Waiting lists for hospital operations at the UK’s National Health Service are soaring as growing numbers of senior doctors turn down extra shifts. Sky News reports that this is prompted by changes in pension taxation that mean these shifts are no longer worth their while.
Hospital trust CEOs say a dramatic increase in the number of consultants declining extra work in recent weeks has had an impact on patient care. One trust reported that a senior anaesthetist at their hospital, who had worked 27 Saturdays the previous year to help reduce a backlog of operations, had informed them they would no longer work any weekends.
The report says the clinical director of a second trust, a senior A&E consultant who routinely worked most Sundays last year, was no longer working any weekends.
Another trust executive said their waiting list for operations had increased by 50% in the last three months, from about 3,000 to 4,500, because consultants were no longer accepting extra work.
People saving for retirement are entitled to tax relief on pension contributions up to a total of £40,000. But, the report says, the annual allowance reduces for anyone earning more than £150,000 – tapering down to a maximum of £10,000 for the very highest earners. Because of the complexity of the rules, which includes all forms of income, and the inflexibility of the NHS pension scheme, people earning £110,000 can be affected.
Almost all consultants and GPs are at risk of triggering these reduced allowances, about 100,000 doctors.
Consultants receive a maximum salary of £105,000 for 10 “programmed activities” – four-hour sessions a week – but, the report says, those paid for extra work have been dragged into the new pension tax bracket. Doctors’ groups, including the British Medical Association, say the change, introduced by the Treasury in the last budget, means that some doctors are effectively taxed at 75% or above on additional income and many are now declining the shifts.
One CEO said: “If I paid a consultant £600 to work a Saturday, after income tax they would take home £350. With these changes, however, they are perhaps taking home £200, and many are asking why they should work for that. All the gains we have made in reducing waiting lists have been from people working extra hours to reduce the backlog, and until now the trade-off between patients, pay and the impact on doctors’ family life has been about right. But now they are asking, what’s the point?”
According to the report, while there may be limited sympathy for well-paid doctors, NHS leaders say the issue has a direct impact on patients and has become more acute in the last month. This follows Health Secretary Matt Hancock’s proposal that doctors cut their pension contributions by 50% in exchange for receiving only half the benefits.
Chris Hopson, CEO of NHS Providers, said doctors have voted with their feet in rejecting the plan. “Trust leaders report that, over the last month, they have had significant numbers of key clinical and managerial staff saying they can no longer afford to work extra shifts and weekends because of the financial penalties. This is now an immediate major problem for the NHS. Trust leaders are saying the impact is growing rapidly. We have multiple trusts telling us they are expecting a significant increase in the number of surgery cases they will have to delay, leaving patients in pain and risking their problems getting much worse. Trusts are also worried that these issues are one of the reasons for the current NHS performance problems in emergency care with April and May performance much worse than expected.”
The report says anecdotal evidence is supported by recent data, though figures for June are not yet available. Data for April showed that the number of patients waiting more than the target 18 weeks for an operation increased 3% on the previous month, and 16% on the same month last year to 579,403, the largest number ever recorded. The percentage of patients treated within 18 weeks is the lowest since current records began at 86.5%, and the total waiting list for operations was nearly 4.3m.
A Department of Health and Social Care spokesperson said: “We want to make NHS pensions more flexible for senior clinicians, in response to evidence that shows this issue is having an impact on retention. We will carefully consider all views on our proposals.”Sky News report