Is the NHS Pay Review Body ‘independent’?

We do have an independent pay review body.

Given the NHSPRB's record, it was clear that the supposed independence of the body had been compromised.

Several readers have asked us whether the NHS Pay Review Body (NHSPRB), which recommends the pay settlement for nurses and many other NHS staff, is truly “independent”. The government says it is, but some trade unionists dispute this.

We know from public information that the NHSPRB is explicitly asked to consider budgets set by government when it makes pay recommendations. But it has also made recommendations the government has previously said would be unaffordable.

What’s been said

The NHSPRB is one of eight pay review bodies that collect and assess evidence in order to advise on pay in the public sector. Officially, it is described as an “advisory non-departmental public body”. It also describes itself as independent.

However, the independence of the NHSPRB has been questioned, as many nurses and other NHS workers go on strike in a dispute over pay.

This comes after the government accepted the body’s recommendations, on behalf of NHS England, to give most staff a £1,400 pay rise, amounting to roughly 4.8% rise in the payroll, in 2022/23. The Royal College of Nursing (RCN) has said this is not enough.

The body’s recommendations also extend to NHS staff in Wales and Northern Ireland, with the decisions on pay there made by the devolved governments. The Scottish Government decided this year not to participate in the pay setting process, but negotiate with unions directly.

ITV News has also reported that the GMB union, which represents many ambulance workers, intends to stop participating in the NHSPRB process because it believes that it is not independent of government. The GMB has confirmed this with Full Fact.

A leaked document, which ITV says comes from the GMB, makes a number of specific criticisms and claims that “the Government has substantial power over the Pay Review Bodies which it has asserted to the full since 2010”.

GMB has said publicly that the NHSPRB “is supposedly an independent body, free from government control (though in practice that is rarely the case and GMB have often challenged this).”

So how much control does the government have over the NHSPRB? We’ve looked at some of the main claims disputing its independence.

NHSPRB is asked to consider government spending plans

It is true that the NHSPRB’s remit is set by the government—but not only by the current government.

The formal terms of reference of the NHSPRB were set out in 2007.

These include a responsibility to “have regard to” several things, including “the need to recruit, retain and motivate suitably able and qualified staff”, but also “the funds available to the Health Departments as set out in the Government’s Departmental Expenditure Limits” and “the Government’s inflation target”.

In other words, the government requires the NHSPRB to consider both the interests of NHS staff and the budgets and targets that the government itself sets, when it makes pay recommendations. 

The health secretaries of the UK nations often also advise the NHSPRB on their priorities in a letter inviting it to begin work.

For instance, the former health secretary Sajid Javid said in his letter last year: “As the NHS budget has already been set until 2024 to 2025, it is vital that planned workforce growth is affordable and within the budgets set”.

Last month, the current health secretary, Steve Barclay, sent the letter to begin next year’s recommendations, in which he said: “Pay awards must strike a careful balance – recognising the vital importance of public sector workers while delivering value for the taxpayer, considering private sector pay levels, not increasing the country’s debt further, and being careful not to drive prices even higher in the future.” 

In its document explaining the latest recommendations, the NHSPRB summarised its understanding of the advice that it was given by the UK health ministers.

As part of its work, the NHSPRB also takes evidence from many unions representing healthcare workers, as well as from government departments, which it then shares with the other participants, in order to allow them to respond to the evidence of others.

Sometimes the government sets hard limits

There have been times in the past when the freedom of the NHSPRB has been constrained by rules that the government set in advance.

For example, in 2010, the NHSPRB was told that the government and devolved administrations would “not submit evidence or seek recommendations for public sector workers paid above £21,000”, because of a public sector pay freeze it was implementing at the time.

The body noted that “the UK Government policy for 2011/12 constrains our role to make recommendations for all staff”, and added: “Any constraints placed upon our role limit our ability to assess the full range of evidence on pay and related matters and potentially undermine the parties’ confidence in an independent Review Body process.”

This certainly suggests that the independence of the NHSPRB was affected in the past, and could be in future. Its most recent recommendations were not affected by a similar constraint, following the end of the recent public sector pay freeze.

Government does not always follow recommendations

The role of the NHSPRB, like other pay review bodies, is to gather evidence and make recommendations, but the final decision on what pay to award or offer staff is made by the central or devolved governments.

In 2014, when he was health secretary, Jeremy Hunt did not accept the recommendations of the NHSPRB, which he described as “unaffordable”.

However, the government also sometimes accepts recommendations that it indicated were unaffordable before. In its evidence to the latest pay review, the Department of Health and Social Care said it was assuming “an overall affordable headline pay award of up to 3%”.

The NHSPRB subsequently recommended a higher overall pay rise, adding about 4.8% to the pay bill, which the government accepted.

In other words, the NHSPRB does sometimes make pay recommendations that appear to contradict what the government has said it wants.

How the members are appointed

The people who make up the NHSPRB (and other pay review bodies for other sectors) are appointed by the government for a three-year term, which can be renewed once.

Members are paid £300 per day for their work, with the chair paid £350 per day. Some appointment announcements say: “The appointments will continue to involve a time commitment of 2 to 3 days per month. Remuneration for the roles will be at a rate of £7,883 per year.”

The government says the appointments are “made on merit and political activity played no part in the decision process.”

The appointments process is covered by the Governance Code on Public Appointments, and regulated by the Commissioner for Public Appointments (CPA). This means, among other things, that ministers are expected to be impartial, transparent and act in the public interest.

The eight members who produced the latest recommendations are:

• Philippa Hird (Chair): Former human resources (HR) director of ITV
• Richard Cooper: Former BT executive
• Patricia Gordon: Worked in health and social care in Northern Ireland
• Neville Hounsome: Former HR director
• Stephanie Marston: Former senior official of Prospect, a trade union
• Anne Phillimore: Public sector HR professional
• Stephen Boyle: Former chief economist of the RBS Group
• Professor Karen Mumford CBE: Academic specialising in labour economics and HR management

Only Ms Marston declared any party political activity in the register of interests, saying she was a Labour Party member. Some have family members who work in healthcare.

Members’ fees and expenses are also published.

The NHSPRB’s support staff

The NHSPRB gets professional support in its work from the Office of Manpower Economics (OME), which says it “provides an independent secretariat”.

According to a recent report, “The OME is an independent non-statutory public body, free from government direction in terms of its policy and operational activities.”

OME staff are civil servants, which means they are covered by the Civil Service code and expected to carry out their work with “integrity, honesty, objectivity and impartiality”.

A Department of Health and Care spokesperson told Full Fact: “The independent pay review bodies (PRB) are made up of independent, industry experts…

“PRBs carefully consider evidence submitted to them from a range of stakeholders, including government and trade unions.  They base their recommendations on several factors including the economic context, cost of living, recruitment and retention, morale, and motivation of NHS staff.”

Image courtesy of the National Cancer Institute