Thread by @iDrSunny

There has been debate from all sides about recent
@NHS strikes by @TheBMA @BMA_JuniorDocs @theRCN vS @DHSCgovuk @SteveBarclay

The government has a duty to the tax payers to spend in the best way possible for the country.

Here is how a 20% rise in wages ACROSS the NHS impacts 🧵

The current NHS staff bill is £56 billion per year.
Approximately 47% of the entire NHS budget


ent%20of%20the%20NHS%20budgetkingsfund.org.uk/audio-video/ke…

If, on average, every staff member was given a 20% pay rise, that would mean approximately a £10 billion cost to the tax payer per year. That does sound like a lot.
However, what is the cost of NOT doing this?

Lets assume 30% approx. on income tax rates - £ 3
billion back in taxes to government

Agency/Locum costs the NHS £3 billion. We could easily save 30% of this cost as this locum/agency workforce - many of them would join back full time/part time (at a lower cost to the tax payer not having to pay agency fees and higher rates for locums)
- saving £ 1 bil

Lets be very clear, an agency staff member is not a one to one equivalent of someone who is a long term staff member at an organisation; theres organisational memory, longer term duty of care, ownership, patient outcomes massively change, length of stay, reduction in complication

and litigations, wait times reduce. It also improves staff morale, reduces burnout and sickness, low and behold, needing less agency staff to cover and filling the existing gaps in workforce (nursing sitting at 40,000 short)
health.org.uk/news-and-comme…

"Burnout" &stress among doctors, nurses, paramedics &other health staff has cost the NHS in England more than 15m lost working days since March 2020, about 50% more than the days lost to Covid infections and self-isolation
bit.lv/41fwut9

If we tentatively calculate this as 7.5 million shifts that need covering a year by agency, locum or bank staff (if the NHS is safely filling all these posts which we will presume they are) -taking very low assumptions of £20/hr to cover the shift (on average) and 8 hour shift

that needs covering (we all know the average for skilled NHS staff is much higher on the £ per shift and hours worked as there are often on call shifts of 12 hours) - this is saving of £1.2 billion on internal bank, agency and locum costs per year

Now what other knock on cost is there of burnout?
Clinicians who are burnt out report a 2:1 increase in medical errors vs those not reporting burnout

med.stanford.edu/news/all-news/…

The NHS spent £2.5 bil in medical claims last year, but NHS resolutions increased its perceived risk to £120 billion (a 45% rise from the previous years' £82 billion).
The real 'annual cost of harm' is £13 billion in 2022.
The major factors in harm have been:

Communication Errors (33%)
Human Error of a Medical Professional (or multiple)
Failure to Carefully Examine Patients
Being understaffed or shortage in manpower

From experience, these communication errors happen more with our current shift patterns, the lack of continuity of patient care due to them, plugging gaps with bank/locum/agencies who may or may not then be following up the care of the same patients

Patient contact time has had to reduce to naturally cover the gaps for the staff that are absent. If the NHS was a privately run nursing home group, having these shortages would mean being reprimanded by the @CQCProf @CQCpressoffice & most likely being shut down a few years back

We will put down 70% of these errors down to unavoidable reasons and circumstances even if we had all the staff numbers due to technical reasons errors etc. 30% of the £13 billion could be prevented.

That equates to a saving of £4 billion a year in annual cost of harm, although perceived risk would reduce by a staggering £13 billion.

bmj.com/content/368/bm…

Each medical school graduate who becomes a doctor in the UK costs the tax payer £230k in their education costs. 9000 doctors a year are produced. Costing the tax payer £2billion a year. It costs £70k to train a nurse. 30,000 nurses graduate each year

fullfact.org/health/cost-tr…

We lose approx 10% of our trained workforce each year (although the quantum is debatably on the far lower estimate) costing the tax payer £0.5 billion a year.

nuffieldtrust.org.uk/resource/the-l…

I have not factored in the cost of further trained HCPs post graduation. For example the cost of losing a consultant in the NHS is £500k for the tax payer.

medium.com/@iDrSunny/the-…

Things I have missed:

- Pensions contribution increase due to this (cost)
- Due to retention reduction in cost for recruitment from overseas (saving)
- Reduction in medical errors further the longer someone stays a part of the system (saving)

Summary:

Overall, this will cost the tax payer £0 at worst and save the tax payer £9 billion (or more) at best per year due to the above.

