What is going on in our Health Service,when intelligent hardworking people feel the need to go on strike.Jeremy Hunt health minister has a daft smirk on his face telling Doctors to talk.
They have been talking for ages Jeremy and you are not listening.Either pay the Doctors or expect them to leave and what are we going to be left with? What about consultants availability on weekends taking some of the slack.What do the folks on here think or want to say about the shambles in the N.H.S.
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What are they striking about Dutchie? How has been the style of and behaviour within the negotiations by both sides until now? Why do you believe that the Doctors should not talk?
Is it as simple as if someone asks for money then you give it to them?
Where do you see that money coming from? Increased taxes? Less drugs? Less police?
By what standard is the NHS a shambles? By what metric(s) should it be judged?
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I don't really think the NHS is a shambles.
Those of us who have really needed it, with very expensive treatment, have always had it.
True there are cases in the public domain where it has been denied and mistakes have been made but we never hear of the ordinary people, getting excellent treatment on a day to day basis because they are pleased with it.
I think junior doctors are a bit like lorry drivers...they like to complain about the long hours they work.
Offer them a solution that means they will work less hours but earn less money, and they complain about that too.
I may well have that all wrong, but it is as it appears to me.
Pat
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I/we have always had excellent treatment/service from the NHS.
As I've said before, we can have the absolute best healthcare in the world, free at the point of delivery, IF we (the public) are prepared to pay for it by taxation.
What I do find discouraging is that so many of our UK trained doctors and nurses leave the country to practice elsewhere, while at the same time we are replacing them with doctors and nurses trained abroad, many from countries with severe shortages of medical expertise themselves.
It's a lose, lose, situation for all parties, surely?
How to solve it is another question, to which I have no answer, but who does?
Last edited by: Roger. on Tue 12 Jan 16 at 17:48
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>>How to solve it is another question, to which I have no answer, but who does?
Make all medical training free in exchange for agreeing to work 10 yrs in the UK system.
Make all medical training expensive in exchange for freedom to work anywhere for, presumably, more money.
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>>Make all medical training expensive in exchange for freedom to work anywhere for, presumably, more money.
It is expensive already. My eldest is already over £50k in debt and only half way through year 4!
Tuition Fees £9k per year, accommodation £5k per year, books £0.5k per year, suits, travelling £3k, etc, etc, etc.
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>>t is expensive already
Agreed.
But if your eldest had been able to do an equation / decision process that said;
Expensive training + freedom to work anywhere versus free training + NHS for 10 years
Surely to everybody's potential advantage?
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Results in with a PASS. No grading for medical degrees. Apparently got a Bachelor of Medical Sciences at the same time.
Starts as an F1 at a major southern hospital in August.
All at chez zippy are overjoyed at the result!
Really pleased that I don't need to pay any more cash out until October when the youngest starts at Uni! Doh!
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Congratulations to eldest. A difficult thing to achieve.
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>> Congratulations to eldest. A difficult thing to achieve.
>>
Ta, eldest is a very hard worker and certainly worked for this!
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Congrats to here too.
I suspect the work gets even harder from now on.
Last edited by: Bromptonaut on Mon 3 Jul 17 at 20:51
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>> Starts as an F1 at a major southern hospital in August.
>>
....Congratulations.
Is she on strike, yet?
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>> Is she on strike, yet?
>>
Won't have time to! Emails received with two years of placements fully planned out with days and hours / shifts etc. All based on the NEW contracts.
A copy has been sent to the BMA for a free check.
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My congratulations too. Very well done I have a good idea how hard it is.
Enjoy the graduation ceremony.
Lots more exams to come but less financial stress for you.
We are off to our daughter's fourth medical graduation in two weeks time.
Of course she is still classed as a junior doctor.
(Other medical diversions have gained her valuable experience but delayed her becoming a consultant.)
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Niece is now a doctor and headed towards being one of the youngest consultants in the UK. Lots of hard work involved.
She trained with this guy.
en.wikipedia.org/wiki/Jamie_Roberts
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>> I/we have always had excellent treatment/service from the NHS.
>> As I've said before, we can have the absolute best healthcare in the world, free
>> at the point of delivery, IF we (the public) are prepared to pay for it
>> by taxation.
We do absolutely have the best healthcare free at the point of delivery. Sure there is better healthcare around, but not truly "free" like ours.
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www.bbc.co.uk/news/health-34775980
Explanation for Mark^
It's not about money as such.
Hunt wants more NHS services to be 7 days a week or 24/7. The rhetoric centres on higher death rates at weekends, although the validity of some of the stats quoted has been questioned.
Trouble is most junior hospital doctors (a junior doctor AIUI is any doctor who isn't a consultant) already work some nights and weekends. But currently they get paid anything between time and 1/5 to double time for hours worked outside of 0700-1900 Monday-Friday.
