You’re hired! A UNISON report on apprenticeships in the NHS

April 2016

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EXECUTIVE SUMMARY

The NHS financial crisis and the government’s apprenticeship policy of setting hiring targets and a compulsory levy are creating a risk that apprenticeships in the health service will be misused.

UNISON data collected from a Freedom of Information (FOI) study looking at employment of apprentices over the three years. It shows NHS employers routinely using the statutory minimum apprentice rate, now £3.30 an hour, or alternatively a wide variety of other ad hoc approaches to apprentice pay. All other staff in the NHS enjoy the protection of a nationally negotiated pay structure which ensures consistent, fair and equal pay. But when it comes to apprentices a free-for-all has developed, allowing employers to push pay down towards the bare statutory minimum, leaving apprentices vulnerable to exploitation.

UNISON’s data also raises concerns that a large number of NHS employers do not appear to be recording data on whether apprentices complete the apprenticeship or gain a qualification, reflecting a general target-driven focus on apprentice starts rather than outcomes. And where data was available, leaving and non-completion rates raise some alarm bells.

Experience so far suggests that the emphasis in the NHS is on delivering qualifications through apprenticeships at educational level 2, equivalent to the GCSE level that 16 year-olds are expected to attain before leaving school. There is little added value for apprentices at this level, and they are quickly fulfilling the same job requirements as their higher paid counterparts, while still paid less. This is a far cry from the gold standard apprenticeships which deliver higher level or degree qualifications, and improved earning prospects, in return for a lower salary while training.

Apprentice numbers in the NHS are set to explode as a result of ramped up targets and the compulsory levy on NHS employers. In England alone the government has set a target for 100,000 apprentice starts a year in the NHS by 2020, almost 7 times the current number.

This is likely to make the concerns we have already uncovered about low pay and a raw deal for apprentices a much bigger problem in the future.

As the NHS Employers have pointed out:

“The imposition of recurrent annual targets may actually reduce options for career progression in the support workforce, as apprentices may be employed on short 12-month fixed-term contracts and then replaced after this period by a new batch of apprentices...Furthermore a desire to meet annual targets may also discourage employers from making best use of higher and degree-level apprenticeships, that would take longer to deliver, the start figures for which could only be included in one annual reporting cycle1.”

1 NHS Employers response to the government consultation on Public sector targets

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The NHS is at a crossroads – it can commit to making apprenticeships a positive force for developing a highly skilled and motivated workforce that better reflects the communities it serves. Or it can risk its own reputation and the apprenticeship brand by churning out cheap and quick apprenticeships which may help balance the books in the short-term, but will let participants and ultimately patients down in the long term.

1) Introduction – apprenticeships in the UK

Since 2010 there has been resurgence in apprenticeship schemes in the private and public sectors, and this growth looks set to continue. The Westminster government has committed to creating three million apprenticeship places by 2020. The Scottish government is working towards having 30,000 modern apprenticeships starts a year by 2020. The Welsh government has an apprenticeship programme which has supported around 30,000 apprentices a year. The Northern Ireland apprenticeship strategy set out to pilot and test by 2016 a new apprenticeship model that emphasises quality and outcomes over numbers, and develops a full range of public sector apprenticeships.

There are key differences in approach between the countries, including the priority placed on apprenticeships for young people in Wales and the stipulation in Northern Ireland that apprenticeships have to last for at least two years. The NHS in Scotland has recently agreed that no apprentice will be paid less than the Living wage, now £8.25 an hour

The extent to which apprenticeships are being used in the NHS in each of the countries varies – for example there are very low numbers in Northern Ireland. In England two-thirds of apprenticeships are going to existing staff and a third to new starters hired in as apprentices. Clinical apprenticeships tend to be in clinical support roles while non-clinical apprenticeships cover a wide range of areas including administration, catering, maintenance trades, IT and customer services.

The introduction of the government’s apprenticeship levy in April 2017 will mean that the bulk of employers in the NHS across the UK (apart from very small ones like GPs) will have to pay 0.5% of paybill into the levy fund. This is a large sum going out of budgets at a time of widespread deficits and financial strain. At the moment the availability of apprenticeships does not map very well to the areas of most acute skills and staffing shortages in the NHS – for example a nursing apprenticeship will take time to develop and there is a general lack of suitable higher and degree-level apprenticeships.

