The NHS is at a crisis point: with swathes of managers thinking about leaving, an above-inflation pay rise is essential to tackle the staff shortages which have engulfed most parts of the service. This is the stark message from MiP's annual pay survey, in which almost 800 members – 13% of MiP's membership – took part.
The survey forms the basis of MiP's evidence to both the NHS Pay Review Body, which covers managers in Bands 8 and 9, and the Senior Salaries Review Body (SSRB), which covers very senior managers (VSMs) at board level or equivalent.
The survey found that two out of three Band 8/9 managers are seriously considering leaving the NHS, or have done so within the last year, while 56% may bring forward their retirement. Among VSMs, the situation is even worse: 70% have seriously considered leaving and two-thirds are thinking about retiring earlier than planned.
"We are likely to reach a tipping point in the next year or two, with so many managers due to retire and others bringing forward retirement or looking for jobs outside the NHS," said MiP chief executive Jon Restell. "We simply can't afford to lose good, experienced managers because their pay isn't keeping up with inflation or they don't feel valued by their employer."
Staff leaving "across the board"
The survey found that lack of appreciation, especially for working through the pandemic, was a key reason for many managers wanting to leave the NHS, along with stress, falling standards of living, slow pay progression, severe staff shortages and "ridiculous" workloads that made management jobs "impossible".
"I won't be staying in the NHS much longer, no matter what happens," wrote one manager. "I'm jaded, tired and know that the only way things will change will be for them to deteriorate. The NHS has had 22 of the best years of my life. I'm done."
Other managers described feeling exhausted with "the constant pressure to make cost savings" or the upheaval caused by the ongoing ICS reforms. "I am now going through my ninth major re-organisation since I've been in the NHS and it's perhaps one too many," one member reported.
Over half of Band 8/9 managers said there were shortages of managers at their own level, particularly for operational roles, while 72% reported shortages of other staff, with IT, admin and clinical roles most severely affected.
"Across the board, experienced staff are leaving sooner than expected", one manager reported, while another wrote: "I see it everywhere. People are exhausted and looking for a less demanding job. They want to see their families and feel like they've accomplished something at the end of the day."
One VSM said shortages affected "every area and every grade above apprentice level," warning that "once staff have transferrable or saleable skills, they usually start looking to leave." Several managers reported losing good candidates during the recruitment process because the NHS couldn't match the salaries offered elsewhere.
"We shouldn't have to beg"
But the survey offers strong evidence that an above-inflation pay rise could help to ease the staffing crisis, at least in the short term. 77% of Band 8 and 9s, and 61% of VSMs, said it would make them more likely to stay in the NHS, while almost all respondents said it would help to keep staff in lower bands.
One VSM described existing pay bands as "insulting", but said an above-inflation pay rise would at least offer "dignity" to managers. "No one joins the NHS for personal glory but we shouldn't have to beg to be paid appropriately for our skills/experience."
One manager admitted that an above-inflation pay rise might "stop me peeking into the private sector", while another added: "It would mean I would feel valued – it would also mean I could recruit staff!"
Many managers said that last year's 3% pay award – now wiped out by rising inflation – had left staff feeling they "weren't valued" by their employer and warned that "goodwill was wearing thin".
"An above-inflation pay rise is the only meaningful way to acknowledge the real heroes of this pandemic," wrote one. "My colleagues are uninterested in well-wishes, empty gestures and words. They have sacrificed time with their loved ones, their emotional and physical wellbeing, and in some cases their lives, in [their] dedication to communities who needed them in a crisis".
Hundreds of members stressed that a real-terms pay rise was particularly vital for lower-paid staff who have been hit hardest by the soaring cost of living. "It feels like I am being forced to 'use' staff to provide services at the expense of [their] wellbeing," said one manager. "Some staff are having to access food banks to make ends meet, while some work unbelievable hours just to increase their income through bank shifts."
Another added: "I can afford to ride out a period of inflation. People on lower bands, especially those on the frontline deserve more. A lot more."
Neither group of managers had faith that current pay systems deliver fair rewards. Only a quarter of Band 8/9s were satisfied with their pay arrangements, with many reporting that pay rises on promotion to Band 8 didn't compensate for extra managerial responsibilities – especially as newly promoted managers had to wait five years for a further "incremental" increase.
Among VSMs, only a third thought the pay system was fair (see below), with many complaining of "political interference" in senior pay, a "lack of objectivity" about individual awards and salary levels falling further behind the private sector.
"There must be easier ways to make a living"
The surveys also highlighted a worrying long-term trend: managers' growing disenchantment with the career opportunities offered by the NHS. Almost half (49%) of Band 8/9 managers said they would not recommend a career in NHS management – the highest figure recorded since MiP began asking this question a decade ago.
While many managers still found their jobs "rewarding" and expressed gratitude and admiration for colleagues, hundreds said management careers were no longer worth the pressures involved. Working in the NHS was "currently worse than a BBC 'mock-umentary' like W1A or 2012", wrote one. Another warned that "you have to be bloody canny to cope".
One VSM added: "As a younger manager, I felt incredibly fulfilled doing what I did because of the impact it had on patients and potential patients who could be my friends and family. However now I feel jaded, exhausted and demotivated. Lower take home pay power makes this harder to take. There must be an easier way to make a living."
Summarising the survey findings, MiP's Jon Restell said: "After the trauma of the pandemic, the review body now has an opportunity to draw a line under previous policy and halt the long relative decline in NHS pay.
"An above-inflation pay rise won't solve all our staffing problems – far from it. But it will send an important signal: that the government appreciates the efforts of NHS staff and recognises that you can't hold down people's pay forever and expect them to carry on as normal. It's time to act – if not this year, then when?"
Execs cast doubt on "unfair" pay system
As well as the NHS Pay Review Body, MiP provides evidence to the Senior Salaries Review Body (SSRB) on the pay of very senior managers (VSMs), including 'executive senior managers' (ESMs) working for NHS England. The SSRB's remit also includes senior civil servants, military top brass and judges.
On many issues in MiP's survey, VSM members expressed very similar views to Band 8/9 colleagues, with an overwhelming majority saying an above-inflation pay rise would encourage them to stay in the NHS. Some other findings specific to VSMs include:
- Only 33% say the VSM pay system is fair
- 40% don't feel valued by their employer
- 69% are considering leaving the NHS or have done so in the last 12 months
- 73% said their morale had fallen in the last year
- 55% said there were problems recruiting and retaining VSMs in their organisation
- 46% have considered leaving the NHS pension scheme within the last year – many because of the tax treatment of pension contributions for senior staff
- Staff shortages, workload, working hours and "unrealistic expectations" were other significant factors for VSMs wanting to leave