Revolution in NHS salaries is unveiled

NURSES WILL have higher promotion possibilities with a new top grade of "nurse consultant" under radical plans for the reform of the NHS pay system which will cover doctors, nurses and midwives.

However, the plans, unveiled yesterday by the Secretary of State for Health, were immediately condemned by Unison, the union representing nurses and low-paid hospital staff, as a "divide-and-rule" strategy.

"I am disgusted and dismayed," said Bob Abberley, the head of the health section for Unison, last night.

The union is angry about proposals to introduce more local pay flexibility and withthe strong hints that staff will be expected to change work practices and work harder for pay increases. It fears that nurses and staff at the bottom end of the pay scale could still lose out under the new system.

The Health Secretary, Frank Dobson, is also likely to face a revolt from consultant doctors at the top of the salary scale. Under his proposals, consultants will be penalised for failing to spend more time than they currently do on NHS patients. The consultants have already told the Government they oppose plans to change their pay system. They were furious when it was suggested by Alan Milburn, Labour's previous health minister, that they were spending too little time on NHS patients.

A consultation document warns the consultants they will have to negotiate a new contract "so that rewards go to those who contribute most to the NHS. We want to move from a contract based on sessions to one based on agreed responsibilities and achieving good clinical outcomes... We need quicker ways to resolve serious performance problems."

Because it comes after the scandal of the Bristol baby deaths, it will be taken as a threat to ensure that pay is more related to patient success rates. It may also mean those consultants who have higher death rates could be penalised in their pay packets.

Mr Dobson makes it clear that he will keep the existing pay review bodies for doctors, dentists, nurses and midwives. Nurses and midwives will have three broad "flexible" pay ranges. There will be a single pay negotiating forum for all NHS staff not covered by the pay review bodies, replacing the 11 separate negotiating bodies which "duplicate discussion and preserve antiquated differences in pay and conditions".

Mr Dobson strongly denied he was introducing performance-related pay in the NHS, but the changes will enable him to target pay increases at staff who are meeting government health targets, including by improving health in deprived areas and "ethnic" areas.

The document says the current NHS pay system inhibits service modernisation and is widely regarded as unfair.