Pay Review Body (PRB) Evidence

The NHS Pay Review Body (PRB)

The NHS Pay Review Body (NHSPRB or just PRB) advises on the pay of NHS staff on Agenda for Change terms and conditions. Touted as an independent review body, members of the PRB are selected by the Secretary of State for Health and Social Care and their recommendations are reported by to the Prime Minister, Health Secretary and other ministers from the devolved nations. 

The PRB can only provide pay recommendations when invited. Since 2022, the Scottish government has not given the PRB a remit and have been leading direct negiotiations on the pay award with trade unions and employers. For governments in England, Wales and Northern Ireland, the PRB still has a remit to make recommendations on a pay award for NHS staff. 

The PRB process 

There are four stages to the PRB process:

1. Governments issue a letter to the PRB chair which sets the parameters and timeline for the process. To read the letter for the 2023 to 2024 pay round, please see here. 
2. The PRB gathers and takes evidence (written and oral) to inform its decisions. 
3. The PRB reports to the government, setting out pay recommendations 
4. The government rules on any pay increases for NHS staff

SoR written evidence for 2023 

Below is a summary of the written evidence submmitted by the SoR this year. We are asking for: 

• A significant, above inflation pay award for 2023 for all AfC grade staff at all grades. This should be paid as close to 1st April as is possible.
• Frame any recommendations so as to limit the risk of burnout from excessive hours.
• Allow Trusts to use money currently being given to Agencies for recruitment and retention payments.
• Ensure banding outcomes reflect job content in 2023, for all grades and job profiles.
• Further immediate recommendations that address obvious barriers to retention and progression, including:
  • Framing recommendations so they support progression and career development, rather than re-enforcing existing barriers to career progression. 
  • Specifically recommending changes to the pension thresholds to remove the New Professional’s Pension Penalty, as part of pension contribution adjustments scheduled for October 2023.
• Government commit to a longer-term programme of guaranteed above inflation pay awards.
• The introduction of independent, published analysis of NHS workforce.
• Establishing real vacancy rates and providing the right level of staffing to meet Safe Staffing levels - establishing and then adjusting to honest real vacancy rates.
• Strengthening central accountability with clear lines of responsibility into Government so employers and unions can go to a responsible national lead on keystone projects, such as the introduction of CDCs.

We will be supplementing our written evidence with oral evidence to the PRB in early February.

Evidence highlights

Our evidence also explains

• Why we are submitting evidence when some unions are not?

  We share many of the concerns shared by colleague unions about the level of independence afforded to the PRB and its ineffectiveness over recent years. However, the Society has been championing medical imaging and radiography since 1920 and arguably there has never been a more important time for us to set out the case for investing more in our members. Radiography is also the clearest lens through which to see the extent of the workforce challenges in the NHS, and to measure progress. Looking through the Radiography lens shows the situation is critical. Whilst still not hopeless, urgent action is required. It’s in this context that we make our members’ case.

  We also continue to have concerns about losing the potential for independent oversight – if the PRB could be made more effective. 

  “Collective bargaining directly with Government is also unlikely to address the workforce crisis. We need a system where Government responds to independent accurate workforce data, mapped against demand for services, that can make independent recommendations on the levels of investment required to sustain the NHS safely. Government should then respond to this by finding the resources, or justifying why it is under-funding NHS staff. Union and employers should then negotiate on how resources are shared. We need to take the politics out of the NHS.”

• How Government are not investing enough in the NHS?

  Spending 20% less per person on health and social care than the EU15 average.

• How sustained under-investment has failed to match sustained growth in demand for medical imaging and radiography.

  This has fuelled a workforce recruitment and retention crisis, our evidence highlighting how staffing levels are unsafe and the working practices have become dangerous for staff and patients as a result.

• How the impact of elements of recent pay awards have re-enforced barriers to retention and blockages to career development.

  For example we cite the £777 increase in pension contributions a when a New Professional gets their first pay rise, swallowing up 51% of their first progression payment; or how promotion to Band 8 will almost inevitably leave someone worse off - the gap between Band 7 and 8a have been progressively eroded to only £42 p/m net excluding lost overtime pay.

• The challenges for specific groups of members in relation not pay, reward and the recruitment and retention crisis.

