My Lords, I have tabled Amendment 83, which sets a deadline for a review and is essentially probing in nature.
I am unashamed. I want to put pressure on the Government to do something—and fast—about the impact of the cap on senior or long-serving doctors and consultants. We have a mini-crisis here which dates back many months, and the situation is even more serious given the potential impact of Covid-19. I join others in commending the Secretary of State and the CMO for today’s all-party meeting, and for setting out all that is being done to manage this alarming virus—including encouraging clinicians out of retirement.
There is a pension problem. As my noble friend Lord Balfe told Parliament on 30 October, a BMA survey showed that 42% of GPs and 30% of hospital consultants were reducing their hours. There have been similar figures from the Royal College of Physicians. Doctors are attracting substantial tax bills to care for their patients, and are therefore reluctant to do extra sessions to clear waiting lists or to take on management. There are reports that as many as half our doctors are retiring younger than they used to and that the lowering of the annual allowance from £255,000 in 2010 to £40,000 today, and the increase in the retirement age to 65, may well be factors.
The situation is worse in hospitals than in GP practices, mainly because the latter earn less. However, GPs can be caught out if their practice income peaks temporarily because of a vacancy or because a doctor is missing. The reward for all the extra work and stress can be an extra tax charge. This is especially difficult for small practices, which, unfashionably, I have found to be the best, because they provide continuity of care, which saves on drugs bills and hospital costs. However, that is a matter for another day.
That brings me to hospital consultants, who are generally better paid than GPs but are critical to patient outcomes. I will never forget the lady consultant at King’s who managed me through the latter weeks of a pregnancy, when my youngest son refused to move.
The situation is serious. The impact of the coalition fix—to allow people to carry forward unused allowance from the previous three years—is, I think, running low. The DHSC consulted recently on proposals to
allow senior medical staff to opt to build up a pension at a lower rate. This was, however, dismissed by the BMA as a sticking plaster. Understandably, it wants a change in the rules. As always, given the noises made by senior politicians, there is much hope—including on my part—about next week’s Budget.
What, therefore, can and should be done? I look forward to hearing from other noble Lords who have been kind enough to support this amendment, and from the noble Lord, Lord Warner, whose Amendment 86 proposes new regulations to ensure that NHS pension scheme members are reimbursed if they are worse off. I look forward to hearing how that would work.
Other approaches might include getting rid of the annual pension cap—the so-called annual allowance—and relying entirely on the lifetime allowance, which has been reduced over time. Alternatively, and perhaps more radically, we could move relevant senior medical staff on to non-pensionable pay, above a certain level, but pay them as salary the notional employer pension contribution that they miss out on. They would have a higher tax charge, but they would not be punished for working, which I think is the concern.
Many very intelligent people have spent hours trying to fix this problem, so it probably is not easy. There are ways to do it, and we must have a solution by the time this Bill reaches Report if the NHS is to overcome today’s growing challenges.