scaredypants – Member

I think Hunt’s proposal may impose a slightly lower overall weekly max, but there’d be essentially no limit to what proportion of that weekly total could be during what used to be unsocial hours due to the removal of what, effectively, is a financial disincentive fror trusts to make individual doctors work very long daily hours without appropriate breaks/rest

right now, if a hospital assigns a Doctor too many hours, in excess of their contract, the hospital can be fined.

Hunt wants to remove that penalty, there will be NO effective barriers to the number of hours imposed on doctors. The limits offered by Hunt are in effect ‘Guidelines’.

Guidelines that will probably have to be ignored.

so, how would we all feel about a new contract being forced on US, that removed all effective limits on our working week, and came with a pay-cut?

i’m not *completely* convinced that the tories want to break the NHS, forcing us all to pay up-front for health care, but if it quacks like a duck…

I have no idea what you wrote after that as I struggle to believe anyone thinks this about any govt let alone this one on this issue. I therefore had no interest in what you subsequently thought

Ok what has the government said (not what you think they said) that does not make sense? I mean their aims make sense. I am not naive enough to think there aren’t some other motives the Torys have hidden away.

I am not on the side of the government or the doctors, have no ideological leaning when it comes to the NHS.

but there’d be essentially no limit to what proportion of that weekly total could be during what used to be unsocial hours

And the problem with that is what exactly? So if I read that correctly then the doctors are campaigning to keep longer working weeks, but at the positive of minimum weekend or night shift work?

that’s all kinds of wrong.

Doctors definitely aren’t complaining about working weekends.

(although one of their minor* complaints is that weekend-work will face a pay-cut)

(*as in, they have issues they’re more cross about, i’m not trying to suggest a weekend pay-cut is not a kick in the balls)

I therefore had no interest in what you subsequently thought

You do seem to struggle with the data and interpretting it 😉

Ok, lets say the doctors agree the new contract – if we want 24/7 health care what do people want to drop from the week time to run at weekends ?

As there are no more staff to go round what or any more money to recruit ones we are going to have to cut services from the week to put them on at weekend ….

Something doesnt make sense to me !

And why didnt I see headlines of cancelled operation for the royal wedding ? there were more people in the nhs yesterday than there for for Will and Kate’s little day !

Ok what has the government said (not what you think they said) that does not make sense?

“7 day NHS”

What do you think that means?

How can you achieve it with the same numbers of staff?

And the problem with that is what exactly? So if I read that correctly then the doctors are campaigning to keep longer working weeks, but at the positive of minimum weekend or night shift work?

No, as mentioned, although Hunt’s proposal implies (I think) marginally shorter weekly hours, there will be fewer mandatory breaks and no comeback on trusts that breach the new “limit” anyway. CHanges to unsocial hours means that trusts can cheaply schedule rotas that are more disruptive and likely lead to more fatiugue amongst these doctors.
(Yes, I know that plenty of folk work disorienting shift patterns but most of them aren’t going to be looking after me when I’ve been under a bus)

My other concern over this: If the exisiting trainees are spread over whole fully operational 7 day weeks, then there are fewer of them around at a given point. Same for consultants. How would you ever get the 2 groups together for training ?

One question I have, if Hunt forces the contract change through do the Doctors have to sign it? And if they don’t what happens.

I ask, as when my contract changes and I need to sign a new one, if I don’t sign it I’m effectively being made redundant. Surely even Hunt would risk laying off all of the Junior doctors; I understand he wants rid of the NHS, so we can all move to privatized healthcare as its worked so well with other essential services that the Tories have moved into the public sector, but that doesn’t seem like a very canny move by him to do it so blatantly and out in the open.

more disruptive and likely lead to more fatigue amongst these doctors.

I’m not sure that’s true, if you add working Saturday but in doing so remove Monday, provided the hours stay the same then overall there is no difference.

How would you ever get the 2 groups together for training ?

Like any business you manage the company needs in terms of staffing, and then make everyone booked on the course come in the same day. It requires a bit of planning and good management but isn’t rocket science.

when my contract changes and I need to sign a new one, if I don’t sign it I’m effectively being made redundant.