It is not yet clear how the devolved administrations will decide to use their levy funding.

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In England the levy is expected to amount to a total of £200m pa being extracted from NHS budgets, recoupable only in the form of vouchers which pay for apprenticeship training, assessment and certification, but not salaries.

In addition the government is setting annual targets in England for the number of apprenticeship starts that public sector employers must achieve. For the NHS an annual target of 28,000 apprenticeship starts is proposed for 2016/17 – a substantial increase on the informal target that Health Education England set for 2015/16 of 17,000. By 2020 the target will be for 10,000 apprentice starts a year in the NHS.

2)UNISON’s research

On 17 November 2015, UNISON sent an FOI request to 281 NHS organisations in England, Scotland, Wales and Northern Ireland. The FOI request focused solely on staff hired to organisations as apprentices, rather than existing staff who have been put through an apprenticeship programme. This is an important distinction to make as a significant number of existing staff undertake apprenticeships. For example, in 2014/15 of the 14,660 NHS apprentices in England, two-thirds were existing staff prior to commencing their training. On this basis the FOI request examined the numbers of apprentices organisations were employing, the jobs they were employed in and apprenticeship pay rates. We were also keen to get beyond the current focus on numbers of apprenticeship starts and assess the outcomes with regards to completions, qualifications achieved and future employment opportunities afforded to apprentices. In total, we received 233 completed responses to our FOI request giving us a response rate of 83%.

Of the organisations that responded table 1 outlines the percentage of organisations that hired apprentices.

Table 1: Percentage of organisations who responded to our FOI request that hired apprentices

Financial year % of organisations who responded to UNISON’s FOI request that hired apprentices

2012/13 49%

2013/14 58%

2014/15 66%

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Over the financial years 2012/13 to 2014/15 the number of new starter apprentices in the NHS organisations who replied to our FoI request (either employed directly or through an external apprenticeship agency) increased by 51%. Table 2 outlines the total number of apprentices hired in each of the financial years.

Table 2: Apprentice recruitment

Financial Year

Number of apprentices recruited among employers responding

2012/13 2,1962013/14 2,9572014/15 3,325

3)What types of jobs are apprentices doing?

Our FOI data shows that apprentices are recruited to the NHS across a wide range of occupational groups; a full list is outlined in appendix 1. There’s a relatively consistent split between apprentices recruited into clinical and non-clinical roles in the financial years analysed. Table 3 documents the split in percentage terms. Within this, the majority of apprentices recruited in non-clinical roles worked in administration and clerical jobs while the majority recruited in clinical roles worked in health care assistant jobs.

Table 3: Clinical vs non-clinical NHS apprenticeships

Financial Year

Clinical Apprenticeships

Non-Clinical Apprenticeships

2012/13 46% 54%2013/14 44% 56%2014/15 48% 52%

Our analysis has also shown that a number of NHS organisations are using the apprenticeship model to recruit roles such as receptionists, domestics, housekeepers and hospital porters that are not traditionally associated with this form of training pathway. This raises concerns about the appropriateness of recruiting staff as apprentices in these jobs, and whether in some instances the apprenticeship model is being wrongfully applied in order to avoid employing staff in substantive roles.

NHS organisations do appear to be increasing the number of apprentices being recruited into non-clinical roles that could offer clear career and educational pathways and the potential to lead to professional qualifications. Howvere, there is less scope for this currently in the type of clinical apprenticeships being offered.

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Table 4 shows this trend in relation to the number of apprentices being recruited in finance, human resources and IT.

Table 4: Apprenticeship recruitment in corporate functions

Department 2012/13 2013/14 2014/15

Finance 31 25 55Human Resources 51 48 73IT 16 24 50

4)Pay rates for new apprentices (2014/15)In our experience existing staff are currently unlikely to see any change to their pay as a result of being put through an apprenticeship programme. But we have been picking up widespread concerns from UNISON branches about pay for staff recruited in to the NHS as apprentices.

