THERE is an argument brewing, again, within the NHS. A “first-world problem”. It relates to those people in the NHS who are in the higher pay scale - typically those earning over £100,000 a year.

It relates to pensions and goes back to a budget when the then Chancellor George Osborne decided that those on high incomes should not get unlimited pension benefits.

The higher your income, the less your pension costs after tax concessions. For most people, for every £1 paid into their pension, it costs them 70p out of their net salary. For very high earners, it costs just 55p.

George Osborne argued that it was unfair that rich people were better provided for in both pay and pension, so capped the amount of investment people could put into their pension schemes.

He did this through a convoluted system of caps and tapers, coming in at around £150,000 income per year and with a lifetime cap of a little over £1 million.

For many people, these figures are unimaginable. But the effects of this on patients is only just coming to light.

NHS clinical staff – doctors, nurses, consultants and those who work in specialist areas – all do an incredibly valuable job.

Indeed, so valuable is their work that they frequently work overtime. In fact, given peaks and troughs in work load and a shortage of staff, we need our NHS staff to work overtime.

The NHS must build in an expectation that around 20 per cent of all hours worked are done so as overtime. The NHS pension is based on average lifetime earnings.

The NHS pays pension contributions on hours worked and the upshot of George Osborne’s pension reforms are that if a consultant or even very senior nurse is earning over £100,000, the increased hours worked, taking into account pension contribution and various penalties, means they get horrific unexpected tax bills.

These bills can be so big that some staff have had to take out second mortgages.

The result? They are worse off by working overtime and so, literally, cannot afford to do extra hours. Worse, they are replaced by agency workers who cost the NHS even more.

It is crazy. I met with the BMA last week and I agree that if we value our NHS staff, and we value our NHS, we simply cannot have a situation where staff must pay to come to work.