[Closed] NHS Staff - is more pay the answer?

having an extra bum on the seat will equal additional income.

I [i]think[/i] there are penalties for not meeting certain SLA's, too, but Mrs BVP7 has never indicated that staff retention policies have come into play, even when pretty hefty penalties were (apparently) being collected.

I found that utterly nuts.

having an extra bum on the seat will equal additional income.

Sorry may read incorrectly, I dont mean the CCG/government pays based on bums on seats, more that savvy Trusts can see that if they increase activity/maintain activity, spending £3k on a reward/rentention is worth it if it generates £50k more income.

I would say it but I don't think NHS consultant pay is unfair. I spent 15 years working 50-60 hours a week to become one and still work 45 hrs/wk and a 7 day week 1 week in 7.

We are well paid but we work hard both to get there and for the money when we do get there.

I think for some staff groups more pay would help but the problem is actually far more than pay - there are far more things that negatively impact morale than just pay in the NHS at the moment.

There does also need to be a sensible discussion about what to fund and not fund as everything isn't affordable.....

Short version, I don't think pay increases are really the answer but banging on about pay and cost and constantly banging heads with doctors could be designed to make them feel undervalued and demoralised. Meanwhile staff shortages caused by people leaving the profession and not enough training will drive wage costs up. At which point Jeremy Hunt and the papers will blame greedy doctors.

BaronVonP7 - Member

If inflation takes off, it looks to me like it might be another sub-prime mortgage jolly.

I don't know about medicine, but the 2010 increase in general tuition fees is likely to be completely wiped out by the fall in tuition fee repayments. The gap's been closing steadily, this years figures have been delayed (indefinitely, not sure we'll ever see them tbh if they're embarassing).

That's so counterintuitive that I'll rephrase it just to make it clearer- tuition fees increased to £9000, saddling many students with 25 years of debt, and then so much gets written off after the 25 year lifespan that they might as well have left the fees at £3300 because the total income is the same. But the writeoffs will be some other government's problem and in the meantime the loan book is treated as an asset.

That's all based on current earnings forecasts to be fair, which are quite likely going to be wrong by 2042. But that's the best we've got and the basis of the policy planning done today.

Pay rises are nice, but not the answer. To my
Mind the answer is spendIng more money ON the staff. I'm an nhs manager (who also works clinically in a different trust.) there is no money to support my team in training or development. If they pay for training or development to take place, then it is in their time as we have no money to cover gaps in Rotas. When opportunity to step up is there, there is no money or support to encourage that, it's just expected (my boss is leaving next week, the replacement arrives in about 3 months, I'm expected to do 2 jobs for that time period, I will not be offered any salary increase or training to manage these roles. I'd like to develop one of my team leaders to do more day to day management, but her pay band prevents that, and as she is at the top of her band there is no point training her. She will soon leave and we'll lose all her expertise and knowledge.

There is no flexibility in the service and staff are starting to get better offers, leading to the staffing crisis we now have. It's getting like a football team, if you're good, you leave, the new players take a while to develop and bond with the team, management changes every 6 months and we're only 3 and games away from relegation.

wl - not sure if I know my stuff but the thing Labour keep pushing very hard is to scare everyone about US Health Firms. What's not clear is if US firms actually have any interest in competing to provide a service to the NHS.

The likes of Kaiser actually oversee a health system that is more integrated and performs better than the NHS on many indices - but Kaiser don't seem to be active here and the fact some of the firms that might operate here could bring some models that improve outcomes and patient experience never gets a mention.

What Labour noticeably don't do is mention the many EU Companies involved in healthcare who could also operate in the UK but again don't.

I rather suspect that the idiosyncrasies of public sector procurement, the incredibly negative political rhetoric and significant cost of building any health business in the UK is more than enough to put most firms off - so the "USA Fear" tactics from Labour is simply a politically expedient way of obfuscating their lack of real policy or detailed answers to the key question:

[b]"[i]what is the real root cause of what's currently not working in the NHS and what is your proposed solution?"[/i][/b]

After giving this some thought, I have the think that this pledge by Labour to give NHS workers more money isn't to try to help the NHS, but to help to ensure it's 1.3m employees vote for Labour.

I don't understand this version of Labour, with everthing that's going on in the UK and the world at the moment they should be having a field day, but they're just not.

The likes of Kaiser

Bit more dismantling to be done before they come in, I imagine

GPs do not have Final Salary Pensions. The poster above got it wrong. We have a complex money-purchase scheme which reflects our earnings in every single year that we have worked. I might get near 50% of my average wearnings as salary, and I am not complaining. The inflationary uplift is quite good.