The workforce is the key driver of a great healthcare delivery and experience, if we can not retain them and keep on haemorrhaging them, we do not have a service that exists.

@healthyopinion @AmandaPritchard @ShaunLintern @HSJEditor

@veggieequallife @RoshanaMN

@BucksHandExpert

@MustBeMistry

Savings to tax payer to be further added:

- reduced length of stay for patients in the NHS with appropriate staffing (
- reduced re-admissions/admissions - the £200 million towards virtual wards for staffing this year from @NHSuk starts to put that business case forward
- breathing space for current staff to truly work on transformational changes which they can actually be a part of rather than have it done to them if they have adequate time in the day to do so - leading to much larger benefits from these changes such as EHR implementations, virtual wards, etc

Would love to hear your thoughts chancellor @Jeremy_Hunt

Ps please do correct any calculations of mine or add anything

Growth for the economy:

- I have missed this out but to be considered- the £7 billion left in the pockets of these staff members given the 20% pay rise - out of that atleast £1 billion (15%) of that will come back into the economy and the growth of the country.

@_VivekTrivedi this may be of some help for negotiations and comms to public.

@NavinaEvans - I hope this will help d for your workforce plans - it’s a high level business plan to retain the best talent we have and on which the NHS functions.

Ps happy to have a call and actually deep dive on these numbers if at all needed (and others which I have missed simply because the business case to give restoration is so clear). Best of luck.

@Rebeccasmt - this may help in some of your reporting about strikes and the wider economic business case to increase salaries across the NHS by 20%.

@MustBeMistry - is there any economic assessment done by the @kingsfund_lib around this? Or anything in the urgent works?

@DrDanGreaves @Aligill79 @NHS @TheBMA @BMA_JuniorDocs @theRCN @DHSCgovuk @SteveBarclay I’m also shocked to see @theRCN recommending the current offer of 5% from the government - they should also read your quote from UCL study.

A cost I have missed and one that should be considered is inflation- I would welcome @Jeremy_Hunt in explaining the impact of this as a cost to the economy given the above.

We expect the inflationary rate to be back towards 2.9% at the end of the year. How much would this change if the above done?

bigissue.com/news/employmen…

However I do not think that the pay correction of NHS employees is the way to control inflation - they’ve been paying for that for the last 15 years.

The correct things to control inflation:

- Russia/Ukraine conflict - find quicker resolutions
- oil price controlled
- utilities prices controlled
- this has a massive knock on on all our groceries and goods.
- if worried about an inflationary wage-price spiral- a study done by the @IMFNews in Nov 22 suggested this isn’t a major concern

.imf.org/en/Publication…

Adding some supporting evidence around calculating the quantum of £ back into @hmtreasury after a 20% pay rise



Thanks @DrDanGreaveslondoneconomics.co.uk/blog/publicati…

@Tom_Seagul @NHS @TheBMA @BMA_JuniorDocs @theRCN @DHSCgovuk @SteveBarclay Also more than happy for government/ministers to spell out their maths of it all. Atleast I’ve given some proper detail. They have given nothing.

Cc: @Prerana_Issar - here’s the business case for your people plan which I know @Jeremy_Hunt has been desperately wanting from you. @AmandaPritchard @NHSEmployers please feel free to copy my homework.

cc: @people_nhs in case @Prerana_Issar is not in post as I type.

@JujuliaGrace this thread may be of some help to @EveryDoctorUK

@drphilhammond

@PippaCrerar

@AyoCaesar may be of interest to @novaramedia

If you are an NHS worker, I would like to understand how safe you feel your staffing levels are on a normal (non strike) day:

Please do this poll 👇🏽

https://twitter.com/iDrSunny/status/1651961651803959297

@LucyJSB @NHS @TheBMA @BMA_JuniorDocs @theRCN @DHSCgovuk @SteveBarclay I wish our leaders had some common sense or maybe this is purely intentional and they are will fully then causing harm

May be of interest @natalieben and @SkyNewsThompson.

Looks like The link broken above

Here it is

theguardian.com/society/2023/f…

£43 billion (35% of NHS budget) loss to the economy each year due to long term sickness of employees:

theguardian.com/business/2023/…

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