Care StaffNewsNursesSocial Care

Health Workforce Report Illustrates Staffing Emergency and Dire Consequences for Staff and Patients

Responding to the House of Commons Health and Social Care Committee report on recruitment, training and retention, which describes “the greatest workforce crisis in history, compounded by the absence of a credible government strategy to tackle the situation”, Dr Emma Runswick, BMA council deputy chair, said:

“This urgent and detailed report illustrates the workforce emergency facing our health and care services and the dire consequences this is having on staff and patients. It is a damning indictment of a government that has completely failed to take any meaningful action on workforce issues, and has no plan going forward.

“Despite obvious need, the Government refuses to do the basic work of laying out how many staff we need to meet the health and care demands of the population, now or in the future. This report now joins the BMA and more than 100 other expert organisations in calling for this.

“The Committee lays bare the scale of workforce shortages – and failed promises from ministers – and recommends solutions that the BMA has long-proposed around both recruitment and retention.

“The Government should drastically increase medical school and training places with full funding. Bureaucratic barriers for our talented international colleagues seeking to practise here should be removed and support increased.

“Alongside this we need support to keep existing doctors in the workforce, especially after the most harrowing and exhausting two years many will have ever experienced. We agree with the Committee that punitive pension rules which push experienced doctors into early retirement or reducing hours are a ‘national scandal’. And this week’s announcement of another brutal real-terms pay cut will drive more doctors away. Some doctors have seen their pay fall in real terms by around a third in the last 14 years, and any workforce strategy will fall flat with no commitment to reverse this huge cut.

“Doctors are sick of being undervalued; whether that’s through years of cuts to our wages, being forced to pay for the ‘luxury’ of parking at our own workplaces, or having no access to a decent meal on night shifts. We’re working in crumbling buildings with outdated and unreliable IT systems that make our jobs more difficult and take valuable time away from treating patients.

“Meanwhile we are still hearing shocking accounts of racism within the NHS – with the BMA’s own devastating research highlighted in this report. This, combined with a significant gender pay gap, lack of support for those experiencing the menopause and limited options for flexible working, means the health service is failing to harness the best out of staff from all backgrounds, ages and genders.

“The NHS is its staff, but we cannot run it on good will alone. If the Government continues to ignore this – or continued warnings from reports like this – the impact on health professionals, patients and the very health of our society does not bear thinking about.”

Commenting on the report’s description of current pension taxation arrangements as a “national scandal”, Dr Vishal Sharma, BMA pensions committee chair, said:

“The Health and Social Care Select Committee findings are correct – it is indeed a ‘national scandal’ that senior doctors are being driven to reduce their hours or retire early, just when the NHS is facing the ‘biggest workforce crisis in its history’. What is most scandalous is that this is a mess entirely the Government’s own doing through its absurd and unfair pension taxation policy – and it is entirely within its gift to solve, quickly.

“It’s good to see the Committee taking heed of the BMA’s warnings, and fully recognise that despite the changes to the taper in 2020, there remains an urgent and pressing need for Government to solve this issue in order to prevent a further exodus of doctors. It is also vital that there is reform of pension taxation rules so that doctors can maximise the amount of care they can provide to their patients.

“For those doctors who are left with no choice but to leave the pension scheme, the Committee highlights the necessity for employers to be mandated to ‘recycle’ the full value of pension contributions back to the employee in their wages, a measure backed by the BMA and most recently the review body for doctors’ pay, the DDRB – as well as the outgoing Secretary of State for Health and Social Care.

“At the BMA we still believe that the long-term solution is a tax unregistered scheme, similar to the one implemented for judges to solve the retention crisis in the judiciary. Such a scheme would remove the disincentives from providing more care for patients and enable doctors to work for longer. It would also ensure that doctors paid the correct amount of tax on their pension savings and therefore is a fair solution for the taxpayer. Whilst the Government argued that the situation for the judiciary was different as judges could not return to private practice, the BMA rejects this argument as the vast majority of doctors do not do private practice, and the BMA wants a solution that will retain doctors within the NHS. We also firmly believe that the introduction of ‘pension flexibility’ would not solve the problem and indeed this has been consulted on twice previously and rejected by both scheme members and the Government.

“Even since the Committee’s evidence sessions, the need for reform has become even greater. The recent 4.5% pay award, representing a real-terms pay cut of over 6%, will provide yet another disincentive for senior consultants to remain in the NHS, as they will potentially lose over £100,000 simply by delaying retirement for a single year beyond the age of 60. Anomalies in the Finance Act, exacerbated by spiralling inflation, will see many doctors paying tens of thousands of pounds of additional tax on non-existent pension growth. In effect, they will be taxed on benefits they will never receive again pushing them towards early retirement.

“In the context of a deepening workforce crisis and record waiting lists it is vital that the Government heeds the warnings of the BMA and the Health and Social Care Select Committee and urgently takes action to solve this issue before it’s too late. Otherwise, we will see an unprecedented loss of the senior medical workforce, a loss from which the NHS may not recover.”