Because Hunt wants more doctoring at weekends, wage costs would go up. So what he proposes is a more level rate, compensated for by a general rise of 11% in the basic rate.
Some doctors (the ones who work the greatest proportion of the most unsocial hours, presumably) will be worse off. There is a "buy out" which must be hideously complicated that should guarantee that nobody loses out, but that is a transitional arrangement that lasts three years.
Hunt is also removing 'increments' and replacing them with rises linked to training completed, which on the face of it sounds reasonable but is almost certainly more complicated too.
This sort of thing has been happening to nearly every occupation for years. What employers ideally want is people on a flat hourly rate on contracted hours (or in some cases zero hours), that they can roster when they need them.
It's an erosion of the general quality of life, but that train left the station a long time ago, so if I was advising the doctors I'd be telling them to get the best deal they can - they have nothing to lose by dragging it out, and NHS staff tend to have quite a bit of public sympathy behind them.
Hunt has a point, although probably not the one he shouts about. There is a lot of expensive kit in the NHS that isn't fully utilised at weekends, so if all those routine tests and elective surgeries were spread over 7 days it should be possible to improve productivity/do more for the same money.
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I think I said that in a lot fewer words than you Manatee:)
Pat
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Junior doctors work immensely long hours now for not much money. Under these proposals they would actually work less hours, for not much less money. I'm confused.
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>> I think I said that in a lot fewer words than you Manatee:)
>>
>> Pat
You usually do.
But I don't think most of them will be working fewer hours. The hospitals will be expected to operate more services 7 days a week, and the changes mean that hospitals can put more unsocial hours on them, collectively, at lower cost. So they will.
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Thank you Manatee.
Although my point was really did Dutchie know what was going on, rather than trying to find out myself.
Having said that I did learn a lot from that article, so thanks.
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I get the vibe that this has all been handled very poorly from the off.
As has been said above Hunt wants to reduce the premium rate for working the weekend hours while at the same time reducing the hours for which the premium rate applies which means that even with an increase of 11% the doctors could still see themselves working longer hours at weekends for less pay even with an increased base hourly rate.
On top of this, as I understand it, the hospitals also have a cap imposed on the hours they can ask a junior doctor to work in a single shift at weekends at present and that going over this cap results in some form of financial penalty to enforce the cap. I believe that this is being removed so the hospitals now have no incentive to not roster a doctor to work longer hours than they do currently.
The upshot is that the doctors now see the potential that they will rostered shifts well in excess of 12 hours at weekends and at the same time receive less for working them.
The reason I say this has been handled badly is that these sort of changes can be handled with carefully considered negotiation, similar changes have been handled in my industry without recourse to industrial action and an outcome acheived which aas accepted by both sides.
In our case the management came to us with proposals and asked for discussions, this was handled in a pretty grown up manner. It would appear in the doctors case Hunt came along and tried to impose the new contract with no discussion as a fait accompli, eventually he agreed to negotiations but only on one or two of the clauses if they accepted the other 21 as a condition of any negotiations taking place; a stance I would not suggest conducive to a meaningful constructive outcome.
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>>The upshot is that the doctors now see the potential that they will rostered shifts well in excess of 12 hours at weekends and at the same time receive less for working them.
That's the impression I get and the eldest has been told that if they make a mistake causing injury or death due to exhaustion, then they should expect to be prosecuted and struck off!
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Hunt has a point, although probably not the one he shouts about. There is alot of expensive kit in the NHS that isn't fully utilised at weekends, so if all those routine tests and elective surgeries were spread over 7 days it should be possible to improve productivity/do more for the same money.
>>
Not sure they can get any more use out of it. If there is only the same amount of people to use the kit then i don't see how they'd get any more use of it?
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>> Not sure they can get any more use out of it. If there is only
>> the same amount of people to use the kit then i don't see how they'd
>> get any more use of it?
Spread the hours around a bit more, where the bottleneck is machine time rather than people? As demand grows, there'll have to be more people anyway, but they might not have to buy as much kit.
I don't think the doctors will work any fewer hours BTW, with the exception of those who are currrently working more than the new cap. I can't see how doctor-hours can be reduced in total, as demand only grows and now Hunt wants the orspickles full personned 7 days a week.
The BMA, according to my retired doctor friend, is a reactionary body that does more harm than good to progress! And he's 85!
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The root cause of unused theatres and equipment at weekends is not with the Junior doctors, it lies with the consultants, who somehow manage to get paid a shedload for turning up (or not) as they wish in the NHS, and then using NHS time earning megabucks in the private sector As well as acting like complete arrogant pigs in the process.
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Not all operations are done by consultants. Some quite senior doctors are junior doctors.
The consultant thing is a racket though. BMA again!
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Quacks are all right, and usually conscientious. They work long hours but have days off and aren't badly paid.
