[Closed] doctors on strike

needs a sensible conversation about how to improve this - tax more or spend less on other stuff.

The problem with tax is that there isn't much headroom for tax increases, the UK as a % of GDP typically sits about where it is now ~36% and we normally spend ~40% of GDP.

The pay issue would be much less of an issue if good will hadn't been almost eroded and there weren't so many gaps in service - my other half is one of 2 people on a 9 person rota - i.e. there are 7 vacant slots. Try delivering efficiency and high quality when you are missing over 75% of your staff....

Very much this.

I work on a 52 bed Acute Medical Unit (Emergency Admissions for those who don't speak NHS!) which has a mix of Level 1 and 2 beds (42/10 split) split across two wards, within a large trust who have an Emergency Department that is one of the busiest in Europe for its size/design capacity.

In order to cope with an ED struggling to deal with a lack of capacity much of the pressure is put upon us AMU staff to "increase throughput" but, such is the pressure put upon staff within the department, we are hugely understaffed (most shifts see an agency/trust Band 5 split of 4/5). Even the decent agency nurses are now turning their noses up at working in the department due to caps on their pay. To counter this the trust have had (and extended since before Christmas) overtime bonus payments of £50 per shift to trust-employed nurses, even this is not enough, it's a taxed payment and few can see the point of doing extra shifts for such little compensation.

So where does this leave us? Well we rarely have full staffing, with the nurses who are supposed to be coordinating the individual wards (whose purpose is to help with throughput and thus increase bed availability for ED admissions) often pulled to work a bay instead. This then leaves the bed managers/duty managers the ones trying to sort out which patients are suitable to move to base wards/discharge home, but as there is no need for such managers to have a nursing/medical background it often leads to conflict/frustration with the Band 5 nurses looking after said patients who are ultimately responsible for their care.

We are an area which, if we were better looked after (correct staffing levels for starters), would hugely assist the ability of the trust and ED Department to meet their targets and thus reduce the fines the trust often gets for failing, yet we are treated poorly, are regularly used as the blame hound with regards to backlogs caused by high demand and consequently staff morale is often incredibly low.

To end, it's not about money (largely), it's about treating staff better. When the message from the top is "the NHS needs to start working seven days a week" (hey Mr Hunt, we already do) and the Right Wing press is banging on about how bad we all are at our jobs it's hard not to think "why bother" and go elsewhere.

Those who think privatisation is the answer, where do you think you'll get the personnel to staff such an organisation? If people are going to be forced to work in a privatised organisation then why stay in the UK, where (if current per capita spending were worked to) they'd have to take a pay cut in order to fit in the private sector's profit margin?

Must apologise though, given this has turned into a bit of a rant. Overall I love working for the NHS and love my job, you never know what you're going to see next and the staff are very close knit and, despite the demands placed upon us, we try to keep our heads held high. It can be very difficult to stay positive though.

mefty - Member

I think that it i pretty obvious what someone is going to say if they have written a book entitled

Market Driven Politics: Neoliberal Democracy and the Public Interest

And I mefty, think it's pretty obvious what someone like our present Health Secretary, Jeremy Hunt, who is responsible for a policy book in which it states, quote :

[i][b]"Our ambition should be to break down the barriers between private and public provision, in effect denationalising the provision of health care in Britain."[/i][/b]

wants to do with healthcare in our country.

.

docrobster - Member

What really annoys me is that the government does not have the guts to say publicly what it is doing and therefore be judged on it at the polling station next time around.

But it's clearly printed in black and white!

And the Health and Social Care Act 2012 couldn't have made it any clearer that the Tory goal is the dismantling of the NHS in England.

Unfortunately the electorate seems remarkably uninterested in what the Tories are saying and doing. But don't blame Tory politicians for that.

If people are going to be forced to work in a privatised organisation then why stay in the UK, where (if current per capita spending were worked to) they'd have to take a pay cut in order to fit in the private sector's profit margin?

