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3. Interviews with stakeholders

At the start of the project a series of interviews was conducted with key stakeholders. These interviewees included: SCoR industrial relations officers; SoR representatives at early implementer sites; members of the SCoR Council at the time of introduction of AfC; imaging and therapy managers familiar with Whitley and AfC grading; consultant radiographers; and experienced practice educators/CPD co-ordinators.

The reason for seeking their views were two-fold: first, to ensure that all relevant issues were addressed in designing the questionnaire; and second, to review staff attitudes towards AfC in relation to career progression opportunities at the time of implementation, and use this information to inform the design of the questionnaire.

Each individual was contacted initially by email, requesting an interview. Only one contact out of the 12 approached declined to be interviewed. With the eleven people who agreed to be interviewed a date and time was arranged for the interview. At the start of each interview the researcher gave assurances regarding anonymity and confidentiality and asked permission to record the interview as well as take notes during the discussion.

The discussion started by asking the interviewee about their role at the time of the debate about, and introduction of, Agenda for Change, and then covered six key questions:

  • their recollection/memories of the introduction of AfC
  • the interviewee’s opinion of its effect now, and whether these had changed since its introduction
  • whether there have been any unintended consequences of AfC
  • whether AfC has had any impact on career progression for radiographers and support workers
  • whether AfC is likely to have any further impact on radiographers and support workers in the future, and if so, what they believed those impacts would be
  • whether AfC is meeting the aims which it was designed to address: to lift morale, aid recruitment and retention, and assist career progression

The majority of interviewees indicated that they would be happy to be identified in the report, but initial assurances of anonymity have been adhered to in reporting the outcomes of the interviews in the following sections.

3.1 Before and after implementation: was there a rationale for implementation?

Many of the interviewees recognised that there had been problems with pay and grading within imaging services for some time, and at first they had believed that AfC represented a real opportunity to resolve those problems:

Whitley wasn’t working anymore and needed replacing – it did not recognise eg advanced practice. I remember thinking it [AfC] was a good idea since there was a total lack of standardisation for sonographers’ pay at that time.

The Whitley scale was no longer fit for purpose. And people doing different work were on broadly similar pay rates. And there was the recognition that the existing structures were not conducive to modernising careers and modernising work practices.

Whitley had had its day and wasn’t working for us.

Interviewees had been aware that many of the workforce were unhappy at AfC – prompted largely by the increase in working hours – but believed that the broader intentions had been good:

It was meant to lead to better training, and it had a good vision… it was meant to look at a range of things like…enabling better team working.

3.1.1 After implementation

Interviewees recognised that, across all bands, the AfC pay scales offered more pay.

The salary range for radiographers was about 20k to 50k tops with very few exceptions. The salary scale for radiographers now ranges from, well, it is still around 20k at the bottom but it goes up to nearly 80k…in terms of the potential pay there is a significant difference between then and now.

However, disparities continued, with the anticipated standardisation of pay rates for jobs of equal value failing to materialise because of variations in practice at local level – one of the issues it had been expected that AfC would resolve. Some interviewees could see this difficulty  increasing with the roll-out of Foundation status.

It has had benefits for some but not for others, as some aspects are not being implemented by some Trusts. There has been a failure of some Trusts to adhere to the ‘whole package’ of AfC….they are actively leaving out the bits they don’t like, such as Annex T.

AfC helped some but not others…there were disparities.

There is still a rash of local agreements which defeats the object of AfC. The new Foundation trusts also defeat the object since these Trusts are in charge of their own budgets and are able to band staff as they wish….therefore one assumes that this disparity is likely to continue to grow.

Interviewees had seen problems arise from variations in the process by which job descriptions were agreed during the initial bandings for AfC. In some cases, people with the same level of responsibility before AfC were assigned to different bands, while in others, people with widely differing experience were assigned to the same band.

People doing the same job are now on different pay bands.

There were two superintendent II radiographers here [prior to AfC] who were [subsequently] banded differently. People had similar roles before AfC but were banded differently. People were put in the wrong bands and mismatched.

In some cases these was misapplication of the process of matching to the criteria, or the criteria could arguably have been misapplied. So across the UK we have got some inconsistencies in matching outcomes, certainly between employers but more significantly the potential for inconsistencies in matching outcomes within individual employers, which has caused some difficulties.

Job evaluation has not been consistent. Matching has been poor, different bands for similar Trusts.

The general perception was that AfC had been rushed through, with managers not receiving adequate training in undertaking job evaluations or writing job descriptions. As a result, the job evaluations had been time-consuming and often were not done as well as would be hoped. A proportion of the variation in banding decisions appears to have been attributable to some managers being more skilled than others in drawing up job descriptions that fully encapsulated the roles within their departments.