Presumably this is still the case with the doctors. Maybe 5% wouldn’t sign it, but I’m sure most have lifestyles etc. that require earning money, and it isn’t like there is another employer they could rush too. But that really would be a nuclear option by both parties and I don’t think the BMA and government are that stupid.

Ok what has the government said (not what you think they said) that does not make sense?

So many to choose from, let’s take Jeremy Hunt’s letter to the Chair of the Junior Doctor’s Committee for a concise example or two:

He starts with “this is not a cost cutting exercise. I can give you a categorical assurance that I am not seeking to save any money from the junior doctors’ pay bill…
… these changes would be cost neutral, rather than cost saving.”

And insists that the BMA calculations are wrong, hardly anyone will get a paycut, despite plenty of worked examples to the contrary.

And then he repeatedly tells the media that this is an 11% pay rise! And then repeats it so much that people think this dispute is about greedy doctors wanting more money!

Of course this is all driven by the need for a seven day NHS isn’t it? He’s made that clear.

Odd then that in the same letter he says: “Junior doctors already work seven days and are the backbone of medical care in hospitals at weekends and at night.”

And of course he says “we must eradicate the ‘weekend effect’ of excess deaths in NHS hospitals”, despite the fact that the paper he is basing the “weekend effect” figures on says quite clearly that it would be “rash and misleading” to think these deaths were preventable as it doesn’t account for the fact that fewer patients are admitted at weekends and they are likely to be sicker and thus at a higher risk of death.

http://www.bmj.com/company/wp-content/uploads/2014/07/NHS-weekend-deaths.pdf

And insists that the BMA calculations are wrong, hardly anyone will get a paycut, despite plenty of worked examples to the contrary.

When Hunt said that the BMA’s calculations were wrong he was completely correct.

The calculator on the website that many JDs were using to calculate their “loss” wasn’t underpinned by the data from the actual discussions or offer, just the BMA’s original guesstimate of what would be offered and the rule tables hadn’t been checked properly with the result it overestimated the losses and underestimated the increase in basic pay and didn’t take into account the increase in pensionable pay on overall remuneration.

When this was pointed out the calculations were very discretely removed in the third week of October and replaced 2 weeks later with one that produced very different (higher) pay forecasts which is precisely why quite a few medics have gone from being adamant they would lose out to now saying the calculator tells them their income won’t change.

With this level of opacity and when some of the BMA’s negotiators have compared the Secretary of State to Nazis and also said they are intent on using the disagreement to fight a proxy dispute with the government about its Austerity agenda it’s not difficult to see why the discussions so far have been less than constructive.

Both sides need their heads banging together but any negotiation in which one side compares a pay dispute to actions in the Holocaust is completely unacceptable – particularly when this is done in the name of professional that commands almost universal public respect.

The basic flaw in Hunt/the government’s logic is that they want the NHS to be truly 7 days a week, but have repeatedly said there is no extra money to pay for this.

Whatever way you cut it they want 2 extra days a week out of the NHS whilst paying the same salaries, that is obviously a pay cut

Whatever way you cut it they want 2 extra days a week out of the NHS whilst paying the same salaries, that is obviously a pay cut

Not necessarily, as it is all about using resources as effectively and efficiently as possible.

Not necessarily, as it is all about using resources as effectively and efficiently as possible.

Is that a hand-waving way of saying that you’d reduce capacity during the rest of the week?

The biggest resource the NHS has got is its staff. “Using them as efficiently as possible” generally means doing more work for the same pay in my experience.
If we are talking about resources like Mri scanners then fair point. But we’re not.

Is that a hand-waving way of saying that you’d reduce capacity during the rest of the week?

Probably yes.

Like any business you manage the company needs in terms of staffing, and then make everyone booked on the course come in the same day. It requires a bit of planning and good management but isn’t rocket science.

It’s not a course – they learn while they work, under senior supervision. Cons teach SpR’s, they teach SHO’s etc

Oh wait, I see – Ah, you should have said. He’s increasing numbers isn’t he ? What silly people we were to distrust him

How can you achieve it with the same numbers of staff?