Our FOI request asked about starting rates of pay for apprentices employed directly by NHS organisations. In this report we present data on pay for rates in the financial year 2014-15 – the most recent full year of data available at the time the request went out to NHS organisations.

Table 5 gives examples of most widely used roles for apprenticeships and the data on pay rates we received. The results show wide divergences in pay rates for the same roles. They also show considerable variation in the basis for determining pay rates reflecting the lack of guidance on the topic, and the absence of an accepted pay framework for this group within the NHS.

Table 5: Pay rates for new starters in the most widely-used apprentice roles, 2014-15

Role % of employers using apprentice NMW rate

Ave £ph Range lowest to highest £ph*

Finance 36% £3.43 £2.65 to £5.79Pharmacy 33% £3.47 £2.69 to £5.48IT 33% £3.62 £2.68 to £7.85Healthcare assistant 63% £3.92 £2.73 to £8.32

Administrative 37% £3.93 £2.65 to £9.63

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HR 24% £4.01 £2.67 to £9.09Clerical 38% £4.03 £2.65 to £9.75Healthcare support worker

36% £4.22 £2.73 to £8.32

Housekeeper/domestic

40% £4.37 £2.68 to £7.31

Electrician 33% £5.16 £2.68 to £9.63

*Some rates may include High Cost Area Supplement

Key pay benchmarks

To put this pay data into context, in this section we provide the key pay benchmarks that applied in the year 2014/15:

Table 6: National Minimum wage rates

October 2013 to September 2014

October 2014 to September 2015

October 2015 to date

Adult £6.31 £6.50 £6.70

Apprentice* £2.68 £2.73 £.3.30

*For those aged 19 or over this can only be paid for the first 12 months of the apprenticeship

Table 7: Living Wage rates (Living Wage Foundation)

November 2013 to October 2014

November 2014 to October 2015

November 2015 to date

UK £7.65 £7.85 £8.25London £8.80 £9.15 £9.40

Table 8: Agenda for Change2 band minimums £ph – 2014/15

Band England and Northern Ireland

Scotland Wales

Band 1 £7.31 7.70 7.85Band 2 £7.31 7.70 7.85Band 3 £8.32 8.52 8.32Band 4 £9.63 9.82 9.63Band 5 £10.98 11.04 10.98

2 The national pay structure for NHS staff

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Analysis

Table 5 shows the wide range of pay rates in use with the highest paying employers paying nearly 4 times as much as the lowest paying employers in some apprentice roles.

The most prevalent approach to starting pay was the use of the statutory minimum rate for apprentices, regardless of the job role. For most of the popular apprenticeships, between a third and four-fifths of all employers were paying just the apprenticeship statutory minimum. There were two outliers – at one end nearly two-thirds of employers hiring apprentice healthcare assistants used the NMW while just 24% of employers hiring HR apprentices used it. (Some employers appear to have been paying a few pence below the NMW although this was hopefully an accounting error rather than non-compliance).

A small number of employers hired apprentices on the bottom of the Agenda for Change (AfC) band for the relevant job, recognising that after a short time the apprentice would be carrying out the basic responsibilities of the role and their pay would progress up the band as they trained and gained experience.

Annex U of the AfC handbook was used by a significant minority of employers (see appendix 2 for further details). It was designed for trainee posts (usually clinical) and applies a percentage of the band maximum depending on the length of training. The agreement also clearly states that pay for trainees should never fall below the adult rate of the National Minimum Wage, yet many employers seemed to overlook this provision.

There were a few isolated examples of employers applying the Living Wage for their apprentices. Since our data was collected it has subsequently been agreed in Scotland that all modern apprentices will now be paid at least the Living Wage3.

Some employers appear to be applying pay rates entirely of their own devising. For example, Aintree University Hospital NHS Foundation Trust paid a new clerical apprentice 75% of the Band 3 minimum (and Burton Hospitals NHS Foundation Trust paid clerical and pharmacy apprentices 55% of the Band 2 minimum (nB Annex U applies a percentage to the Band maximum).

Among the most widely-used apprenticeships in the NHS, finance roles have the lowest average pay rate and electricians the highest (see table 4).

