Hospital operations at risk in staff overtime dispute over pensions

Royal Bournemouth Hospital
Health secretary Matt Hancock speaks with Royal Bournemouth Hospital staff

OPERATIONS could be delayed or even cancelled at the Royal Bournemouth Hospital because consultants are not prepared to work overtime shifts due to changes to their pension taxation.


Currently there are 53 theatre lists – amounting to around 150 procedures – scheduled until late July which consultant anaesthetists will not cover. That is partly due to the pension row and the lists of staff volunteering to do more work being “in decline”, the hospital has admitted.

But to assuage patient concerns, the trust which runs the hospital – the Royal Bournemouth and Christchurch Hospitals Trust (RBCHT) – has insisted urgent procedures will not be delayed.

“Our operating lists are prioritised so the most urgent operations will continue,” a RBCHT spokesperson told the A&T. “However, more routine lists, such as elective orthopaedics for joint replacements, may be deferred.

“Patients are and will be given notice of any such cancellations. These will be minimised as much as possible, and the goodwill of all staff to treat as many patients as possible through regular operating lists will continue until a national solution is found.”

The RBCHT spokesperson explained that each month the hospital circulated theatre lists asking for staff to volunteer for extra sessions and “the vast majority of these” got cover.


But she did add the pension crisis was not the only contributory factor. “While the national pension issue is a contribution to the 53 theatre lists to cover for July, involving up to 150 procedures, there are also vacant consultant posts and we are interviewing for these.”

The situation is a reflection of a growing national crisis – which has seen consultants across the UK refuse to work extra hours because doing so could lead to them taking home less money.

The changes mean some doctors are effectively taxed at 75% or more on any additional income they earn. So, where a consultant who worked for six hours on a weekend previously would be paid £600 and take home £350 after income tax, under the new rules they receive about £200.

It stems from the policy that people saving for retirement are entitled to tax relief on pension contributions up to a total of £40,000. But the annual allowance decreases for anyone earning more than £150,000 – reducing 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 – meaning almost all consultants and GPs in the UK are at risk of triggering the reduced allowances.

The RBCHT spokesperson said the problems it was facing were connected to the crisis.

“What has changed recently is that more and more consultants are having unexpected upfront tax bills for changes to their pensions in decades to come,” she said.

“The effect is that doing any additional work is actually resulting in a reduction or no additional take-home pay. As a result, the number of lists covered by volunteers to work these extra sessions is in decline.”

The spokesperson stressed RBCHT had a “very positive and productive relationship” with its dedicated anaesthetic medical workforce, adding they provide around 200 anaesthetic sessions every week that were primarily theatre lists.

“Our anaesthetic team offer a great deal of flexibility to cover vacant lists for which we are very grateful, with many consultants routinely working over their contractual hours,” she highlighted.

The problem is a growing crisis for the Secretary of State for Health, Matt Hancock.

Coincidently, Mr Hancock visited Royal Bournemouth last week and the issue was “raised” with him, the RBCHT spokesperson confirmed, although she declined to go into what was said.

“We know that it is on his agenda, as well as being taken up by NHS providers and [the national union for UK doctors] the British Medical Association (BMA),” she added.

During Mr Hancock’s visit he was shown plans for future developments, including new operating theatres at Poole Hospital and new emergency, paediatric, maternity and critical-care building at Bournemouth, toured the stroke unit and he spoke of combining technology in connecting NHS systems.

Afterwards he said it was “great” to visit and said the plans he had been shown were “exciting”, adding: “I was very glad to have the opportunity to thank staff from Dorset for all that they do for the local community and tell them how grateful we are.”

However, less positive is the BMA, a spokesman telling the A&T the taxation changes were “absurd” and the BMA planned to “lobby the government hard for change”.

Dr Rob Harwood, consultant anaesthetist and BMA consultants committee chairman, said: “For the first time, we are seeing hospital trusts publicly admit there is a problem and hospital chief executives acknowledge something the BMA has known for months: doctors are being forced to say ‘no’.

“No to extra shifts to reduce huge waiting lists, no to covering for staff shortages and no to overtime weekend cover. Not because they want to, but because if they don’t, they face huge bills, created by the ludicrous pensions taxation rules that the Treasury is so far refusing to overhaul.”

“We have no wish to see hospital leaders having to admit that their patients are being left without the care they need, and that staff are voting with their feet,” Dr Harwood added.

“No doctor wants to do anything but their best for their patients but if, in doing so, they face bills of tens of thousands of pounds, something has to change.”

He went on: “This government absolutely has to see sense and agree to a major overhaul of pension taxation before patient care is bereft of high-skilled, experienced doctors and lives are lost.”

This week Dr Tony Goldstone, consultant radiologist and clinical director at Hull University Teaching Hospitals NHS Trust and an expert on NHS pensions, appeared on Sky TV.

He told news anchor Mark Austin: “What we’ve started to see is really the tip of the iceberg. Unfortunately worse is very much to come, unless the government takes the urgent action required to reverse these changes.”

His remarks gained the support of Rachael Hall, an independent financial advisor who specialises in the NHS pension scheme.

She added on Twitter: “The issue with these tax liabilities is the size of the liabilities (the largest I have seen is £500K), the measures people take to pay the tax (remortgaging their homes) and it has a detrimental effect on people’s mental health.”