Some less equal than others

In the brave new world of multidisciplinary
and multi-agency teams, how much you earn may depend not on what
you do but on who your employer is, which may lead to disparities
in pay and conditions. Sarah Wellard reports.

How would you feel if, several months into a
new job, you discovered most of your colleagues were earning
several thousand pounds a year more than you, even though they had
similar qualifications and less post-qualifying experience? Or what
if the boot was on the other foot and you were earning several
grand more than better qualified colleagues doing exactly the same
job? Beware. As the new care trusts come on stream over the next
few months, this is exactly the position that many of their new
employees may find themselves in.

Keith Bramber (not his real name), a
psychotherapist working in a community mental health team for a
health trust in the south east, knows how unpleasant this
experience can be. A few months after starting work in 1999 he
discovered that most of his co-workers were earning around
£3,000 a year more than him. He says: “Knowing you are
undervalued is hard to live with. We’re doing exactly the same job,
with the same job title and job description.”

Most of Bramber’s co-workers are community
psychiatric nurses (CPNs), but there are also social workers, a
psychologist and an art therapist. He says: “It makes some people
feel guilty and feel that they should work harder. Other people are
resentful and feel they should work less hard. It’s very difficult
to raise it with managers without being seen as difficult and

After two years of negotiation, Bramber
eventually succeeded in getting his and a colleague’s pay upgraded
in line with the nurses. But no back pay was offered. And now that
the government has introduced special cost of living allowances for
key workers, a differential has appeared again, of £600 a
year. This time social workers as well as psychotherapists and art
therapists are losing out.

Some might argue that staff from professions
like social work and psychotherapy, which are not aligned to
medicine, are always going to be at a disadvantage working in the
NHS, where the medical model predominates and there is a tendency
to undervalue social or psychoanalytical perspectives.

Nurses and teachers employed by social
services may also lose out financially, according Dawn Gregory, who
manages five multidisciplinary community child mental health teams
in Norfolk. When Gregory began setting up the service three years
ago, the department agreed that all staff should be employed on the
same job description and the same pay scale, irrespective of their
previous professional identities. She says: “Because of the way the
government has targeted some professions with extra pay increases,
health staff and teachers in the teams now earn less than if they
had stayed within their own service. The government wants us all to
be fully joined up, but they haven’t thought through the
practicalities in terms of pay and conditions. A health visitor or
school nurse could be earning about £2,000 a year more.” Which
is a considerable amount of money, especially as none of these jobs
are particularly well paid.

Gregory would like to be able to improve
everybody’s pay, but that isn’t an option. Instead, she talks about
finding ways of managing the difficulties that can arise. She says:
“People coming into these teams are usually up for a challenge. But
sometimes when you really want a job you don’t always think through
the downsides, like realising that in three years time you won’t be
earning as much as if you’d stayed within your profession. You
can’t shove it under the carpet. You have to talk to staff about it
without becoming defensive.”

Rob Pinkham, deputy director of the Employers’
Organisation for Local Government, anticipates that these kinds of
difficulties may increase as more staff find themselves working in
teams alongside staff from other employers. He says: “Bringing
together staff from difficult cultures, with different training and
different approaches to customers is a big challenge. We’re not yet
picking up on many difficulties, but it’s still very early on in
this process. Our view is that organisations should aim to develop
a common pay structure before transferring staff, but the speed at
which changes occur means that doesn’t always happen.”

Staff transferring to care trusts will be
covered by the Transfer of Undertakings (Protection of Employment)
Regulations 1981 (Tupe) employment protection rights, ensuring that
pay, terms and conditions are not worsened. But at some stage
trusts have to introduce a new pay structure and try to persuade
people to transfer. Pay and conditions for health service workers
are under review and the first tranche of care trusts have yet to
devise new structures.

Owen Davies, social services national officer
at Unison agrees that experiences like Bamber’s are likely to
become more common if employers introduce different pay and
conditions for new staff. He says: “Most of these organisations
respect Tupe. It’s rare for us to have members complaining that
they been pressurised to accept poorer conditions. So you have the
transferred workforce on Tupe and the new staff on lower
conditions. It becomes a two-tier workforce that leads to bad
industrial relations.”

Davies does not think that a single unified
pay structure for all staff in health and social care would be a
panacea. Instead, he believes that proper funding for new bodies is
the best way of preventing organisations that generally accept that
they have a social purpose from behaving like bad employers.

In practice, however, managers of teams of
staff seconded from several different employers rarely have any
control over pay and conditions. Workers may be doing a similar job
for hugely different rewards. This is the experience of many youth
offending teams (YOTs) who typically include a mixture of directly
employed and seconded staff. Mike Hitchings, acting manager of
Wiltshire YOT, explains that at first the team adopted a generic
approach, with social workers, police, probation officers, the CPN
and educational welfare officer all doing more or less the same

“When we set up it was a problem. Now three
years on it doesn’t feel like one anymore,” says Hitchings.
“Initially we went for a generic approach which heightened the
sense of unfairness as well as professional tensions with people
feeling, ‘I’ve been trained to do this. How can you come in and do
it without training ?’ Now team members have reverted to more
functional roles, with staff working more closely in line with
their professional experience.”

Hitchings adds: “Before the YOT was set up, we
were all working with the same young people but with little
knowledge or understanding of what staff from other agencies were
trying to do. Now we’re doing it as a team.”

Janette Brown, programme manager for Howdon
Sure Start in North Tyneside, agrees that differentiated roles
within a multidisciplinary team, with each member understanding the
role the others play, can help a team work together without
tensions arising about differences in pay and conditions. She has
day-to-day operational responsibility for 47 staff, all of whom are
seconded onto the programme by their employers, who include the
local authority, a health trust, a voluntary organisation and
private sector not-for-profit business. “So far pay and conditions
haven’t been an issue,”she says. “It’s not something I’ve discussed
much with other Sure Start managers, but the varying hours worked
by staff contracted to different organisations could be an issue
for the future.”

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