NHS Pensions and Staffing

– in the House of Commons at 7:34 pm on 13th July 2022.

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Motion made, and Question proposed, That this House do now adjourn.—(Adam Holloway.)

Photo of Daniel Poulter Daniel Poulter Conservative, Central Suffolk and North Ipswich 7:38 pm, 13th July 2022

I draw the House’s attention to my entry in the Register of Members’ Financial Interests as a practising NHS hospital doctor, although I am not personally affected by the issues I am about to raise.

I think we would all agree that following the pandemic, the NHS is facing unprecedented challenges in delivering patient care. The current demands on the system are too high to be met by the existing workforce and resources alone, and while the Government rightly seek to increase the NHS workforce by training more doctors, nurses and other frontline clinical staff, it is equally vital that we retain the existing workforce. Simply put, losing senior and experienced staff at this time would be an unmitigated disaster for the NHS and the patients it serves.

One of the biggest threats to the retention of the most senior and experienced NHS staff is the punitive and unfair interplay between long-standing Government pension taxation policies and the NHS pension scheme. Those policies, and the punitive financial penalties that result from them, will cause many senior NHS workers to take drastic steps such as reducing hours, leaving leadership roles or taking early retirement. These pension penalties will result in senior and long-serving NHS workers aged 59 or 60 potentially losing over £100,000 from their pension pot if they delay retirement by one year, rather than retiring this year. That is resulting in senior and experienced NHS workers being advised by actuaries and accountants to reduce their working hours in order to avoid being hit by huge pension tax bills that will see them working for little pay, or in some cases no pay at all.

Photo of Philippa Whitford Philippa Whitford Shadow SNP Spokesperson (Europe)

Obviously, I too was a doctor until recent years.

This is an issue for all four health services across the UK, and is taking away people with the knowledge, skills and experience to not just look after patients but teach. Is the underlying problem not that when this policy was introduced in 2015, the talk was about preventing tax avoidance? It is not possible to play games with a final salary scheme. It was never open to doctors to play games with their pension, and therefore it is simply the wrong policy for the wrong group of people.

Photo of Daniel Poulter Daniel Poulter Conservative, Central Suffolk and North Ipswich

The hon. Lady is absolutely right. There were some further unintended consequences of the Finance Act 2004, which I will come to in a moment, but doctors, nurses and healthcare professionals cannot chose the rate at which they contribute to their pensions—they have to contribute at a fixed rate. There is no choice, so unintentionally, we find ourselves in a situation where senior healthcare professionals are facing punitive, eye-watering annual charges on their pensions worth tens of thousands of pounds. That cannot be right.

Photo of Jim Shannon Jim Shannon Shadow DUP Spokesperson (Human Rights), Shadow DUP Spokesperson (Health)

I congratulate the hon. Gentleman on all he does in his position as a doctor, and on securing this debate on a really important issue that affects many of my constituents and those of many other Democratic Unionist party Members. During April this year, 8,902 pension awards were made, compared with 6,932 in April 2021—a year-on-year increase of 28%. Does the hon. Member agree that that is indicative of an increase in staff who simply cannot take the long hours, the lack of support and the soul-destroying pressure that our NHS is fast becoming renowned for, and that it is critical that changes are made urgently to keep staff in place rather than have them bolt through the door at the first possible opportunity? I look forward to hearing the Minister’s response.

Photo of Daniel Poulter Daniel Poulter Conservative, Central Suffolk and North Ipswich

Will the hon. Lady first allow me to reply to the previous intervention?

I congratulate Jim Shannon on making those points; he is absolutely right to make them, and I am grateful to all his DUP colleagues who have turned out this evening to support the debate. It is very much appreciated, because as he rightly highlighted, this issue affects all healthcare professionals in all parts of the United Kingdom. We need to see changes to the punitive pension regime.

I will give way just one more time for now, if Members will forgive me, because I know that a lot of people want to speak in the debate.

