I recently wrote to the Permanent Secretary seeking urgent clarification on the situation in Northern Ireland, following the Prime Minister's public indication to accept the Doctors' and Dentists' Review Body's recommendation of a 6% pay increase for doctors and dentists for 2023-24.
A reply was received from Permanent Secretary Peter May reinforcing the point that the DoH budget does not enable a pay rise to be offered. The Department is currently unable to accept the pay offer – but that could change, and further engagement with be required.
With no government, no health minister and a dire budgetary situation, we've been told that any uplift is unlikely."
The DDRB report was published during peak holiday season on 13 July, setting out a recommendation for a 6% pay increase for NHS dentists. This has been accepted by the devolved governments in England and Scotland, in contrast to Northern Ireland, where with no government, no health minister and a dire budgetary situation, we've been told that any uplift is unlikely.
DoH facing significant financial difficulties
The health budget accounts for over half of the entire budget in Northern Ireland. While the £7.3bn Resource Budget remains at a similar level compared to 22/23 funding, no allowance has been made for pay, price and demand inflation – meaning DoH has projected a funding gap of some £732m and will be required to deliver significant savings to achieve breakeven.
The DoH have documented a plan to do this with efficiencies and savings, but even with these, a funding gap of circa £432m remains. Trusts and Arm's-Length Bodies have been tasked with making a range of further savings – and still that leaves a significant shortfall. The Department has said that 'every effort will be made to maximise savings during the year in order to enable a pay offer to be made… Without significant additional funding, any pay offer will inevitably fall short of expectations.'
Without a sitting Assembly or Executive in place, uncomfortable, difficult decisions fall on the desk of the departmental permanent secretaries, without political party representatives being available to take accountability or face scrutiny.
Where does that leave dentistry?
A below inflation increase last year, followed by the same this year (6% offer while CPI inflation runs at 8.7%) means that this is not just technically a pay cut, it is an actual pay cut – something to which we have strongly remonstrated in response.
There is still no acknowledgement of, or even a basic measure of, increases in practice expenses. With the cost of delivering NHS care skyrocketing, this will only fuel the exodus from the NHS. If this is how it looks in England with 6% accepted by government, where will no uplift leave dentists in Northern Ireland when it comes to escalating expenses?
It will leave them with difficult decisions. No clinician should have to choose between caring for loyal NHS patients and the survival of their business. We have been warning the Department for years about the impact of short-term spreadsheet decisions on Health Service Dentistry. Dental Core Trainees are already in significant salary deficit compared to colleagues in other nations. Waiting lists in Community and Hospital Dentistry are longer than ever – and high street practices are struggling to make ends meet from month to month.
Fighting for fair pay
We recognise the difficulties and adversity facing the Department, but this is not of our making. The fall-out from no pay rise for 2023-24 would be devastating. The exodus from Health Service Dentistry will accelerate – and ultimately, patients will suffer, especially the most vulnerable and infirm.
The Department was already criticised in the DDRB report for unacceptable delays in implementing pay uplifts in previous years. Now it looks likely that there may not even be an uplift. The consistent "no more money" mantra is weak and paltry, shifting the financial burden of delivering NHS dentistry straight on to the shoulders of clinicians.
No longer do dentists receive a fair day's pay for a fair day's work. It is unfair for dentists to be made to feel further undervalued when morale is already at rock bottom.