Better pay will save the health service

Junior doctors working in Northern Ireland are voting with their feet due to pay erosion. It’s time that changed, writes Steven Montgomery

Location: Northern Ireland
Published: Monday 31 July 2023

Junior doctors in Northern Ireland are paid less than in every other country in the UK.

We have had an over 30% pay cut in real terms since 2008. Every pay award since 2019 has not only been below inflation, but awarded after substantial delay, with the 2019 uplift received 18 months after it was announced.

To make matters even worse, we have been told by the Department of Health that this year’s DDRB recommended pay uplift of 6%, plus £1,250 – which is actually a pay cut as it is less than the current rate of inflation – will not be awarded in Northern Ireland due to funding shortfalls.

These shortfalls are as a result of the budget set by the secretary of state for Northern Ireland back in April in the absence of a Northern Ireland Executive or Assembly. This budget committed to repaying the previous year’s overspend through the return of any future funding uplifts that result from increases in spending in England, otherwise known as the Barnett consequentials. In plainer language, this means that our colleagues in England will still get this year’s DDRB-recommended uplift while they continue to fight for full pay restoration, but we get nothing.

The pay situation in the other devolved nations is also more positive than here. Our colleagues in Wales are currently in pay negotiations with the Welsh Government with the aim of achieving full pay restoration, while our colleagues in Scotland are currently consulting members on a pay offer from the Scottish Government.

Northern Ireland already struggles with staffing issues and the pay disparity with the rest of the UK contributes to this. We struggle to fill trainee jobs, which causes workforce gaps further up the ranks, creating a medical workforce crisis impacting on all grades and specialties. This year there were 294 jobs for foundation doctors (F1) and already 30 doctors have resigned. Of the 425 specialty jobs advertised this year, only 360 have been filled.

This then contributes to our waiting list crisis, which is the worst in the four nations of the UK. The continued uncertainty with our devolved institutions means that these issues will only continue to worsen.

I already know of many doctors who have left Northern Ireland for jobs elsewhere the UK and further afield. I hear reports from these doctors almost daily about how much better the working conditions are. How they are working with appropriate staffing levels, how they are able to come home from work without feeling exhausted and burnt out. How their pay is significantly better than it is here. I hear of the training opportunities they get at work as they have appropriate staffing levels to safely allow for training.

I don't blame these doctors for leaving. In fact, every day I have to consider if all the things I love about living here are worth being paid less, worth working myself to burnout and having to work in a healthcare system that is ultimately failing both its staff and patients.

The Department of Health tells us that it cannot afford to restore our pay or pay us equally to the other nations. Yet the health service here spends a significant amount of money on locum doctors compared to the other nations. Our medical locum spend is high because we are losing doctors. If this money was directed towards paying trainees and improving staffing conditions, it could save the health service a significant amount of money in the long run.

We need to fix pay now for junior doctors working in Northern Ireland if we want to future-proof our health service. If we do not fix pay now, we will continue to see a drop in the number of doctors working or applying for jobs here. Who can blame them, when they could get better pay and better conditions in the rest of the UK and beyond.

Steven Montgomery is deputy chair of the NIJDC (Northern Ireland junior doctors committee)