Photo of Nia Griffith Nia Griffith Shadow Minister (International Trade)

I congratulate the hon. Member on securing the debate, and I implore the Minister to listen, because although health is devolved to the four nations, retention is a central issue that we are all affected by. I will let the hon. Member get on with his speech.

Photo of Daniel Poulter Daniel Poulter Conservative, Central Suffolk and North Ipswich

I thank the hon. Lady for her support, and she is absolutely right to highlight that this issue affects all of the United Kingdom.

This year in particular, due to certain factors related to inflation, we are facing a real challenge that is created by the pension penalties that exist under the current legislation. That needs to be looked at urgently, or we will see a reduction in the NHS workforce at the very time we can least afford it, while we are tackling the covid crisis.

“Scheme pays”, which is effectively a loan against a pension, is often suggested by the Government as a way for doctors to pay their pension tax bills. However, it attracts an interest rate of CPI plus 2.4%. So in the current climate, with inflation being at over 9%, “scheme pays” is prohibitively expensive and can result in a significant reduction in the total value of the pension, particularly for younger NHS workers in their 30s and 40s. Many doctors and nurses are left with little option but to pay the tax from their post-tax income instead, take out bank loans or, in some cases, increase the size of their mortgages. As I shall explain later, due to rising inflation, senior workers are being billed thousands of pounds in tax for pseudo growth in their pensions which never materialises as inflation continues to rise.

What is the impact on the NHS? The NHS is at a care and staffing precipice. GP workforce numbers are falling, while hospital consultant numbers are not increasing rapidly enough to keep up with demand. Many staff are also feeling burned out and demoralised due to workload and rising instances of abuse. In addition, the secondary care backlog in our hospitals for both urgent and elective operations, as well as for cancer care, is at an unprecedented level, with 6.48 million people currently waiting for treatment. Return referrals to GPs have also seen an 87% increase and a care backlog for general practice, with 401,115 patients waiting for treatment as of November 2021. Those circumstances, coupled with low levels of hospital beds, mean that staff and patients alike are feeling the impact.

We can all agree that the NHS needs more staff. England would need the equivalent of an additional 46,300 full-time doctors simply to put the NHS on an equivalent standard to today’s OECD EU average of 3.7 doctors per 1,000 people. However, as of March 2022, over 100,000 posts in secondary care are vacant, more than 8,000 of which are medical posts. The NHS needs to keep the staff it has simply to keep the current level of service running. In the year between June 2021 and May 2022, the NHS lost 323 GP partners and 462 salaried and locum GPs. That means the number of fully qualified GPs decreased by a net 785 full-time equivalent GPs in just under one year.

That trend is exacerbated by the fact that despite there being 1,737 fewer fully qualified GPs today than there were in 2015, each practice has on average over 2,000 more patients than in 2015. So, there are fewer GPs but each with more patients to care for, and many more patients now have complex care needs to manage.

Pension rules are making it financially unviable for some senior doctors and nurses to either stay in the NHS or work the number of hours they would like to. By tackling the NHS pension crisis through amending the Finance Act 2004 and introducing a tax unregistered scheme for those senior NHS workers, we could help to keep those much-needed doctors and other frontline clinical staff in the NHS for longer, and we would be supporting patients to get the care they need. Without those changes to the pension rules, more staff will leave and the care backlog together with waiting times are likely to continue to rise.

Photo of Jonathan Edwards Jonathan Edwards Independent, Carmarthen East and Dinefwr

I thank the hon. Gentleman for giving way. I congratulate him on securing the debate and on making that key point on the retention of staff. When a similar problem happened with the judiciary, the Government brought in a tax unregistered scheme which, critically, breaks the link between working more hours and the additional tax bill, as well as ensuring that the right amount of tax is paid. Does he think that the UK Government should consider that?

Photo of Daniel Poulter Daniel Poulter Conservative, Central Suffolk and North Ipswich

Absolutely. The hon. Gentleman is right, and that is one of the recommendations I will make in my concluding comments to the Minister.

