore what changes can be made to the AfC system to provide a modern and responsive pay, progression and reward structure that meets the needs of NHSScotland and its staff.

The working group were tasked with the following key priorities in relation to pay and reward. These include assessing and undertaking:

• Identification of areas surrounding pay and reward requiring reform;
• Cost modelling of any proposed changes;
• Set out an implementation plan of the review by September 2023 for consideration of STAC Secretariat and approval by Ministers, and;
• Draft and present an implementation plan for consideration for STAC Secretariat.

Areas Considered for Reform

The working group considered the following areas (inclusive of modelled costs and Employer / Staff Side positions) surrounding pay and reward with potential to reform:

Restructuring of Pay Spine – incremental distribution and pay progression;

• Pay on transfer;
• Pay on promotion;
• On-call allowance;
• Compensatory Rest;
• Unsocial hours; and
• Annex 21.

The working group developed a set of recommendations for each of these areas and presented their proposal to STAC in November 2023. The working group agreed that these recommendations were separate from the other working groups formed for the Review of AfC and will be used as basis of future pay negotiations.

Working Group 4 – Reduced Working Week

The working group was established to explore the reduction of the hours in the working week, with the aim of getting to a 36-hour working week without the loss of earnings within an agreed timescale taking account of matters including, but not limited to, service provisions, safe staffing levels, staff wellbeing, and costs. Implementation of any recommendations were costed, fully resourced and reflected in local NHS Board workforce plans and set out in future NHSScotland health and social care workforce plans.

Following the first 30-minute Reduction in the Working Week for all AfC staff on 1 April 2024, the Cabinet Secretary for Health and Social Care confirmed on 18 February 2025 that a further hour reduction in the standard working week will come into effect on 1 April 2026 as per NHS Circular: PCS(AfC)2025/1.

NHS Boards developed and submitted outline plans prior to 1 May 2025, and full and final Implementation Plans by 1 October 2025, both of which having been agreed by the Area Partnership Forum. These robust plans, overseen by STAC, will ensure these changes are delivered in a way that is safe for patients and staff, supports the continued recovery of services and avoids any extra burden for our workforce.

The reduction in the working week presents an opportunity for NHS Boards to modernise how staff are rostered and work, ensuring that NHSScotland is a leader in flexible and family friendly working practices, and that it remains an employer of choice for health care staff.

A healthy work life balance for is essential for our NHS staff who provide high quality of care to the people of Scotland.

Who it will affect

These policies and processes, and supporting documents, set the standard for employment practice for all AfC staff in Scotland to follow.

These policies and processes also support Employers to provide a fair and consistent approach for AfC staff across the whole of NHSScotland.

Risks that may prevent the desired outcomes being achieved

This policies and processes, and supporting documents, set the standard for employment practice for all NHS Boards in Scotland to follow pertaining to AfC staff.

NHS Boards are responsible for managing and ensuring implementation in full of the refreshed workforce policies or processes in their respective Boards, in partnership, and within the requested timescales.

Costs

The recommendations the AfC Review come with a significant cost attached. Furthermore, any and all costs will be recurring on an annual basis.

The Cabinet Secretary confirmed that £200 million was allocated to Health Boards in 2024/25 in order to support the delivery of the reform commitments, with a further commitment of £150 million in 2025/26. Further funding will be provided to NHS Boards in the financial year 2026/27 to support the final hour reduction.

Review of Band 5

• There was disagreement on an implementation date where any staff may be moved between bands – Staff Side had a desire for the review to begin in April 2024. However, the Cabinet Secretary approved the recommendation to proceed with the recommendations of the review on 1 March 2024.
• Following the approval from the Cabinet Secretary, the working group has:
  • Designed a process (consistent with the existing NHSScotland Job Evaluation system) for the delivery of a bespoke banding review for AfC Band 5 Nursing staff; and,
  • Overseen the development of a digital portal for the submission and consideration of applications as part of this review.
• Band 5 Nurses who wish to apply for their current role to be re-evaluated were able to access this digital portal from 17 June 2024.
• Projected cost of £16.7m if 10% of staff at the top of band 5 move to the top of band 6. Costs would increase based on the proportion of staff that move to band 6.

Protected Learning Time

• While the current expectation around Protected Time for Learning is already factored into legislation, it is recognised that given the current pressures on the system not all learning time has been protected due to service pressures.
• NHS employers have a responsibility for making reasonable adjustments to enable staff to access and complete all statutory, core mandatory and role specific training relevant to their role. This includes providing staff access to a computer or other equipment that is required for them to complete this training.
• Projected cost of £7.5m for nursing staff to £5.8m (to close completion rate gaps) for all AfC staff.

Pay & Reward

• The assessment of the suggested enhancements to the existing pay spine would add just over £248 million in total to the Agenda for Change paybill, which works out at just over 3.1% of the predicted 2023-24 AfC paybill of £7,910 million.
• It is acknowledged by the working group that other elements of the review such as a Reduced Working Week and an increasing number of Band 6 staff will also have an effect on cost, meaning the real increase will be proportionately higher.
• This will also impact other pay and reward considerations including any changes to unsocial hours rates.
• Does not necessarily deal with the pay on promotion for staff who work regular out of hours and move to a promoted post which has less regular out of hours.

Reduced Working Week

• Potential for reduced service delivery if mitigations are not delivered effectively.
• Risk of delivering against key commitments around NHS Recovery and Waiting Times.
• Risk that services do not fully optimise and adapt to a reduced working week resulting in staff feeling overwhelmed.
• Risk of increased agency and overtime spend to maintain levels of service delivery.
• The projected costs for RWW are the most uncertain as not all lost hours would or could be replaced. Taking the nursing and midwifery job family as an example, replacing these lost hours on a like for like basis without mitigation would cost £124m based on the 23/24 pay bill.