Managers are a big problem. They are paid far too much for what they do, and what they do is often more harm than good. They ought to be suppressed, but they have the capitalist system behind them. No doubt some are all right. But I don't want to have to get past them to see the doc. Nurses are perfectly OK so what are managers for?
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>> consultants, who somehow manage to get paid a shedload for turning up (or not) as they wish in the NHS, and then using NHS time earning megabucks in the private sector As well as acting like complete arrogant pigs in the process.
Have you been scolded or snooted by one Zero? No doubt some behave like arrogant pigs, but the ones I've had truck with seemed conscientious and perfectly civil.
They are often quite busy and have more excuse for being rushed and a bit rude than managers for example, whose manners can be very poor.
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Have you been scolded or snooted by one Zero? No doubt some behave like arrogant pigs, but the ones I've had truck with seemed conscientious and perfectly civil.
They are often quite busy and have more excuse for being rushed and a bit rude than managers for example, whose manners can be very poor.
In my experience, consultants are more easy to contact directly than my GP. Two of them now have given me their email address, a favour I am very careful not to abuse (I'm utterly deaf, can't do phone calls). Getting a message to the GP though requires going through the front desk - and I was lucky to get that email.
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I have had significant contact with 3 consultants in recent years;
One treated me and was excellent, the second treated my wife and was sufficiently bad that he, and the hospital, waived the multi-£000 fee and the last almost killed my daughter and wrote us a cheque purely out of the goodness of his heart - no admission of liability, you see.
The problem with consultants in my opinion is the lack of challenges they face from other members of the medical establishment. It is not a self-healing environment, whereas I think GPs, for example, mostly are.
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>>The problem with consultants in my opinion is the lack of challenges they face from other members of the medical establishment.
True. Eldest advises that whilst most are good, some are very arrogant. One example introduced himself to her by asking when she was going to have children and stop being a burden on the NHS and then refused to speak to her until she started asking questions of the anaesthetist, he got jealous and spent the next week pouring out advice and ensuring that she was included in all consultations and surgery.
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>> The problem with consultants in my opinion is the lack of challenges they face from
>> other members of the medical establishment.
Spot on.
Around a year ago Mrs B got a respiratory infection which left her with a persistent hacking cough. GP couldn't sort it and referred her to an ENT consultant at Northampton General Hospital under the '14 day rule' ie possible cancer. Request was for a camerascope as far as her larynx.
Consultant was, from start, brusque to point of rudeness. Camera is a fibreoptic thing inserted via the nose. Anxiety and unfamiliarity made it difficult for erin to follow his instructions resulting promptlyin him saying in saying 'if you'd done as I told you it would be over by now'. The word empathy was completely missing from his vocabulary.
Result was all clear but we really should have made a formal complaint.
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The word empathy was completely missing from his vocabulary.
I think that's quite common in older senior consultants, it is in the ones I've met. But I generally just be as brusque with them as they are with me. I've found the appointment goes better from then on.
I do wonder where they learn this from or does being a consultant just attract those who don't know how to talk to others?
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>>I do wonder where they learn this from or does being a consultant just attract those who don't know how to talk to others?
Doctors are generally decision makers - some decision makers are inclusive and empathetic, some are dictatorial and rude.
I probably make 2-3 critical, 4-5 serious, and 50-60 trivial decisions each day at work dealing with patients, referrals, results and correspondence. The expectation is that every one of these decisions will be 'correct' - the reality of course is that you can't be right 100% of the time.
One problem is that doctors are taken from a very narrow pool of academic high achievers - just because someone has AAA in their A-Levels does not necessarily mean they will evolve into a good (or happy) decision maker.
It also means doctors are chosen from a group of students who are likely to have been very self-sufficient, driven, and have had little taste of failure/uncertainty in their pre-medical lives.
Those who don't learn how to deal with uncertainty, mistakes, and other peoples' opinions can become arrogant jerks.
Last edited by: Lygonos on Thu 14 Jan 16 at 21:04
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>> It also means doctors are chosen from a group of students who are likely to
>> have been very self-sufficient, driven, and have had little taste of failure/uncertainty in their pre-medical
>> lives.
>>
>> Those who don't learn how to deal with uncertainty, mistakes, and other peoples' opinions can become arrogant jerks.
Interesting I suppose that does follow. Although it's not always arrogance when I said can't talk to people. Some look very awkward, like a teenager at their first job interview, seen a few like that. Not that there is anything really wrong with that, it does surprise me when I see it in senior drs.
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The only one I'm wary of, I discussed with other patients and discovered he was a knife (scalpel) happy chap... Wanted to carry out a procedure that I've been told by two, perhaps three other consultants would not work on me. (The procedure has worked on one patient - but my understanding is that is pretty unique as on others it has not).
My mum (a qualified nurse) always warned that some consultants were knife happy but the one above is so far, the only one I've encountered.
