The government has been sluggish in responding to the strikes and to the NHS’s underlying workforce problems. But the pace is picking up. In his budget on March 15th Jeremy Hunt, the chancellor of the exchequer, announced that to retain more senior doctors, he would abolish the cap on the lifetime amount that people can save for their pensions before paying additional tax. The next day, a government pay offer to NHS staff, excluding senior managers and doctors, was accepted by all but one of their unions. These actions, combined with the upcoming publication of a long-awaited workforce plan, mean that things are in a “more optimistic” place than they have been for a while, says Professor Helen Stokes-Lampard, chair of the Academy of Medical Royal Colleges.
Still, big questions remain. Start with the pay offer. The proposal, a one-off payment for the current 2022-23 fiscal year and a 5% pay bump for 2023-24, will be put to a vote of union members in the coming weeks. But how it will be funded is an open question. A Treasury emergency fund may cover the lump-sum payment but next year’s pay rise may well be covered by what the government calls “efficiency savings”—in other words, raiding existing NHS budgets. This would be counterproductive: leaking roofs and bad IT are not good for productivity or morale.
Junior doctors, meanwhile, who are asking for a pay rise of 35%, have not yet been offered a deal. Their 72-hour strike this month has already led to the cancellation of over 170,000 appointments and procedures, dealing a blow to the government’s pledge to slash waiting lists.
The pension reforms are a boon for senior doctors (not to mention other high-earners like bankers, say critics). Yet the government has not been able to say how many doctors will be retained as a result. Hospital consultants are pleased, but it is “not quite as effective as what we were pushing for and arguably more expensive”, says Dr Vishal Sharma, who chairs the consultants’ committee of the British Medical Association, the doctors’ union. They favoured a reform, which has already been introduced for judges, in which their pension schemes are non-registered for tax purposes, thereby exempting them from annual and lifetime allowances. Dr Sharma’s committee may still ballot members on a strike over pay next month.