06/04/2026
The Scottish NHS has a hospital consultant vacancy rate of 16.8%, with well over a thousand posts unfilled according to BMA Scotland.
Why? Faced with excessive income taxes, doctors are incentivised to cut back their hours and retire early. Many hospital consultants earn a gross salary of £100k-125k a year, which because of the combination of high tax rates and the withdrawal of the personal allowance means they get to keep less than 31p of every extra £1 they earn – and less than 22p if they still have student loans to repay.
It’s even worse if they have young children, because by becoming a hospital consultant at all, and so getting a raise above the £100k threshold, they immediately lose all entitlement to tax-free childcare – £2,000 a year per child (£4,000 if the child is disabled).
In other words, a doctor with young children on £99.9k actually takes home more pay than a hospital consultant with a gross salary of £106k, or even £109k if they still have a student loan to repay. Is it any wonder we have such a high vacancy rate for hospital consultants when getting a promotion perversely loses them money?
When this cliff edge was introduced in 2007 by Labour, hardly anyone earned over £100k, so it did not have as much of an impact. But after two decades of inflation without any change to the threshold, it now affects more and more experienced workers across the NHS and the public sector as a whole, gradually making our public services worse.
This is damaging enough as it is, but Labour’s uncosted manifesto pledge is to increase the tax-free childcare allowance to £3,000 (and £6,000 for disabled children) without changing the threshold – which means that under Anas Sarwar, a hospital consultant with children would need a salary of over £110k (or £114k with a student loan) in order to take home more pay than a doctor on £99.9k. And they would make it even worse for hospital consultants with disabled children.
In other words, Labour has pledged a policy that would only hasten the hollowing out of experience in the Scottish NHS, exacerbating the already serious crisis in recruitment and retention, and leaving even more wards understaffed and theatres empty while waiting lists continue to grow. As is so typical of Holyrood’s failure to think for even a second about incentives or the consequences of their uncosted pledges for more spending, Labour’s inattention to detail would be disastrous.
Reform UK’s approach is to instead address the fundamentals: to stop punishing people for working hard and gaining experience across the economy as a whole, getting rid of the perverse incentives in the tax system, increasing take-home pay across the board, and ensuring that those with experience are rewarded for staying in work.
To do this, a Reform government in Holyrood would use its first budget to cut all income taxes to below England’s, across every band, for which we will need to find savings of £2bn, or just 3% of Holyrood’s budget – savings that will come from cutting the devolved civil service’s rapidly bloating bureaucracy, which has seen its headcount swell by 72% in just the last ten years.
And a Reform government would do everything it can over the following years to ensure that, whatever your income, for every extra £1 earned you always keep at least 50p of it.
To illustrate what that means, the tax cut alone would immediately mean an extra £5,200 per year in extra take-home pay for a hospital consultant with a year’s experience, while smoothing away the punishing cliff edges would mean that they will no longer be forced to cut back hours – with similar effects across the entirety of the public and private sectors too.
We cannot afford another five years of the other parties failing to address these fundamentals, and giving us the same old story: of having to increase spending for public sector raises, of raising income taxes to pay for it, and so of taxing it back off those very same workers while failing to fix the underlying problem. With the private sector stifled in the process as well.
The only party offering a fundamental change on May 7th – of sensible taxes and a more productive public sector – is Reform UK.