5)Outcomes and completion ratesIn order to gain greater insight into the quality of apprenticeships being offered across the NHS, our FOI request asked a number of questions in relation to

3 http://www.sehd.scot.nhs.uk/pcs/PCS2016(AFC)04.pdf

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outcomes and completion rates for apprentices. The information received raises concerns about the numbers of apprentices in the NHS leaving without completing apprenticeships or securing further employment.

Non-recording of NHS apprenticeship data

The most worrying trend we uncovered was the considerable number of NHS organisations who are employing apprentices and not recording important information in relation to apprenticeship outcomes. This issue was particularly prevalent when it came to recording data about the qualifications apprentices received following their apprenticeship. Our analysis shows us that in the financial year 2014/15 39% of NHS organisations employing apprentices did not record any data on whether they achieved an accredited qualification as part their apprenticeship. This raises transparency issues about value for the public funding that many NHS organisations use to cover the cost of apprenticeship training provision.

Non-completion of NHS apprenticeships

From the organisations that provided outcomes data, table 9 shows the number of apprentices whose apprenticeship came to an end in each of the financial years. The proportion of apprentices leaving without completion is reducing, however, a non-completion rate of 16% is worrying raising questions about the quality and value to apprentices of programmes being offered in the NHS.

Table 9: NHS apprenticeship non-completion rate

Outcome 2012/13 2013/14 2014/15

Left without completing their apprenticeship

343 328 333

Completed their apprenticeship

1263 1568 1686

% of apprenticeships that came to an end without completion

21% 17% 16%

Employment prospects

Table 10 gives some insight into ongoing employment prospects for apprentices in the organisations where they completed their apprenticeship. As outlined in the table the percentage of staff that leave their organisation following the completion of their apprenticeship remained consistent over the financial years analysed.

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An apprentice leaving rate of between 26 and 29% is too high and raises questions about whether the NHS is getting the most efficient return on their investment in apprenticeships. This also raises the concern that NHS organisations might be using apprenticeships as a cut-price option to plug short-term workforce gaps.

Table 10: NHS apprenticeship ongoing employment outcomes

Ongoing EmploymentOutcome

2012/13 2013/14 2014/15

Continued in employment in your organisation

974 1219 1332

Left employment in your organisation

391 419 507

% of apprentices that continued employment in the same organisation following completion of their apprenticeship

71% 74% 72%

% of apprentices that left the organisation following completion of the their apprenticeship

29% 26% 28%

6)UNISON policy

UNISON supports the use of high quality apprenticeships as a means of widening participation and enabling candidates from disadvantaged groups to gain a start in the NHS. However we have growing concerns about the crude target-driven approach which measures apprenticeship starts, rather than completions, outcomes or the quality of training. There is also a concern that what is currently being delivered for existing staff through many apprenticeships does little more than accredit existing skills, and consumes resources that would be better put into genuine development opportunities.

UNISON is concerned that having to pay into the levy may force employers to divert money from existing learning and development programmes.

Cheap labour or genuine trade-off?The wide variation in approach to setting apprentice pay rates brings with it the risk that some employers will seek to replace large numbers of substantive posts with apprenticeships in order to meet targets, and to access a supply of cheap labour as

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they lose money to the levy and the financial squeeze continues. Previously these posts might have attracted the payband minimum while providing on-the-job training – because the AfC bands are based on developing skills and expertise while progressing towards the rate for the job.

UNISON accepts that a salary detriment may be justifiable where the apprentice would take a substantial period of time to attain the skills, qualifications and competence levels that are normally job entry requirements. Or where the apprenticeship provides access to high value training/qualifications which unlock enhanced career prospects and earnings potential, especially for degree level apprenticeships which spare participants from paying university tuition fees. In these situations there is a clear trade-off for the apprentice in return for accepting a lower initial salary.

However, a lot of what UNISON is seeing in the NHS appears to be lower level apprenticeships where people are employed on apprenticeship pay rates yet are quickly fulfilling the basic requirements of the job. On completion they are going on to the band minimum, having already been in post for a year or two and the apprenticeship has not delivered career progression opportunities into higher banded jobs. In these situations there is no clear trade-off for the apprentice and what they are getting is a raw deal.

