James Watts, Consultant in Anaesthesia and Critical Care Medicine, East Lancashire NHS Trust, looks into working conditions and pay in the medical industry
Introduction
2023 will be remembered as a period of almost unprecedented social and political unrest with strikes across the private and public sector, including the junior and senior medical staff, which at the time of writing are still ongoing, although a substantive offer is being considered by the consultant body(1).
The background to this was an extraordinary level of discontent amongst medical staff of all grades, centering on both working conditions and pay. (2)
The unrest came at a unique time: the country was still suffering the after-effects of the COVID-19 pandemic and the social and economic upheaval that had resulted. Following this, a variety of factors had contributed to a rise in inflation, followed by an increase in interest rates in a bid to control it, and an associated rise in the cost of living. It was Government policy to keep public pay sector wage increases low as a tool to control further damaging inflation. However, this led to public sector workers who had been on the frontline in the pandemic- including care workers, nurses, doctors, hospital staff, police, fire, paramedics etc- feeling undervalued; whereas the cap on so-called bankers bonuses was removed without issue; and Criminal barristers obtained a 15% across the board rise for funded defence fees following industrial action. (3-6).
As a result, one of the main grievances cited, particularly by so-called ‘junior doctors’ (a term that includes some highly skilled professionals with years of experience) was a relative reduction in pay over the years which had caused a recruitment and retention crisis. The workforce planning of the health sector is extremely complex, and factors other than pay had certainly contributed to this. Whatever the main cause, failure to appropriately expand staff numbers, and an increasing workload, were believed to be creating what was regarded as at best an unsatisfactory, and at worse a dangerous, working environment for staff and patients. (7)
As a result, it was reported that pay and working conditions were the main cause of doctors leaving the NHS and the UK after reaching a moderate level of competency, and moving abroad where the pay and working conditions were better. This information was spread widely on social media, and in 2023 the BMA began propagating the concept that over the years doctors had suffered a relative and increasing deficit in pay – greater than that of other health workers – due to the failure of the government to keep pay in line with inflation. The figure of a 35% deficit was widely suggested and became entrenched as a minimal pay demand in the minds of the media (8).
This analysis will not comment on politics, or whether NHS staff should or should not be able to strike; but will only concentrate on changes to wages since 2008.
Recommendations on pay are made by the Doctor and Dentist’s Pay Review Body (DDRB).
The Doctor and Dentists Pay Review Body
The Doctors’ and Dentists’ Review Body is a committee established in 1960 by Parliament in response to the Royal Commission of Doctor’s and Dentist’s Remuneration. It is sponsored by, but is not part of, the Department of Health (which means that the DoH provides infrastructure, supports its website and publishes its reports etc); and is independent of both Government and the profession.
In making its recommendations, the DDRB invites evidence from a range of stakeholders, including the BMA and the Government, and then provides a report as to how much doctors’ pay should increase in the following year. This is a recommendation only and whilst the Government can take this under advisement, it is free to ignore the recommendation when making an award through NHS Employers
The overriding principle of the DDRB is to provide some safeguard to doctors wh