It is useful and important to use an example of a particular workforce group. I will focus primarily on the pension crisis faced by doctors by means of an example of the way the pension rules need to be changed. How many doctors could the NHS lose as a result of the current pension rules? There is not an exact figure, but British Medical Association modelling suggests it could be anything from 10% upwards by the end of 2022. We already know that the average retirement age has fallen from 61 in 2007-08 to 59 in 2018-19. There has also been a fourfold increase in the number of voluntary early retirements since 2008, with 30% of consultant retirements and 54.7% of GP retirements in 2020 being voluntary early retirement.

A survey of 800 GPs in Pulse last month found 47% said they intend to retire at or before 60. Respondents gave a number of reasons why they wanted to retire, with problems around pensions being listed as a significant reason. A survey by the Royal College of Physicians last year revealed that more than a quarter of senior consultant physicians expect to retire within three years. A survey by the Royal College of Surgeons showed that 68% of consultant surgeons were actively considering early retirement because of the pension arrangements, and 71% of consultant surgeons were considering reducing their non-clinical commitments, including educational and managerial roles—that relates to the point made by Dr Whitford—which has worrying implications for the future training of surgeons.

A British Medical Association survey of more than 8,000 doctors revealed that 72% said that freezing the lifetime allowance would make them more likely to retire early; 61% of respondents said that they would be more likely to work fewer hours; and 41% would be more likely to give up additional roles and responsibilities. At the time of the BMA survey, CPI was only at 0.4%. It is now at 9.1%, and in real terms that is the rate by which the lifetime allowance is reducing each year. The BMA believes, with some credibility, that if it were to rerun the survey now, the results would show a significant increase in doctors intending to retire due to the impact of inflation on NHS pension policies. There can be no doubt that senior NHS workers are looking to leave the NHS in significant numbers, and a significant contributing factor to that—alongside burnout and workload—is the punitive pension taxation policies that they face.

Photo of Amy Callaghan Amy Callaghan Shadow SNP Spokesperson (Pensions and Inter-Generational)

I congratulate the hon. Member on securing the debate and on all the work that he has done so far on this issue; my constituents who have raised this issue with me are incredibly grateful for that work. As he said, the BMA figure shows that roughly 10% of medics would be affected and would potentially leave the NHS. More than 100 of my constituents have been in touch with me over this issue. If we apply the 10% to just the ones who have reached out to me, we will lose at least 10 experienced medics at NHS Greater Glasgow and Clyde. This really significant issue needs to be noticed and action needs to be taken, but not like the action that was taken with the taper, which did not affect enough doctors. We need to see this action from the Minister.

Photo of Daniel Poulter Daniel Poulter Conservative, Central Suffolk and North Ipswich

I agree with the hon. Lady, who, like all Members who have intervened, is strongly advocating for her constituents and for healthcare workers throughout the country. I have been written to by doctors in Scotland in advance of the debate and I know how serious this issue is. I thank all the Scottish National party Members who have come to this debate for their support in raising this issue, which is important for those working in Scotland.

Turning to the technical information—this issue is very technical—why is this happening? The pensions annual allowance allows for the value of a pension to increase by up to £40,000 without incurring penalties. That is completely unsuited to defined-benefit schemes such as that in the NHS, and it should be scrapped in defined-benefit schemes. That view has been supported by Treasury advisers and by the Office of Tax Simplification. However, the Government did not agree with the recommendations and instead only raised the annual earnings taper thresholds to £200,000 and £240,000. Pensions experts were clear at the time, and have been ever since, that although this approach mitigates some of the issues around the taper, it is not an effective solution to issues with the annual allowance, as the unfair interactions between pension taxation and the NHS pension scheme regulations remain. Crucially, it does nothing to affect the punitive effects of the general annual allowance, which is set at £40,000, nor the lifetime allowance, which is set at just over £1 million.