Instead of having hospitals understaffed a weekends you spread that out over the weekdays. As per @dragon above

The Troies have committed an extra £8bn pa to the NHS which is what the NHS was asking for. Labour committed £2bn pa.

I want a much much better NHS than we have but people won’t vote for the tax rises for everyone that will be required. As my many NHS friends agree its very good at critical care, otherwise there are many things its really quite poor at given how rich a country we are. As an aside a provitised BT is about a million times better than the state owned one, when did you last have to wait 3 months for a new phone line ?

understand he wants rid of the NHS, so we can all move to privatized healthcare

@rich this is just scaremongering nonsense, see the budget increases I noted above. It is however true the NHS is quite unlike healthcare in say Germany, France or Switzerland. Open your eyes to the fact that might not be a good thing

@GrahamS if doctors are so badly treated and paid how come the queue of applicants to study and work in the NHS is so massive ?

this is just scaremongering nonsense

And yet here you are, the Tory faithful, telling us how much better off we would be if it was broken up and privatised?

@GrahamS if doctors are so badly treated and paid how come the queue of applicants to study and work in the NHS is so massive ?

If the queue of applicants is so massive why are so many wards understaffed and why do we rely so heavily on recruiting foreign doctors?

@GrahamS if doctors are so badly treated and paid how come the queue of applicants to study and work in the NHS is so massive ?

There are holes in rotas at virtually every hospital in the land

The biggest resource the NHS has got is its staff. “Using them as efficiently as possible” generally means doing more work for the same pay in my experience.

Using NHS staff efficiently also means a whole bunch of other things as well:

– Using experience correctly. There’s still plenty of day to day work that can be done to the same standard by less expensive resources thus releasing the more experienced / expensive staff to focus on more complex treatment and getting it right first time. A good example of this in Primary care is the use of prescribing Pharmacists and Nurses to relieve workload from GPs – in many cases prescribing nurses make better decisions with Patients who are living with a long term condition.

Getting the diagnosis and care right first time, not the second or third time. This avoids unnecessary use of expensive diagnostics or having to treat the patient several times before the condition is properly managed. This typically reduces emergency admissions and associated in patient admissions.

Smoothing the flow – so instead of the peaks and troughs that occur for scheduled care, diagnostics suites, wards etc. making more continuous use of resources and thus avoiding the need for bank staff etc. This is well established on the continent but something UK Doctors say can’t be done her because it’s not possible.

Tackling the waste of resources caused by the separation of care / social care – this generally results in a “we’re not responsible” attitude on both sides, a massive waste of resources and the patient invariably stuck in the middle.

Breaking antiquated and inefficient working practices by using Technology to streamline and automate. Anyone who’s been on the receiving end of numerous letters all from the same hospital and same day confirming diagniostics all on different days will probably get this. The NHS hasn’t even tried to make it’s processes patient friendly and the result of this is missed appointments, endless telephone calls and for some patients – getting sick and requiring an otherwise avoidable emergency admission.

It is however true the NHS is quite unlike healthcare in say Germany

German doctors spend a third of their week contesting bills with insurance companies amid a climate of permanent reform

Yeah sounds great.

see the budget increases I noted above. It is however true the NHS is quite unlike healthcare in say Germany, France or Switzerland. Open your eyes to the fact that might not be a good thing

Healthcare spending as % of GDP, 2013:
UK 9.1 (downward trend)
Germany 11.3 (upward trend)
France 11.7 (upward trend)
Switzerland 11.5 (upward trend)

By a BANK – must be good !

NHS costs approx £2,200 pa for every man woman and child. As only about 55% of the uk population is working age that’s £4,400 in taxes required from every working person to meet the current budget

@scardey – exactly. We don’t spend nearly enough. To meet those amounts we would need an increase in taxes by wjat 20% (2.5/9) ? People won’t vote for it

@Graham, their secretaries should be doing that. The insurance / top up system is the one they have in France

People won’t vote for it

Then perhaps Jeremy should impose it upon them ?

The sad fact is, the NHS used to be 24/7 and it used to cost a lot less than it does now.

