Comment: 'It would be folly for government to ignore the warning signs on pay'

Last week’s banner headlines reporting the generous pay award for NHS doctors were an exercise in government spin which glossed over not just its two-tier nature but also the reasons why our pay review body recommended a real-terms rise, writes HCSA President Dr Claudia Paoloni.

By presenting this year’s award as a kind of pandemic payment for services rendered, it also sent a damaging message to those locked into multiyear deals that they were not worth rewarding equally. Junior doctors unfortunately are now directly experiencing the reason for HCSA’s opposition to a four-year “ball and chain” pay deal which was accepted in a referendum last year.

The truth is that the government was merely implementing the recommendations of the DDRB pay review body, which it had based not on Covid-19 but on deeper concerns about the state of the profession. The DDRB was explicit that an above-inflation rise was needed to address the serious erosion of medical wages. This echoed HCSA’s fear that pay decline is inevitably having an impact on staffing and career decisions. Any reward in appreciation for the Covid-19 response, the pay review body added clearly in its report, should come on top of this.

Whatever the shortcomings of the DDRB process, not least that its remit is set out by government, it has this year displayed a refreshing understanding that pay erosion is having a growing impact.

In its report it acknowledged the decline in real value of hospital doctors’ wages, and the particular erosion of Junior Doctors’ salaries.

But the elephant in the room is that the entire pay process is framed by a government and in particular Treasury which hold all the cards. It is the government which writes the script which the DDRB, in general, follows. This included an instruction not to consider Junior Doctor pay in England. It is the government which then deigns to either accept or reject based on whatever fiscal mood it is in at the time.

While a pause in the decline in the real value of doctors’ wages is welcome, there is no suggestion that we are now in a new, more generous era. Quite the opposite, in fact, with the Treasury writing to government departments stating that the future will be one of further pay restraint.

This exercise in giving with one hand this year in order to take away with the other in the next feels deeply cynical.

In HCSA’s view, while there are understandably going to be huge pressures on public finances, failure to grasp the nettle on NHS pay decline will prove disastrous.

HCSA has tried hard to disentangle the broader discussion around pay from the Covid-19 response. The DDRB’s shift in focus underlines that we are beginning to succeed in moving the debate.

HCSA is clear that the erosion of doctors’ pay, which has seen the real value of wages fall steadily against comparable professions, is part of a wider landscape encompassing changing expectations around work-life balance which the NHS has been slow to acknowledge, huge issues created by the pensions taxation system, and growing pressure from the centre for greater “productivity”. At the same time managerialism has led steadily to professional disempowerment for hospital doctors.

The pandemic has underlined the commitment of staff, but it is also placing a huge burden on many of us. Healthcare workers have faced the same personal challenges as everyone else while also being drafted in to work longer hours with leave cancelled, facing concerns over PPE, and being directly affected by caring for Covid-19 patients.

Many HCSA members have already told us they are considering retirement and cutting back on hours.

Yet the desire to bring down waiting lists and the prospect of further waves of Covid-19 mean that healthcare workers will be placed under continuing intense pressure for the foreseeable future.

If we are to avoid an associated intensification of the staffing crisis it will be important to tread carefully on the terms and conditions of the hospital workforce. We cannot just have more and more work piled upon the same increasingly worn-out individuals without steps to mitigate this situation. This includes a properly planned approach to emergency rotas, which have frankly been abused by some employers, and the linked issues of adequate time for rest and recuperation, professional development and training.

HCSA is clear, though, that when it comes to pay the best way to recognise the value of NHS staff would be a respectful fact-based strategy based not on abstract notions but on recognising the reality that there is a link between recruitment, retention and remuneration. In particular, maintaining the pay comparator with similar professions is important to attract the next generations of doctors.

We certainly should not be punishing and demoralising our lowest-paid doctors hardest of all. These are, after all, the future of our profession.

As part of the HCSA delegation in April I warned the DDRB that there could be no return to wage restraint, in large part due to the profound impact the current pandemic will have on the medical profession, as it will on other healthcare colleagues.

We stand by that position. HCSA will be stepping up its campaigning work in coming months to highlight the folly of ignoring this coming storm.