So here we are in the 8th month of the doctors’ dispute with the Conservative government for pay restoration of 35% to repair salary losses over the past decade plus.
We are not talking about a pay increase just restoration, not unreasonable. How did this happen? – well, in short, because doctors are excluded from any of the pay awards made to other NHS staff because doctors pay is the remit of a so-called independent pay review body which takes care of doctors (and dentists) pay, except it doesn’t, and when it finally made a recommendation, the government deemed it unaffordable, so ditched it.
To put this in context, the judiciary were given 15% in 2018 without so much as a shot fired in anger; the doctors got 1% that year. The justification for such a high settlement for judges and barristers? – recruitment and retention.
That rings a bell, oh yes, there’s a crisis of recruitment and retention in the NHS medical workforce too.
Could the fact that many MPs have a legal background and vanishingly few a medical one be a factor? – a case of us and them?
During the pandemic which followed soon after, I don’t remember the judiciary stepping up to the plate, in fact the courts more or less closed down, at least for the first year, and are now getting back up to speed.
No judges or barristers were called upon to help turn patients who were on ventilators in ITU every 2 hours, wearing inadequate protection, up close and personal face to face, day after day, week after week, month after month. Doctors were going in to work every day, as was the whole health and care workforce, throughout that national nightmare, not working from the comfort of their homes on Zoom and in their pyjamas, too many paid the ultimate price in that first year.
Prime Minister Sunak recently stated, before he went off on holiday, that ‘a generous offer of 6% is final and no further talks will take place’ – hmmm, that doesn’t quite do it, does it?
It will apparently cost £1.5 billion to settle the doctors claim, that’s a lot of money I hear you say, true, but to put that in context, the PFI contracts, of which we hear absolutely nothing regarding affordability are costing the NHS £80 billion a year, that’s right, £80billion, that’s half the annual £160billion NHS budget. You will have seen from another article on LDV that the annual NHS repairs bill topped £10billion this year for the first time, that’s on top of the £80billion PFI payment.
So it’s about choices. Why have there been no questions in parliament about PFI affordability, let alone renegotiation of those contracts, set to run for 30years, and quietly but surely bankrupting the NHS. I wonder how many of those hedge fund managers are friends of the Tory party.
The excessively relaxed and smooth Mr Barclay doesn’t look like a Secretary of State who has a problem being at the helm of an NHS crashing onto the rocks. In fact he looks supremely confident, to the point of smugness and clearly has the backing of the Prime Minister.
Steve Barclay knows he is safe whilst following the 20+year old Tory Lansley plan to fragment, and then dismantle the NHS and sell it off to private providers. A key part of that strategy is about demeaning, downgrading and demoralising the workforce. Perhaps he thinks he can blame the doctors as winter approaches and we return to traffic jams of ambulances outside A&E, as we surely will, and all that goes with it.
The government has succeeded in bludgeoning the nurses back to work. It’s hard to take the loss of a day’s pay for every strike day when you have to use a foodbank every month to make ends meet.
The government may be able to bribe older doctors with pension giveaways but a workforce strategy that relies on time-expiring doctors and invitations (the latest wheeze) to ‘recently retired’ doctors to return and take on some of the ‘easier’ tasks of the NHS won’t work.
They tried that in the time of Covid; 27,000 retired doctors volunteered to return during that national emergency, only 12,000 were ever used and mostly on the side-lines as it very quickly became clear that it was exceedingly difficult to re-integrate retirees into a complex and highly regulated structure dealing daily with high risk activities, and the ever present danger of litigation; it didn’t work.
Meanwhile, fresh, young doctors are leaving the NHS, and the country, in droves, for greener pastures with better salaries and work conditions. Highly skilled and mobile they can go anywhere, and many won’t return. That’s a taxpayer loss on investment of more than £250,000 per doctor, and there are no easy replacements from European countries anymore, Brexit put paid to that.
