WHEN someone with inside knowledge of a situation tells you something is going to happen it usually makes sense to listen; when hundreds in the same boat start telling you the same thing it would be wise to take action.

At the start of this year NHS consultants started warning that the health service was facing a staffing crisis at the senior end because a complex system of pension-related tax charges was resulting in higher earners effectively being penalised for taking on extra shifts. Though their departments had come to rely on those shifts in order to function, hundreds of senior practitioners were shunning the work to avoid being hit, with many others warning they were likely to have to do so too.

For those working in the system the implication of that was clear: at a time when consultancy vacancies were continuing to rise, not having those shifts covered would mean waiting lists would begin spiralling and patients, ultimately, would suffer.

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Somebody should have listened. Last week a survey from the British Medical Association’s (BMA) Scottish arm revealed that nearly half of all consultants working north of the Border have either given up or are considering giving up the overtime deemed necessary to reduce patient waiting times, with the pension situation said to be entirely to blame. A similar picture is emerging south of the Border, too, with a survey conducted by NHS Employers, an organisation that acts on behalf of all NHS trusts in England, finding that 18 per cent of consultants have already reduced their hours as a direct consequence of the pension taxes while a further 44 per cent are considering following suit.

The impact is there for all to see. Figures released to the Liberal Democrats at the beginning of this year showed that hundreds of Scottish patients had been kept waiting more than a year to be seen by a specialist in 2017/18. At the most extreme end, one patient reported waiting almost two and a half years for an appointment. This is despite legislation passed in 2012 stipulating that all inpatient or day treatments should be carried out within 12 weeks.

Nor is the situation improving. In the first three months of this year just 70 per cent of routine operations and outpatient treatments were carried out within the required 12 weeks, with the figure falling to under 50 per cent in NHS Grampian in the first quarter. At the same time, one in five people diagnosed with cancer waited more than the required two months for treatment, with just one health board, NHS Lanarkshire, meeting the target of seeing 95 per cent of patients within the mandated timescale. Figures released this week, meanwhile, revealed there has been a ten-fold increase in the number of patients waiting more than three months for hospital dental treatment since 2015.

There are many reasons why waiting-time targets are not being met, with ever-tightening budgets and the consequent shortage of doctors high up on the list. Yet talk to any senior doctor working in the NHS at the moment and they will all tell you the same thing - the fear of breaching byzantine tax regulations that are so complex even many financial advisers cannot work them out is proving paralysing. Worse still, they believe the situation is not just profoundly worrying but that it is leading to a disastrous compromise in patient care too.

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It is a crisis that should have been predictable, with the tapered way tax reliefs have applied to higher earners since 2016 meaning doctors earning over £110,000 were always likely to run the risk of incurring large tax bills as a result of doing extra work. While that may seem like a fair outcome, the complex way the charges are calculated has resulted in many doctors having to pay more in taxes than they have received in overtime pay. And, as stories of doctors mortgaging their homes or taking out large loans in order to pay those bills abound, many are choosing to shun the extra work instead.

Who could blame them? Sure, everyone has a duty to pay their fair share of tax, and it is quite right that those with the broadest shoulders should bear the greatest burden. But nobody – higher earner or otherwise – should be expected to either work for free or pay for the privilege.

The UK Government is finally waking up to the problem it has created, with health and social care secretary Matt Hancock this month announcing a consultation that could ultimately allow clinicians to halve the amount they save into the NHS pension in return for halving the rate at which their own pension pot will grow.

Bringing some flexibility into the scheme is certainly to be welcomed, and not just because it would allow those higher earners to avoid falling into the pensions-tax trap. Indeed, as things stand NHS employees either pay up to 14.7 per cent of their salary into their pension to receive the employer’s 14.9 per cent or they get nothing. Allowing those who cannot afford those levels to pay less while continuing to build a pension has got to be a good thing.

It is hardly a satisfactory solution to the staffing crisis, though. Defined benefit pensions are, after all, deferred income; anything that devalues a doctor’s future pension effectively devalues what they are being paid in the here and now. At a time when all NHS employees report having to work harder than ever with fewer resources at their disposal, devaluing the pay of those voluntarily working overtime to keep the service going is hardly the morale-booster they need to stay engaged.

Doctors groups such as the BMA and the Hospital Consultants and Specialists Association are very clear about what they would like to see happen instead: they want the complexity to be taken out of the system by the tax taper being scrapped. More than that, though, the Treasury needs to urgently rethink how tax reliefs work full stop so that lower earners rather than higher ones are encouraged to save for their retirements.

The future of more than just our health service depends on it.