A top doctor has said the government “must get a grip” on its handling of the NHS or face inflicting “irreparable damage” on the workforce.
Dr Nick Scriven, president of the Society for Acute Medicine, said England was “lagging way behind” its devolved counterparts on the introduction of safe nurse staffing levels.
And he warned there was a “real prospect” of a shortage of doctors as a result of failing to address the pensions tax crisis promptly, fill senior vacancies and tackle the uncertainty caused by Brexit.
“It really is quite astonishing to see what has happened to the NHS in recent years – the government must get a grip on its management or face the real prospect of causing irreparable damage by driving staff away,” said Dr Scriven.
“On big issue after big issue we have seen the government fail to make decisions or act quickly enough, such as the junior doctor contract saga, the state of social care provision and the reduction in acute bed numbers.
“That is all playing out again right now, with targets remaining unmet, the pensions crisis unresolved and eating away at the consultant workforce, no laws to ensure safe staffing levels and no answer to the growing number of vacancies.”
Despite 40,000 nurse vacancies in England, there is no law related to nurse staff – despite legislation being in place in Wales, a bill introduced in Scotland and a framework in place in Northern Ireland.
Meanwhile, with 10,000 consultant vacancies, some doctors are reducing hours or turning down additional work due to the tapered annual allowance, introduced in 2016, which reduces the tax-free amount that anyone earning over £110,000 can save into a pension each year, leading to tax demands so high some doctors have had to remortgage their houses to pay.
In addition, senior doctors retiring after 40 years on a final salary of £100,000 – or a shorter period on a higher salary – are opting to retire early to avoid being penalised by an additional lifetime allowance tax on their pension pots.
“For a service that relies on senior staff regularly going many extra miles to try to shore up rotas and creaking winter services, removing what are punitive additional taxes must surely be an absolute priority,” said Dr Scriven.
“We are in a situation where additional blocks of work, such as an extra weekend to fill a gap or cope with pressure, could lead to a five-figure tax bill for a doctor simply trying to do what is best for patients.
“More often it will mean a consultant no longer offering to work routinely beyond the basic contracted 40 hours a week which has consequences with rota gaps in acute services unfilled or doctors no longer offering to do extra work to reduce waiting lists.”
Dr Scriven said that while the problem is “biting” on older, more experienced doctors, more younger clinicians are “looking ahead” and staying on the basic NHS contract.
He added: “From figures recently released, well over 20,000 doctors have been hit with tax bills in excess of £10,000 in the last few years.”
A recent Society for Acute Medicine survey identified staffing as a major concern of frontline staff, with 60% of respondents believing any Brexit arrangement will negatively impact further on what is already a crisis.
In addition, more than half (55%) said that regardless of the political arena, workforce issues – including staffing numbers and morale – were their biggest current worry.
“Despite these significant and multiple problems, the Prime Minister has now announced her departure while the health secretary is busy preparing for his leadership bid,” said Dr Scriven.
“Yet again, this demonstrates the disconnect between the Westminster bubble and the issues that are eating away at our healthcare services – and the consequences could be terminal.”