In the last ten years, the percentage of new doctors entering the postgraduate training programmes for higher specialist training every year has fallen from 85-90%, which is where it needs to be to ensure sufficient new GPs and consultants coming out at the other end, down to around 50%, which is woefully inadequate. Each unfilled training place can’t be filled retrospectively, but runs right through each programme, which means gaps in every rota, in every speciality, in every hospital for the entire length of the 4-8 year programme (depending on speciality) and more pressure on everyone else in that training programme. You can’t join part way through, so that training place is effectively lost forever from the workforce, it’s ‘baked in’ as they say. Year on year more and more deficit is accumulating and will continue to do so until we get back to the 85-90% participation level.
We know the public value the NHS, we know they want it to continue to offer everyone treatment free at the point of need, paid for out of general taxation.
So the question is simple; does Sunak’s Conservative government value the NHS sufficiently to staff and fund it properly? – Yes or No.
I think we will know the answer to that question by 2024, just in time for the general election.
* Catherine Royce is a retired medical doctor, a former member of the Federal Policy Committee and a member of LibDem Women and Liberty Network.
Follow @LibDemVoice on Twitter
Like us on Facebook
Subscribe to our feed
Sign-up for our daily email digest
Mystery at Witchend is Went the Day Well? and Seven White Gates is A Matter of Life and Death
The long role of the Jewish community in Liverpool
Labour's post-election (non-)honeymoon: The Week in Polls
September now
Farron photos
Peter Martin
Mick Taylor
Michael BG
Jennie
Nell Jerram
20 Comments
” PFI contracts, of which we hear absolutely nothing regarding affordability are costing the NHS £80 billion a year, that’s right, £80billion, that’s half the annual £160billion NHS budget. ” -this is nonsense as even a moments thought would show. Also NHS budget for 22/23 is £180bn.
“You will have seen ….. that the annual NHS repairs bill topped £10billion this year for the first time”
The total bill for doing the needed repairs is £10bn – not the annual bill
“I wonder how many of those hedge fund managers are friends of the Tory party.” Hedge funds have nothing to do with PFI
“To put this in context, the judiciary were given 15% in 2018 without so much as a shot fired in anger; the doctors got 1% that year.” Neither of these is correct:
https://www.gov.uk/government/speeches/judges-annual-pay-review-201819-david-gauke-blog
https://www.bmj.com/content/362/bmj.k3236#:~:text=In%20his%20announcement%2C%20Hancock%20said,2%25%20recommended%20by%20the%20DDRB.
“Steve Barclay knows he is safe whilst following the 20+year old Tory Lansley plan to fragment, and then dismantle the NHS and sell it off to private providers”
There is no such plan
http://www.kingsfund.org.uk/publications/health-and-social-care-england-myths
There clearly is a case for increasing Dr’s salaries. But the reality is that there has been a huge increase in NHS spending – about £35bn in real terms since 2017/18.
https://www.kingsfund.org.uk/projects/nhs-in-a-nutshell/nhs-budget
There is a real debate to be had about how much more we need to spend but it should be based on facts – not Labour myths
Very mixed feelings about your article.
UK doctors – both Specialists and GPs – come quite near the top of pay rates compared to pay of doctors in other European countries. Nurses are in the middle.
OECD figures show a very small loss in real pay for UK doctors from 2010-2020 of about 1%.
You have also forgotten that doctors remain very well paid compared to the average worker and have indeed not fallen back in that regard.
There have been strikes by doctors in many European countries this year; my Spanish doctor friends complain how badly they are paid in comparison with their UK counterparts. (Before Brexit it was a no-brainer to hive off to the UK. None coming the other way btw)
And of course there are doctor shortages and trying working conditions in many European countries. And indeed in many other professions.
And above all, your figure of 35% for pay “restoration” is manifestly false.
@Chris Moore
Yes, the BMA claims that wages have fallen behind by 26% since 2008
Chris – they do.
The IFS disagrees https://www.channel4.com/news/factcheck/factcheck-how-much-has-junior-doctors-pay-fallen-and-what-pay-rise-do-they-want
Real wages across the UK economy began to fall after the financial crisis and have been pretty stagnant ever since. Today they are about where they were in 2007 Stalling wage growth since 2008 costs £11,000 a year
Junior doctors in common with many public sector workers have seen a steep decline in real wages How much do junior doctors really get paid in England?.
