As consultant doctors walk out for 48 hours, Sky News analysis has found that their real terms annual earnings have fallen by 15% since 2010.
The NHS Confederation has said the consultants’ strike is a “step into the unknown” – and it feels like that in terms of the statistics used by both sides to make their case. The British Medical Association and the government each have their own favourite figures.
Let’s start with the real terms pay cut. The BMA says that, because inflation has risen faster than pay, consultants have seen their real take-home pay fall by 35% over the past 14 years.
But the BMA is using the Retail Price Index (RPI) to calculate this. The problem is that it’s not how we measure inflation – the Office for National Statistics (ONS) recommends using the consumer price index – CPI – instead. That’s the measure you see when we talk about inflation on Sky News.
And if you use the CPI to chart consultants’ earnings, they haven’t fallen by quite that much – it’s a 15% decrease since 2010.
But that’s still a big decrease, especially when you compare it to the public and private sector averages.
It’s also worth noting that 2010 was a relative high point for consultants’ pay.
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Billy Palmer, senior fellow in health policy at the Nuffield Trust, told Sky News: “People typically use 2010 as a baseline, but in fact that was a fairly high point in the somewhat cyclical nature of consultants’ pay. If you look back over a longer period, three decades for example, consultants have actually received a pay rise.”
What about the amount of pay itself?
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You might think this should be uncontroversial enough but again, both sides prefer different data.
Tom Dolphin, a consultant and a member of the BMA council, spoke to Sky’s Kay Burley on Thursday morning and referred to the starting basic pay of a consultant – £88,364.
But any pay rise would be applied to all doctors so we should probably use the average basic pay instead, which is £97,406. And if you compared basic pay to 2010, it’s clear that doctors are being paid less.
And basic pay has fallen more in England than in Scotland across all levels of experience.
While a consultant in England working for 10 years would receive a basic pay of around £105,996 in the 2022/23 year, a consultant in Scotland would get £108,345.
In comparison to 2010/11 (adjusted for inflation) this means consultants in England see a bigger decrease in basic pay – 14% compared to 12% in Scotland.
That figure, though, is still some way away from the figure the government likes to quote, that the average annual salary last year was £127,228. That includes non-basic pay: things like working beyond contracted hours (£14,566), medical awards such as the clinical excellence award (£6,028) and money received for being on call (£2,882).
The government likes this higher number – it’s nearly four times the average UK annual salary – but it’s also not an unfair statistic to choose.
The government also likes to mention its offer of a 6% increase in pay for NHS staff consultants, which might sound relatively generous.
But again, if you use CPI forecasts for next year, this would increase doctors’ annual earnings by only 1% in the year ending March 2024 – still far short of that actual 15% decrease since 2010.
Comparisons to other countries and professions
Dr Dolphin also mentioned that consultants were being tempted by job offers from countries where the weather is sunnier and the wages are higher.
Some of the comparisons here are a bit trickier because of different definitions and data.
We’ll start in the UK and compare how “specialist medical practitioners”, which would include consultants as defined by the ONS, compared to other categories in the professional occupations category.
And they compare very, very well – a median gross annual income of £68,614 in April 2022. That’s 3% more than headteachers and nearly three-fifths higher than aerospace engineers.
So specialists are top of the league at home. Abroad, though, they’re mid-table.
Consultants in the UK rank moderately in terms of earnings on a global scale.
The OECD puts a UK medical specialist’s earnings at $155,418 (we’re using dollars now for ease of comparison). This is nearly a third higher than a consultant in France but around a quarter lower than in South Korea.
Private pay and extra work
One last issue to think about. We’ve been talking about consultants’ pay from the NHS. But they’re also free to do work privately. Unfortunately, we don’t know how much they earn on average from this. (We couldn’t find any reliable data – if you have some, let us know!)
The BMA has said that any striking doctors “should not schedule any other work, including in private practice, when they are taking part in industrial action”.
However, there’s nothing stopping them legally.
And consultants may have also benefitted from their junior doctor colleagues striking. “It appears that the medical pay bill has increased over strike periods. So some doctors are demanding and receiving large amounts to cover a shift,” Mr Palmer told Sky News.
“But in that context, there doesn’t seem to be as much of a financial friction as there would be in maybe some other services and professions about going on strike for some staff,” he added.
To sum it up: consultants have high salaries compared to the UK average; they may have earned more money during other BMA strikes and they may – if they choose to – work privately during strikes. That gives them more financial resilience than other occupations: a train driver can’t really drive a private train on a strike day.
Coupled with that very real 15% drop in wages, they could be prepared to wait a long time for a better offer.
The Data and Forensics team is a multi-skilled unit dedicated to providing transparent journalism from Sky News. We gather, analyse and visualise data to tell data-driven stories. We combine traditional reporting skills with advanced analysis of satellite images, social media and other open source information. Through multimedia storytelling we aim to better explain the world while also showing how our journalism is done.
The so-called “Brit card” would verify a citizen’s right to live and work in the UK.
The plans would require anyone starting a new job or renting a home to show the card on a smartphone app, which would then be checked against a central database of those entitled to work and live here.
