As the NHS begins to fail before our eyes, the media and the government continue to push damaging lies.
Throughout this article, you will see reference to “locum” and “substantive” workers. "Locum" stands for "locum tenens" and is Latin for temporary vacancy, and "substantive" references workers hired by hospitals on permanent contracts, internally.
On the weekend of 10th December 2022, a scandal rippled across the pages of British newspapers: “NHS hospitals paying up to £5000 for single agency doctor shift”. Ripples of fury spun through comment sections and busy cafes. Questions began to bubble across the surface of this public rage. Why are they striking if that’s how much they can get paid? Can the NHS really be in a monetary crisis if they are willing to throw five thousand pounds at one person to cover one shift?
The press in the UK fed this narrative, consulting indignant pundits and conservative talking heads to feed the fervour. I, and those like me who understand the gears of the NHS and the grinding rust of 12 years of Tory rule, watched and listened with frustration as the narrative of “greedy healthcare workers” continued to gather steam across all channels of communication.
There are so many talking points which have been finely crafted by the government and its enablers that it can be hard to break them down equitably for those who are not entrenched in the truth of the situation. So I felt it was important to write this piece to put to bed some of the misinformation the government and its’ media mouthpieces are all too happy to erroneously recite.
Firstly, a concession: accepting £5000 for one shift is ridiculous. The idea of someone being paid five thousand pounds for one day of work is obscene. It’s also not representative of the market as a whole.
I have twelve years of experience in providing locum doctors either to the NHS from private agencies, or hiring locum doctors within the NHS, and I can assure you that is the most galling, frightening salary I’ve ever seen. But it bears questioning from a different angle than the talking heads will tell you: the necessary question is not “why did someone get paid that much?” so much as, “why are hospitals so desperate for staff that they are forced to pay it?"
The necessary question is not “why did someone get paid that much” so much as “why are hospitals so desperate for staff that they are forced to pay it?"
The most I ever paid for a locum doctor was a GP who was asked to work a last minute twelve hour shift in an Urgent Care Centre on the outskirts of a northern city during a snowstorm: I negotiated £110 per hour for the doctor, totalling £1,320 pay, no travel payment. The doctor drove approximately 30 miles to the unit where he worked for twelve hours: had he been unable to go and a suitable alternative found, the UCC which abuts an A&E department would have closed, forcing patients into the already swamped A&E.
The highest salary I ever paid an “internal” locum doctor – a doctor recruited by the NHS on a specifically locum tenens role, rather than a long term role – was almost £190,000 for one of the foremost surgeons in his area. The top salary for consultants when I worked in the NHS capped out at £111,000 for over 10 years experience, but salary garnishes through special awards – achievements of excellence – could be paid. Bear in mind, by the way, that this doctor was one of the only people in the world who was capable of his expertise, and his salary was an almost 50% pay cut from the job he left to move to the UK.
Why, you may ask, was he recruited to a locum tenens rather than a substantive role? Because the hospital wasn’t sure if they would have the funding to retain this expert long term.
The locum industry is, bluntly, predatory. It also exists to fill a problem that the government (successive governments, in fact) have long been aware of.
Ultimately, the question comes down to thinking in the present: would you rather see a doctor who is paid £12.25 more an hour than a substantive doctor is paid, or would you rather languish in a corridor? The locum industry was set up to capitalise on an emerging market problem, designed to siphon money from the NHS into workers pockets.
In their initial inception, locum placements were easy: You needed a DBS criminal record check (CRB back then), a negative Hepatitis B surface antigen result, and an up-to-date CV.
Since then, the financial arm of the NHS have designed frameworks to control the quality and flow of locums. Agencies are beheld to quality standards for their candidates and must expend money that the NHS would otherwise have to pay for pre-recruitment and training. Regardless, the industry does still capitalise on an ever increasing problem in the NHS.
But before we rage against doctors who take private work, it is prudent to pry into the rationale. As locums are paid more than their substantive counterparts and are given less restrictive working conditions (as they are not bound to Jeremy Hunt’s NHS contract), the idea of locuming continues to gain popularity. This increase in privately supplied doctors means higher salaries, better working conditions and less restrictions, and yet the government does nothing to counter this slide towards privatised workers... because this move is by design.
