• Evidence gathered by HCSA reveals pensions crisis is forcing trusts to outsource work
  • One trust has outsourced radiology work to Australia
  • Doctors also reporting higher reliance on expensive agency workers to cover vacancies

The NHS pensions crisis is forcing trusts to outsource elective work at a “significantly higher cost” and rely on expensive locums to cover vacancies, a doctors’ union has warned.

The Hospital Consultants and Specialists Association, which undertook research involving more than 1,000 of its members, discovered recent pensions tax changes had led to staff stopping waiting list initiatives and trusts therefore having to outsource, which is “increasing costs”.

Concerns have already been raised changes to how pensions savings are taxed were discouraging doctors from taking on extra work or influencing them to leave the health service altogether. Since 2016, the annual allowance taper has restricted the amount of tax relief available to those with a threshold income over £110,000, reducing it from £40,000 to as little as £10,000.

One HCSA member said half the pathology staff at their trust have stopped waiting list initiatives, so the trust is having to send work to an external backlog reporting company at a higher cost. Another union member said radiology work at their trust has been outsourcing to Australia.

Another said the pensions tax changes have resulted in a “catastrophic reduction” in programmed activities from “highly productive senior consultants in radiology”, which is increasing outsourcing and waiting times for radiology exams.

HCSA members also reported an increased use of locums to manage waiting lists. A doctor from Cheshire said vacancies are being covered with agency rather than bank locums and another from Yorkshire said only junior consultants are doing on-call locum shifts.

Another union member said: “[There are] fewer people willing to cover uncovered theatre lists or cover last minute sickness, so cover is being provided by agency locum consultants, leading to greater costs. Or if no cover, list cancellations.”

“More options on the table”

The government is currently consulting on possible changes to the NHS pension scheme to stop senior doctors being hit with large tax bills. It is focusing on a 50:50 option, which would allow clinicians to halve their pensions contributions in exchange for halving the rate of pension growth.

However, HCSA president Claudia Paoloni said the Treasury’s refusal to scrap the taper is “undermining hospital budgets as well as waiting lists and services”.

“The costs of diagnostic outsourcing are higher; the quality is lower and the scale of the backlog is growing.

“Together with reduced income from activity and rising use of external locums to ease an underlying medical vacancies crisis, this threatens to eat up funding earmarked for the long-term plan,” Dr Paoloni said.

“By [the consultation’s] deadline in October, we may already be locked into a downward spiral of rising waiting lists and diagnostic paralysis,” she added.

Saffron Cordery, deputy chief executive of NHS Providers, also said the pensions issue is having a “substantial impact” on how trusts operate.

“Many trusts are already telling us that they are expecting to delay a significant number of operations, or are worried about their [accident and emergency] performance at the time of year they should be catching up ahead of winter,” Ms Cordery said. “In some cases, this is leaving trusts with little option but to rely on expensive temporary staff to fill rota gaps.”

“In the short-term, this is bad enough and costly to the NHS in terms of agency spend. But in the long-term, this issue could have a lasting impact as we lose these valuable staff and skills within the NHS workforce,” she said.

She added the pensions consultation is a “belated recognition of the seriousness of this issue” and called for “more options on the table”.