NHS Pensions and Staffing

Jonathan Edwards Excerpts

Wednesday 13th July 2022 Commons Chamber

[Dr Poulter]

I thank the hon. Lady for her support, and she is absolutely right to highlight that this issue affects all of the United Kingdom.

This year in particular, due to certain factors related to inflation, we are facing a real challenge that is created by the pension penalties that exist under the current legislation. That needs to be looked at urgently, or we will see a reduction in the NHS workforce at the very time we can least afford it, while we are tackling the covid crisis.

“Scheme pays”, which is effectively a loan against a pension, is often suggested by the Government as a way for doctors to pay their pension tax bills. However, it attracts an interest rate of CPI plus 2.4%. So in the current climate, with inflation being at over 9%, “scheme pays” is prohibitively expensive and can result in a significant reduction in the total value of the pension, particularly for younger NHS workers in their 30s and 40s. Many doctors and nurses are left with little option but to pay the tax from their post-tax income instead, take out bank loans or, in some cases, increase the size of their mortgages. As I shall explain later, due to rising inflation, senior workers are being billed thousands of pounds in tax for pseudo growth in their pensions which never materialises as inflation continues to rise.

What is the impact on the NHS? The NHS is at a care and staffing precipice. GP workforce numbers are falling, while hospital consultant numbers are not increasing rapidly enough to keep up with demand. Many staff are also feeling burned out and demoralised due to workload and rising instances of abuse. In addition, the secondary care backlog in our hospitals for both urgent and elective operations, as well as for cancer care, is at an unprecedented level, with 6.48 million people currently waiting for treatment. Return referrals to GPs have also seen an 87% increase and a care backlog for general practice, with 401,115 patients waiting for treatment as of November 2021. Those circumstances, coupled with low levels of hospital beds, mean that staff and patients alike are feeling the impact.

We can all agree that the NHS needs more staff. England would need the equivalent of an additional 46,300 full-time doctors simply to put the NHS on an equivalent standard to today’s OECD EU average of 3.7 doctors per 1,000 people. However, as of March 2022, over 100,000 posts in secondary care are vacant, more than 8,000 of which are medical posts. The NHS needs to keep the staff it has simply to keep the current level of service running. In the year between June 2021 and May 2022, the NHS lost 323 GP partners and 462 salaried and locum GPs. That means the number of fully qualified GPs decreased by a net 785 full-time equivalent GPs in just under one year.

That trend is exacerbated by the fact that despite there being 1,737 fewer fully qualified GPs today than there were in 2015, each practice has on average over 2,000 more patients than in 2015. So, there are fewer GPs but each with more patients to care for, and many more patients now have complex care needs to manage.

Pension rules are making it financially unviable for some senior doctors and nurses to either stay in the NHS or work the number of hours they would like to. By tackling the NHS pension crisis through amending the Finance Act 2004 and introducing a tax unregistered scheme for those senior NHS workers, we could help to keep those much-needed doctors and other frontline clinical staff in the NHS for longer, and we would be supporting patients to get the care they need. Without those changes to the pension rules, more staff will leave and the care backlog together with waiting times are likely to continue to rise.

[Jonathan Edwards (Carmarthen East and Dinefwr) (Ind)]

I thank the hon. Gentleman for giving way. I congratulate him on securing the debate and on making that key point on the retention of staff. When a similar problem happened with the judiciary, the Government brought in a tax unregistered scheme which, critically, breaks the link between working more hours and the additional tax bill, as well as ensuring that the right amount of tax is paid. Does he think that the UK Government should consider that?

[Dr Poulter]

Absolutely. The hon. Gentleman is right, and that is one of the recommendations I will make in my concluding comments to the Minister.

It is useful and important to use an example of a particular workforce group. I will focus primarily on the pension crisis faced by doctors by means of an example of the way the pension rules need to be changed. How many doctors could the NHS lose as a result of the current pension rules? There is not an exact figure, but British Medical Association modelling suggests it could be anything from 10% upwards by the end of 2022. We already know that the average retirement age has fallen from 61 in 2007-08 to 59 in 2018-19. There has also been a fourfold increase in the number of voluntary early retirements since 2008, with 30% of consultant retirements and 54.7% of GP retirements in 2020 being voluntary early retirement.

A survey of 800 GPs in Pulse last month found 47% said they intend to retire at or before 60. Respondents gave a number of reasons why they wanted to retire, with problems around pensions being listed as a significant reason. A survey by the Royal College of Physicians last year revealed that more than a quarter of senior consultant physicians expect to retire within three years. A survey by the Royal College of Surgeons showed that 68% of consultant surgeons were actively considering early retirement because of the pension arrangements, and 71% of consultant surgeons were considering reducing their non-clinical commitments, including educational and managerial roles—that relates to the point made by the hon. Member for Central Ayrshire (Dr Whitford)—which has worrying implications for the future training of surgeons.

A British Medical Association survey of more than 8,000 doctors revealed that 72% said that freezing the lifetime allowance would make them more likely to retire early; 61% of respondents said that they would be more likely to work fewer hours; and 41% would be more likely to give up additional roles and responsibilities. At the time of the BMA survey, CPI was only at 0.4%. It is now at 9.1%, and in real terms that is the rate by which the lifetime allowance is reducing each year. The BMA believes, with some credibility, that if it were to rerun the survey now, the results would show a significant increase in doctors intending to retire due to the impact of inflation on NHS pension policies. There can be no doubt that senior NHS workers are looking to leave the NHS in significant numbers, and a significant contributing factor to that—alongside burnout and workload—is the punitive pension taxation policies that they face.