Dr Tony Goldstone Profile picture
Jul 17, 2022 26 tweets 11 min read Read on X
1/26 V Important 🧵 on this weeks debate in the House of Commons tabled by @DrDanPoulter

Highlights & my analysis. Pls read to end & share/RT👇. Vital we resolve this to fix *retention* & backlog

Part 1/2 - Dr Poulter (Pt 2/2 Minister response soon)
2/26 Really important points from @Dr_PhilippaW

1️⃣ vital issue needing 4 nation solutions @BMACymru @BMAScotland @BMA_NI
2️⃣AA is the wrong tax for the wrong group of people & its destroying the NHS
3/26 A further intervention from Northern Ireland's @JimShannonMP again pointing out the 4 nation problem and large rise in retirements in the NHS since April (my prediction - unless this fixed very urgently, retirements will increase +++ in 22/23)
4/26 Similarly Dame @NiaGriffithMP again pointing out that Wales too affected by the same retention issue. And @DrDanPoulter pointing out this isnt the same issue as previously discussed due to the unique position in the current tax year due to inflation
5/26 Crucial point from @DrDanPoulter on the "just use scheme pays" argument used by government
1️⃣ Eye Wateringly expensive currently as inflation+2.4% so >>10%
6/26 2️⃣ Unfair 22/23 as being billed thousands of pounds in tax for "pseudogrowth" in their pensions which never materializes

So whats the impact on the NHS
- Waiting lists continue to rise 6.48m waiting for treatment 📈 (and rising)
7/26 - care backlog for general practice, with 401,115 patients waiting for treatment
8/26 So on staffing...
-England needs additional 46,300 full-time doctors OECD EU average
- Over 100,000 posts in secondary care are vacant, >8,000 medical
- The NHS needs to keep the staff it has simply to keep the current level of service running.
9/26 - Pension tax > financially unviable stay in the NHS or work the number of hours they would like to.
- By tackling the NHS pension crisis through amending the Finance Act 2004 & introducing a tax unregistered scheme for those senior NHS workers
10/26 Without those changes to the pension rules, more staff will leave and the care backlog together with waiting times are likely to continue to rise.
11/26 Next Jonathan Edwards points out a similar issue with judges was solved with a tax unregistered scheme which "critically, breaks the link between working more hours and the additional tax bill, as well as ensuring that the right amount of tax is paid.". Poulter agrees
12/26 Now to LTA. Government froze the LTA in 2021. Back then inflation was 0.4%, with 2% long term prediction. A survey of 8000 Gps/con. 72% said LTA freeze⬆️likely retire early; 61% ⬆️ likely work fewer hours.

That would surely be worse now as LTA rapidly falls with inflation
13/26 Next @AmyCallaghanSNP intervenes - >100 of her constituents contacted her re this issue. "This really significant issue needs to be noticed & action needs to be taken, but not like the action that was taken with the taper, which did not affect enough doctors. "
14/26 OK pay attention now. This is the technical bit - but essential nonetheless.

- AA "completely unsuited" to defined-benefit schemes such as that in the NHS
- should be scrapped in defined-benefit schemes. That view has been supported by Treasury advisers & @OTS_UK
15/26 Next Dr. Poulter turns to the 3 reasons inflation is crucifying retention

(1) Doesn’t pay to stay
16/26 (1) - Doesn’t pay to stay - my thoughts
17/26 (2) - CPI disconnect S235
18/26 (2) - Finance Act S234
19/26 (2) - Finance Act - My thoughts
20/26 (3) - The lifetime allowance & inflation
22/26 (1) - Solutions #FixTheFinanceAct #CPIdisconnect #FixNegativePIAs - My thoughts
23/26 (2) AA Compensation scheme
24/26 (3) #Taxunregistered - fair to taxpayers and doctors. Already delivered to judges.
25/26 AA charges arising from the defects in the Finance Act are *manifestly unfair*. It is clear to any reasonable person that the intention of the Act was to measure growth *above inflation*. It is doing nothing of the sort. Hence @TheBMA asks
26/26 The unintended consequences of rapidly increasing inflation could be dire for the NHS. Please fix this. It needs *urgent* action. @NHSMillion @TheBMA

Please share widely / watch the debate☝️ / RT

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More from @goldstone_tony

Jun 29
1/ NEW & IMPORTANT: Quarterly NHS pay data updated 27/6/24 👇 In BREAKING NEWS NEW charts now show ALL SECTORS have reached #FullPayRestoration (though NOT, of course, the NHS)

We MUST fix pay/retention to fix #WaitingLists

Please read whole [long bumper] 🧵 & share widely/RT

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2/ You'll notice when ministers are in the media, they often talk about how hard "your viewers/listeners" have been hit by inflation. But what we need to do is separate fact from fiction (aka LIES), it was 👇excellent @jburnmurdoch @FT chart that really showed this well last year Image
@jburnmurdoch @FT 3/ But its not just government ministers gaslighting NHS workers that they have no right for their pay to keep up (like everyone else's), it was also so-called "independent" DDRB👇

Apparently doctors & dentists should not be protected when "its not taking place in other groups" Image
Read 33 tweets
Mar 29
1/ NEW & IMPORTANT: LOTS of new data this week incl new pay data 28/3/24 👇 NEW charts incl NHS satisfaction (SPOILER: Its grim #MindTheGap)

MUST fix pay/retention to fix #WaitingLists- next GE WILL be won/lost on NHS.