7)Conclusions

Our FoI research has found low pay, no consistent approach to pay setting and a worrying lack of attention to outcomes and future prospects for apprentices in the NHS. These findings raise timely alarm bells due to:

the expected explosion in apprenticeships as a form of employment within the NHS due to take place over the next four years

the focus on ‘quick and cheap’ apprenticeships that deliver low level training and skills rather than those which reward apprentices with genuine career and pay progression prospects for the future

the risk that targets will push employers to use a conveyor belt of apprentices without offering permanent jobs

the danger that with a growing financial crisis the NHS tries to balance its books by exploiting the lack of a pay structure for apprentices and using them as cheap labour

the risk of reputational damage to the NHS and to the apprenticeship brand that the government is trying to protect

the prospect of a divisive and demoralising two-tier workforce in large parts of the NHS workforce

the likelihood that poverty pay rates will damage the ability to recruit and retain apprentices and subject patients to a hgigh turnover of staff

the risk that the ad hoc nature of pay rates could leave employers without a defence against equal pay challenges

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UNISON wants a fair deal for apprentices in the NHS

UNISON is calling for

1. A strong commitment in the NHS to offering higher level apprenticeships which provide clear added value, higher level qualifications and career mobility for those undertaking them.

2. A new agreement within Agenda for Change on pay for apprentices building on the progress made in Scotland to establish the Living Wage as the pay floor for apprenticeships.

3. More progress on the use of apprenticeships to bring in young people, and those from disadvantaged backgrounds who would not otherwise get work in the NHS.

4. A joint working group involving unions, employers and workforce education bodies to agree minimum employment and quality standards for apprenticeships in the NHS, and monitoring of outcomes rather than just numbers of starts.

5. Apprenticeship levy money pooled and ring-fenced to the NHS so that unused funding can be offered out around the NHS rather than lost to other sectors.

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Appendix 1

NHS apprentice occupational groups as listed in FOI responses

AdministrativeAllied HealthAmbulance CareAnalystAssistant TechnicianAssistant/Associate PractitionerPractitioner - NursingAsst. Tech OfficerBiomed CadetBiomed SupportBricklayerBusiness SupportCardiologyCarpenterClerical workerClinical CodingClinical Imaging AssistantClinical ServicesClinical SupportCommunity Service ApprenticeContact CentreCookCritical CareCSSD Assistant (Sterile Services)Dental NurseDental Surgery AssistantDesignDietetics AssistantEducation ApprenticeElectricianEmergency Care AssistantEmergency OperationsEngineering ApprenticeEstates & Ancillary

Facilities ManagementFinance apprenticeFitterGardener/Grounds personGeneral Support WorkerGovernanceHealth & Social Care ApprenticeHealth InformaticsHealthcare AssistantHealthcare Science AssistantHealthcare Support WorkerHotel Services ApprenticeHousekeeper/DomesticHR apprenticeIT apprenticeKitchen ServicesKitchen Services/cateringLearning & DevelopmentLibrary AssistantLogisticsMaintenance MarketingMaternity & PaediatricMechanicMedical Equipment LibraryMedia & Public RelationsMedical EngineeringMedical Laboratory AssistantMedical SecretaryMedical Support ApprenticeMotor Vehicle (Mechanic)NeurophysiologyNursery NurseNursing

Occupational Health Occupational TherapyOrthoticPainter/DecoratorParamedicPerformance AssistantPreoperative SupportPharmacy Pharmacy apprenticePhlebotomistPlay workerPlumberPodiatryPorterProcurementPTS ApprenticeQuality & Risk RadiologyRadiotherapyReceptionistRecruitment& SupportResearch AssistantSecretarySecuritySocial Care Support WorkerStoresSupply Chain AssistantTechnicianTheatre SupportTherapy AssistantWard ClerkWarehousingWorkshop TechnicianYouth worker

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Appendix 2

Use of Agenda for Change Annex U for apprenticeships

Annex U was designed for ‘trainees’ and not specifically for use with apprenticeships. But in the absence of any other nationally agreed framework many employers have started to use it as their apprentice numbers increased.

Extract from Annex U

1) The NHS has a wide range of people described as trainees, working and studying within its services. The arrangements set out below describe how those trainees employed by the NHS should be dealt with...