I bet you in the private sector you'd get a pay increase due to market forces and there no longer being a monopoly that can hold wages down (i.e. the NHS).

At a fundamental level for an employee working in the private sector it is no better or worse than in the public, most of what makes work good or bad, is your manager, team etc. and there are great people in both and tossers in both.

Well if the profit doesn't come from cutting wages then it will have to come from increased pricing. The profit has to come from somewhere.

Which I guess is why healthcare provisions based on the private sector offer far less value for money than healthcare provisions based on the public sector - an excellent example of poor value for money is of course the United States.

If public sector healthcare provisions are unaffordable then private sector healthcare provisions are even less affordable - so obviously not the solution.

Well if the profit doesn't come from cutting wages then it will have to come from increased pricing

Or increased efficiency

Or less provisions.

Or through exporting expertise

Or poorer working conditions

BTW mefty this doesn't exactly inspire confidence that private health care providers are shinning examples of efficiency

[img] [/img]

There is a difference between private health providers and people who provide medical services, there is no proposal to change the system where healthcare is free at the point of use. But other the US, which is mad, I am not sure that graph proves a great deal.

It shows that the us has got it badly wrong.

Well I guess you think the graph doesn't prove a great deal because it doesn't quite fit into the Tory agenda.

However most people accept that the US relies heavily on private healthcare providers, much more so than other comparable countries. Most people also accept than the US devotes far more of its GDP on healthcare than any other country.

As I suggested, the example of the US doesn't exactly inspire confidence that private health care providers are shinning examples of efficiency.

Even the Washington Post reports that [i]"despite healthcare spending levels that are significantly higher than any other country in the world"[/i] a baby born in the U.S. is less likely to see his first birthday than one born in Cuba.

There is an increasing voice from a wide variety of sectors that NHS funding is way too little and it needs a sensible conversation about how to improve this - tax more or spend less on other stuff.

The problem there is that the model of NHS healthcare funding is predicated on the fallacy of demand as a constant rather than human nature resulting in it inevitably growing to outstrip demand.

It doesn't matter how much more you pour into the NHS - every time you add more money, the system will grow to do new things - keeping people alive longer, using up more resources, the continuing medicalisation of the human condition.

What *exactly* is the role of the NHS - if fifty years ago you had suggested that fertility or gender identity were responsibilities of the state (and thus the the taxpayer should fund treatment for) you would have been laughed at, where should it stop? Impotence, male pattern baldness? paedophilia? are they all medical issues that the NHS should treat as well?

Yes we need to address demand.
But why do we have treatments available for make pattern baldness etc, this constant medicalisation of normal life?
Profit motive.
Whether it is the state paying, or individuals either directly or through insurance, the constant need for profit drives the supply which feeds into demand.
[url= http://www.bmj.com/too-much-medicine ]Toomuchmedicine[/url]

Are they still on strike? Crikey.

correct staffing levels for starters

Well said, sootyandjim. Excellent post.

Good question Chewwy. Have you tried googling?

ernie_lynch - Member
Good question Chewwy. Have you tried googling?

where should it stop? Impotence, male pattern baldness? paedophilia? are they all medical issues that the NHS should treat as well?

Nhs already treats impotence and has done since long long before sildenafil. Public funding (rarely delivered under nhs budgets) also attempts to manage the risk of paedophiles through psychological interventions. If you want to call that 'treatment' you can but both are very much already resposibilities of the state and very much taxpayer funded.

Perhaps you would care to say whether you think these conditions are worthy of state/taxpayer funding or not and why? Male pattern baldness the only one i would question at all, dependent on age and impact on functioning and ability to contribute to socisety and as a taxpayer.

Well I guess you think the graph doesn't prove a great deal because it doesn't quite fit into the Tory agenda.

No because that graph shows how the health spending is funded - if the Tories privatized every hospital, out patient clinic etc etc that graph would not change as the state would still be paying for the healthcare not an insurance company. It therefore has absolutely no relevance when you are talking about provision of medical services to the NHS.