It is hoped this would reduce the attraction of working in the UK illegally, including for delivery companies.
At the moment, workers have to show at least one form of physical ID in the form of documents, but there are concerns within government that these can be faked.
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French President Emmanuel Macron has repeatedly warned that the lack of ID cards in the UK acts as a major pull factor for Channel crossings, as migrants feel they are able to find work in the black economy.
Image: A BritCard proposed by Labour Together.
Pic: Labour Together
Sir Keir is due to speak at the Global Progress Action Summit in London on Friday, alongside Australian Prime Minister Anthony Albanese and Canadian Prime Minister Mark Carney.
The plan represents a shift in the government’s position, as last year ministers ruled out the idea following an intervention from Sir Tony Blair just days after Labour won the general election.
The former Labour prime minister has long been an advocate of ID cards and took steps to introduce a system that would begin as voluntary and could later become compulsory while in office.
The rollout was scrapped after Labour was ejected from power in 2010, having been opposed by the Liberal Democrats and the Tories at the time.
Last July, then Home Secretary Yvette Cooper said of the idea: “It’s not in our manifesto. That’s not our approach.”
Image: Small boat crossings have reached a record high. Pic: Reuters
The UK has only previously had mandatory ID cards during wartime, with the last tranche scrapped in 1952.
The idea has long been opposed by civil liberty and privacy groups in the UK.
Sir Keir is said to have shared their concerns but came round to the idea amid record high levels of small boat crossings.
A report by the Tony Blair Institute published on Wednesday said digital ID can “help close loopholes that trafficking gangs and unscrupulous employers currently exploit, reducing pull factors driving illegal migration to Britain and restoring control over borders”.
Labour Together, a Starmer-backed thinktank, published a report in June which said digital ID could play a role in right-to-work and right-to-rent checks, supporting “better enforcement of migration rules”.
How would digital ID work?
There is no unique regime for identity cards, but decisions the government would have to make include who is required to register, how much information they should hold, and whether physical forms of the ID should also be made available.
Pat McFadden, now the work and pensions secretary, started a cross-government unit to look at how it could work while he was in charge of the cabinet office.
He visited Estonia last month, before the cabinet reshuffle, where he said the Baltic country’s model could be used as an example.
In Estonia, citizens are given a unique number at birth which they use to register marriages, access bank accounts, vote, book GP appointments, file their tax return and even collect supermarket loyalty points, among hundreds of other services.
Mr McFadden told The Times digital ID could be applied “to the immigration system, to the benefit system, to a number of areas”.
‘Checkpoint society’
The government’s plan will be subject to a consultation and would require legislation to be passed, before being rolled out.
Labour MPs on the left of the party have already hit out at the idea.
Nadia Whittome labelled the policy “divisive, authoritarian nonsense”, adding: “If we’re going to reheat Blair-era policies, can we please focus on lifting children out of poverty?”
Reform UK and the Tories are also against the proposal, arguing it will not stop small boat crossings.
The Lib Dems meanwhile said they were against the principle of people being “forced to turn over their private data just to go about their daily lives”.
The civil liberty group Big Brother Watch said: “Plans for a mandatory digital ID would make us all reliant on a digital pass to go about our daily lives, turning us into a checkpoint society that is wholly unBritish.”
Fans of digital ID cards argue that they will speed the UK into a digital future by giving everyone a way to prove who they are.
What’s confusing about this argument is that we can do that already.
We have physical ID cards in the form of passports and driving licences. We also have an extensive system of digital identification and a whole range of laws that require you to prove your identity, sometimes multiple times a week.
If you’ve employed someone recently, even for a few days, you’ll know that you have to check their right to work documents, either physically or digitally.
It’s the same if you open a bank account, hire a solicitor, file a tax return, vote in an election or apply to get government services like Universal Credit. These days, even accessing pornographic content online requires an identity check.
The trouble, from a government point of view, is that none of these systems are joined together, which makes it possible to slip through the gaps.
Despite all the checks, for instance, illegal immigrants regularly get access to bank accounts. The Home Office is meant to share its data with banks and building societies to stop this happening, but the information is often incomplete or just plain wrong: that’s why the system had to be paused for four years after the Windrush scandal came to light.
A truly efficient system would clean this kind of data, link it up, and connect it in one sweeping overview. But that would require the creaking civil service to access information that’s often hard to find, let alone share.
Much easier – or so advocates of ID cards say – to sweep the old bureaucracy aside and begin again with a single central system.
The result, they say, would be a system that’s faster and more reliable for citizens. But mainly this is a piece of infrastructure that, its proponents hope, would make government function in the way it’s supposed to.
All of which raises the question – do we actually want that?
Do we want a government that can track us in every part of our lives? That can actually enforce the law, in a way it has no hope of doing currently?
The government believes the answer is yes. Their focus groups and polling tell them that people are sick and tired of failing government systems and desperate for decisive action, especially on immigration.
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3:53
Are we in a cyber attack ‘epidemic’?
That’s why the bigger risk in all this might not be the politics but the delivery.
