Vital role of secretaries

10:05am Tuesday 23rd October 2007

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Medical secretaries at York Hospital have been balloted over possible strike action. STEPHEN LEWIS investigates the cause of the dispute.

THE prospect of a strike at York Hospital will be horrifying for anyone who is ill or who has sick relatives.

Okay so it is "only" medical secretaries who are balloting about strike action.

They do not treat people, so if they went on strike it wouldn't affect patients, right?

Wrong. Anyone who has ever worked in a busy office must knows how vitally important secretaries are.

Without them, most offices would collapse into chaos. There is no reason to doubt that a busy hospital like York would be any different.

Consultant anaesthetist Dr Peter Hall admitted as much when he spoke to The Press last week.

"Theatre waiting lists would be affected and there would be a lack of communication between consultants and GPs because clinical letters wouldn't get there," he warned.

"Patients would not receive their treatment as promptly as they ought and this means their condition could deteriorate and they may end up suffering for longer than they need to."

Hospital chairman Professor Alan Maynard has no doubt about the vitally important role the medical secretaries play.

"They run the consultants, and the consultants run the hospital," he said dryly.

Vitally important they may be: but secretaries - medical or otherwise - aren't usually noted for being militant.

That is one unusual feature of this dispute. But it is also unusual for another reason. It isn't at all your classic workers versus management dispute.

As readers of The Press will know, 49 hospital consultants - among the most senior people at the hospital - have signed an open letter supporting their secretaries.

With the exception of the GMB which represents that 50-odd secretaries, however, other unions representing hospital staff support the management, and think the secretaries are wrong to be pursuing their action.

"I greatly empathise with them," said Edna Mulhearn, Unison rep at the hospital and leader of the Staff Side partnership of unions and workers' representatives.

"They are all hard-working and loyal to this trust. But this is not the way to solve the problem."

So what on Earth is going on? And how did the hospital find itself in this position anyway?

An agenda for change

MEDICAL secretaries are not the best paid members of staff in a hospital.

Most secretaries at York Hospital are on band 3 or band 4 of their pay scale.

A band 3 secretary earns at most £16,799, according to Edna Mulhearn of Unison, while a band 4 secretary earns a maximum of £19,730.

The reason for the dispute is that in 2004 the Government initiated a process for simplifying NHS pay. It was called Agenda for Change - and it is at the heart of the dispute, because it is as a result of Agenda for Change that most medical secretaries in York found themselves on a band 3 salary rather than a band 4.

That is despite the fact that some other medical secretaries doing the same job, both in York and in neighbouring hospitals such as Harrogate, are on the higher band 4 salary, the GMB says.

Agenda for Change was a simple enough idea. Salaries in the NHS had become nightmarishly complicated. People were being paid different rates for the same job, no one really knew what anyone else was earning - and it was difficult to ensure equal pay policies were applied.

Agenda For Change was intended to cut through all this. The myriad different pay bands and pay scales were to be sim plified into nine main pay bands.

All hospital staff - with the exception of doctors and dentists, who would have their own scales, and very senior managers - would have their jobs evaluated so that they fitted into one of those bands.

It was inevitable, admits Edna Mulhearn, that there would be some winners and some losers in that process. Some staff would be assigned to a band slightly higher than the one they had been on - while others would be assigned to a band slightly lower.

The process, especially in an organisation as bureaucratic as the health service, was bound to be a long and difficult one, in other words.

Nevertheless, Mrs Mulhearn says, the procedures laid down for allocating staff to different pay bands were clear, and were approved by unions like her own Unison.

Those procedures made clear that assignment to new pay bands would be based on a job description prepared by individual employees and their immediate managers.

Edna Mulhearn believes staff were made aware of the importance of the job descriptions they were being asked to draw up, and were given access to advice and help.

Job descriptions had to be agreed between staff members and their managers, Mrs Mulhearn said. "And they were told, if you're not happy with your job description, then if you are in a union, go to them. If you're not, go to the Human Resources department."

However, Joan Keane, regional organiser for health of the GMB union which represents the 50-odd medical secretaries, insists staff were not made fully aware at the time of just how important their job descriptions were.

They didn't realise, she claims, that the job descriptions they had agreed would be used to decide their pay band.

As a result, some people filled in their descriptions more carefully than others.

When the job descriptions were collated, and used to assign staff to pay bands, that led to some ridiculous anomalies, says Joan Keane.

"We had two women on a job share, one working in the morning, one in the afternoon, and they were getting different pay bands."

The Agenda for Change process did allow for a review of job descriptions. But that is where the real heart of the dispute lies.

The Hospital Trust, plus Unison and the other unions, says that when employees unhappy with their new pay bands requested a review, they could not change any factual information in the job description. They could not say, for example, that their job required a masters degree when before they had only said it required a bachelor's degree.

What they could do was provide further clarification of the role.

That was the procedure agreed by everybody, says Edna Mulhearn.

When medical secretaries who were unhappy with their pay banding resubmitted job descriptions in which factual changes had been made, therefore, those changed were crossed out. Only clarifications were allowed to go through to the review panel.

As a result, none of the secretaries who went to review had their pay band changed.

That was years ago.

The hospital has now agreed that the majority of band 3 medical secretaries can be upped to grade 4, as part of a fresh review independent of Agenda for Change.

The GMB, however, insists that secretaries it represents have been underpaid for three years. It wants them to get back pay to cover that underpayment.

"The Trust has set up a working party to look at the pay bands," admitted Joan Keane.

"It was decided that the medical secretaries would be allowed to be re-graded, but if they accept this settlement they will lose any right to back pay. This dates from October 2004 and is a significant amount of money for these women."

The Trust is refusing to agree to this, however.

The procedures for introducing Agenda for Change had been agreed by the hospital and by the unions - and hospital managers had followed them to the letter, says Peta Hayward. To agree back pay for the medical secretaries would effectively be to treat them as a special case, and apply different rules to them than to other hospital staff.

"We would be treating that group of staff differently: and whatever we do, we ought to be equitable," she said.

What's more, says Edna Mulhearn, if hospital managers did offer back pay, it would mean a union, the GMB, had effectively got away with breaking a procedure agreed by all unions.

That could damage union/ hospital relations, and end up making things worse for everybody, she said.

So there is stand-off, with hospital managers and most of the unions on one aside, medical secretaries, consultants and the GMB on the other.

It is complicated by the fact that the GMB was recently "de-recognised" by the hospital - though the hospital insists this is nothing to do with the GMB balloting its members over strike action, but is more of a long-standing disagreement with the union.

One thing all are agreed about, however, is that no one wants a strike.

"All we're doing is asking members how strong their feeling is on the issue," said Joan Keane.

Ms Keane says she has been trying without success to get a meeting with hospital managers to look at ways of resolving the issue.

Hospital managers, meanwhile, say say they hope to meet with her this week.

Hospital chief executive Patrick Crowley insisted today that the medical secretaries were hugely valued members of staff.

He can understand consultants supporting their secretaries, he said.

"But I don't believe industrial action is in anybody's interest - not ours, not the patients. It is something we will be working hard to avoid."

For the sake of patients, let's hope they succeed.

* Stephen Lewis, chief feature writer for The Press, is an elected governor of York Hospital.