Together with BMA council chair Chaand Nagpaul, the branch of practice chairs and chairs of the devolved national councils, I attended the Doctors and Dentists Review Body oral evidence session.
I was present at the meeting in a dual capacity, representing consultants on behalf of the consultants committee chair, and in my role as chair of the BMA pensions committee.
The BMA team described the extraordinary lengths doctors have gone to in the last 12 months, leaving the DDRB in no doubt about the disappointment the profession has felt with regards to recent pay awards.
The council chair spoke about the level of anger across the NHS at the Department of Health and Social Care’s suggestion of a 1 per cent pay uplift in England, and I highlighted that consultants across the UK have had to transform services at short notice, worked excessive hours (in many cases including resident on call shifts for no additional pay) and regularly put their own lives and those of their families at risk in the course of treating patients.
Consultants, I explained, are exhausted; BMA surveys consistently demonstrate that morale is low. I also spoke about how the McCloud judgement (which will result in thousands of doctors reverting to legacy scheme membership with a retirement age of 60) and the issues of pension taxation (that have worsened following the ill-conceived announcement to freeze the lifetime allowance until 2026) combine to push consultants towards the exit door. After all consultants have given in the last year, a low level of pay award from the DDRB or government may be the final straw.
We were asked how doctors felt their pay compared with those in other sectors. I responded that, following the financial crash in 2008, the banks were bailed out while the public sector in general – and doctors in particular – were ‘clobbered’.
During COVID, doctors have gone above and beyond to support patients while the private sector was rightly supported financially. However, despite the efforts of the NHS, the DHSC’s suggestion of a 1 per cent pay rise suggests the NHS workforce will be ‘clobbered’ once again.
I reminded the DDRB that consultants have suffered the worst pay restraint of any group within the public sector, with the take-home pay of the average consultant falling by 28.6 per cent since 2008. We are frustrated by the role of the DDRB in allowing this to happen and we reminded them that within their remit they must always take into account cost-of-living increases.
We highlighted that now more than ever we need a fully independent DDRB that fairly represents the interests of doctors and dentists.
We’ve asked for an uplift of at least 5 per cent this year for consultants and made it clear that this needs to be part of multi-year above-inflation awards to rectify the pay erosion that has occurred in the last 12 years. This has been informed by a survey of consultants and the public demonstrating significant support for a substantial pay award.
The DDRB asked a number of specific questions relating to our written submission. An important area of discussion related to the gender pay gap in medicine. We reaffirmed that the BMA is committed to its eradication.
For consultants, I highlighted three issues. First, the gender pay gap often begins to develop at the time caring responsibilities become necessary. It is therefore essential that enhanced shared parental leave is offered to all doctors. I expressed just how disgraceful it was that the Government indicated they would only offer this to consultants if we accepted aligning terms within our contract with Agenda for Change – terms which included a number of detrimental clauses, such as reduced redundancy pay.
I also explained that the current 19-year pay scale was detrimental to women who took career breaks or maternity leave or who worked less-than full time during training, and it meant that it was a very long time into their consultant careers before they caught up with their male colleagues.
We had tried to address this during contract reform but the Government’s position was that the cost of addressing this was to be met by pay restraint for older consultants – despite clear DDRB recommendations that the cost of transition to a new contract should be met from outside the current pay envelope – something that we could not agree to.
Finally, we discussed the role of CEAs (clinical excellence awards) and I highlighted our disappointment that the DDRB had failed to uplift CEAs in England at the very time we have been working with NHS Employers to ensure that CEAs are more equitable.
Regarding pensions, I highlighted that the increase in the level of the threshold income has certainly not ‘fixed’ the pension taxation problem. Indeed, I strongly expressed our disappointment at the freezing of the lifetime allowance until 2026 in the recent budget.
Moreover, a BMA survey indicated that 77 per cent of consultants would retire even earlier as a result of the freezing of the LTA. I explained the effect of the tiered contributions in the NHS pension scheme, annual allowance and lifetime allowance on the overall cost of the scheme and how in effect this results in the same pension growth being taxed multiple times.
Indeed, this results in higher earners in the NHS paying multiple times more for the same £1 of pension than lower paid colleagues, which affects doctors particularly badly.
I also raised the recent announcement by the Government in respect of the judiciary, which means that their reformed pension scheme will be tax unregistered. This means that they will not receive tax relief on their pension contributions (though their employee contributions have been decreased to 4.26%) but, as there is no tax relief on the contributions, their pension growth will not be subject to assessment against the annual or lifetime allowance.
This change was implemented as a consequence of recruitment and retention difficulties within the judiciary, but I stressed that these very same issues affect the NHS with a significant increase in voluntary early retirements since 2008. I also highlighted the vital role the senior salaries review body, the equivalent pay review body for judges, played in securing these changes.
This will be an important year for the DDRB process. Through the written, supplementary and oral evidence, the BMA has made very strong representations on the behalf of doctors to the DDRB and, given the English Government’s indications of a 1 per cent pay uplift, the DDRB is presented with an opportunity to demonstrate its independence.
For the sake of doctors, and particularly for the patients we care for, it is essential the DDRB really does adhere to its founding principles and ensure that consultants receive the award that they deserve.
Vish Sharma is BMA pensions committee chair and deputy chair of the UK consultants committee