Can they make sure this system is built on budget and without massive delays? Can they get it operating at scale without suffering a hack or a major technical glitch?
Can they show people that the problem is the current system, not the way it is being used?
This is a task that even Google or Amazon would quail at. One that makes HS2 look easy.
Yet Whitehall – not known for its tech expertise – might be asked to take it on, perhaps in time for the next election.
A taxi driver who dropped triple killer Axel Rudakubana at a Southport dance studio and then drove away as he launched his attack has apologised to the families of the victims for not doing more.
Alice Aguiar, nine, Bebe King, six, and Elsie Dot Stancombe, seven, were killed at the Taylor Swift-themed class on 29 July last year by Rudakubana, who was later jailed for a minimum of 52 years.
The inquiry was told that Rudakubana was picked up from his home in nearby Banks by Gary Poland from One Call Taxis. He got into the back, wearing a green hoodie with the hood up and a COVID-type face mask.
The pair did not speak during the journey, but when Rudakubana got out of the taxi in Hart Street, and was asked “cash or card?”, he walked off without paying.
Mr Poland got out of his vehicle and pursued Rudakabuna as he walked down an alleyway to a vehicle body shop, but the killer told him and workers at a nearby garage: “What are you going to do about it?”
Mr Poland got back into his car and drove down the alleyway that led to the Hart Space, telling him: “You pay now, or the police are on their way, you f**king knob.”
Image: (L-R) Alice da Silva Aguiar, Elsie Dot Stancombe and Bebe King
He saw Rudakubana as he tried the door to the ground floor, and then found the door to the upper floors was unlocked and went inside.
The taxi driver turned his vehicle around, but as he prepared leave, children could be seen in the rear dashcam running alongside the taxi, and it was possible to hear their screams, the inquiry was told.
Mr Poland looked in the rearview mirror, then drove off. He took another fare before returning home and eventually calling the police at 12.36pm, 50 minutes after the attack.
It was only then that they were able to identify Rudakubana, who had refused to tell them who he was when he was arrested by two unarmed police officers.
Mr Poland told the inquiry, in a statement: “On reflection, I do consider that I should have called the police earlier. In hindsight, I wish I had done, and it is something that I think about every day – what I should have done, and how this is my fault because I drove him there.
“I regret not helping the children, their screams were harrowing, and I can still hear them when I think back to that day.
“I regret not doing more. There isn’t a day that passes when I don’t think about that day and what ifs. What if I had called the police? What if I had got out of my car? What if I had apprehended him for not paying me? But I do not know the answers.”
Image: Three children were killed in the attack last year. Pic: PA
He said he thought there was a “gunman shooting at people” and believed it was the person he had just been shouting at to pay and threatening to call the police, and was worried about becoming a target.
Mr Poland admitted hearing the screams and seeing children running out of the building and said he “just panicked and was not thinking clearly.”
“I did what I did based upon fear, shock and panic, these are human emotions which I could not control. I can only say that I panicked, and I fled for my own safety,” Mr Poland added.
“I cannot imagine what the victims and the families of the victims have been through, and they have my deepest sympathy for what happened that day.”
As he drove off, Mr Poland said children were running “like a stampede for their lives” and added: “I was in a state of complete mortal terror and shock.”
Tattooed and wearing a black zip-up top, white t-shirt and glasses, he told the inquiry: “I just remember seeing the face. I can’t sleep at night, I shut my eyes, I see his face, it’s just there all the time in my head.”
However, in a phone call to his friend, who ran the vehicle body shop next door to the Hart Space, recorded on the dashcam after he pulled up around the corner, Mr Poland said: “I’ve just dropped a lad off, I chased him down your thing. He ran next door and I think he shot some people.
“Do you not hear screaming and shots go off? He’s just f**king shot everyone ain’t he?”
His friend, Julian Medlock, told him: “Lucky you weren’t in it” and Mr Poland added: “He shot upstairs and I heard these f**king shots and I f**king shot off Jim. Lucky he didn’t shoot me, weren’t it?”
Nicholas Moss KC, counsel to the inquiry, said: “The outside observer listening to this exchange may pick up a sense of disbelief from you about what had happened, but not ‘mortal terror and shock’
“That wasn’t your state at the time that you made this call, was it?”
Mr Poland replied: “All I can say is I was in shock and I didn’t know what was what.”
Mr Moss added: “At any time during this call, did you say anything about those young girls or their welfare?”
Mr Moss said: “The fact that you were prepared to confront him verbally might be thought to suggest you are not a shrinking violet, would that be fair?”
“Correct,” Mr Poland replied.
He told the inquiry: “If I thought he had a knife, I probably would have got out and disarmed him. It’s only a knife.”
When Rudakubana went into the building, he thought that he had gone to get him his money and he would wait.
“I was thinking, he’s not said much, I’m thinking, he’s gone to get some money, and then that’s when, a minute or two later, I heard all these screams, and I thought, what’s going on there.’
“What I thought I heard was gunshots, four or five gunshots. That’s when I got worried, and I thought, I’m not going to confront anybody with a gun. I don’t think anybody would.”