Vital services could be cut if the government insists on funding NHS pay rises from existing health budgets, the leader of England’s hospital bosses has said.
Sir Julian Hartley, the chief executive of NHS Providers, said the health service could not afford to finance the increases itself and that without additional funding, social care, prevention and public health services were at risk.
He said: “The government has announced a pay rise for doctors and dentists, but this has not yet been agreed with unions, and funding for it remains unclear.
“The NHS does not have the cash to fund this uplift without additional support from government. Trusts’ budgets are already stretched to the limit. If the Department of Health and Social Care is asked to absorb the cost, vital areas such as social care services, prevention and public health services are also at risk of being cut.”
No 10 has defended pay rises of 6% for NHS consultants and GPs. It said that the rise for junior doctors, who are getting an additional consolidated £1,250, was an average of 8.8% and argued that the increases were “fair and appropriate”.
A spokesperson said the health secretary, Steve Barclay, would refuse to hold any talks on pay with the unions, but would be approachable for discussions on any wider workforce issues.
It came as the Royal College of Nursing said it had written to Barclay calling the government’s pay offer of 5% to nurses, made under separate negotiations, “unjust”, “divisive”, and “cavalier and reckless at a time of the greatest industrial unrest the NHS has ever seen”.
The letter says that nursing staff, and all those on NHS agenda for change terms and conditions in England, have received the lowest pay rise in respect of the 2023-24 deal among public sector workers.
In the letter, the RCN general secretary, Pat Cullen, wrote: “Why does nursing deserve the least? Particularly, given nursing is one of the most diverse and female-dominated professions within the public sector. The government has very clearly signalled it does not recognise or value their public service in the NHS compared with other professions.”
But Downing Street said it was “wrong” to look at only headline pay rise figures, arguing that one-off bonus payments made to staff on agenda for change contracts meant their increase in earnings had actually been worth more than a 6% rise.
As junior doctors head into their third day of strikes on Saturday and with consultants due to walk out next week, Hartley also expressed frustration that ministers were refusing further pay talks.
“Trust leaders are also deeply concerned that the government is refusing to re-enter pay negotiations with unions,” he said. “The only way to break the deadlock and resolve ongoing disputes is for both sides to get around the table. The strikes are hitting patients hard – the last thing anyone wants – and the financial impact is huge.”
Hartley’s intervention comes as the British Medical Association said the government’s stance would drive doctors abroad and refused to call off the industrial action.
Despite the head of the Australian Medical Association suggesting disgruntled medics would emigrate to look for better-paying jobs abroad, Rishi Sunak’s spokesperson said the “vast majority of qualified doctors remain within the UK” and suggested concerns of an exodus of staff to Australia was overblown.
The BMA also castigated the government’s proposed formula to fund doctors’ pay rises. The immigration health surcharge, a fee for foreigners to access the NHS, will be increased from £624 to £1,000 to cover the rise in pay for junior doctors.
Though No 10 acknowledged it was monitoring the impact of raising visa fees, it said “we don’t believe it will impact on recruitment or filling positions” in health and care roles.
But the BMA called the plan “shameful” on Friday and described it as a tax on vital health colleagues from overseas. The BMA chair of council, Prof Philip Banfield, said: “The proposed increase in the charges on migrant health workers to pay for the government’s already compromised pay deal is frankly shameful.
“The immigration health surcharge is an additional punitive tax on much-needed overseas colleagues. The NHS should be funded from general taxation, not charges that unfairly target individual groups – that’s why we called for abolishing this tax completely.”