We welcome the opportunity to submit evidence to the Review Body on Doctors' and Dentists' Remuneration (DDRB) on behalf of NHS trusts and foundation trusts, to inform the 2023/24 pay round. The key messages from our submission, based on a number of information sources including our survey of trust HR directors, are as follows:

• The 2023/24 pay round is commencing against the backdrop of what is likely to be the most widespread industrial action in the NHS' history, in response to the sub-inflationary 2022/23 award and increasing pressures on staff
• 31% of respondents called for an uplift of 5% as a starting point, with only one respondent suggesting a percentage uplift below this would be appropriate. 28% of respondents supported an award of 6-8% and 16% supported an uplift of 10% or more
• 46% of respondents were against the possibility of targeted pay initiatives for those within the DDRB's remit. For those supporting the implementation of targeted pay, the highest support was for junior doctors (25%), followed by specialty and associate specialist (SAS) doctors (6%). There was no support for targeted pay directed towards consultants
• We continue to reject the narrative of a 'direct trade off' between increased pay and more staff. These are interdependent factors, as fair pay helps to attract high quality staff and support their retention
• We ask that the DDRB makes explicit recommendation for government to commit to fully funding the pay uplifts it decides to award NHS staff. Given that pay is a recurrent cost, this pay funding shortfall will have to continue to be met by NHS England year on year
• 93% of trust leaders are concerned about staff burnout and 80% about staff morale
• Figures released in August 2022 show retirement figures for Q4 of 2021/22 were 50% higher than at any point in the last five years, with 9,737 members of NHS staff taking retirement. Pension scheme inflexibilities and pension taxation policies are a well-publicised contributing factor, particularly for higher earners
• 96% of respondents agreed that increased pension flexibilities for all staff are very important (74%) or important (22%). 92% of respondents further agreed that government reform of pension taxation regulations is also very important (73%) or important (19%)
• Trust leaders have told us that the British Medical Association's (BMA) SAS and consultant rate cards campaign is proving difficult to manage locally. We would like NHS England to manage the response to BMA rate cards centrally and are engaging with them on this matter
• 86% of trust leaders are worried about having capacity to meet demand for services over the next 12 months. Effective workforce planning is fundamental to ensuring the NHS is well-resourced to meet demand for services in the future
• The Secretary of State for Health and Social Care, Steve Barclay, stated that "the NHS budget has already been set" until 2024/25. We would, however, note that pre-set levels of funding for the NHS were increased by an additional £3.3bn in 2023/24 and 2024/25 to cover additional pay and inflation pressures
• We expect to submit supplementary evidence should further significant changes arise between now and the announcement of the review body's recommendation.