Not only has the rise in taper thresholds not fixed the problem, but the situation has reached a further crisis point due to the combination of levels of stress and burnout across the NHS, the freezing of the lifetime allowance in 2021 and, most significantly, the rapid rise in inflation and the CPI. That is compounded by a flaw in the Finance Act 2004 such that its provisions no longer operate as originally intended—that is, measuring pension growth above inflation. So the situation has reached a crisis point.

To address the long-standing issues of the interaction of pension taxation policies with the NHS pension scheme, it would be sensible to introduce a tax unregistered scheme similar to that made available to the judiciary—as Jonathan Edwards outlined—who face similar recruitment and retention problems to those we are beginning to face in the NHS.

It is worth asking why the CPI rise has turned the crisis in retention and recruitment into a disaster for the NHS, particularly this year. There are three major impacts of CPI inflation. First, the Department of Health and Social Care has suggested that, even though CPI is likely to hit 10% by September 2022, the likely pay award for hospital doctors nearing retirement age with final salary schemes will be 2% or 3%. This unprecedented gap between the level of inflation and the likely pay award risks significantly devaluing the pension of members aged 59 or above if they delay retirement by even a single year. There are no late retirement factors in the 1995 pension scheme—the scheme that the vast majority of staff approaching the age of 60 are in. That means that, for every year spent working beyond the age of 60, the level of annual pension that could have been received if they had retired at 60 will effectively be lost.

A doctor may be well over £100,000 worse off if they retire at 61 rather than at 60. That cannot be right; it is a perverse reward for years of dedicated service to patients. The consequence of the current pension rules will be to push more experienced doctors, nurses and other healthcare professionals to take early retirement at the very time when they are most needed to reduce the covid backlog.

The second pressing issue is that two different measures of inflation are used in the NHS pension scheme. That has a particular impact on those who are on a career average revalued earnings scheme; as GPs are wholly within a CARE scheme, it has the biggest impact on this group of doctors. The current rules use a different CPI value for the opening value: it is based on the CPI rate in September last year, whereas the revaluation of earnings that is built into the NHS pension scheme is based on the CPI rate in September this year. When inflation is stable, last year’s CPI rate and this year’s are similar, so that does not usually present a major problem. However, when inflation changes rapidly, as is happening now, it becomes a very significant problem for many GPs.

For example, CPI in September 2022 is likely to be approximately 10%. Under the scheme rules, the pension will be revalued by inflation plus 1.5% and will therefore increase by approximately 11.5%. However, the opening value of the pension will increase by only 3.1%, which is the September 2021 CPI figure. Therefore, even though the annual allowance is only supposed to test pension growth above inflation, the discrepancy caused by those two different measures of inflation will result in a purely inflationary growth being tested against the annual allowance. For many people, that will use a significant proportion of the available annual allowance, and in some cases it will exceed it entirely, resulting in an additional tax charge simply as a result of inflation. A GP from Scotland who wrote to me before this debate told me that it would result in her receiving a tax bill of about £19,000.

The impact is compounded by the fact that the opposite scenario will occur next year if, as predicted, inflation returns to more normal levels. Although workers in the NHS will receive only one NHS pension, following the public sector pension reforms, many NHS staff are in the 1995, 2008 and 2015 pension schemes. Under the Finance Act, those schemes are all considered separately, so even though one scheme may have negative growth, it is not offset against positive growth in other schemes. For example, if a member had £20,000 negative growth in the 1995 or 2008 scheme and £60,000 positive growth in the 2015 scheme, even though their combined pension growth was £40,000 and within the standard annual allowance, the 1995 or 2008 scheme growth is considered to be zero. Instead, the member is taxed on the £20,000 excess in the 2015 scheme.

In addition, the negative growth in the 1995 or 2008 schemes cannot be carried forward or backward to offset previous positive growth in these years. That effectively means that GPs in particular will face additional annual allowance tax bills of tens of thousands of pounds this year for pseudo growth, the majority of which will be lost next year but with no refund or reduction in the extra tax paid this year. That cannot be right; it will push many GPs into early retirement. This year, a typical GP with median partner earnings of £115,000 will receive an annual allowance charge of more than £32,000 as a result of this flaw in the Finance Act, which incorrectly measures pension growth above inflation.

