NHS England has promised to top up the pensions of senior doctors and nurses in an effort to end the alarming staffing crisis caused by their refusal to work extra hours because of the financial penalties they would incur as a result.
Accident and emergency, intensive care and surgery are among the departments that have been struggling to maintain enough staff to keep patients safe and give them the treatment they need. A letter from the Academy of Medical Royal Colleges earlier this month spelled out to the government the crisis that the NHS was facing, which will only grow as the winter pressures begin, with more people falling sick.
The academy supplied the health secretary, Matt Hancock, and the chancellor, Sajid Javid, with a sample of the many examples of hospital departments fighting to cope without the numbers of senior doctors they need. It “paints a stark picture of the negative impact across different specialties and across the UK,” wrote Prof Caroline MacEwen, chair of the academy.
“It is evident from the findings that, due to severe medical staff shortages, the NHS has become entirely dependent on consultants delivering service provision over and above their existing contracts; this service is being put at risk because of the current pension taxation position.”
The situation was also undermining the morale of NHS staff more widely, which, she said, was “detrimental to the recruitment and retention of the medical workforce”.
The dire shortage of consultants in some hospitals is worsening a general staffing crisis in the NHS, which is a key election issue.
Hospitals reported to the academy that they were struggling to cover shifts in intensive care and emergency medicine, where they were already short of staff. At Fairfield general hospital in Greater Manchester, the consultant rota for intensive care “is becoming increasingly fragile, with only three substantive consultants in a rota which requires a minimum of seven”.
Mid Essex Hospital Services NHS Trust has warned it may have to close its high dependency unit at weekends and a major trauma centre in the north-west is struggling to ensure patients can see a proper consultant.
NHS England’s chief executive has now responded with a pledge to top up the pensions of senior doctors in order to stave off the crisis. “We have heard loud and clear from local teams and national leaders that these rules are disadvantaging staff who only want to do the right thing by patients,” writes Simon Stevens to the British Medical Association and the royal colleges.
“I am convinced there is an urgent operational requirement to tackle the problem in the NHS. NHS England and NHS Improvement have therefore decided to take exceptional action to address the issues you have raised.”
Senior doctors and nurses who had reached their annual pension allowance were receiving hefty tax bills because of the extra pension payments they received for doing additional shifts. Stevens says that those bills can now be paid directly from each individual’s accrued pension pot – and the deficit will be made up by the NHS once they retire so that they will not lose.
“Clinicians are therefore now immediately able to take on additional shifts or sessions without worrying about an annual allowance charge on their pension,” says Stevens in his letter.
Prof Derek Bell, president of the Royal College of Physicians of Edinburgh, which has members all over the UK, welcomed the announcement but added, “we still need to see a sustainable position on NHS pensions for the UK outlined by the Treasury”.
However, the confidence of senior doctors and nurses, damaged in the long-running row, will not quickly be rebuilt and the Doctors’ Association UK saw the move as a political fix by the government.
“This latest announcement – at best a stopgap – smacks of an electioneering gambit to deflect criticism of the Conservative party, who are solely responsible for this crisis. Given this government’s history on pensions reform, and its leader’s perceived casual relationship with the truth, we cannot recommend to members and colleagues that they deplete their pension pots on a hurried promise they’ll be topped up one day in the future. Doctors should continue to take steps to reduce their commitments where necessary to avoid punitive tax bills,” it said in a statement.