The job evaluation exercise consumed so much energy and resources of the people involved, it was not handled properly, and people didn’t know what they were doing. There were a lot of training programmes to help prepare people for going through the exercise, and panels for implementation with trade union reps on, but there was not enough preparation, for it to work there had to be accurate and up-to-date job descriptions…if it had been done properly it would have been a fantastic opportunity. But one hospital told its line managers that they had to agree job descriptions with their employees within three months. What it flagged up was the problems and the different perceptions of what constituted an adequate job description – there were heads of nursing bringing in five page job descriptions and heads of estates bringing in just three lines. The process identified the problems and the training requirements of the line managers on what a job description was, but there was no time to do that. So the panels did heroic work but they were hamstrung by things that should have been done five years ago, the failures of management training in the NHS.

People were banded differently according to how clever their managers were at writing job descriptions and at ticking the boxes on the job evaluation questionnaires.

Meanwhile, in other Trusts, managers appear to have been involved hardly at all:

We were all asked to submit as individuals, which we did. However, initially all superintendents were lumped together as a group during the assessment stage – consequently every superintendent grade (diagnostic) was banded as a 7, taking no account of their experience, role, seniority or level of responsibility/accountability. The initial banding notifications came back with the wrong job descriptions – for example, RNI superintendents came back with MRI responsibilities!

Interviewees believed that the end result of people witnessing such events had been a disastrous drop in morale, and a feeling that radiographers as a group had been let down by the implementation process.

I thought it had potential for unfairness right from the start and this has been borne out.

It has been really demoralising and in some cases morally wrong. For example diagnostic grades were banded a whole grade lower (except for new graduates) than their radiotherapy counterparts….some staff have also gained advantage under AfC, especially in areas where there are staff shortages. But this too is morally wrong on experienced staff. In our case a radiographer was given a band 7 RNI post after only being qualified for two years – this put them on the same banding as both superintendents, who have many years’ experience and responsibilities. This decreases morale and mocks experience.

However, it should be noted that one interviewee did believe that at least some of the differences between the bandings following AfC reflected real differences in what people were doing previously.

Two senior Is employed by the same employer after matching could come out in different bands. Now from their perspective they could see that as iniquitous, but the problem is that you are not necessarily comparing like with like.

3.1.2 Continuing problems with contracts and working arrangements

There was a wave of appeals following the banding decisions. However, further problems arose from trusts being selective and, some said, manipulative in the ways in which they chose to apply AfC.

Appeals are still going on now.  A colleague was awarded a band 7 late last year after a long fight. But she’s a reporting mammographer so she should never have needed to go to appeal in the first place. She should have been banded 7 from the start.

In my department you had the choice of signing a Trust contract or an AfC contract and I went for the Trust option because I was led to believe it afforded me protection both in terms of hours (36hrs only) and pay.  But soon after, I found I was not being paid enough and an agreed bonus that I had worked hard for was ‘capped’ by the Trust, who said I couldn’t get the full amount since I was already at the top of my pay band. So I switched to the AfC contract instead.  The Trust contract was supposed to mirror Whitley pay but the Trust never revealed its pay structure.  There was a lot of confusion and uncertainty among staff about which contract was best for them. 

There had also been a range of different approaches amongst Trusts in implementing Annex T. Because of this, and despite the intentions of this part of the agreement, staff at some trusts still have to wait for vacancies to arise before progressing, regardless of skills, and contrary to intentions:

In my trust Annex T has been implemented so that at 18 months radiographers do go up to the next band providing they have completed the requirements.

There has been a failure of some Trusts to adhere to the whole package of AfC. They are actively leaving out the bits they don’t like i.e. Annex T.

There have been vague attempts to introduce extra pay points and most staff have gained a few increments, but this is irrelevant compared to the feelings of disappointment in AfC. This is especially true of Annex T and link grading.  Previously our Trust had link grading for radiographer grades (into senior II), however this is not acknowledged now (despite Annex T being an integral part of AfC).  This means band 5 radiographers have to wait for vacancies – leading to a decrease in motivation to progress or to staff moving away to other Trusts with vacancies. 

In part these problems were seen as arising from the poor drafting of sections of AfC, which meant that, as a consequence, Annex T was being individually negotiated at each Trust. Secondly, the loose wording of the Annex had subsequently allowed these local implementation agreements to vary a great deal:

[It was] a badly-drafted agreement, so there are lots of anomalies and confusion, there are contradictory paragraphs – a paragraph that says one thing on one page and it’s followed by a paragraph on the next page that says the opposite...Under Annex T they can spend the first two years acquiring fast track experience and authority in order to progress onto Band 6 without having to wait for a vacancy to arise. But we are struggling to get that implemented in every trust as it is poorly drafted and it is being left to each trust to negotiate with the trade unions.