Thirdly, the current high levels of inflation have exacerbated the impact of the decision to freeze the lifetime allowance.

Let me very briefly offer the Minister some possible solutions. First, we need to address the issue of CPI and rising inflation and amend the Finance Act. As I have outlined, only growth above inflation should be tested against the annual allowance. In this rapidly moving inflationary environment, section 235 of the Finance Act does not do so; two different values are used. Simply amending section 235 to ensure that the opening value is aligned with this year’s CPI—not last year’s—so that the inflationary uplift of benefits is tested in the same year will ensure that only “growth" above inflation would be subject to testing against the annual allowance, as was clearly originally intended by the spirit rather than the letter of the legislation. At the same time, it is imperative to amend section 234 of the Finance Act 2004 to recognise years of negative growth and allow them to be carried backwards or forwards to measure real growth over a longer period.

Secondly, in the year 2022-23, we should allow the NHS in all four nations to replicate the 2019-20 compensation scheme to protect clinicians from pension growth so that they are freed up to work at maximum capacity in the NHS. This is not a “tax perk” for one group, but rather recognises that the annual allowance charges are largely based on non-existent pseudogrowth.

Thirdly, to solve the wider and long-term issues facing senior and experienced NHS staff, we should move to a non-tax-registered scheme. It is clear that in the long term, the solution to this problem is a scheme of that kind for those impacted by pension taxation in the NHS. When faced with similar recruitment and retention problems with the judiciary because of these punitive pension taxes, the UK Government introduced a non-tax-registered scheme which immediately addressed the issue, and resulted in the appointment of more judges. That is a fundamentally fair system. It ensures that the correct amount of tax is paid on pension growth, and as no tax relief is provided on employee pension contributions, there is no requirement to subject scheme members to either the annual or the lifetime allowance.

Senior and experienced NHS workers are not asking for special treatment. They are, however, asking for a fair system: a system that does not penalise them for working more shifts, taking on leadership roles, or staying in the NHS after the age of 60. It cannot be right, at a time when the NHS is desperate to retain its workforce—particularly the senior workforce who are so crucial in training new doctors, nurses and other frontline staff or workers, and advising on the most complex cases—that senior clinicians will actively lose money from their pensions for working for longer, or face huge tax bills on pension growth that they will never see materialise.

If the Government are serious about valuing NHS staff, if the Government are serious about helping healthcare staff to meet the covid care backlog, and if the Government are serious about meeting the needs of patients, they must act now to reform NHS pension rules.

Photo of Richard Fuller Richard Fuller The Economic Secretary to the Treasury 8:01 pm, 13th July 2022

Thank you very much, Mr Deputy Speaker.

Let me begin by thanking my hon. Friend Dr Poulter for securing the debate and for the points that he has raised. I also note the contributions of the hon. Members for Central Ayrshire (Dr Whitford), for Strangford (Jim Shannon), for Llanelli (Dame Nia Griffith), for Carmarthen East and Dinefwr (Jonathan Edwards) and for East Dunbartonshire (Amy Callaghan), who made, forcefully, the point that this is an issue that affects all parts of the United Kingdom.

Because these issues are complex and my hon. Friend rightly set them out in full in order to put them on the record, I am rather short of time, so, if I may, I will move rather quickly in responding to some of my hon. Friend’s recommendations. Let me add that I shall be happy to follow this up with other Members who have spoken if they want to raise specific constituency points.

I think that everyone present has noted the pressures on our NHS. Indeed, before taking on my new role, I spent a considerable amount of the last six months with my own GPs. I know that the issues relating to pressures on GPs are complex, including the overall questions of compensation and burnout, and my hon. Friend rightly mentioned the issue of abuse of NHS staff, which has occurred to a shameful degree over the last six months and which no member of our health service should ever have to deal with.