BUT - set against that, the Conservative Government's bizarre and counterproductive changes to Annual and Lifetime pension allowances are currently pushing almost any GP aged 55 or over out of the scheme or into reducing hours at a time when we have a national shortage of GPs which will absoultely kill the service.

So - for me - a bit of thought by the Treasury could have, at very little expense, by just leaving things the way they were, avoided an impending absolutely calamitous situation.

Six years of pay restraint have left the average public sector worker earning thousands of pounds less than they would have been if pay had kept up with inflation.

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My simple solution would be to introduce more generous tax codes to the lower paid front line community workers, which include nurses, carers, social workers etc. I'd also include similar measures for police, fire, teachers etc.

Seems ridiculous that one government department, e.g. DoH, transfers numbers to another department, e.g. HMRC, when the numbers came from the Treasury in the first place. Unnecessary beauracracy, silly to impose a tax at all for these people. Could possibly help staff/skills retention too as the private sector would no longer be financially viable for the employees.

I have no figures, but could make some up if required 🙂

How has the same period impacted private sector workers? For context it's important to see what has happened to the rest of society

some skewing of the figures there, band 5 covers £28,462 to £21,909 depending on the pay point

you could easily have a £21,909 nurse and a £28,462 ambulance driver

the band 6 midwife could be as low as £26,302

Dirtyrider: good job there are percentages there then. Also bear in mind most people are at the top of certsinly closer to the top of their pay scale than the bottom: When I was one, i was at the top of band 5 for more years than I was at any of the other points in that scale combined. Same is true for 2/3 of my department who have maybe moved jobs sideways but stayed on same salary point (i.e. top of band) since Agenda for change came in 12/13 years ago.

There is a calculator on here if you want. https://www.rcn.org.uk/nursingcounts/calculate-lost-earnings

By that website, my theoretical 'lost earnings' over seven years do not take into account my increased pension payments and retirement age, but they are almost exactly the same my local MP's salary increase for a single year. Smooth.

There is no getting past the facts that 1) NHS staff are required year on year to do more with fewer staff. 2) the biggest cost component by far in healthcare is the wages of the staff- and the 'frontline' staff far outnumber the support/non-clinical/management staff.
What is harder to argue is productivity and clinical outcomes- I have a sense that because I am a person of principle and basically find things to do st work rather than avoid them, that I actually help children and families more when I have fewer of them and my actual "throughput" and 'relapse rate' are better when I am at a level slightly below "maximum busy" - I think that is very hard to reliably measure though our department audits do support this notion.
So personally I would quite like more colleagues again as much as I would like to have the same standard of living in 5 years as I do today.

@bunreep public sector employees aren't the only ones who have experienced real terms pay cuts.

That being said pay levels in the NHS are too low imo, far too low

Out health provision needs a major rethink, imo more taxes and better integration with and involvement of the private sector. Another true story ..

My wife went to the doctor with 2 different issues. First requires an ultra-sound, she got an [b]emergency/urgent[/b] refrerral. That appointment is in 4 weeks !!! Second requires an mri in her view (recurrence of old wakeboard injury), Dr in UKmprescribed strong painkillers and wait and see. As her father is ill we came back to Paris this weekend. Dr here will give her the ultra-sound in his surgey tomorrow (3 day wait) and for her neck she has an MRI tomorow (2 day wait) and some specialist (sports injury clinic) injections. Days not weeks, specialist treatments. Now this will not be free, her appointments have a modest cost over and above what her private medical covers.

I have an mri in a few weeks, both knees. Both need acl replacement surgery. I strongly suspect I'll be told (directly or indirectly) I am too old (54) and/or surgery isn't available. In that case I'll get it done privately in France where its much cheaper (as private works hand in hand with state instead of the UK "luxury tax" way), the surgeon there has already recommended it and says my age is nit a factor for him.

Our system is badly broken and getting worse. It is NOT a party political issue, its as bad under Tories as it was under Labour. We are not addressing the fundamental problem of health costs rising at 4% pa

There's no such thing as good housekeeping within the NHS. The price-gouging of drugs has been left unchecked with eye-watering amounts of money being paid. There seems to be nobody responsible for procurement.

Tough decisions need to be made, Lord Sugar is the person for the job!

[quote=Northwind ]tuition fees increased to £9000, saddling many students with 25 years of debt, and then so much gets written off after the 25 year lifespan that they might as well have left the fees at £3300 because the total income is the same. But the writeoffs will be some other government's problem and in the meantime the loan book is treated as an asset.

