Thread by @rcolvile

Have written my column this week on the NHS pay row, and how a 1% pay rise isn't actually a 1% rise. You can read it here, but a few highlights below thetimes.co.uk/article/welcom…

The most important thing to know is that the NHS pay system is incredibly weird (except to all the NHS staff in my mentions for whom it is completely normal...)

We put out a paper on this a few years ago cps.org.uk/research/an-nh… but under the 'Agenda for Change' system (which doesn't cover doctors, but they have their own version) each job is broken down into its components, with points allotted

So “advanced or high speed driving a heavy goods vehicle, ambulance or articulated lorry” is a Level 3a activity within the “physical skills” category - but so are “advanced keyboard use”, “restraint of patients/clients” and “advanced sensory skills”.

Every job is then placed in one of a dozen pay bands. Band 4 would include dental nurses, pharmacy workers and AV technicians. Up at Band 6, you’d find school nurses, paramedics, biomedical scientists and health records officers.

The key thing in terms of the current pay row is that as well as getting the national pay award, there is also the chance to move up within your band (which in the past has happened near-automatically each year).

In other words, there is the national pay rise, and then a potential individual pay rise. That's, as we calculated, NHS pay actually went up by roughly 2.7% pa between 2012-2017, even though there was a 1% pay freeze in place

Likewise, the current '6.5% deal over three years' actually means 'between 6.5% and 29% depending on your role'. I looked at the pay data and two years in, average pay has increased by 6.2%, when the headline figure is 4.7%

This isn't to say that there aren't underpaid people in the NHS - there are! Or that we shouldn't be grateful for their efforts in the pandemic - we should! But given the NHS pay bill is at least £65bn a year in England alone, even small increases translate into huge figures

(Historically, UK nurses have been underpaid vs other countries, and doctors overpaid. NHS workers have suffered since 2010 - but their pensions, perks and job security are still way better than private sector, which has been hammered by the pandemic. In short, it's complicated.)

And while I don't really get into this in the article, there is a strong case, as our paper by @pg_onthemove says, that this system is A Very Bad Thing. For starters, at any given time, 40%+ of staff are stuck at the top of their pay band, so only get the national rise. Unfair!

But equally, unlike pretty much any well-functioning organisation on the planet, there is no way to use pay as an incentive. You can't reward star performers properly. You can't set objectives for a team (curing X patients, saving X money) and reward them for meeting them.

It's harder than it should be to vary pay to recruit people in areas where there's a shortage, or parts of the country/hospitals that are struggling to recruit. And the only bonuses go to doctors, on a multi-year basis, with nothing to do with hitting targets set by managers.

In summary, the private sector has had it much worse than the public during the pandemic (and was already worse off esp when pensions were included). A public sector freeze, except for 1% for NHS, is harsh but the public finances are hilariously bleak.

A 1% pay rise for the NHS isn't actually 1%. But more importantly, the entire NHS pay system is not, not, not geared to delivering the best care and rewarding the best staff for success, and if we want better healthcare we should probably try to change that.

All this and more in my column, which also features a couple of excellent Hilary Mantel quotes thetimes.co.uk/article/welcom…

So @pg_onthemove has just reminded me of another bad thing about the current pay system - at the top end it is hilariously good for the old boy's network. This is a chart of the top 100 earning doctors in the country. Let's play spot the women...

(These figures a few years out of date so all the numbers will be higher.)

And here is how the bonuses were distributed. Same theme.

(Basically go read his excellent report - cps.org.uk/research/an-nh…)

Also, to all the people saying 'yes but the government is spaffing ££££ on Track and Trace', first I'm not a big fan of that either, and second that's a short-term cost whereas pay increases get consolidated and compounded.