Please read whole [long bumper] 🐇🧵 & share widely/RT

Image
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2/ You'll notice when ministers are in the media, they often talk about how hard "your viewers/listeners" have been hit by inflation. But what we need to do is separate fact from fiction (aka LIES), it was 👇excellent @jburnmurdoch @FT chart that really showed this well last year Image
@jburnmurdoch @FT 3/ But its not just government ministers gaslighting NHS workers that they have no right for their pay to keep up (like everyone else's), it was also so-called "independent" DDRB👇

Apparently doctors & dentists should not be protected when "its not taking place in other groups" Image
Read 35 tweets
Feb 24
1/ *VERY* concerned about the quality & type of information coming to @BMA_Pensions members to allow them to make choices in regards to McCloud.

For members who chose to move to 2008 (so called "choice 2", we saw the first of this information last week - deep dive 🧵
Pls RT

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2/ OK first of all, lets rewind. Pre 2008 we were all in the 1995 section. For most members that had a fixed retirement age of 60, and gave us "80ths" of final salary. Work 40 years, get 40/80ths or 1/2 of your final salary. Simple. Back in the day contributions were 5% or 6%
3/ As we all started to live longer, government felt this was unnafordable as we were spending longer in retirement. So they introduced the 2008 scheme
- 1/60th not 1/80ths
- Retire at 65 not 60
- So called "Reckonable" pay - based on best of 3yr in last 10, inflation adjusted
Read 30 tweets
Feb 22
1/ NEW: Consultation response out & confirmaiton of rates 1st April '24 , dropping the 13.5% tier.

Grateful government listened to concerns about feezing the top tier so tiers WILL uplift with CPI, not creating (another) "fiscal drag" for higher earners

gov.uk/government/con…
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2/ This repesents a change from previously announced where tiers were to be uplifts of AFC awards (largest employee group). I had suggested a "double lock" of greater of CPI or announced awards, which was supported by the scheme board, but sadly rejected by government Image
3/ @BMA_Pensions again raised concerns that the @nhs_pensions has a higher contribution rate than many public sector schemes, and has the steepest structure.
We continue believe it should be much flatter, or flat, in a CARE scheme will all paying the same for the same £1 pension Image
Read 6 tweets
Jan 15
1/ NEW & BREAKING: @instituteforgov supported in analysis by @CIPFA issue an UPDATED pay erosion chart for NHS workers including @TheBMA doctors & @theRCN nurses👇

WHY is this so relevant: This now includes pay data released in '24 to Sept '23 INCLUDING 6/12 of 23/24 pay awads
2/ This crucially important 📉shows

- pay erosion in NHS from austerity
- uses CPI preferred by gvmnt & some economists
- crucially shows 6/12 effect of DDRB 23/24- starting basis for all pay deals (i.e. not a lot) Image
@RobLaurensonD4P @_VivekTrivedi @TheBMA @BMA_Consultants @BMA_JuniorDocs @Doctors_Vote 3/ So this chart uses the latest available data (released in 2024) includes the latest pay deals

Despite this @BMA_JuniorDocs down a STAGGERING 25.0% in real terms

REMEMBER: This is using CPI, not RPI, which would produce a higher figure (RPI includes mortgage interest etc) Image
Read 11 tweets
Jan 7
1/ *Deeply* worrying from @RishiSunak @10DowningStreet on @bbclaurak

Watch the clip in full 👇and pick out the blatant untruths - its so unbelievable they went unchallenged Laura K?

Apparently "The government has now reached resolution with every other part of the NHS. ....
2/ "Nurses, midwives, paramedics, consultant doctors, specialty doctors most recently. "
"So EVERY other part of the NHS workforce, and I'm grateful to them for everything they're doing, has reached a resolution with the government on a reasonable, fair pay settlement. "
3/ According to our PM

"The only people that haven't are the junior doctors."

How can this go unchallanged?

To be clear @BMA_Consultants (nor @BMA_SAS) have *NOT* "reached a resolution with government on a "reasonable, fair pay settlement"

This is simply NOT true
Read 15 tweets

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