Wow - they manage to do the accounts like that from the creditor side? Because my understanding is that from the debtor's side the banks take into account the write off after 25 years, so it's treated as a payment/tax/deduction from income rather than a debt when taking on other loans.

As you say, if it's the same for nurses as other student loans, then it will be nothing like another sub-prime mortgage thing, whatever inflation does. Well I suppose there will be lots of "defaulting" on the debt, but that's going to happen anyway.

Any discussion about the NHS must start with:
- do we decide how much we, as a country, can afford and then decide how we allocate
OR
- determine what we want from the NHS; then cost it and adjust tax rates accordingly without affecting any other governmental expenditure.

Put simply, decide between what we want to pay (and accept the service which results) or what we need (and accept the costs) - without screwing any other planned gov spend.
Thirty year time horizon.
Time for grown up discussion by politicos - no party agenda; what is best for the residents of the uk.
No current or aspiring mp will support the inevitable cost - and tax - increases which result from funding the NHS to deliver what we need.
In summary, we're always in the shit it's just the depth that varies.

Time for grown up discussion by politicos - no party agenda;

This.

Reading this thread you would assume the NHS is a total disaster but to give a bit of balance here's my experience.

I fell off my bike before Christmas which led to a compound ankle fracture that was limb threatening as in loss of leg below the knee territory. This was a Saturday evening and a remote location. Mountain rescue recovery to ambulance and straight into A&E and into 8 hours of surgery to save the leg. Two further operations one lastly 16 hours to graft and plate up the ankle. 12 days in hospital and 30 plus appointments for wound dressing and physio to a point today when I can walk with a stick and can count 10 toes. I've still got a way to go but what I would say is the dedication and skill of the 100 plus people who helped me and still are is amazing.

My experience of the NHS is it might not be perfect day to day and you might not always be able to get an appointment with your GP but when you have a real need it is there and it is world class.

"My experience of the NHS is it might not be perfect day to day and you might not always be able to get an appointment with your GP but when you have a real need it is there and it is world class."

Agree. I've had two new kids and a major Op in the last five years. Every step of the way the NHS has been flawless.

I also saw an ENT consultant privately and the only difference I could see was free biscuits in the waiting room.

...but if health care inflation is at 20pc every five years, something needs to change fast to keep things sane in the future.

Those biscuits weren't "free" you paid for them, over the odds I'd imagine.

"Those biscuits weren't "free" you paid for them"

Good point.

I know what isnt the answer

some slimy cockwombe setting up a huge cancer drug fund, because he'd rather piss 1.3bn up the wall than tell the Daily Mail that NICE knows more about drug efficacy than the they do

[url= http://www.bbc.co.uk/news/health-39711137 ]Cancer Drugs Fund 'huge waste of money'[/url]

another great legacy of Cameron

Surely the voters are to blame for that bit of lunacy?

More pay is part of the answer, not THE answer.

respecting the people who work their by not eroding their take home pay for 9 years in a row will certainly help prevent demotivation

More money into the NHS in total is the answer. More staff. better equipment, better pay, better facilities.

Having working in the NHS for 30+ years I have seen the difference increased funding makes and the damage decreased funding makes.

Private medicine in any form is not the answer. Its less efficient so you get less improvement for the extra money if it comes from private sources. Utter nonsense to suggest that the private sector involvement in European countries is a model we should follow. for a start most of the "private" involvement in european healthcare is actually charitable or religious non profit organisations

too many folk commenting on this thread have zero idea about the complexities and reality of running a health service

The elephant in the room is that we need to pay more taxes. significantly more. For example the Netherlands. You pay more income tax than you do here - and then you pay significant sums for healthcare on top of this. the UK is a low tax country

"More money into the NHS in total is the answer."

How much more? 4pc extra pa?

20% extra to bring us up to the european average.; Take ten years to do I guess as the money spent needs to be planned.

"More money into the NHS in total is the answer."

20pc over 10 years is a significant reduction in real terms.

So you actually want less money for the NHS.

Deliberate misrepresentation of what I said and meant. 20% increase over inflation.

I could solve the NHS problems easily and so could many NHS employees that understand the situation

Step 1 take control of the NHS out of politicians hands completely. Politicians set the total budget and broad aims and nothing else

Step 2 - pledge to increase funding to the european average over 10 years

Constant reorganisations waste huge sums of money and as importantly the energy and enthusiasm of the staff.

It's obvious he meant in real terms since he was talking about raising it to other nation's levels. But you know that.

frankconway - Member

No current or aspiring mp will support the inevitable cost - and tax - increases which result from funding the NHS to deliver what we need.

And yet it's the cheapest option. Increased privatisation will drive up costs. Continued underfunding will drive up long term costs (cheaper to maintain than rebuild). The cheapest option is to fund it properly, all the time, from top to bottom.

