I always knew this would be a busy role, but even from that starting point, a great deal has happened since I was elected as chair of BMA Scotland’s consultants committee in September – indeed I find it difficult to believe I only took up the job just two months ago, especially given the number of chancellors and prime ministers we’ve gone through during that period!
As hard as it is to keep up with the fast-moving pace and revolving door of politics, these are also very difficult times for many people, with everyone feeling the cost-of-living crisis. Those of us working in the NHS will feel like we have been working through an eternal crisis since the start of Covid, pressures that we were used to seeing over the winter months are now a part of everyday life for those of us working in health care, with no clear respite in sight.
In this blog I’ve had a go at looking back on the key points and developments for consultants since the summer.
Starting with pensions, there was finally a step in the right direction earlier last month when the Scottish Government announced that it has now devolved powers to NHS boards to allow for flexibilities within NHS Pension arrangements and thus enable the creation of a pension recycling scheme. While this is progress, we do however recognise that it certainly doesn’t fix the underlying problem and fundamental reform is still required from the UK Government to fix the immensely complex and unfair pension taxation issues.
We’ve had an initial meeting with the Management Steering Group (NHS Scotland employers) where it was clear they share our views on how important this mitigation is to help retain experienced staff who are otherwise considering reducing sessions or early retiral. We’ve provided our draft thoughts on how a sensible and pragmatic scheme could be offered that would minimise the administrative burden for both employees and employers. Going forward it will be vital that all health boards work together alongside staff unions to ensure the scheme is implemented equitably, consistently and – crucially – in a timely fashion across NHS Scotland. With less than six months left in the current tax year we emphasised the importance of this last point.
I recently met with the Cabinet Secretary for Health and Social Care and recognised the progress in offering flexibilities in the pension scheme. I was pleased that he shared my views regarding both the need for this to be an ongoing scheme and also in ensuring it was available across Scotland, in particular including smaller Health Boards. I did however also take the opportunity to highlight the unresolved issues around contribution rates and the gap that was starting to emerge with the rest of the UK in this regard. He is expecting an updated consultation to be launched by the SPPA before the end of the year on this topic. You can read more detail on all the issues related to pensions in my recent blog. Progress on contribution rates is important as this makes a major difference to take-home pay each month and we can’t continue to have the situation where doctors are paying disproportionately more per pound of pension in a career averaged scheme, but even more so where those in Scotland are paying more than colleagues elsewhere in the UK.
This of course brings us onto the whole issue of pay. Over the summer you let us know just how disillusioned you are with this year’s pay award in our survey – which some 1,100 of you responded to. We heard that loud and clear – and I hope you saw the responses from our then outgoing council chair Dr Lewis Morrison, and his successor Dr Iain Kennedy. There is no doubt you felt this year’s award of 4.5% was too low – and we have made that absolutely clear to the Scottish Government. At this stage, they have indicated they are simply not prepared to look again at this year’s award for senior doctors. However, given they have at least started to take pensions seriously we are now focussing our efforts on delivering the best possible REC scheme and pushing for revised contribution rates, as I have set out above. If we can get that sorted, we will at least have a foothold in terms of overall income that we can try and build on. It would also mean that there is a means by which any future pay rises may not immediately cause the pension taxation charges many of us fear.
A further issue the survey looked at was our ongoing relationship with the independent pay review body – the DDRB – which makes recommendations on pay awards for doctors to the Government every year. The results here for consultants were mixed; there is considerable disillusionment – but the largest proportion of consultants (36%) did indicate they wanted the BMA to stay engaged with the process. Of course a potential alternative option to the DDRB that some people raise is direct negotiation with Government. However, we know the Scottish Government’s Public Sector Pay Policy (as per their submission to the DDRB) is for a flat pay award for those earning over £40,000. Indeed, we have seen in the recent directly-negotiated pay award for Agenda for Change staff the Scottish Government’s ongoing preference for a flat award, which would have been far below 4.5% if it had applied to consultants. The consultants committee agreed we would submit evidence on behalf of Scottish consultants this year, but equally the BMA in Scotland is continuing to make clear its ongoing dissatisfaction with how the whole process works.
When we add together pensions, pay and workplace pressure issues, there is no surprise that morale amongst the consultant workforce is pretty much as low as it can get. We are stretched to the very limit, and I fear things are only going to get worse. In September I commented on the consultant vacancy rate statistics, these only further highlighted the senior doctor retention crisis we are currently in the midst of. Staff shortages are affecting our ability to deliver the high-quality patient care we strive for, as well as affecting the high-quality training of junior doctors we want and are expected to deliver. We know the workforce is running on empty: there are reports of widespread burnout and an array of workforce and workplace pressures which were a problem long before the pandemic. I am clear both Scottish and UK Governments simply must take this seriously otherwise we will just go on haemorrhaging senior doctors from the workforce at a time when we can least afford to lose them. There are several strands of work underway on this which I hope to say more on soon.
I want to take this opportunity to pay tribute to my predecessor, Dr Graeme Eunson, who campaigned tirelessly for the issues affecting consultants, particularly pensions and the creation of a REC scheme. The announcement on the REC scheme was the culmination of the pressure Graeme applied over the years. I know he remains on the committee, and I look forward to drawing on his experienced advice and guidance.
I don’t underestimate the challenge that lies ahead for us over the next few years, I am a realist about what we will be able to do but I always hope and strive for better.
Dr Alan Robertson
Chair of BMA Scotland’s consultant committee