  These include:

  • Support staff and Assistant Radiographers 
    Who are poorly paid whilst needing clearer and more sustainable training and development pathways
  • Sonographers and Mammographers
    Areas where demand has grown dramatically but NHS staff numbers have virtually stagnated, and where the NHS panic management is compounding the problem, with Agencies having captured the market.
  • New Professionals at Band 5
    Our evidence showing their real disposable income is £30 p/w worse off than before last year’s award
  • Managers and Leaders 
    Showing that professionals will lose money if they seek Band 8 posts and how recent pay awards have made this worse, at a point when managers are under unsustainable pressure.
  • Overseas Recruits 
    We emphasise how critical they are to bridging the staffing crisis but how the NHS is failing to recruit and retain from overseas because of uncompetitive pay, reward and working conditions.

• How Agencies are out competing the private sector using the NHS’s own money

  For example, citing 3 regions where the NHS is paying £120 p/h for a sonographer when the NHS tariff is £40 p/h.

Key data from our PRB Evidence

• Government are not spending enough

  By 2018, OECD data shows the UK was spending 20% per person less on health and social care than the EU average – so whilst we are spending more than ever before we are not spending enough. 

  • The £6.5bn extra NHS funding announced over 3 years fails to recognise current inflation, as if hospitals are immune from rising energy, transport or staffing costs. 
  • ONS calculate the Government spent £47bn Test & Trace and  defective PPE.
  • It will take them almost 22 years to re-invest an equivalent amount into the NHS at current rates.

• Radiography a Keystone but workforce planning is inadequate
  • NHS England’s “Priorities and Operational Planning Guidance for 2023-24” (pub. December 2022) requires a 13% increase in cancer treatment capacity and a 25% increase in diagnostics. 
  •  £2.3bn of capital investment has been set aside or Community Diagnostic Centres but there is no co-ordinated national plan on finding additional staff to work in them
  • The latest NHS Vacancy Statistics show a record 132,139 staff vacancies, a 20% rise from March 2022. 
    • Vacancy rates for Diagnostic Radiographers have risen from 12% to 13% in the last year. 
    • The Sonography workforce, a critical modality for addressing waiting lists, has increased by only 2% since the start of 2020. 
    • NHS Mammographer numbers have increased in the same period by just 1 person.

   

  • In 2019 the radiography workforce needed to increase by 6% p/a in diagnostics and around 7% p/a in therapeutic radiography until 2030 to meet forecast demand for scans
  • The Richards’ Report (adopted Nov 2020) required an additional 28% growth in the total diagnostic workforce in England by 2026, including for the CDC programme
  • Between 2014 and 2020 growth was only 3% (DT) and 4%(TR) – around half what was needed, thus increasing the shortfall each year.
  • At the end of September 2022, 1,554,700 patients were waiting for a key diagnostic test, up by 139,741 from the previous September. 
    • The number waiting six weeks or more increased in the same period by 94,700*.
    • The National Imaging Board has set a 120% of pre-pandemic scans target.
    • 35.5% of those waiting more than 6 weeks for a scan need a non-obstetric ultrasoundscans(NOUS). 
    • Fewer NOUS were conducted in 2021-22 than 2018-19 (7.54m vs 8.01m) 
    • 29% of the current sonography workforce are near or beyond retirement age. 
    • The vacancy rates for sonographers and mammographers alone equal 46% of the total current training cadre.
    • Agency costs = 8% of all sonography costs. 
    • National outsourcing costs for NOUS reached £7.4M in 2021-22, averaging £78.33 per scan when the NHS tariff is £40. 
    • We have identified 3 regions where the sonography agency rate is £120 p/h.

• Retention Sabotage – the NHS is a dangerous and demoralised workplace

  (evidence from the SoR 2022 NHS Workplace Conditions Survey)

   

  Unsafe for patients or staff:

  • Only 22% said their workplace was very safe, as opposed to 25% who said it was somewhat or very unsafe.
  • 29% said not all possible DATIX reports are completed, and less than ½ (49%) said they were confident they would be acted upon.
  • 24% said they lacked confidence their employer would do anything to make their environment safer if they were injured at work.
  • 56% said they had witnessed a colleague being abused, bullied, threatened or harassed at work.
  • Only 1 in 10 said they were very confident their employer would support them if they were a victim of abuse, bullying or harassment at work.
  • Only 4 in 10 said they would recommend working in the NHS to a friend or family member, significantly lower than the 68% who would recommend radiography as a career.

