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NHS workers at three hospitals will strike later this month over plans to transfer staff to a new subsidiary company.
Estates staff at Kent and Canterbury Hospital, Margate's QEQM and Ashford's William Harvey have voted for five days of industrial action from September 24 to 28.
Up to 42 employees of the East Kent Hospitals trust, who are responsible for day-to-day building maintenance, are expected to take part unless plans to transfer them to a 'wholly owned subsidiary company' called 2together Support Solutions are shelved.
Unite, the country's largest union, says it is concerned that NHS trusts are forming subsidiary companies to avoid tax by registering for VAT exemption.
It claims the move is part of a drive towards privatisation, which could lead to job losses and "salami slicing" of services.
The union's regional officer Michael Cott said: "We are strongly against the formation of these entities which, we believe, could lead to a Pandora's Box of Carillion-type meltdowns – with the adverse knock-on effects on patient services and jobs.
"Our members in Kent are very concerned that their hard won terms and conditions will be eroded over time as part of what, we believe, is a continuing drive to privatise NHS services.
"They are worried about their pensions as it has still not been confirmed whether they will stay within the NHS scheme which they have contributed to over many years.
"We fear that such a move will create a two-tier workforce with new staff on inferior conditions and this, in turn, will increase the problems of recruiting and retaining new staff.
"We are seeking an undertaking from East Kent Hospitals University NHS Foundation Trust that it agrees to continue to employ all our members and not transfer them to this new subsidiary with all the negative impacts that will flow from this move."
Unite is calling for the trust's management to engage in "constructive talks", but says members would put patient safety first in the event of an emergency.
A spokesman for East Kent Hospitals said the transfer, which affects about 250 estates, procurement and facilities employees and 850 former Serco employees, would deliver savings which could in turn be invested in frontline clinical services.
They also said plans are being put in place to ensure there would be "no disruption" to essential services as a result of the industrial action.
"Routine maintenance work to our buildings will be rescheduled, but all essential work will continue," the trust said in a statement.
"Setting up our own NHS wholly-owned company, 2gether Support Solutions, which is based in east Kent, employing local people, gives the local NHS direct control and accountability of these important services.
"The Trust Board has given 2gether Support Solutions a 25-year contract to provide services to the Trust which removes the need for the Trust to return to the market every seven to ten years, giving greater certainty to staff.
"850 staff have transferred from the private sector into the NHS company and the lowest paid staff have already had a pay increase to £8 an hour.
"We have confirmed NHS staff who are transferring to 2gether Support Solutions do so on their existing terms and conditions, this includes pay, annual leave and access to the NHS pension
scheme.
"We have also agreed that NHS staff transferring into 2gether Support Solutions will receive the NHS three year pay deal, and we have committed to future Agenda for Change pay agreements for NHS staff that transfer.
"From the beginning of the process, the Trust has engaged with Unite and staff, in a transparent and accountable process and we have always maintained that it has been integral to the Trust's plans that the Estates department would form part of 2gether."