But why do we have treatments available for make pattern baldness etc, this constant medicalisation of normal life?
Profit motive.
Whether it is the state paying, or individuals either directly or through insurance, the constant need for profit drives the supply which feeds into demand.

The first known written treatment for baldness is from 1553 BC - a thousand years later, Hippocrates was obsessed with treating it.

It think its difficult to blame it on Big Pharma

^^that's a funny but ultimately ill-informed comment.

Where do you stand on adhd and methylphenidate?

if the Tories privatized every hospital, out patient clinic etc etc that graph would not change

That's your opinion, apparently.

However if "the Tories privatized every hospital, out patient clinic etc" then you would indeed expect the graph to change.

Or are really suggested that healthcare spending in the UK would not increase in GNP percentage terms if it was all in the hands of profiteers?

chewkw - Member

I have given up on googling the outcome ... too long winded.

So you're not actually interested.

Just fancied trashing another thread?

ernie_lynch - Member

chewkw - Member
I have given up on googling the outcome ... too long winded.

So you're not actually interested.

Just fancied trashing another thread?

I am interested but can't be arsed to find out more because the argument is always the same, hence I just want to know the final outcome?

No, not trying to trash thread and you are giving me too much credit there. Imagine if I can trash a thread then what does that make you lot?

you are giving me too much credit there.

Believe me I'm not.

You came along and made one of your usual pointless and inane comments. I know it's about as much as you can manage.

ernie_lynch - Member

you are giving me too much credit there.

Believe me I'm not.

You came along and made one of your usual pointless and inane comments. I know it's about as much as you can manage.

Okay, since you think that I made pointless comments I shall elaborate. My opinion so if I am wrong I am wrong but that's how I read the current situation.

1. The NHS is unsustainable because it has grown so big now everyone thinks it's "free" hence consider them natural entitlement.

2. The question of entitlement means we now have the full rights be treated "free" and the funding should come from the "have" rather than "have not". (the blame on the "rich" in trying to take away the free services provided to the poor etc)

3. As the coffer is getting lower the govt decides that an intervention is called for but objection starts which is normal.

4. The stake holders - The public, the employees and the govt - none of which wants to give up their ways.

5. The public demand free services because health etc is the fundamental human rights but someone got to pay for it who?

6. The employees demand better work condition i.e. not long working hr and certainly no pay cut (might even demand more). The only way through this is to use their bargaining chip to escalate their demand. i.e. The public health.

7. The govt knows their coffers are running dry slowly and that to sustain a system that growing is going to be very difficult, so try to intervene before they are blamed. This means "rationalisation" or "re-engineering" but that is wishful thinking because other stakeholders will not co-operate.

The bottom line is that the NHS system will slowly degenerate into a mega bureaucratic system where it will so huge it will suck the life out of those who want to improve it.

The public health is now used as political football.

The question is who is going to score their own goal first?

Have you found out if the junior doctors are still on strike yet?

ernie_lynch - Member
Have you found out if the junior doctors are still on strike yet?

[url= http://www.independent.co.uk/voices/the-junior-doctors-strike-is-over-but-the-fight-to-save-the-nhs-is-just-beginning-a7040991.html ]News here from the Independent[/url]

Now it says battle to save NHS ... I see another strike sometime in future don't you?

So you know the answer despite asking "Are they still on strike? Crikey."

Jolly good. Any more questions that you know the answer to?

ernie_lynch - Member
So you know the answer despite asking "Are they still on strike? Crikey."

Jolly good. Any more questions that you know the answer to?

I don't know the long term answer or the future hence I want to know if they are still on strike or intend to strike again in future.

I want to know if they are still on strike or intend to strike again in future.

Are still they on strike (i.e. actively taking part in industrial action)? No.

Has the threat of strike passed? Well an agreement has been reached and the BMA will put it to its members. They won't strike again until the members are consulted. I think it is unlikely that the members will want to strike again over this particular issue.

