The must-read stories and debate in health policy and leadership.

Pensions crisis = Winter crisis?

The traditional winter orders have been reaching the desks of local leaders over the last few days.

While trusts may not have been explicitly instructed to stuff the consultants’ mouths with gold, the underlying message is not far off.

NHS England and NHS Improvement have told providers they should offer additional salary payments to consultants who opt out of the pension scheme (using the money that would have been used as the employer contribution), as part of a series of actions local organisations should take this winter.

Clearly these payments will need to be high enough to persuade staff to do extra shifts that many are declining because of pension-related tax bills, and even then it might not be that enticing.

As one reader noted: “As a consultant, offering me more money to do a waiting list initiative [or] clinic/list is simply not enticing, it will just push me further above the annual allowance threshold income and generate even more taxes.”

Asked how worried they were about the situation, one provider chief executive told HSJ: “Nine out of 10, but others aren’t as optimistic”. Another feared the “psychological compact” with staff had already been broken and that doctors would rather earn less money and have the time off.

Nevertheless, the move underlines just how concerned national leaders are about the issue as the system heads into winter off the back of a hugely challenging summer – and with the election putting the NHS right under the spotlight.

More beds please

Dame Pauline also said trusts should aim to have more general and acute beds open over winter, which echoes what NHS England chief executive Simon Stevens said last month.

This follows sustained calls from royal colleges and NHS Providers about the system’s overall capacity shortage. RCEM estimates the system is between 4,000 and 6,000 beds short on a acute hospital bed base of around 103,000.

The call for more beds will be hugely challenging for local trusts to deliver and contentious among local leaders who will be already doing all they can to free up and better utilise both their staffing and physical capacity.