In addition, while AfC was intended to remove the problem of split posts these had in fact continued at some sites:

Even though I was in that role, leading that service, it has taken me until this year to get my band 7 – well I did get band 7 payments after the introduction of AfC, but it was only per session, I was on a split grade. 

One person left because of an issue about split bands.

I hear a lot of people talking about being on split posts but AfC says quite clearly that this should not happen under any circumstances. Therefore, this has got to be a misinterpretation at Trust level.

There had been further problems arising from the way in which the change to hours had been implemented. In many cases, managers had failed to take into account the additional time that many radiographers gave voluntarily in advance of the contractual change brought in under AfC.  As a result there had been a significant loss of goodwill at some sites:

People have generally got used to the hours thing. But it has been abominably badly introduced since December(3). We are hearing about for example one manager who has said ‘You’ve got to start 12 minutes early every day’ - yet radiographers work over their hours anyway – if you are halfway through x-raying a patient at 5 o’clock you don’t just walk away. There has to be some give and take surely?

[There have been] problems with introducing the extra hours. It is complicated for part-time staff due to the method of calculating it and therefore difficult to police. I now calculate annual leave in hours rather than days.

It is a real nightmare now, working out when and how these hours will be used, working out staff working arrangements and things like holidays, because they are all arranged pro rata.

I have found it hard. A lot of unrest has been to do with the 37½ hours, people are still struggling with this.

Previously people would come in a bit early, then think ‘Well I’m here, I may as well make a start’, and most likely with the extra bits of time and the willingness they were probably working around 37½ hours anyway. Now they don’t come in until bang on 9 o’clock and they go home prompt at 5.

(3)The change to hours had commenced in December 2008, partway through the research

In addition, one interviewee reported that in some cases newly qualified radiographers had been started on the 37½ hour working week while other, more senior staff, were still on 37 hours, due to transition arrangements for phasing-in of AfC working hours for existing staff.

The interviewee said that as a result this had sometimes meant that:

Very junior staff were working unsupervised. There was a certain amount of resentment against colleagues on protected hours. It was also difficult to incorporate this into out of hours’ shifts.

3.1.3 Banding and recognition

While people widely acknowledged the improved pay on offer under AfC, other aspects of the rewards arising from the job were less appreciated. One of the key psychological benefits which individuals gain from employment is the status arising from, or attached to, their position. The bringing together of two previously different grades in the hierarchy into one broad band had therefore led to a real sense of grievance amongst some individuals, who felt that their authority had been eroded.

So there was a larger pay scale with more room for progression, and it was intended to have the advantage that people no longer had to apply to be promoted from senior II to senior I, but instead people say “I am a senior I, and they’re a senior II and do less than me, but they’re on the same pay band as me!’ People still see themselves as ‘senior Is or senior IIs’ and Senior Is don’t want to see people ‘catching them up’.

The title changes have caused confusion and upset and in some cases caused problems with command chains and the team. 

The system means that senior I radiographers were put into Band 6, the same as senior II radiographers when they had more responsibility.

At the same time, this change had also brought difficulties in terms of management structure for some departments.

In addition now with the banding there are unclear lines of authority within departments. Previously when we had basic grade, senior I, etc., there was a clear authority structure. Now it is band 7s in charge and everyone else is band 6; people who are newly qualified very quickly get a band 6 and we have them working alongside more established staff. There is no differential for experience etc.

I also think that Band 6 is too broad.  It captures too many people.  Lots of senior Is and senior IIs are all in the same pay band and this is wrong since it doesn’t reflect properly their experience and responsibility.

Similar issues were identified relating to the Band 7 band, particularly in the context of sonographer responsibilities:

Band 7 is too wide for sonographers. Most sonographers are on band 7 whether they just come in, do the minimum and go home again, or whether they are stars leading services and advancing practice. 

Clearly, although pay improved under AfC, individuals perceived AfC as failing to adequately recognise seniority and the different levels of skills and responsibilities held by individuals.

3.2 Impact on career progression

Comments in response to the question of career progression were inextricably linked to the views previously expressed regarding initial banding and the appropriateness of the various bands (especially bands 6 and 7). In particular interviewees returned to the question of the nature of the rewards and recognition sought by individuals in these jobs, and it is clear that in many cases, pay was not the sole issue involved in individuals’ decisions:

The problem is with the old senior Is, they say ‘Where do I go? More money is not enough. Where are the opportunities for me?’ I don’t know if it is better for them under AfC. But there is not enough room for everyone to progress beyond band 6.

As a consequence, the interviewees believed that there had not been as much impact on career progression as had perhaps been expected at the outset. As has been evidenced by the comments reported in the earlier sections of this chapter, many staff still have to wait for vacancies regardless of skills, while for other groups there simply is no obvious further progression route.

There is no career progression for sonographers – they are all stuck near the top of band 7 with nowhere to go.