[quote=tjagain ]too many folk commenting on this thread have zero idea about the complexities and reality of running a health service

Much like the Secretary of State for Health then.

[quote=Northwind ]It's obvious he meant in real terms since he was talking about raising it to other nation's levels. But you know that.

I read it as an admission of being a trolling idiot.

"Deliberate misrepresentation of what I said and meant. 20% increase over inflation."

Appologies, wasn't deliberate.

So over 10 years, 20pc plus the 40pc required to keep up with health costs inflation?

60pc?

Step 1 take control of the NHS out of politicians hands completely. Politicians set the total budget and broad aims and nothing else

Could we do the same with education too?

I'm not saying that NHS staff don't deserve a rise.

But as one of the millions of public sector workers doing "less vital" work and also having pay restraint erode our take home pay, from a starting point below that of a nurse, I'd be a little annoyed if they got preferential treatment over the rest of the public sector.

Love us or loathe us, but if us drones didn't sort out the taxes coming in first, it's not just the NHS that would be ****ed.

Private medicine in any form is not the answer.

Yeah, those GP practices are total carp. Get rid of them entirely.

And the French system, with large scale private sector involvement - must be utterly useless. https://en.wikipedia.org/wiki/World_Health_Organization_ranking_of_health_systems_in_2000

The elephant in the room is that we need to pay more taxes. significantly more. For example the Netherlands

You mean the Netherlands and their mainly private (for-profit) healthcare? https://en.wikipedia.org/wiki/Euro_health_consumer_index

The netherlands is not mainly " for profit"

Yes AA - same approach - a board made up of professionals who understand the running of the service with the politicians setting broad aims and budget only

tj: ~60pc over ten years, yes?

For me the question isn't about the NHS, it's about long term plans for healthcare regardless of what that takes.

There is in my mind no doubt that private healthcare is going to be a boom town at some point - even if you look at one piece of it like care homes, people are living longer with complex care needs.

That, however you look at it is a savage environment to work in - physically, emotionally, technically... and at the moment the reward is incredibly poor - my view is that the area at the moment is staffed by a lot of people who are doing it because they feel called to it. As the population continues to age you're going to exhaust the goodwill and supply of these people and have to start to get in others who will have different motivating factors - and money is a big motivating factor for everyone!

There was an excellent presentation at one of the national conferences a while ago - healthcare is becoming unaffordable for the population of the world - not just the NHS.

More funding is needed but so is better efficiency and useful data on cost effectiveness and outcomes of treatments. There are lots of treatments done with not as much regard for effectiveness or cost as there should be...

OOB - that would require knowing the future
Funding to 10% of gdp in as short a time as the service can mange to plan and spend the money effectivly. Takes years to do this.

As for efficiency - the NHS is extremely efficient with very low management costs - or was before the tories introduced their fake market reforms which cost a huge amount to administer

One of the best things the SNP did was remove the worst of the fake market reforms immediatly on getting the ability to do so then left the management structure alone. result is that NHS scotland spends half what NHS england does on management and is able to plan effectivly

There was an excellent presentation at one of the national conferences a while ago - healthcare is becoming unaffordable for the population of the world - not just the NHS.

I think that sums it up. If inflation is 1.5pc and medial inflation is 4pc it doesn't take Alan Turing to work out that if spending keeps pace with medical inflation before long 100pc of all resources are spent on healthcare.

So compromises need to be made. For whatever reason the decisions that get made by politicians and civil servants WRT health are always deeply unpopular. [1] [2]

The only way to address that is to go 100pc private so people make the judgements that suit them best.

So I might choose to be poorly covered for diseases of extreme old age, in exchange for better cover elsewhere. My mate who keeps sharing demands on FB for 'life saving' drugs to be provided an the NHS can pay for that cover at the expense of cover he deems less important.

No matter how well funded it is Health provision will always be rationed. Loads of people don't like the way the government ration it. They need to be allowed to make their own choices.

[1] Look at todays news. A few years back everyone was up in arms that obscure cancer drugs with little benefit weren't provided by the NHS. So they spent a fortune providing obscure cancer drugs with little benifit and guess what, people still aren't happy.

[2] TJ (for example) has zero chance of an extra 60pc funding from the state over 10 years. If he's paying for his own he can have his 60pc increase tomorrow.

Funding to 10% of gdp in as short a time as the service can mange to plan and spend the money effectivly. Takes years to do this.

GDP growth doesn't keep pace with medical inflation. So wouldn't 10pc of GDP would mean a long/medium term real terms reduction?