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 2022/23 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 majority of HR directors responding to our survey support a pay award of at least 3% for 2022/23, with 16% supporting a 5% uplift, and 11% supporting 4%, against the backdrop of increasing inflation, cost of living, and service demand in the NHS.
  
  
• Trusts and their staff are working at full capacity, with extensive and sustained operational pressure caused by COVID-19 infections, winter pressures, a nationwide vaccination campaign and a significant backlog in care.
  
  
• Respondents to our survey did not support the targeting of pay between grades of medical staff, with 65% against the possibility. This is likely in reaction to last year’s decision to not grant equivalent pay awards to junior doctors and SAS doctors on the new contracts.
  
  
• We welcome indications from our survey that the new SAS contracts have been relatively straightforward to implement, but uptake remains low due to last year’s 3% pay uplift on the 2008 contract and a new increase should be applied to remedy this in 2022/23.
  
  
• 86% of HRDs responding to our survey said that reform to local clinical excellence awards (LCEAs) is very important or important, with several suggesting that LCEAs should be ended entirely.
  
  
• Trust leaders are concerned about the possibility of partially funded pay uplifts, as trusts will have to make up any shortfall from existing budgets which have been allocated to ensuring service delivery. This will have operational impacts will affect patients directly.
  
  
• We continue to reject the concept of a “direct trade-off” between more funding for pay or staff numbers. These are interdependent factors, as fair pay helps to attract high quality staff and supporting their retention.
  
  
• The delays to the announcement of pay awards each year have a negative impact on staff morale, increasing uncertainty for staff and complicating trust financial planning. There is a specific recruitment and retention case for higher pay awards this year, as low morale and increased uncertainty from delays will be compounded by ongoing cost of living increases and a National Insurance rise.
  
  
• It is welcome news that the Office for Students reports a record number of applications to medical and dentistry degrees for 2020/21 and 2021/22. However, trusts are clear that they would welcome the removal of the medical school cap, which is being reapplied for 2022/23 after being lifted previously due to the impact of COVID-19 on A-level examinations.
  
  
• Flexibility can be built into the service both through the fuller utilisation of new roles and a focus on generalism, but also through the provision of flexible working options for staff. A fully costed and funded national workforce plan is needed to realise this, to build resilience into the system and to plan sustainably for future demand.

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