While some would argue that it has been good for senior IIs (and potentially very good for the newly qualified at sites where Annex T is recognised) interviewees also saw Agenda for Change as having impacted negatively on the career progression options for senior Is (and for new graduates at sites where Annex T has not been implemented). At those sites where the system is working as was planned interviewees felt there was clear evidence of benefits. It was acknowledged though that this was not universally the case:

In this trust as people develop their roles, their increased duties are added onto their job descriptions and then sent to the AfC panel for re-assimilation to the next band. They do not have to wait for jobs to become vacant. So it has helped in that way. Things are added at appraisals, therefore with rebanding the staff go up a band. It happens at this trust but may not be happening a lot a lot of trusts.

Another interviewee confirmed that this was not the case at all Trusts:

Specific vacancies depend upon ‘dead men’s shoes’. People will not be re-banded without vacancies; the funding is just not available. There has to be a vacancy before anyone can be re-banded.

Some interviewees believed that, potentially at least, AfC made career progression more of a possibility for radiographers.

AfC has highlighted that people can expand roles.

The AfC pay and grading structure much better enables the four tier structure and the pay and grading structure correlates with the four tier structure so it facilitates that better, arguably this is because the pay is better than under Whitley, [so] it is a better enabler than Whitley.

However, not all agreed with this view, and some perceived AfC as having had a significant negative impact, particularly on progression into specialist areas of practice:

It has held back role development and recruitment in mammography.  At the moment a band 6 radiographer in the main dept can earn a good wage and supplement it with on-call. However, if they transfer to mammography and study for a postgraduate certificate they are still only graded at 6 and are no longer able to enhance their wage with on-call duties! Who would, in effect, take a pay cut and give themselves a lot of additional studying for no pay or status reward? I have to say, when I joined mammography prior to AfC one of the incentives for me was a Senior I post. That has gone now.

3.3 Motivation, morale, recruitment, retention and the future

Whilst a few of the interviewees felt there had been no real impact on motivation and morale, and in one case the interviewee noted that negative and positive views amongst the profession were often related to the banding awarded by the trust, the majority felt that AfC had been deleterious to both morale and motivation.

Yes there has been a decrease in motivation. AfC was meant to reward skill and experience, [but] no initial gradings were deserved and experience was not taken into account at all. Staff felt undervalued and de-motivated. This consequently gave no incentive to progress, expand knowledge or expand practice.

Has it lifted morale? Definitely not! Maybe in the odd case yes, but mainly no. Will it have any real impact on recruitment and retention? Perhaps, but I’m doubtful. Will it help with career progression? Only in those places where there are extended roles and the opportunities to [extend roles] and where advanced practice is supported.

Now that AfC is in the swing there is no positive effect on morale, there possibly was a slight negative effect on morale because people were led to believe it would solve problems but it has not.

Morale is much the same for most but for the lucky ones yes it has improved.

Lift morale? No, everyone is rather disillusioned with the whole thing I think.

Few of the interviewees believed that AfC had had any significant positive impact on recruitment or retention.

Has it improved recruitment and retention? I don’t think so. People come into the profession because they want a clinical career and it has not made the clinical prospects of radiographers better than those of anyone else.

The offer of role extension keeps some people. Others have moved in order to get promotion.

3.4 Implications for the survey

In general, it is clear that the interviewees held mixed views.  Most were clear about the benefits accruing to the new pay structures; however, for most, these benefits had been obscured by the problems arising from radiographers’ dismay at changes to hours, offence to their sense of “fair play” and natural justice and the failure for any real support for progression to emerge. Only a minority felt that the anticipated benefits for radiographers’ career opportunities had emerged and many felt that, perversely, there were now disincentives to further advancement. Indeed, some felt it was now harder to progress than previously. Discrepancies between the actions of different trusts meant that local circumstances may have continued to have more impact than AfC itself.

However, the main aim in undertaking these preliminary interviews was not to draw firm conclusions but to take soundings from informed individuals in the profession to assist in the design of the survey instrument. Gaining a better understanding of the range of opinions across the profession assisted the research team in drawing up lists of response options that would make the survey questionnaire as comprehensive and easy to complete as possible. Therefore, the content of these interviews were drawn on in designing the sets of response categories for each of the substantive questions in the online survey(4).

The interviews served a further purpose, in suggesting hypotheses that could be tested out in analysing the survey. For instance, one interviewee felt that views following implementation of AfC were related to how individuals felt they had been treated in the initial banding negotiations. This therefore served both to inform design of the questionnaire (for this reason respondents were asked if they had had to appeal their initial banding) and the later analysis stage.

We return to the issues raised here in Chapter 5.

(4)It should be noted that, in each case, respondents were also given the option of giving their own free response where they felt the options offered did not fully represent their view.








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