NHS Pensions: Taxation

To ask the Chief Secretary to the Treasury to make a statement on the implications for patients of the taxation of NHS pensions.

The Government keep public sector pay and pensions policy under constant review in the context of the wider public finances. For the majority of savers, pension contributions are tax-free. The annual allowance is a fiscal measure that operates across all registered pension schemes in both the public and private sectors, alongside the lifetime allowance. The measure is kept under review by the Government to ensure that the benefit of tax relief on pension schemes remains affordable.

Some senior clinicians face pension tax charges owing to the increase in the value of their pension accrual. I understand that the Secretary of State for Health and Social Care is currently engaged in discussions with senior representatives of the British Medical Association. The Government are taking this issue very seriously, and that is the right place for those discussions to be held. However, the House will recognise that the same tax rules must apply identically to everyone in the same situation, regardless of their employer. It is simply not possible for the tax rules applying to senior clinicians in the NHS to be different from those that apply everywhere else.

I understand that the Secretary of State for Health and Social Care is to publish a consultation on proposals for a new 50:50 scheme providing pension flexibility for clinicians in the NHS. The scheme will give senior clinicians in England and Wales more choice in respect of their pension accrual, and will thus control tax charges. Since last autumn, all members of the NHS scheme on the taper have been able to elect for the pension scheme to pay any tax charges now, and so avoid any impacts on take-home pay, in return for an actuarially fair reduction in their pensions.

I recognise the concerns that have been raised, and I assure the House that the Government will continue to monitor the impact of pensions policies on public service delivery.

The unforeseen consequences of recent pensions legislation, initially supported in all parts of the House, are now resulting in very worrying consequences for the NHS as hospital doctors who have regularly worked weekend overtime to get waiting lists down are understandably refusing to continue to do so because they are being made worse off as a result. Can we imagine a conversation between couples along the lines of, “So you are leaving me and the children again this weekend to go voluntarily to work to make our family worse off?” It is not going to happen, is it? The same applies for GPs, many of whom are now doing fewer sessions each week than they want to and their patients desperately need in order not to be made worse off by breaching their annual pension allowance.

We do not have conscription for healthcare staff; we cannot force them to do weekend overtime or more sessions than they want to, and it is not surprising that they choose not to if they are being made worse off as a result. For example, in The Guardian this morning we learned of one senior anaesthetist who worked 27 Saturdays last year in order to reduce waiting lists and has now said he cannot afford to work any extra Saturday shifts this year because it would give him a large tax bill he cannot afford to pay.

Very few doctors have earnings that exceed the adjusted income threshold of £150,000, but due to the inclusion of hypothetical pension growth as income, doctors are being affected by tapering. This is different from what the Chancellor said in Treasury questions on 21 May when he said that someone has to be earning over £150,000 a year before the tapered annual allowance affects them. Taxable income and adjusted income are very different as regards pensions taxation.

The Government should also be aware that members of the imposed 2015 pension scheme had no option but to become a member of multiple schemes including the GP CARE—career average revalued earnings—scheme and as a result incur significantly higher annual allowance tax bills than those members who are protected members in only the final salary scheme. This means that all full-time consultants who are a member of more than one NHS pension scheme will be affected by the tapered annual allowance and will need to reconsider how much work they do for the NHS to mitigate these tax charges. Furthermore, this punitive pensions tax penalty means that doctors are not just working less but are retiring earlier than they would like to in order to avoid significant additional tax charges. In a survey of more than 2,400 consultants, more than half cited pensions taxation as a reason for their decision to retire early.

The answer to my hon. Friend’s first question is that the Health Secretary is currently in discussions with the British Medical Association and other health representatives about precisely what can be done, and of course the consultation will come out shortly. Some of the issues he mentioned in terms of legislation will clearly be a matter for the new Prime Minister and Administration, but the fact that my hon. Friend has raised this urgent question today will draw to people’s attention the urgency of this issue and one would expect it to be considered very early on by a new Administration. The point I was trying to make earlier is that there is a fundamental distinction between how we deal with the issues in the NHS, on which the Health Secretary is leading, and the broader issue of our pension system, which is there to encourage people to save. That has to be considered in a holistic manner so we cannot just design it around one workforce. It has to be designed to work for everybody in both the public and private sectors. That takes time of course, and we are working through some of the conclusions of the reforms that took place a few years ago.

I am grateful to the hon. Member for South West Bedfordshire (Andrew Selous) for asking this urgent question. It follows a Westminster Hall debate two weeks ago on this issue, when Members from across the House raised concerns about the Government’s mismanagement of the interaction between their pensions relief policies and the NHS pension schemes.

The worst-case scenario that we all feared has become a reality. Hospital leaders are raising the alarm that waiting lists for routine surgery have risen by up to 50%. Unless this issue is dealt with, there is a risk that the approach of the end of the financial year will lead to even greater levels of working to rule after the summer.

The changes that have led to these issues relate to the interaction of the taper, which George Osborne introduced in the summer Budget of 2015, with other rules on tax reliefs and the three NHS pension schemes. Despite decisions being taken around these measures some time ago, there appears to have been next to no communication by the Government with representative groups about this issue until the crisis had already begun. That is very different from the “constant review” that the Chief Secretary to the Treasury has just referred to.