That answer it?

Oh and..

The employees demand better work condition i.e. not long working hr and certainly no pay cut (might even demand more).

At no point did the junior doctors strike to demand better work condition or more pay.

I'd be amazed if you could read this read and believe that.

They did strike to [i]prevent[/i] what they believed would be [i]worse[/i] working conditions and worse pay.

Their "demand" was essentially "don't make things worse!"

This doesn't increase demand for health services at all.

Thanks GrahamS.

So it is in consultative period ... interesting.

At no point did the junior doctors strike to demand better work condition or more pay.

I'd be amazed if you could read this read and believe that.

They did strike to prevent what they believed would be worse working conditions and worse pay.

Their "demand" was essentially "don't make things worse!"

Okay, fair enough.

docrobster - Member

This doesn't increase demand for health services at all.

Okay, okay no toenail please ...

This doesn't increase demand for health services at all.

Well I don't expect that many people are languishing in A&E departments with severe cases of onychomycosis, or that many GPs are referring their patients with dodgy toenails to hospital specialists, so in that respect probably no.

But I guess the fact that Trosyl or Terbinafine require prescriptions probably does at least put some burden on the NHS.

you can buy amorolfine ernie - if you cared about the NHS you would 🙁

A toenail infection can be caused by diabetes, poor circulation, a weakened immune system, or sweaty trainers. I'd rather go to A&E just to be sure.

Well I don't expect that many people are languishing in A&E departments with severe cases of onychomycosis...

I think you'd be surprised at the pathetically minor ailments some folk do turn up at ED for. It's very difficult sometimes to stay professional and not tell people to man the $#@€ up and do one, it really is.

My 'favourite' is a regular attender who lives in the countryside and comes to hospital with 'heart pains' to get a bed for the night, when he misses the bus or doesn't have enough money to get a taxi home after drinking sessions in town. Every time he comes in we run the same tests on him, ECGs, cardiac monitoring for the night, even an angio a few times. All the time he is demanding this and that be provided, complains to anyone and everyone that he isn't being taken seriously etc. Then he sobers up in the morning, packs his few belonging and self-discharges.

There are also any number of folks who claim 'vomiting/abdominal pains' because they rather like effects of Morphine and Cyclizine.

One of them was sent packing a few years back so went to the local press to complain, hospital can't comment without said person's consent (which they obviously didn't get) so hospital gets ripped to pieces in press for sending poorly/borderline junkie* (*delete as appropriate) person away.

A toenail infection can be caused by diabetes, poor circulation, a weakened immune system, or sweaty trainers. I'd rather go to A&E just to be sure.

Are you taking the piss?

sootyandjim - Member

Drac - Moderator

ernie_lynch - Member
A toenail infection can be caused by diabetes, poor circulation, a weakened immune system, or sweaty trainers. I'd rather go to A&E just to be sure.

Are you taking the piss?

Are you taking the piss?

Why - what makes you think that?

Drug companies aren't allowed to advertise prescription only medicines to the public, so they advertise the "disease" instead.
Only in this case its not really a disease is it, its just discoloured toenails generally.

Comments like
"many GPs are referring their patients with dodgy toenails to hospital specialists,"
rather miss the point. Do we only count secondary care spending now? I know GP is an infinite resource but...

rather miss the point

I was trying to figure out how much stress dodgy toenails were putting on the NHS.

Well clearly toenails on there own aren't much more than a minor annoyance.
The point I was trying to make was the general medicalisation of all of life's woes is a problem.
Kids that fall outside society's accepted behaviour patterns, adults whose shit life makes them feel sad, pensioners who don't see a living soul from one week to the next, these are all now medical issues that must be treated by doctors with drugs.
It's not exciting hi tech life and death stuff like what makes good telly, but it's much more common than the exciting stuff those clever hospital doctors deal with and it is something that we as a society now need to provide a health service for.
I've probably seen one too many today so I'll leave it there and open another beer!