President's message: The battle on pay continues

HCSA President Dr Claudia Paoloni sets out the next steps in HCSA's campaign on pay - and explains why now is the time to get organised

Medical pay, to HCSA, is not an issue which we must dare not speak about. Currently it has receded from the headlines, and perhaps the forefront of our minds as we face yet another Covid wave.

Yet the relentless erosion of real-terms wages for hospital doctors is still grinding away. If anything, the pandemic and its aftereffects make the case even stronger for a dogged battle to redress this decline.

HCSA’s decision to take a stand on medical salaries, underpinning our Doctors Deserve Better campaign, is not based on the idea that we as a profession are unique nor the only section of the economy whose salaries have suffered from over a decade of real-terms devaluation.

It is grounded in the very real fact, exposed so cruelly during this pandemic, that if we are to recruit and retain the hospital doctors we so desperately need then pay is a significant part of the equation.

We know Consultants are incentivised to leave the NHS for a variety of reasons, including pension taxation and the erosion of independence and work-life balance, but we cannot simply set pay to one side either. All of these factors must be confronted.

From Consultants in particular, I often hear concern at the prospect of raising the issue of medical salaries - concern centred on the public perception which calls to increase relatively high pay for doctors will create.

Given the huge economic impact, on individuals and nationally, of events over the past 21 months, and the periodic media attacks on supposed “fat cat” doctors’ pay, this is perhaps an understandable stance.

Yet for junior doctors - a growing section of HCSA’s membership - the past three years have experienced a dismal trifecta of pay awards which have seen them fall ever further behind their more senior peers as a result of a four-year pay straitjacket. The past two awards, wrapped as they were by government in a garland stating “Reward for Covid”, offered nothing to junior doctors.

But as inflation returns with a vengeance, the issue of pay is set to move centre stage in 2022. Our pay campaign slogan of Retain, Recruit, Respect remains as relevant as ever.

There were misgivings among some HCSA members when we became the first health organisation to announce an indicative ballot on pay back in July. However, as a democratic organisation which has been guided by our members since its inception, we felt we must do so - and be true to the result.

Over past weeks HCSA has reflected deeply on the outcome of that ballot. Four in 10 members took the time to consider the issue and vote. Of those, seven in 10 supported some form of industrial action.

This result displays significant support for action and reflects deep anger among many hospital doctors at the government’s dismissive approach to medical pay.

However, the legal bar erected in front of health unions by the government in order to take industrial action of any sort - even working to rule - is also intentionally high. To take action the turnout in a postal ballot must be 50 percent and 40 percent of an organisation’s qualifying membership must vote in support.

With turnout in our indicative ballot at 42 percent and the vote in favour of action 31 percent of total membership, and with other health unions focusing on the pay round to come, HCSA has therefore decided there was insufficient support to move towards a full postal ballot on action.

Yet these sentiments cannot and will not be brushed away by HCSA. We have no intention of simply “moving on” over pay.

First, we shall be fighting for reform of our pay review body the DDRB. It and the process which surrounds it are, in our view, fundamentally flawed. All the power rests with government - the body is not truly independent and its remit is tightly controlled.

Second, we shall build an alliance to press for a full review of NHS retention and remuneration beyond the narrow confines of the annual pay round: after over a decade of wage erosion and with staffing shortages so cruelly exposed during the pandemic, this issue shall only grow ever more urgent without action.

Third, we shall mount a renewed campaign on behalf of junior doctors who have been so disgracefully treated on pay but who have also faced huge disruption to their training as a result of the pandemic. Junior doctors are right to demand - and expect - recognition, dignity and respect.

Finally, and most importantly of all, we shall organise. HCSA is laying down a challenge to our profession. For too long we have been taken for granted. But for every inch that has been given, we have had a yard taken from us. Over the decades the erosion of medical influence over the NHS has seen our profession go from resistance to resignation, in some cases quite literally.

If we are to exert influence over the factors which impact so greatly on our hospital doctors, it is essential that we build a strong voice that is deeply grounded in the hospitals in which we work.

It is for that reason that HCSA is today announcing the launch of a new activist development pathway. Registration is now open for the first training courses in spring.

I would urge all HCSA members who wish to play a role in strengthening our profession’s hand to consider joining this initiative.

Doctors deserve better. The future is not yet written. Each of us has a part to play in deciding how it will come to pass.


More on HCSA's Activist Pathway