The prospect, at 30-plus years' distance, of working into my late 60s and beyond is a daunting one. In fact, I feel exhausted at the prospect of it, and yet that is what we are faced with as a result of the NHS pensions reforms.
In considering this issue, it is important to separate out what it is that is troubling. There are three aspects that warrant consideration. Firstly is the sense of injustice that many within the health service felt that the pensions had been renogiated in 2008, and that the system was sustainable for the next generation.
Secondly, is the cost: whatever the system issues behind the affordability of the NHS pension scheme, it feels, on an individual basis, like a big hit to see one’s pension contributions go up from 8% to 12.5% in one month, as will happen this month. Whatever your social views, this is a difference that you will feel.
Finally, and most importantly for me, is the issue of autonomy: I have always assumed that I would put myself to gainful employment for as long as I could. As someone who gets bored on a week off, I recognise the need to be active, to be productive, and to be part of something bigger. And the evidence supports this idea: elderly people who remain active, and in work, are healthier,
and live longer. Behind getting married, staying in work is the healthiest thing that men can do. Apparently, women do not gain the same survival benefits from marriage as men do. Make of that what you will.
Change is one of the most important ways of staying fresh. By having a go at something new, you can tackle the feeling that you are standing still, stagnating, growing old. But my big fear with the pensions reforms is that the option to look for new challenges may be subverted by the time one has to spend achieving a full pension. By the time you’ve put in your full work quota for the NHS, you may well be too exhausted to start on anything new.
Is it reasonable to expect a consultant once in post, to be prepared to do that job for the rest of his or her career? If it is, then the system needs to be prepared to deal with a high burn out rate. If it isn't, then the system needs to support its doctors and nurses move on to new challenges. Does it seem feasible that a doctor in their mid 60s can maintain the same drive and energy as someone in their mid 30s, new to the job and eager to impress?
And with the traditional career structure, the way it works is that there is really only one direction of travel. Each individual progresses as high up the ladder as they are able to, and that is the level they remain at until they retire, or get fired. Perhaps, if we are expected to work for longer we need to think about this differently. For example, if someone in their 60s is keen to carry on working, but would prefer to have a bit less responsibility and perhaps work fewer hours, the system does not really allow or encourage that person to do just that: they either work at their current level or they retire.
In reality, however, I don’t think that the new pension age is that relevant. In view of the successful passage of the health bill, I suspect that the reality for many of us over the course of our careers is that we will find ourselves at different times working for a range of different health providers. And although all staff will be TUPE’d on to the same terms and conditions that they received under the NHS when the services are first taken over by these new firms, it won’t be long before business conditions allow these terms and conditions to be changed. And with the natural turn-over of staff, new employees will be offered the standard terms of employment that each particular firm offers.
What this will probably mean for us, is that over the course of our careers we will pay in to a number of different pension schemes, each with slightly different conditions, and calculating our retirement income will be a much more complex matter.
I have to admit that this idea only occurred to me two paragraphs ago. Up until 5 minutes ago, I was seriously pondering how one finds the resolve to stay in the same job for 35 years. Then it hit me, that in the post reforms health service, more and more of us will spend time working for healthcare providers outside the NHS. And if I am right about this, then more and more of us will only spend part of our careers in the NHS pension. Perhaps, therefore the government missed a trick: if they’d realised this, they could have kept us sweet by saying that the pension age could stay the same, knowing full well, that once they are embedded in the health service, private organisations will offer different and less expensive pension schemes.
Perhaps this is the issue none of us realised: without realising it: the Health Bill also had pensions reforms built into it. How long will it be before clinicians are working on fixed term contracts, with renewal based on a number of performance indicators?
This is going to need more thought.......