It is fair that tax reliefs should be consistent with other core principles of taxation and that the pension allowance should decline progressively for those people who earn high incomes. However, at issue here is the interaction of that system with the NHS pension schemes, on which the representative organisations maintain they were not properly consulted. Many consultants are only now becoming aware of their liabilities. I asked two weeks ago, and I ask again, whether the Government believe that their communication with those affected has been sufficient. Furthermore, does the Chief Secretary to the Treasury believe it is acceptable that many of those affected have not even received pension statements in a timely manner, due to delays by Capita? Surely that is only exacerbating these problems.

We acknowledge that there is an issue. That is why the Health Secretary is poised to launch the consultation—

When?

Order.

That is also why the Secretary of State is meeting representatives of the medical profession today. The hon. Lady asks whether the 50:50 scheme is enough and whether more can be done. Those are precisely the issues that the Health Secretary is discussing with those representatives of the medical profession. Of course he is working hand in hand with the Treasury to find NHS-specific solutions to deal with the problems that we all acknowledge and that have been raised today by my hon. Friend the Member for South West Bedfordshire (Andrew Selous). We all acknowledge that.

The important thing to remember is that, while we need to look for NHS-specific solutions—which is precisely what the Health Secretary is working on—the broader issue of taxation cannot be looked at just for one profession. The broader issue of the pension system has to be looked at in the round and in the whole. I am not going to stand at the Dispatch Box today and announce an entirely new pensions policy. We are pragmatically dealing with the situation that has arisen in the NHS, and of course we continue to review our pensions system to ensure that it makes financial sense for those people contributing to it as well as for the Exchequer. We pay more than £50 billion-worth of pension tax relief and it is important that we get value for money for that—that is why the reforms were conducted earlier—but of course we continue to review the arrangements to ensure that they are providing value for money as well as the right incentives for people to save for their later age.

In west Berkshire and Wokingham, we desperately need to recruit and retain more doctors and other senior medical personnel. Will the Treasury look at the 60% tax rate that kicks in at £100,000 for a band of income above that? A lot of important public service workers, not just in the NHS, are caught in that band and are paying higher marginal tax rates than people earning a lot more.

My right hon. Friend makes an interesting point. In general, I am in favour of lower taxes and a simpler tax system that always rewards those who go out to work.

Tapering lifetime allowances have already driven many senior doctors out of the NHS in their late 50s. The issue now is the tapering annual allowance, which is reduced by £1 for every extra £2 earned. This issue was raised in 2017; it has not just come to light. In May, the Chancellor talked about a threshold of £150,000, yet the problem kicks in at £110,000, and many senior consultants and GPs earn above that. The average extra bill is £18,500, but many have faced tax bills of almost £100,000. The British Medical Association survey shows that three quarters are citing this as a reason to retire. At the moment all income, including non-pensionable income, is included. That does not make sense, so can that be changed? It is not just earnings, but the growth of a pension, yet people might not live long enough for that to be income, so why is it counted? The BMA does not think that the 50:50 approach will solve the issue, so will the Treasury have open consultation and, because this is about interaction with the pension system, look at all the options? Otherwise, we will face a workforce meltdown.

As I said, the consultation will be launched fairly soon—the Health Secretary is looking at that—and people will of course be able to feed their views into it.

It is welcome to see a Treasury Minister answering this question; it was a Health Minister in the Westminster Hall debate. As a former cancer Minister, I was incredibly proud of our Government’s 75% ambition, and I doubt whether there is a Member in this House who does not support that. The news from my trust is that this pension issue is hitting radiology, which is hitting cancer diagnoses. Theatre lists are being cancelled because we cannot get anaesthetic cover, as my hon. Friend the Member for South West Bedfordshire (Andrew Selous) mentioned earlier, so may I stress to the Minister the urgency of the situation? We need to grip this and fast, because the longer this goes on and the further it falls, the harder it will be to retrieve. Urgency is the key word here.

I can assure my hon. Friend that I spoke with the Health Secretary earlier today. We are seeking to get the consultation out as soon as possible. The Government have been working on this now for a number of weeks.

This matters first and foremost because of the impact on patient care, not only through increased waiting times in hospitals but in patient’s ability to see a general practitioner out of hours. May I stress the urgency of the situation, as others have? Patients cannot afford to wait for the extended process of finding a new leader of the Conservative party.

May I briefly flag up another issue? One of my constituents, who wrote to me recently to say that he had requested an update on his pension, was told that it would take three months. He was then informed that Primary Care Support England had not updated his pension records for three years and that he would have to wait a further three months once they had been updated. Will the Minister also look at the delays facing doctors trying to get an update on their situation?

I thank the hon. Lady for her question. I will raise that matter with the Health Secretary. It is for the NHS to make sure that its pensions are properly administrated. As I have said, we are dealing with this issue urgently. We are not waiting for the election of a new Conservative Prime Minister to do that. My point about a new Prime Minister was that general tax and pension reforms are not likely to be happening in the next two weeks.

I thank my right hon. Friend for her statement. Will she confirm that this problem, as she said at the beginning, was created in 2016? Working hard for a few weeks now is probably necessary, but it ought to have been possible, by paying attention to the representatives of consultants and GPs and to those in these sorts of areas with similar earnings, to realise that this problem should not have been allowed to continue for quite so long. Will the Minister’s advisers look at the British Medical Association’s “Frequently asked questions”, which in February spelt out many of these issues? I ask, for the sake of those involved and the patients they wish to serve, that there should be a bit more speed—I almost gave it in Latin, but I might have sounded like a Tory leadership candidate. Get on with it, please.

I am strongly receiving the message in favour of urgency.