   

  Barriers to career development with:

  • More members saying they don’t have adequate access to professional development and support than do (48% vs 47%).
  • Only 1 in 3 said they had protected study time.
  • Of those who do, only 32% say the time they have allocated is sufficient.
  • 60% are no longer interested in promotion, with 28% of these saying if they applied their manager would block it.
  • 20% said promotion wasn’t financially viable for them.

   

  Not enough staff:

  • 89% of all responses saying there were not enough staff to meet their department roster without requiring regular overtime.
  • 60% saying there were fewer rostered staff now than before the pandemic.
  • 4 in 10 believe colleagues leaving in the next 12 months would not be replaced.

• Pay & Reward Reality

  Assistant and Support Staff:

  • Vacancy rates for Assistant Practitioners are 17% and 10% for imaging support workers. 
  • The gross hourly rate at the top of Band 4 is only £13.48 p/h . 
  • Salary jump from top of Band 4 to the start of Band 5 is only 2.9% gross or 2.3% net 

   

  Ultrasound and Sonography

  • 8% of all costs in this area go to Agencies
  • Sonographers are disproportionately likely to bring successful Personal Injury Claims
  • The private sector is growing in obstetric ultrasound. This area is largely unregulated.
  • National outsourcing costs for NOUS reached £7.4M in 2021-22, averaging £78.33 per scan when the NHS tariff is £40. 
  • We know 3 regions where the sonography agency rate is £120 p/h.​

   

  New Professionals at Band 5

  • The starting salary is uncompetitive, even in areas of the public sector where £30,000 is already the graduate entry starting point
  • Progression is stalled by a £777 increase in pension payments after 1 year – a New Professionals Pension Penalty – which = 51% of their increment
  • The 2021-22 award increased a 2nd year Band 5’s net pay by only £16 p/w
  • The real disposable income for a 2nd year Band 5 living in Salford fell by £30 to only £148 p/w

   

  Managers and Leaders

  • Despite a growing number of radiographers in the workforce the number in leadership posts is static since 2014. Radiographers are not progressing into leadership roles.
  • A Band 8a managing the overtime roster will earn less than those they are managing
  • The jump in basic pay from Band 7 to Band 8a is worth only £26 p/w gross or £9 p/w net
  • The difference in pay between the top of Band 7 and the start of Band 8a = £61 p/m gross or £42 p/m net.
  • Band 8a have to wait a minimum of 4 years for a progression payment
  • The 2022-23 pay award Band 8a was less than 3% and less than the top of Band 5 
  • Our 2022 Pay Survey found members in Band 8b and above work the longest number of average extra hours, with no overtime paid above Band 7.
  • Our 2022 Managers’ Survey found:
    • A relatively low 54% said they’d been in their post for 3 years or more, suggesting high turnover.
    • 52% said they manage 20 or more staff.
    • 39% said they manage 30 or more staff.
    • 45% said they had received no specific training from their organisation in managing their team.
  • Overseas Recruits
    • 2 in 3 diagnostic radiographers being recruited into the UK workforce from overseas are being recruited directly into the private sector. 
    • 56% of the 3% growth in NHS diagnostic radiographer recruitment 2016-2020 was international
    • The number of UK-based FTE NHS radiographers in the grew by 9%, the number of internationally trained FTE grew by 147%.
    • Almost 4 in 10 of those recruited from overseas between 2016-2020 had already left the NHSby 2022.

• Data on agency cost in medical imaging and radiography
  •  The competition are outspending the NHS and using the NHS’s money to do so.
    • In 2021-22 the NHS spent almost £136M on agency and bank pay for imaging service. 
    • This equals 13.4% of the total substantive pay bill for all imaging services. 
    • Approximately 60% of the increased imaging services pay spend (from £2.7bn to 2.8bn) comes from extra Agency and bank costs. 
    • Agency costs = 8% of all sonography costs. 
    • National outsourcing costs for NOUS reached £7.4M in 2021-22, averaging £78.33 per scan when the NHS tariff is £40. 
    • We have identified 3 regions where the sonography agency rate is £120 p/h.