Cover story: Pay decline cannot go on

HCSA President Professor Ross Welch says the government should not underestimate doctors’ anger in the wake of another real-terms wage cut

Hospital doctors were left to stew for several months prior to receiving the government’s pay offering. The outcome is desperately poor, with even the independent pay review body’s conservative proposals being sidelined.

The suggestion that somehow this six-month deal, to be implemented in October and therefore again below inflation for all grades, is fair reward for medical staff is no less than an insult.

HCSA’s quite reasonable proposal was that any rise should match RPI inflation, as a way to begin to tackle the erosion of over nearly a decade of pay restraint.

While rejecting this figure, reached following wide consultation with HCSA members, the DDRB did acknowledge many of the concerns we raised.

Pay packets have fallen by around 20 per cent in real terms over that period. The DDRB recognised the scale and pace of this decline, and it admitted seeing mounting evidence of issues in retention and recruitment.

Its conservative conclusion was that a 2 per cent rise, roughly equivalent to projected CPI inflation, was required this year in a bid to keep pay levels “stable.”

While it is HCSA’s contention that the DDRB position of a 2 per cent rise, rising to 3.5 per cent for SAS doctors, was insufficient, the government’s response was a quantum leap worse.

The Department’s justification, we understand, was that there was insufficient funding in place for Trusts to bridge the gap between the Treasury position of 1 per cent and the additional cost of the pay review body’s recommendation.

But why force the additional costs onto Trusts in the first place? Any workable government plan for health should clearly consider the workforce required to operate services. 

By contrast, in recent years it has seen medical staff as a piggy-bank from which to extract savings.

Effectively the government, by squeezing down pay rates, has been milking the medical workforce to fund its “efficiency savings” over many years. It appears intent on continuing to do so.

This in turn has fuelled a locum and temporary staff economy that makes no sense for an NHS tightening the purse strings, and if overused can be destabilising and demoralising for permanent staff.

The government’s failure to acknowledge the role of pay in fuelling the current vacancies crisis, the rapidly growing tendency towards early retirement among our most experienced doctors, and worrying dropout levels among trainees, is truly shocking.

The fact that he attempted to dress up further real-terms pay cuts as a generous pay rise has done the new Secretary of State no favours at all.

He will need to work hard to build the bridges with staff that he claims to wish to. That means taking on the might of the Treasury too.

In the meantime, the current callous disregard for medical workforces, who are facing the squeeze in every area, is likely to come back to bite the policy-makers responsible, not just in fuelling the problems within retention and recruitment but also in the growing rebelliousness of doctors.

The government has indicated its desire to press on with “reform” of the Consultant and SAS contracts, dangling the carrot of a multi-year package for pay.

Given the ongoing erosion of salaries and the general approach towards medics, it would be naive to expect hospital doctors merely to fall in line with its plans.