The government refuses to raise pay at all, never mind in line with inflation. Workers were given badges of honour rather than pay for surviving the pandemic (if, indeed, they did). They enforce restrictive contracts, binding workers to multiple different specialty on call rotas with no salary uplift; then spin the narrative that those who leave the NHS’ employ to work through agencies are money hungry or selfish. All without questioning whether it is their lack of foresight in ensuring NHS staff feel supported and remunerated properly that may cause the shift. Again, we must recall — this is by design. Never forget that this is not accidental. Encouraging doctors, nurses, ODPs, and paramedics to work privately to be paid acceptable salaries, then demonising them for doing so is the trick of a government desperate to push a lie about hard-working staff.
The fact is, the NHS is broken: it’s being held together by those who care enough to keep trying. We have a 7.2 million strong patient backlog which continues to rocket up. Medical staff are leaving to find jobs which carry less stress and pressure. Ambulances queue for hours just to drop off patients whose conditions are exacerbated. Rather than hunt for solutions, the Conservatives continue to push rhetoric of greed and the shadow health secretary and opposition leader talk about “can do” attitudes.
The NHS “can do” very little, until resolutions like safety measures against a preventable and dangerous virus are implemented, and any denial of that is a denial of fact.
When we demonise workers who garnish their salaries or even work full time as locums, we miss out on a basic fact: the NHS’ salaries almost never moves up, never moves up in line with inflation, and is frankly insulting to medical staff.
Many staff members who practice different areas of medicine must pay their respective professional bodies like the General Medical Council, Nursing Medical Council or other councils, retention fees to stay qualified; they pay for qualifications, for accreditations. They pay travel, are bound into small zoning allowances close to the hospitals, amongst other expenses.
It is, and always has been, my firm belief that an equitable pay raise would decimate industries like locum agencies because many workers do not wish to be locums for any reason other than equitable pay. I would know — I have asked thousands of locums why they do it.
The government will, the entire time, sell the big lie: “we just don’t have the money."
Even putting aside the UK’s financial status as a fiat currency country (latin for ‘let it be done’ and meaning our money’s value is not derived from an asset, meaning we cannot run out of money... ever), this is a lie easily disproved when you hear the government’s next refrain: “but we plan to recruit more staff!”
It is demonstrably more expensive to recruit people on the same salaries, than it is to uplift pay for existing workers. Unfortunately for the Conservatives, they need to do both, but one cannot say “it is too expensive to offer pay raises,” at the same time as loudly declaring that you will hire more workers. It, itself, is an expense.
The main problem in confidently declaring intent to hire more workers relies on problems both home grown and further afield: they don’t exist.
Firstly, I’m afraid we need to talk about the B-word… Brexit. Already pre-Brexit most medical professionals the world over were screened behind an extensive, expensive and exhaustive visa process which was so tedious that many people simply gave up (this happened to me no less than three times during my two years of NHS recruitment) and found other jobs abroad instead. We, through Brexit, extended this tedious, expensive and restrictive system to twenty seven other countries.
Experts in immigration like Colin Yeo speak of what is called the “violence of the immigration system.” The UK’s immigration system is deliberately adversarial, leading to difficulties in even attracting staff to go through it initially, to say nothing of visa renewals down the line. The council who meets to discuss visas only meets once every so often so the process is drawn out and comes with so many caveats, even experienced doctors often fail to meet the requirements; we are pricing ourselves out of quality candidates because of xenophobia, yet asking why the shortfall exists. Bear in mind, nursing referrals from the EU dropped an average of 96% after the result of the referendum was announced.
Secondly, the UK’s lazy attitude towards education and cost of education create a dual problem: education does not change to cater for the best styles of learning.
This is not the fault of teachers but the fault of an archaic government resistant to change, desperate to keep the “conserve” in Conservative. If children are not given the best ways to learn for their style, if they are not taught the correct information because of outdated or poor syllabuses, they cannot rise to their potential. Even if they somehow do rise to their potential, another problem lurks: classism.
I myself was from the poorest families who went to university and so was given the maximum student loan at the time, and I am still saddled with thousands of pounds of debt where richer students, given lower loans & supplemented by their parents, can walk away from uni with minimal to no debt at all. Asking someone to take on at least five years of university debt is too much for many, effectively freezing many out of the necessary steps in order to qualify as a medical professional in the first place. Since I went to university, some institutions have quadrupled their prices in line with the governments’ suggestions. One has to wonder whether courses and outcomes have improved as a result…
As the NHS continues to be subsumed by poor leadership from a government whose interests lie in outsourcing profit from healthcare, these issues will persist. Only a rejection of anti-NHS rhetoric, an understanding of the systemic issues, and support for those protesting for safer working conditions and better pay will lead to a positive outcome. The longer the UK continues to entertain a government whose ethos is to scorn the workers who are keeping us alive against the odds, the further into slow-motion disaster we sink.