Doctors and Nurses used to command the respect their profession demanded, that along with other professions that used to be revered is no longer the case and the more they act like striking miners, tube drivers or any other group that gives maximum public inconvenience then the less public opinion they command and the stronger the Governments position.

You all might know good hard working Doctors, sadly I only know the opposite and as for Consultants what was it Nye Bevan said he had to do to get the greedy bastards to even accept the health service, ‘fill their mouths with gold’ I believe the quote went. Which is what jnr Doctors are working toward and it’s always been acknowledged that they work their butts off until they reach their nirvana of Consultancy where they become rich people doing as much or as little as they desire.

That is the common mans opinion and this striking none sense is not helping their case.

The sad fact is, the NHS used to be 24/7 and it used to cost a lot less than it does now.

The NHS is more 24/7 than it has ever been and it used to do a lot less than it does now.

That is the common mans twazzock’s opinion and this striking none sense is not helping their case.

FTFY. Seriously, put the red tops down and step away from Jeremy Hunt.

(Alternatively, maybe I shouldn’t feed the troll).

It’s not a course – they learn while they work, under senior supervision. Cons teach SpR’s, they teach SHO’s etc

Fine you adjust your shifts appropriately. Seriously all jobs have some form of on the job training and a lot are shift based and they manage this side of things fine.

NHS still is 24/7 or I think it is because if it’s I’m not sure where I’m supposed to be an hour’s time.

Stolen from another forum and I think it sums it up what will happen and the typical media response.

The government will impose these conditions on the junior doctors if they don’t negotiate.
Now let me figure this one out.
If they negotiate the government will end up imposing these conditions on them.
If they don’t negotiate the government will end up imposing these conditions on them.

Last night it’s reported that 3,500 operations were cancelled due to junior doctors taking industrial action

Let’s try a new headline.

3500 OPERATIONS WERE CANCELLED DUE TO THIS TORY GOVERNMENT THREATENING YET AGAIN TO USE BULLY BOY TACTICS, ON A SECTION OF THE PUBLIC SECTOR.

@Graham, their secretaries should be doing that

Are their secretaries really qualified to argue with insurance company medics about appropriate treatments and drugs?

Healthcare spending as % of GDP, 2013

As I understand it that table covers overall private and public expenditure on health. You can combine it with this table that gives you the % of that total healthcare expenditure paid for public funds and you get:

UK: 9.1% of GDP of which 83.5% public
Germany: 11.3% of GDP of which 76.8% public
France: 11.7% of GDP of which 77.5% public
Switzerland: 11.5% of GDP of which 66% public

So (I think.. scratching head..) that means you can say that healthcare expenditure as % of GDP from the public purse is:

UK: 7.5985
Germany: 8.6784
France: 9.0675
Switzerland: 7.5900

So it looks to me like even if we adopted Germany or France’s system we’d still need to increase taxes to reach their levels of healthcare spending.

NHS still is 24/7 or I think it is because if it’s I’m not sure where I’m supposed to be an hour’s time.

It’s daft to suggest that the NHS works exactly the same on weekends as it does weekdays – emergency services, sure, but not everything

I think it’s disingenuous and counterproductive to bullshit the public on that sort of thing – as it is to talk about basic salaries when “all” docs get additional payments. NHS is 5plus2halves and they can barely afford / won’t pay for any more than that. The man in the street (possibly excepting bluehelmet here 😉 ) can understand that AND would be able to compare those salaries with a) Jeremy’s and b) comparably high-flying graduates elsewhere

The BMA should be open & honest, talk plainly and that way show Hunt up for exactly what he is

It’s daft to suggest that the NHS works exactly the same on weekends as it does weekdays – emergency services, sure, but not everything

Yes but the Juniour Dr’s are working the same as they use to which is kind of the point.

NHS is a blackhole, which is fundamentally unsustainable with an ageing population, an increasing number of whom are living to a ripe old age many years after they retire.
It’s a pickle…but I’d rather drop dead at 65 and be done with it than go to endless hospital appointments whilst sucking yet more money which should be going to future generations.
An unpopular view, I understand.