Diane Coombs. Image: Ralph Hodgson
Diane Coombs is a regular face at Medway Maritime Hospital in Kent. From major injuries in A&E, where she works as a clinical support worker, to the delivery suite, where she is a maternity support worker, Diane can often be found doing what she does best – caring for people in their hours of need.
Diane’s face lights up as she talks about her work. “I absolutely love my job, I can’t think of anything better,” she says. “I like the variety; I don’t like standing still. And I like the people, you know?”
But unlike many of her colleagues, Diane is a bank worker. It’s the NHS version of the zero-hour contracts at the heart of the gig economy. Diane does not have a regular working pattern nor guarantee of work. Instead, she picks up shifts that suit her as they come up. She has various health issues and family commitments, which would make regular contracted hours near impossible.
“I’ve had asthma all my life, and I’ve had a life-threatening episode,” she says. “But I still want to work. I like that freedom.”
Diane is one of around 150,000 NHS bank staff. The NHS relies on bank staff, and more than 70% of bank workers rely on bank work as their main source of paid employment.
Unlike permanent (or substantive) workers, bank staff have no guaranteed hours, no sick, maternity or other parental pay, and must pay for their own training.
“There’s quite a few pitfalls when you want to be bank staff,” says Diane, but she doesn’t blame the hospital for that. “I won’t diss them, as I think it needs to be managed on a higher level.”
She finds the lack of paid training particularly disappointing. “When I first started, I couldn’t believe it,” she says. “I’ve still got the same outgoings as the full-time staff.
“If I’ve done courses, I’ve done them on my own because I want to get on, I want to have it all in my arsenal. I’ve done over 60 hours free. Free work! Who could afford that? And no one can give me a good enough excuse as to why.”
She adds, “It’s outrageous really, isn’t it?”
‘Us and them’
Diane says that it can sometimes feel as though it’s “us and them”, without the same value placed on workers like her as with substantive staff.
The 2024 NHS Staff Survey found that less than half (48.48%) of all bank workers were “satisfied with the extent to which their organisation values their work”.
Bank workers also miss out on the national pay awards and back pay won for substantive employees. Their pay is set locally by employers and bank providers, usually without union involvement.
This is a particular issue for Kenneth Flynn, a former nurse of 30 years. He has worked on a bank basis for the past six years as a care support worker at University Hospital Southampton and is employed by NHS Professionals, the staffing agency owned by the Department of Health and Social Care.
“NHS Professionals keep saying that pay is not a matter for them, it’s a matter for their partner trusts, so they’ve washed their hands of that really,” Kenneth says.
“I don’t actually want a permanent contract,” he adds. “I like to have that flexibility and not have anyone tell me when I’m going to work. I like going from ward to ward.” Another concern is his elderly parents. “I really don’t know what’s going to happen health-wise with either of them,” he says, so stays on the bank in case he needs to travel to them in Northern Ireland.
But despite his appreciation of the flexibility, he is frustrated not to receive the same pay awards and back pay as his substantive colleagues. “At the moment, it’s a very uncertain situation to be in. We were told earlier this year we were not on Agenda for Change any more, and that any future pay rises would be in line with the national living wage.
“I think the trust is continually trying to save money, and whether or not it’s because they know we don’t have a trade union agreement, they seem to be primarily looking at the bank staff as they main source of saving money. I feel quite angry about it, to be quite frank.”
Diane agrees. “Bank workers didn’t receive the uplift all the other NHS workers received, or the back pay,” she says. “We always miss out on that. No acceptable explanation is ever given; the only answer is that it is because we are bank staff.”
Paying the price
When employers decide to make cuts, it is often bank staff who pay the price.
“Our trust, like most hospital trusts in England, have great financial difficulties,” says Kenneth. “They’ve made shifts shorter. They’re trying not to use bank staff so they can save a bit of money.
“What I’m finding is that there is work available, but it’s becoming more and more short notice. I wait until an hour and a half before I’m ready to go to work, and I look at the shifts available and decide that way.”
Employers also have the right to cancel shifts that have been agreed to – without compensation. “We get shifts cancelled sometimes at short notice if we do book far ahead, which is annoying because you think you’ve got a good shift and then you log on to NHS Professionals and find you’ve got a message saying that it can’t be covered by temporary staff or is cancelled or whatever,” says Kenneth.
“If we cancelled at the last minute, we would probably get a warning from NHS Professionals. We can’t cancel at short notice, but the trust can and does.”
A two-tier workforce
The substantive/bank worker divide results in a two-tier workforce. It is a divide felt even more starkly by women and Black workers, who are far more likely to be bank staff.
More than one in three bank workers have ethnic minority backgrounds, compared to around one in four of all NHS staff. NHS data shows that Black bank workers are nearly six times more likely to enter a formal disciplinary than their white colleagues. Another report found that nearly one in three (28%) Black and ethnic minority bank workers experience physical violence from patients, compared to less than a quarter (23%) of white temporary workers.
This makes it all the more important for bank workers’ rights to be improved – and why UNISON is campaigning on the issue.
Hope on the horizon
The NHS Survey data suggests that around four in five bank staff always or often work in the same department or work area. Many could be moved onto flexible permanent contracts. This is a right UNISON is pushing for.
But UNISON understands that substantive contracts would not work for everyone. And for many, the only realistic alternative is employment agencies that are often exploitative. What the union does want, though, is for bank work to be appropriately valued and rewarded.
Thanks to pressure from, and negotiations with trade unions, not least UNISON, the Labour government is in the process of strengthening the rights of bank workers as part of its Plan to Make Work Pay. The first phase of this is the Employment Rights Bill. While still working its way through parliamentary processes, its exact details are yet to be settled. However, it is expected to include rules, rights and provisions including:
- Stronger incentives for employers to take part in collective bargaining with unions when setting zero-hour contract pay and conditions
- A ban on exploitative zero-hour contracts
- Guaranteeing workers the hours they regularly work.
UNISON is involved at every stage of the legislation’s passage to ensure it is brought to its full potential.
What can members do?
UNISON is encouraging members to lobby employers to make changes now, ahead of the legislative changes. For that reason, it has produced a Better NHS Bank Charter. This can be adopted by employers in preparation of the changes, while also showing they support and value bank workers.
Among other things, the charter calls for bank staff who work regular shifts to be offered flexible permanent contracts, for collective bargaining and for a dynamic link between bank contracts and NHS terms and conditions.
UNISON members may also be able to use collective bargaining to improve bank contracts if they have a partnership agreement in place. There may be resistance to this from employers, but the Better NHS Bank Charter and UNISON’s Organising to Win strategy can be useful tools to get employers to the negotiating table.
Unless action is taken, bank worker morale risks falling yet further.
“If you really need someone, and you haven’t got any cover, you call on the bank staff,” says Diane. “We’re supposed to be a team, we’re supposed to be all together.”
“In other industries, if people want work covered at short notice, people would be charging an extra premium for that,” says Kenneth. “But it seems with hospital bank workers the idea of charging an extra premium goes out the window.
“We’re just struggling to get a pay rate that everyone else seems to get.”
For more information, and details of how to join UNISON’s bank network, click here
