Issues facing ancillary workers in healthcare in the United Kingdom

1. Issues facing ancillary workers in healthcare in the United Kingdom Mike Jackson Senior National Officer (Health), UNISON

2. Background UNISON • Largest Union in UK – 1.4 million members working in the public sector • 425,000 members in the National Health Service, representing a broad range of professionals and ancillary workers – the NHS is Europe’s biggest employer with over 1.2 million health workers • 40,000 in the private sector – ancillaries • 80% of members women

3. My background • National Union of Public Employees (NUPE) 1978 – 1993, Area Officer, representing ancillary workers and nursing assistants. • UNISON 1993 – 2004, Regional Officer, representing all healthcare workers • UNISON 2004 to date, Senior National Officer (Health), Lead Negotiator NHS Terms & Conditions, NHS Staff Council

4. Ancillary Workers in the NHS • Catering – Chefs, Cooks, Kitchen Porters and Assistants, Ward hostesses, Dining Room assistants • Domestic – Cleaners, Housekeeping staff, • Portering – incl transport and security, • Laundry - incl Linen and Sewing room staff, • Other - Switchboard/Call Centre, Sterile Services, • Not classified as ancillary (but similar) – Healthcare assistants (nursing), Healthcare support workers, Administrative and Clerical staff, Maintenance –buildings, car parks and grounds

5. Battle for Equal Pay • Whitley Councils (9), including Ancillary Staff Council, determined pay since 1948 • Carlisle (North Cumbria) cases 1997 Compared domestics, HCA’s, entry nurses with maintenance workers • ‘Agenda for Change’ Project - Agreement to harmonisation of NHS terms and conditions plus job evaluation • Negotiations 2000 – 2004 • Equal Pay Implementation NHS 2004 – 2006 • Equal Pay Private Sector Ancillaries from 2006

6. ‘Agenda for Change’ (AfC) • Job Evaluated Pay & Grading Scheme • Introduced a Knowledge & Skills Framework • Covered over 1 million NHS Staff (excl Doctors) • Introduced new NHS Minimum Wage = £5.88 per hour, Since ‘Agenda for Change’ Oct 2004 • Average earnings (UK)= Men £11.31 per hour, Women £9.84 per hour (ONS. Nov 2005) UK Minimum Wage = £5.05 per hour

7. Current AfC Ancillary Pay NHS • Band 1, £11,494 - £12,539 (Domestics, Catering Assistants, Porters, Laundry Assts) Band 2, £12,209 - £14,739 (Higher Level Domestics, Chargehand Porters, Patient TS Drivers, Sterile Service Assts, Security, Cooks – also Health Care Assistants (HCAs), Ward Clerks, Reception, Maintenance Assistants) Band 3 £13,694 - £16,389 (Cook Supervisors, Portering Supervisors, Domestic Supervisors- also Higher Level HCA’s, Maintenance Craft Workers)

8. Ancillary Staff Pay – Private Sector • October 2005, Agreement between UNISON, Department of Health and CBI for Agenda for Change implementation– covering allancillary staff except maintenance workers • Interim Minimum Pay £5.65 per hour from October 2005 moving to £5.88 per hour in April 2006 • Job Evaluation and KSF from October 2006 • AFC minimum pay rates from October 2006 • Terms & Conditions equivalent value from October 2006 • Resistance by Employers to implement

9. Privatisation of Ancillary Work • 1983 – Compulsory Competetive Tendering (CCT) –Domestics, Catering, Laundry – others later • Lowest cost basis – fair wages clause abolished • Most NHS Hospitals in England privatised (female dominated) ancillary work • 1991 TUPE regulations • 1998 – Compulsory Competitive Tendering abolished but much ancillary work remains outsourced to the private sector due to PPP/PFI projects – one third of domestic work

10. Impact on Ancillary Workers • Balance sheet cost savings but….. • high staff turnover • exploitation of women and ethnic minorities • low and unequal pay • loss of pension (if they had) • loss of sick pay/high sickness rates • union de-recognition • little staff development • No longer part of a healthcare team

11. Impact on Service Delivery • Reduced domestic (cleaning) workforce by 50% over 20 year period 1984 - 2004 • Huge turnover rate (50% in London) • Loss of skills and experience • Rise in cross infection and MRSA • Nurses forced to do cleaning • New hospitals built with no kitchens! • Cook chill units = poor nutrition

12. Cleaner Hospitals Campaign • UNISON launched campaign in 2004 • Raised profile of importance of cleaners • Focussed responsibility for cleaner hospitals on Senior managers not individual cleaners • Demonstrated that contracting out reduced standards (9 out of 10 dirtiest hospitals had privatised) • Linked poor standards with spread of MRSA • Became 2005 General Election issue • Forced Government action on standards

13. Issues facing Ancillary Workers • Remain the lowest paid with poor pension provision • Many women part-time – face discrimination • Improved pay but overall unequal pay – compared to male average earnings • Privatisation reducing but job insecurity – always first to face cuts if savings needed • Marginalisation – access to training, careers, team • Exploitation of women and of black & ethnic minority workers - denied rights and access to opportunity www.unison.org.uk www.unison.org.uk/healthcare/cleanerhospitals/