“The government says it has accepted the latest recommendations made by an independent pay review body and its most recent offer represents an 8.8% annual pay rise for the average junior doctor in England.” I think the settlement has to reflect some restoration of the very steep decline in real wages in the public sector versus the private sector. The offer may have to be upped to include a similar annual increase next year of say 6.2% (i.e. 15% in total across two years) to bring real wages closer to the levels they were in 2007 and annual increases based on CPI thereafter. That will, however, have knock on effects on other public sector pay.
Most of the PFI contracts in the NHS will expire by 2037. At Budget 2018, the Chancellor announced that the government would no longer use PFI or PF2 for new projects. As a result, PFI contracts represent a decreasing amount in financial liabilities for the public sector. NHS unitary charge payments under these contracts are currently circa £3 billion per year.
Medical staff should absolutely be amongst highest paid in the land due to importance of the work they do.
You’ve raised how long it takes to train medical staff. I think if you polled those pursuing the career when they started few would say that pay motivates them (at least as top motivation) and polled those leaving few again would say simply pay caused them to leave (as opposed to pay versus working conditions).
I wonder if it’s a better solution to spend money on making working conditions improved (management training so the right people are in charge, equipment, reducing the number of people coming through the door by improving people’s health and reducing number of people staying by investing in care services) rather than simply pay for individuals?
It’s quicker and in some ways easier to just pay staff members more but really we need investment into making sure everyone is healthier (free NHS prescriptions because people should not be paying for drugs to get them back into work? Increasing rate of SSP so ill people don’t come into work? Sugar Tax used to make healthier choices more affordable?) and making sure care services can manage (properly rather than half-arsed performances you see in some care homes) those whose only health condition is being older and needing more support.
Hi Mel, the figure of 26% as far as I can see is supposed to refer to basic pay of first year junior doctors in certain limited circumstances and doesn’t take into account a host of compensating factors. It’s a nonsense.
In particular, it’s simply mendacious to extrapolate this figure across the whole profession.
Doctors receive several times average pay in the UK and haven’t lost ground comparatively.
Wanting 35% when everyone else is getting about 7 is unreasonable. Also, pensions have to be included in comparisons.
@ Russell “Wanting 35% when everyone else is getting about 7 is unreasonable”…. I’ll tell you what’s unreasonable, Russell…… the fact of the general drop in NHS pay since 2010 (and we know who had a part to play in the first five years of that) :
1. Maternity and care assistants have suffered a cumulative real-terms pay loss of £30,000 since 2010 – the equivalent of 14 months’ worth of salary.
2. Nurses and physiotherapists have suffered a cumulative real-terms pay loss of £37,000 since 2010 – the equivalent of 13 months’ worth of salary.
3. Midwives have suffered a cumulative pay real terms pay loss of £48,000 since 2010 – the equivalent of 14 months’ worth of salary.
According to research by the Nuffield Trust, private sector pay has actually increased over the same period.
And….. by the way…… unlike the issue in England, I believe the matter has been settled in Scotland……
So, it seems I poked a stick into the hornet’s nest.
To clarify, the 15% for the judiciary was announced in early 2017 and implemented the following financial year, which brings us to 2018. It actually doesn’t matter if it was 2017 or 2018 (dancing on the head of a pin?) my point stands: -one highly skilled profession, valued by society and with whom the government is comfortable was recompensed with a 15% salary uplift to address recruitment and retention, whilst another highly skilled profession valued by society, but with whom successive Tory governments have a longstanding ideological conflict got diddlysquat.
Remember this was the May government’s ‘end of austerity’ rhetoric period and whilst Jeremy Hunt was Secretary of State for Health. It followed on closely from an unresolved conflict he had with doctors in 2015/16 over the imposition of new contracts (you can read about it on Wikipedia which has a reasonably accurate and short summary) and was not very different from the previous run-in with doctors and attempt to crash the NHS in the Thatcher years.
