The implications of the NHS White Paper for staff, which should ring alarm bells for all unions organising in the NHS.

Greg Dropkin, a retired NHS administration worker and long term warrior and researcher for the NHS campaigns spoke at our zoom meeting about the impact of the proposed legisaltion as foreshadowed in the NHS White Paper. These are his notes

Every trade unionist should be interested

“I will be talking about the implications for staff, which should ring alarm bells for all unions organising in the NHS.  But let’s start with the Health Systems Support Framework, an NHS England scheme to accredit companies to support the development of Integrated Care Systems.

The HSSF already involves 200 companies including 30 US firms involved in the health market, providing health insurance or supplying services to insurers. IBM, Optum – owned by UnitedHealth, Cerner, Centene, Palantir. The Bill is expected to allow them onto ICS Boards and Committees, with pivotal roles in setting up digital and data systems. Already in Bristol, Virgin is on the ICS Board. It is accredited for 6 topics under the Framework:

1) Shared or Integrated Care Records (Implementation Support); 2) Development of Service Change and reconfiguration proposals; 3) Transformation project and programme management (expertise and capacity); 4) Organisational redesign, governance, payment and contract reform; 5) Workforce and leadership development; 6) Patient pathway optimisation and care model design

This isn’t about Virgin getting a contract to run a service designed by the NHS, it’s Virgin and other transnationals lined up to tell the NHS how it should redesign and govern itself with new payment systems and contract models, and develop the workforce to deliver new models of care.

The Bill will be based on a White Paper which adopted proposals from NHS England.

I’ll talk about 3 issues for staff: national agreements, flexible working, and deregulation.


Currently, NHS staff are covered by national agreements on wages, terms and conditions. The agreement covering all healthcare staff apart from doctors and dentists, is called Agenda for Change.

Neither the White Paper, nor the Consultation which NHS England ran over Xmas, nor the Workforce Strategy for Cheshire & Merseyside, mentions Agenda for Change or wages, terms and conditions. If you search for “pay” in the Workforce Strategy, the only thing that comes up is: “…we must improve the experience of our people. At every level we need to pay much greater attention to why many of them leave the NHS” (!)

Breaking up the NHS into 42 separate ICSs each with their own budget, threatens the national agreements, because each ICS will be trying to cut the costs in their own area, and staffing is the biggest item because healthcare is still labour intensive, although of course they want to change that.

Back in 2012, employers in the South West tried to break from Agenda for Change. It was known as the South West Pay Cartel, and all the unions including the RCN fought it off. Here’s what NHS South of England said at the time:

We are aware that some employers are considering working more collaboratively in order to ensure that their pay frameworks represent best value for money… the Strategic Health Authority continues to work with employers and trades unions in applying national terms and conditions where employers do not have the freedom to develop their own.

Now the ICS will give employers that freedom. Before Xmas, an NHS England consultation on reform of the payment system stated:

The blended payment model would involve: •a fixed payment based on the costs of delivering a level of activity conforming to the ICS system plan •The fixed payment would be based on consideration of costs, rather than prices. •The value of the fixed payment would be determined locally. •Fixed payments would be expected to include funding for new ways of delivering services – for example where there are service design changes

Now a locally determined fixed payment based on consideration of costs means that there is no guarantee that staff costs will be tied to a national agreement on wages, terms and conditions.

The latest guidance from NHS England, issued this month, includes a commitment to protect terms and conditions for CCG staff being directly transferred into the ICS body, but says nothing about the other 1 million NHS employees.


The latest NHS England guidance, like the earlier consultation, highlights flexible working.

To support local and national people priorities for the one workforce in the system,

the ICS NHS body should work with organisations across the ICS to:


Develop new ways of working and delivering care that optimise staff skills, technology and wider innovation to meet population health needs and to create flexible and rewarding career pathways for those working in the system. This should be enabled by inclusive employment models, workforce sharing arrangements and passporting or accreditation systems.

This will allow continual redeployment as and when deemed necessary.

It will interfere with union organisation, demoralise staff, reduce continuity of care, undermine local knowledge and team working, and require more travelling, which is bad for the environment as well as staff.

Also, inclusive employment could allow redeployment into private sector partners.

Later on in the document, NHS England say NHS bodies are expected to

“adopting a simplified cloud-first infrastructure that provides agility and frictionless cross-site working experience for the workforce.”

This poorly written phrase suggests that as long as the computer system is set up for it, all other problems with continual redeployment are irrelevant.


A) Non-nurses in nursing roles.

On 9 June, the Guardian reported the RCN warning that NHS trusts are recruiting people without the right qualifications to act as registered nurses, despite the risk to patients. One trust advertised for a matron – a managerial role usually filled by a senior nurse – to work in acute medicine but said that a qualification in nursing was not necessary. Another trust sought to recruit a matron who would be responsible for older people’s mental health and learning disability services, but did not specify that the successful applicant had to be registered with the Nursing and Midwifery Council, which regulates both professions. Another advert for a nursing role stressed that the recruit could be a staff nurse, nursing associate – a new role being expanded to help plug the shortfall of registered nurses – or healthcare assistant.

B) The White Paper would give power to the Secretary of State to remove individual professions from regulation in future. “over time and with changing technology the risk profile of a given profession may change and while regulation may be necessary now to protect the public, this may not be the case in the future.” But technology means taking decisions by algorithms and apps instead of clinical judgement. If the healthworker lacks skills, training and experience, they won’t even be able to tell their manager they think the computer is wrong, either because of a glitch or a badly written programme. This is a risk to patients and also threatens professional development.

C) The Bill will remove the NHS from the scope of the Public Contract Regulations 2015. This is being promoted as an end to privatisation, but it actually means an unregulated market, without the protections in the PCR 2015 under which “contracting authorities may consider incorporating social, ethical and environmental aspects into specifications, contract conditions and award criteria. In addition specific rules have been included for handling abnormally low tenders, and on the exclusion of suppliers who have violated certain social, labour and environmental laws.” Those protections will vanish.

Over the last year, Government spent £37 billion on a Corporate Test & Trace which failed – even as the Delta variant emerged, when case numbers were low and the timing was ideal for it to work. The government threw billions more at private sector crony contracts, like those in the latest revelation from the Good Law project:

*Uniserve Limited* is a logistics firm controlled by Iain Liddell

Prior to the pandemic the firm had no experience in supplying PPE, yet the firm landed a staggering £300m+ in PPE contracts from the DHSC and an eye watering £572m

deal to provide freight services for the supply of PPE. The company shares the same address as Cabinet Minister Julia Lopez MP and is based in her constituency. Here they are together.

Now the government have the audacity to claim their response to Covid is the model for redesigning the entire NHS through partnerships with the private sector.


Leafleting staff: what we’ve done and will do.

Model motion.

Talk to people. MPs. “

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