Reductions in staff numbers, terms and conditions and skill levels have been a direct result of contracting-out and the diversion of the patient care budget to pay off PFI debts.
Medical staffing has been affected by reductions in the patient care budget. Service-related savings, which often account for a significant proportion of total savings required, have been associated with reductions include management, ward nursing, ward management, maintenance, sterile supplies, clinical support and operating theatres.
Data on staff reductions is not systematically collected. The following table shows staffing proposals for Edinburgh hospital's PFI. It shows a proposed reduction in the medical and nursing budget of £14 million and associated staff reductions of 345 nurses and doctors (table 6).
Table 6
Edinburgh Royal Infirmary PFI, staffing projections, February 199741
|
| 1996 (whole time equivalents) | 1996 staff budget (£m) | Projected (whole time equivalents) | Projected staff budget (£m) |
| Medical | 544 | 28.0 | 499 | 25.0 |
| Nursing | 2,144 | 40.0 | 1,844 | 29.0 |
| Clinical support | 899 | 16.5 | 886 | 15.0 |
| Admin & clerical | 802 | 12.0 | 556 | 8.0 |
| Ancillary* | 502 | N/A | 312 | N/A |
| Total | 4,892 | 96.5 | 4,000 | 77.0 |
Non-medical staff have also been affected. The majority of NHS PFI contracts involve outsourcing 'soft' services, such as catering, cleaning, security, helpdesk support and portering. In the first deals, members of staff involved in these contracts were transferred from NHS employment to the private sector without protection of their terms and conditions. The policy led to trade unions protests and since June 2001 most facilities management staff involved in PFI agreements have transferred under secondment arrangements, and have thereby retained their NHS employment.
However, staffing numbers and wage levels for new employees are not protected. In June 2009, the public sector trade union, Unison, called for an end to outsourcing: "Allowing the private sector to provide these services undermines quality, lowers staff wages and conditions and is extremely inflexible."42
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41 Pollock AM, Dunnigan M, Gaffney D, Macfarlane A, Majeed FA. What happens when the private sector plans hospital services for the NHS: three case studies under the private finance initiative. BMJ. 1997;314:1266-1271.
42 Unison. Reclaiming the initiative: putting the public back into PFI. London: Unison, 2009.