• Pauline Philip has told NHS trusts to urgently look at making additional pay offers to their consultants
  • Comes as trusts report serious concerns around doctors refusing to take on extra shifts due to increased pension taxes
  • Letter also tells trusts to increase bed capacity

Trusts have been instructed by NHS regulators to urgently offer consultants additional payments that are high enough to persuade them to do extra shifts many are now declining because of pension-related tax bills.

In a letter to local leaders, seen by HSJ, NHSE/I national urgent and emergency care director Dame Pauline Phillip sets out a series of measures trusts must take ahead of the expected surge in demand for acute services over winter.

It comes amid serious concerns over hospitals’ ability to cope with winter pressures, and at the start of a general election campaign in which NHS performance is likely to be under the spotlight.

Staffing shortages at many acute trusts have been exacerbated this year after many senior doctors were hit with increased taxes on their pensions, which has led to many turning down additional shifts, and some to consider quitting the NHS.

Dame Pauline’s letter notes that some providers have used unpaid employers’ pension contribution to make additional salary payment to those doctors who have opted out of the pension scheme due to tax issues.

While acknowledging other options outlined by NHS Employers are available, Ms Philip highlights this measure.

She adds: “We are now signalling our expectation that trusts that have not done so already should make immediate use of the flexibilities available (unless they are demonstrably not experiencing any issues with medical staff availability)….

“We would find it very helpful if chairs or chief executives confirm in the next fortnight the arrangements they have in place or intend to put in place, through regional directors.

“Given the urgency, where remuneration committee approval is considered necessary we would ask that these meetings are arranged on an extraordinary basis.”

She said a number of trust board members had requested clarification on what the national “default” position on handling the pensions issue should be.

Meanwhile, Ms Philips 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 this winter the system is between 4,000 and 6,000 beds short on a acute hospital bed base of around 103,000.

The call from Mr Stevens and Dame Pauline marks a subtle change in tone from previous winters. While the system has always sought to flex up capacity over winter by opening escalation wards, the emphasis from system leaders over the last few years has been smarter use of its existing bed stock.

Last winter a major drive was to “free up” 4,000 beds by December by shortening the length of stay of patients who have spent over 20 days in hospital.

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.

Trusts are heading into winter off the back of the worst summer performance against the four-hour target on record and have little in the way of spare capacity either in the way of physical capacity or the workforce to staff the beds.

Just 85.4 per cent of patients were seen within four hours in September, the last recorded month. This is already worse than previous recent winter months, and nearly four percentage points down on the 89.1 per cent the same month in 2018.

NHS leaders expect performance to drop further when October’s data is published next Thursday.

 A major driver is the sharp rise in demand. There were 529,903 emergency admissions in September, which is 3.8 per cent higher than the same month last year. Emergency admission growth over the last three months was 3.6 per cent and over the last twelve months is 4.9 per cent.

Ms Philip also called for better collaboration with local authorities to improve delayed transfers of care.