So, as I said it’s about choices and the Conservatives have ‘form’.
Chris, the NHS is a more or less unique institution globally, so comparisons with other countries and health services is not very easy and may not be very useful, it’s complicated.
£35billion over 5 years may be a lot of money but the fact is it is not sufficient to maintain and grow the service and therefore amounts to a cut in funding and results in the NHS services going backwards, at a time when medical technological innovation is accelerating, that costs money if we want patients to benefit from it.
Highly skilled people, and particularly doctors and nurses in this context can take their skills to almost any country they choose if they don’t like what they are offered in their own country. Which is why so many international medical graduates gravitate here, and why so many of our own new doctors are now choosing Canada, Australia etc. in broad terms they can double their salary and have much better terms and conditions.
This government has not understood that for many doctors we are entering the endgame, given the confrontation history I’ve sketch above; -staff attrition is accelerating, staffing levels are no longer safe for patients, let alone for the health and well-being of staff, the current situation is simply not sustainable and is becoming dangerous.
Support for continuation of strike action (as a last resort) was rock solid at the recent BMA annual conference in June and unless the government comes up with a substantially better offer strikes will continue in the coming months, ‘Christmas day service’ will become the norm, which means emergencies only and no work on surgical waiting lists or medical out-patient clinics.
Suddenly that £1.5billion to settle looks like a bargain (at least it does to me)
Perhaps if Simon doesn’t like my interpretation of the damage PFI is doing to the NHS finances he can supply a list of contractor names, contract prices and repayment schedules for the last 15 years and the remaining 15 years they have to run. Oh yes and a list of the non-PFI hospitals which have had their budgets squeezed to death so PFI payments can be met, that might help us with the discussion on accumulating outstanding repairs, an additional annual burden on budgets.
simon mcgrath “dismantle the NHS and sell it off to private providers”
There is no such plan”
No? Good luck finding an NHS dentist.
I broadly support the Doctors. Not to the extent of 35%, but certainly more than 6%. At the heart of this is a necessary realization that good things need to be paid for, particularly perhaps by those who use them most. I’d like to see NI extended to the over 65s, and money raised directed principally towards the NHS.
@David
Are your figures inclusive of pension rights?
@James
The government commenced an NHS/Care hypothecated NIC tax but then reversed it. Which all opposition parties supported. I thought that was wrong as it was money being raised for NHS and care. Consequently, reform of care sector has been kicked down the road.
The NHS needs more money and reform so it becomes joined up and less bureaucratic, it is a jewel in our crown. One quirk though is that GP’s are not NHS employees but are self employed consultants, who prefer the latter and most of the GP practices are in fact privately owned. Surely this is difficult to manage? Doctors and consultants in Hospitals are however NHS employees. A left over from the NHS’s founding in 1948 when Nye Bevan had a difficult job getting some Doctors to agree to the NHS in the first place.
@Catherine: the fact is UK doctors are well-paid in comparison to most of their European peers. I’m glad you don’t dispute that.
Nor have they lost ground relative to other UK workers. Heaven forbid that that should happen! They continue to be paid several times the average wage.
They CAN migrate in search of even better pay to Australia or Canada, for example. But other workers can do this too; my nephew – a train mechanic – is considering doing just that. So what? That’s not a good argument for above inflation pay rises for already handsomely paid staff.
I have sympathy for above inflation pay rises for NHS auxiliary staff.
And also for care assistants, supermarket personnel, teaching assistants, rubbish collectors etc i.e. REALLY poorly paid workers without industrial muscle. To all those doing diagreeable difficult and unglamorous jobs, without the social cachet of doctors may THEY, disregarded as they are cut the yawning pay gap that separates them from hard done by NHS consultants.
The issue is valuing professionals who commit formative years of their lives to studying and training so they can serve the population while enjoying a reasonable quality of life. Until we as a society value those who make sacrifices in order to sustain us there will be issues such as we are witnessing. It is not only pay but work conditions, progression and having sufficient autonomy to enjoy the work.