...2 (ii) trainees who are undertaking a short period of learning on the job, usually less than 12 months. Typically these staff enter whilst already in possession of the basic skills and knowledge to undertake the role. This type of trainee can be also be evaluated using the NHS JE scheme. If profiles for this role exist, the lowest banded profile will be appropriate...An example of this type of trainee is trainee secretary

2 (iii) trainees who enter the NHS and undertake all their training whilst an employee. Typically these staff develop their knowledge and skills significantly during a period of time measured in years. Given the significant change in knowledge and skills...the use of JE is not appropriate. Pay should be determined as a percentage of the pay for qualified staff.

3) For trainees covered by para 2 (iii) where periods of training last for between one and four years, pay will be adjusted as follows:

i) up to 12 months prior to completion of training: 75% of pay band maximum for the qualified rate

ii) more than one but less than two years...70%iii) more than two but less than three years...65%iv) more than three years...60%

4) Starting pay for any trainee must be no less than the rate of the main (adult) rate of the National Minimum Wage. Where the calculation results in the NMW being payable for year two and beyond an addition to pay should be made on top...

5) On assimilation to the pay band following completion of training the trainee should enter either on the first pay point of the appropriate pay band or the next pay point above their training salary.

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Table 5A: Application of Annex U in 2014/15 – England and Northern Ireland scales £ph

Up to 1 yr 1-2yrs 2-3 yrs 3yrs +75% of max 70% of max 65% of max 60% of max

Band 1

(£5.76 £5.37 £4.99 £4.61)

Band 2

£6.68 (£6.24 £5.79 £5.35)

Band 3

£7.39 £6.90 £6.41 £5.91

Band 4

£8.44 £7.88 £7.32 £6.76

Band 5

£10.70 £9.99 £9.28 £8.56

Table 5B: Application of Annex U – Wales scales 2014/15 £ph

This is the same as for England and Northern Ireland except for Band 1. The Band 1 application is shown below. The difference arises as a result of the application in Wales of the Living Wage.

Up to 1 yr 1-2yrs 2-3 yrs 3yrs +75% of max 70% of

max65% of max

60% of max

Band 1

(£5.89 £5.50 £5.10 £4.71

Table 5C: Application of Annex U – Scotland* scales 2014/15 £ph

*In Scotland it has now been agreed that all modern apprentices will be paid at least the Living Wage, and Annex U has been amended to reflect this4

Problems with Annex U

4 http://www.sehd.scot.nhs.uk/pcs/PCS2016(AFC)04.pdf

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Up to 1 yr

1-2yrs 2-3 yrs 3yrs +

75% of max

70% of max

65% of max

60% of max

Band 1 (£5.91 £5.52 £5.12 £4.73)Band 2 £6.83 £6.37 (£5.92 £5.46)Band 3 £7.53 £7.03 £6.52 £6.02Band 4 £8.53 £7.96 £7.39 £6.82Band 5 £10.81 £10.09 £9.37 £8.65

Rates highlighted in yellow in Tables 5A-5C should not have been used as they fall below the adult rates of the National Minimum wage that applied in October 2013 and 2014. According to para 4 of Annex U, the adult rate of the NMW forms the absolute floor. However our data suggests that there has been selective use of Annex U disregarding para 4.

It is also noticeable that Annex U produces some anomalous looking outcomes depending on which band you are in, the length of the band and how long the apprenticeship lasts. For example an apprenticeship for a band 1 job that lasted two or more years would start on £4.99 per hour which is just 68% of the Band 1 minimum. However an apprenticeship for a Band 5 job lasting two or more years would start on £9.28 which is 84% of the Band minimum.

London Ambulance Trust has a paramedic apprenticeship scheme which pays £9.99 or £10.70 an hour. This corresponds to 75% or 70% of the Band 5 maximum as set out in Annex U. It is notable that £10.70 an hour is just 28p an hour below the band 5 minimum.

So an apprentice in this role suffers very little financial penalty compared to someone starting on the Band minimum, whereas apprentices in Band 1 and 2 roles suffer a very considerable penalty compared to an employee starting on the Band minimum. Furthermore they have to go to the band minimum at the end of their apprenticeship even though they may have been doing the job for more than a year.

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