A report by NHS Providers suggests concerns over taxation of pensions may lead to an exodus of NHS leaders in the next two years.

An unnecessary divide: the impact of pensions taxation on NHS trust leaders includes survey findings indicating almost half of all trust leaders (44%) plan to, or are considering, leaving the NHS because of the pensions crisis.

The findings reveal widespread concerns about the impact of restricting solutions to clinical, as opposed to non-clinical leaders, as the interim solution for the current tax year, launched in December, did. The survey highlights that there would be a significant adverse impact on morale, retention and the effective running of services if non-clinicians are exempted from the solution the government has said it will announce in the Budget on 11 March.

Senior NHS non-clinical leaders have a difficult but vital role to play in supporting high-quality, frontline care for patients. They do this by ensuring staff are well supported and have the facilities they need to do their jobs well, overseeing and managing frontline delivery.

Nine in ten respondents to the survey said that they and their organisation were concerned that differential arrangements for different staff groups.

   

Nine in ten respondents to the survey said that they and their organisation were concerned that differential arrangements for different staff groups – for example offering a solution to senior doctors and nurses but not managers - would also create divisions and harm culture and morale.

The findings also reveal:

• Over a third (37%) of board-level directors said fewer staff in their trust are seeking or accepting promotions, while 60% said clinicians are now less willing to take on leadership roles.
• Nearly 70% of clinical executives have turned down or would consider turning down promotions into roles required for the effective running of services or taking on additional leadership responsibilities.
• There was a near-unanimous view (97%) that senior non-clinical staff should be eligible for any pension contribution flexibilities implemented by the government.
• Almost as many (95%) felt that flexibilities should be available to all NHS staff.
  
  

Leaders from 188 trusts (84% of the total) took part in the survey. Comments included:

“This solution creates a dividing line in that team that does not fairly recognise the 24/7 contribution of those non-clinical staff.”- NHS trust finance director

“We run the risk of a very unequal set of arrangements within the workforce which could give rise to tensions and feelings of resentment between clinicians and non-clinicians which in turn could impact on the delivery of frontline services.” NHS trust governance director

While others were worried about the impact on services and the ability to secure good leaders to keep services running effectively.

“Poorly led organisations have higher mortality rates. Senior managers do on-call, and work seven days a week. Vacancies lead to operational decisions, especially around emergency care, becoming ever more difficult.” – NHS trust director of operations

“The NHS pension scheme was a significant recruitment, and retention tool and the current tax issues are likely to discourage good quality people from taking on these roles, and certainly have an impact on the number of clinical staff taking on non-clinical leadership roles.” – NHS trust chief executive

The survey findings come as a large number of consultants have been reducing their hours or number of additional sessions they are willing to do, in order to avoid punitive additional tax bills. Despite attempts by the government to put in place a solution for 2019/20, only 7% of respondents have confidence it would be enough to encourage clinicians to pick up additional shifts again.

NHS Providers deputy chief executive Saffron Cordery said:

“We welcome the efforts so far to try and address the impact of pension taxation rules on the clinical workforce. This is an urgent problem and requires an urgent, full and fair solution.

“With many senior doctors reducing the hours they are working or stepping back altogether, this is exacerbating already difficult workforce challenges, and we are now seeing the impact on services with delays and disruption for patients.

“Senior leaders on which the effective running of NHS services depends have widespread concerns about the effectiveness of proposals on the table, both to tackle the loss of clinicians and on the ongoing impact of pension problems for leaders and managers in the NHS.

Without urgent action, we face the possibility of an exodus of NHS leaders, at a time when the need for their experience, skills and commitment has never been greater.

Saffron Cordery    Deputy Chief Executive

“Without urgent action, we face the possibility of an exodus of NHS leaders, at a time when the need for their experience, skills and commitment has never been greater.

“We need to see a fair solution for all staff affected by these punitive taxes. There is a real risk of further impact on staff morale if we continue not to offer solutions to all groups of NHS staff.

“The strength of feeling indicated by these findings shows that an artificial distinction between valued groups of staff is counterproductive and hugely damaging with a knock-on impact for patient care. Services rely on the additional discretionary efforts of all staff, including managers, who regularly work beyond their hours to keep services running. We can’t afford to undermine this further or put clinicians off moving into leadership roles on which the sustainability of services depends.

“The evidence suggests that the current solutions do not have the full confidence of clinicians, and leaders do not expect them to bring the doctors back. A fair solution has to include both a change to the taper and address the impact of the annual allowance for all staff moving into senior roles or through pay increments.”

Notes to editors:

• An unnecessary divide: the impact of pensions taxation on NHS trust leaders summarises the findings of a survey sent to all executive directors of the 223 trusts within the provider sector, and describes the evidence of the significant impact of annual allowance taxation on managers, on morale within the NHS and the consequent impact on services and frontline care.
• The survey was open between 20 December 2019 and 9 January 2020 and was sent to all trust executive directors.
• 437 individuals submitted a response. These came from approximately 188 trusts (84% of all trusts).
• The highest number of responses came from those in HR/workforce / OD roles (18%), with chief executives (17%) and those in finance / commercial roles (16%) also well represented.
• All trust types; including ambulance, community, mental health and acute trusts, and all regions are covered in the survey.