However, my hon. Friend focused on the issue of pension tax and the NHS, and made three specific recommendations. The first concerned the differential use of CPI figures, and he was right to raise that issue, because it is the spike in inflation that has laid bare some of the problems in the way in which calculations are made. The issue relates to the disparity between the CPI figure used for uprating the opening value of a member's benefits and the CPI figure used to assess revaluation in public service schemes. This effect is particularly notable in the NHS pension scheme, where accrued benefits are adjusted upwards each year by CPI plus 1.5%—which, to be fair, makes it one of the most generous pension schemes available.

I understand that this difference in figures will lessen the headroom that scheme members have in their annual allowance calculation. That may cause more members to exceed the annual allowance, and cause those who already routinely exceed it to exceed it by more, with the result that some may receive annual allowance tax charges. The British Medical Association has asked the Government to amend the Finance Act 2004, so that the CPI figures used in uprating the opening value and the figure used for revaluation in public service schemes are the same. However, there are some further issues that must be considered in this discussion, which my hon. Friend may not have mentioned.

First, the Government have a duty to balance support for all pension savers across the United Kingdom. The use of September CPI to measure inflation in the year before the tax year is a well-established feature that is used across the tax system. Any changes would impact all pension savers, not just NHS staff.

The current approach provides certainty to individuals at the start of the tax year about what their opening pension value will be for annual allowance purposes. I appreciate that, for those with a defined benefit pension alone, this certainty may not be seen as much of an advantage. However, for others across the country who may have some defined benefit accrual but are now saving into a far less generous defined contribution scheme, this certainty allows them to plan their finances and pension contributions for the coming year.

Photo of Richard Fuller Richard Fuller The Economic Secretary to the Treasury

I really cannot; I have only two and a bit minutes left.

Secondly, there is a perception that the use of different CPI figures will disproportionately hit senior NHS staff. This is said to be because the revaluation of accrued rights in the 1995 and 2008 sections of the NHS pension scheme will lead to a large pension input amount for clinicians, while the annual allowance calculation will use a lower CPI figure when calculating their opening value. This is the so-called pseudogrowth that my hon. Friend mentioned. I am afraid that this point ignores the fact that, for most NHS employees in the 1995 and 2008 sections of the NHS pension scheme, their accrued benefits remain linked to their final salary, which means that they do not have their benefits revalued each year.

Thirdly, I have heard concerns over so-called negative accrual that cannot be used to offset positive accrual in later years. This point conflates actual pension accrual that benefits pension savers with notional accrual used for the purposes of the annual allowance calculation. It is a fact that defined benefit schemes are more difficult to compare against the annual allowance than defined contribution schemes. In a given year, where individuals accrue rights to future annual pension payments, it is necessary to calculate a comparable figure for their savings to test against the annual allowance to ensure fairness between those in defined contribution and defined benefit schemes. On this point, my hon. Friend and other hon. Members have raised an important issue this evening, and I will go away and consider it further.

In response to my hon. Friend’s second recommendation, I know that the BMA and others have said that the action taken at Budget 2020 on the tapered annual allowance was not enough. However, the cost of this intervention was £2.2 billion over five years, and it was targeted at the very highest earners in society. It will be hard to justify focusing more Government support on them, especially in the current climate. This includes replicating the temporary scheme used in the 2019-20 tax year.

My hon. Friend’s third recommendation for an unregistered scheme was also mentioned by the hon. Member for Carmarthen East and Dinefwr. I understand the comparison that senior clinicians draw with the position of the judicial pension scheme 2022, which is unregistered for tax purposes. However, I believe that a distinction remains to be drawn between NHS high earners and the judiciary, and that there are unique circumstances relating to judicial appointments—in particular, that judges are unable to return to private practice after taking up office, and that many judges take a significant pay cut to join the judiciary. However, we all recognise that there are significant issues around doctor and GP retention, and the points raised this evening have struck a chord with me. I look forward to discussing them further with hon. Members.

Question put and agreed to.

House adjourned.