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Dean Royles
Director, NHS Employers
Dean Royles

Fairness in the public sector - NHS

Authors: Dean Royles Chief Executive of NHS Employers

08 April 2014

The recent NHS pay award, in which the Government took the decision to only partially implement the Independent Pay Review Body recommendation, was met with a variety of responses by staff and trade unions. Anger, frustration, worry, anxiety but mostly saying “it’s not fair”. There was a real sense of that all staff should be treated the same. Why should some staff get an increase and others not? It's team work that delivers good care, isn’t it?

The approach to pay this year is that staff at the top of the incremental scale will get a one per cent non-consolidated pay increase, while staff on increments receive no other payment. The question of fairness from staff is also often raised in relation to workload and bullying and harassment, particularly in relation to staff feeling able to raise concerns safely.

The response around this issue of fairness, in the public sector at least, has been to try to ameliorate anxiety about fairness by strengthening and amending policies and procedures. This is done in the belief that, if we treat people the same, we will reduce the anxiety about fairness - that the distributive justice argument would be done. I was reminded of a picture I saw on Twitter about the difference between equality and equity.

The pay award decision was a tough call for the Government to make. The decision to partially accept the Review Body recommendation may impact on morale and motivation. But, to accept it in full could have led to significant job losses.

This concept of fairness is going to be tricky to crack. Last year a deal was reached with NHS unions that bought in more pay for performance for hundreds of thousands of staff. How it’s implemented will have a huge impact on how fair it is seen. Our inherent mind-set of treating everyone the same won’t wash. To be seen as fair will require us to marshal better arguments about the differences between equality and equity and justice.


Dean Royles is Chief Executive of NHS Employers