Zero Hours Contracts in the NHS and Social Care

This is NHS Check report no 12 originally published by Labour’s Shadow Health Team in July 2013

REVEALED:

• 67,000 NHS staff now on zero hour contracts – up 10,000 under David Cameron
• Clinical staff account for two thirds of list as three in four hospitals now use zero hour contracts
• Over 300,000 social care workers on zero hour contracts – an extra 50,000 in two years

Labour calls on the Government to review the use of zero hour contracts and their impact on the care of patients and older people where they are used in place of permanently contracted staff.

Background

Zero hour contracts that give employees no guarantee of work are on the rise in England’s NHS and care services.

Such contracts for health and care workers:

1. Do not guarantee to provide work;
2. Only pay for work undertaken;
3. Have no specified working hours or patterns.

Labour’s Shadow Health Team submitted requests under the Freedom of Information Act and Written Parliamentary Questions to reveal the numbers of health and care workers employed under these conditions.

Zero hour contracts in the NHS

In 2012/13, there were 67,242[1] members of NHS staff employed this way compared to 57,632 in 2009/10 – an increase of 9,610 NHS workers since Labour’s last year in Government.

The number of clinical staff employed on zero hour contracts has risen from 42,177 in 2009/10 to 47,433 in 2012/13 – now totalling 70% of all NHS staff using these contracts.

A distinction must be made between NHS staff who join a hospital’s ‘Bank’ for extra hours or increased inflexibility, and situations where staff are expected to be on call without payment and are unable to turn down a shift offered.

Labour’s concern is that the NHS is increasingly favouring casual contracts over offering permanent roles.

Of the 131 NHS hospital trusts that responded to the Freedom of Information request, 99 confirmed that ZHCs are used – 75% of hospitals.

The ten NHS hospital trusts with the highest number of zero hour contracts are:

Zero hour contracts in the social care sector

Ministers have also admitted, in a written response to a Labour question in Parliament, that 307,000 workers are employed are now employed on zero hour contracts – a figure that has increased by 49,000 since 2011.

The answer also confirms that 2011 saw a significant increase on Labour’s time in Government – “pre-2011 was not large enough to make robust estimates […] for these years, the proportion on zero-hours contracts was lower than in 2011.”

More than a quarter of the new zero hour contracts are in London – an extra 13,000 compared to two years earlier.  The Eastern region has experienced the most significant increase outside of London, with 7,000 extra contracts.

The figures by region are:[2]

What does this mean for health and care in England?

On David Cameron’s watch, thousands of extra health and care workers are working on zero hour contracts whilst hospitals are short-staffed and social care has reached breaking point.

In the NHS, the rise in the number of staff employed on such contracts is a product of the Government’s mismanagement of the NHS £20 billion efficiency challenge – favouring the ‘low hanging fruit’ over longer-term efficiency savings.

Four thousand nursing jobs have been lost since the General Election and the regulator has uncovered 1 in ten hospitals without adequate staffing.

At the end of his three-year inquiry into Mid-Staffordshire, Robert Francis recommended benchmarks on safe staffing. Labour supported his recommendation but Ministers have chosen to ignore it.

Meanwhile in social care, the rise in zero hour contracts is symptomatic of the sector’s standing as a malnourished cut-price business grappling with a £1.8 billion local authority cut to older people’s care budgets.

Today’s 300,000 care workers on these contracts make up 20% of the entire social care workforce. If the staff do not have the security of knowing what they will earn from week to week they could find it harder to give a sense of security to those they care for.

This week, Camilla Cavendish’s report for the Government on the training and support of healthcare assistants raised the increasing use of zero hour contracts as a key issue affecting the care sector.

Cavendish notes that “Some low paid HCAs and support workers will heroically keep going as long as they feel they are still giving good care. But the advent of zero hours contracts, fee cuts and no payment for travel time is making it financially prohibitive for some domiciliary care workers to struggle on. Attrition rates are already dangerously high: and they will only increase when carers feel that they can no longer even give good care. Society will lose some talented carers unless the commissioning process changes radically and Government starts to move money from health to reward social care for its contribution to lowering NHS costs.”

She also adds, “For home care workers on zero-hours contracts, who are not guaranteed a fixed number of hours work per week, the need to travel for longer distances to do fewer visits is making it harder to make ends meet. The fact that some employers will not pay for travel time between clients means that there are now serious questions about whether some workers are actually being paid less than the National Minimum Wage.”

In England, a care system has developed where too many operators cut corners on the care of vulnerable older people to increase profit margins. At present, society believes that looking after someone else’s parents is the lowest calling a young person can answer, rather than the highest.

Labour is calling on the Government to review the use of zero hour contracts and their impact on the care of patients and older people.

Appendix 1 – Number of staff on zero hour contracts in each NHS hospital trust in 2009/10 and 2012/13

[1] Based on 136 responses from Trusts in England.  Detailed statistics to be found in Appendix 1