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Twenty years ago, when I was a rookie heart patient, I used to go to the clinic at the local hospital for a check. The consultant I saw regularly was an aloof, elderly man obviously no longer trusted in theatre and working his ticket.
One day he had three or four students with him and was showing off. He noticed a box of drugs that were made in Slough and started quoting Betjeman's poem to the lads. He only got two lines out when I corrected him and threw in a few lines by Tennyson about death for good measure.
I don't think he liked that, Probably thought I was a dumbo.........never saw him again !
I'm a poetry loving dumbo !
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> Spread the hours around a bit more, where the bottleneck is machine time rather than
>> people? As demand grows, there'll have to be more people anyway, but they might not
>> have to buy as much kit.
>>
I suppose it depends on what the bottleneck is. I can't see it being worth it. How much demand is there on a Saturday night for all these services?
I know of someone tasked with trying to sort out the extra hours in an nhs dept. They set out the hours and to cover them they need an extra 40% in wages. The answer from from the gov is that there is no extra money.
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Horlicks to it all. 5 days. 7 days. Yabba yabba. So what. A day is a day is a day. Same rate for all. Why should £millions of £ worth of equipment lay idle at weekends? Ya work this weekend ya don't next. It goes around. I know its not that simple, but for Heavens sake things need to change. I don't get any more £ for Sunday over Monday. I don't really care.
I had a chap once who said that he wanted double time for a Sunday. I said "no problem". He smiled. I said you can work for 8 hours and get paid for 4. That's the only double time you'll get. He flocked off. No loss.
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Weekends are important to people, that's why double time exists. Might not matter a jot to you, but does to many. And still plenty of places offer very good overtime rates for weekends.
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>> Weekends are important to people, that's why double time exists.
Shift premiums for sunday are slowly - actually faster than slowly - disappearing, we are moving to a 7 day society, sunday is not what what it was.
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>> >> Weekends are important to people, that's why double time exists.
>>
>> Shift premiums for sunday are slowly - actually faster than slowly - disappearing, we are
>> moving to a 7 day society, sunday is not what what it was.
>>
>>
I can't speak for every industry and type of work. But it's around in the area i know of. Not even a weekend either, in the gap between xmas and ny, it was double time and a day off in lieu.
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>> I can't speak for every industry and type of work. But it's around in the
>> area i know of. Not even a weekend either, in the gap between xmas and
>> ny, it was double time and a day off in lieu.
Your area is becoming the rarity, it will change or it will die.
Take a bus driver. he starts on on an hourly rate, that may or may not include a premium for working shifts. But thats it. He wont get "double time" or "time off in leu" He signed to work a variable shift pattern at an hourly rate and that shift includes weekends /nights
Take train drivers. The drivers refuse to work weekends unless they get s shift premium. Train companies are taking on part time drivers just to cover that shift. At a normal rate.
Take an IT contract worker, has to be at a contract at the other end of the country in Monday morning. Will he get paid for travelling on Sunday? NO
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>> Your area is becoming the rarity, it will change or it will die.
Like i said i don't know every industry/job inside out, so i can't say. But no signs in the slightest of it moving.
Interesting about the train drivers, i thought it was expensive to train train drivers? Clearly not. Not an expert in the slightest but i would have got it cheaper to give them the overtime rather than train extra drivers?
Last edited by: sooty123 on Tue 12 Jan 16 at 21:37
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>> >> Your area is becoming the rarity, it will change or it will die.
>>
>> Like i said i don't know every industry/job inside out, so i can't say. But
>> no signs in the slightest of it moving.
It will come, those who wont will be replaced or outsourced by those who do.
>Interesting about the train drivers, i thought it was expensive to train train drivers? Clearly not. >Not an expert in the slightest but i would have got it cheaper to give them the overtime rather >than train extra drivers?
People go onto wait lists to get the chance to be trained as drivers. You pass all the tests, meet all the standards, and the train company will keep you hanging on for years and then expect you to drop everything and join a training stream. No shortage of applicants.
Last edited by: Zero on Tue 12 Jan 16 at 21:42
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> It will come, those who wont will be replaced or outsourced by those who do.
>>
Could well go in circles all night ;) should i hear of it changing you'll be the first to know ;)
Just to clarify it's not me getting loads of double bubble. Infact overtime whats that? But i do work with them and theres loads of money swilling around in the contract.
> No shortage of applicants.
Oh I've no doubt, i always thought for some reason or an other it was an expensive training course. Must be pretty cheap.
Last edited by: sooty123 on Tue 12 Jan 16 at 21:54
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>> Weekends are important to people, that's why double time exists.
I have no doubt... however, if you work in a job where 24/7 working is required, what's the problem? You knew that when you started, didn't you?
Working shifts or weekends has its advantages anyway, you get a day off mid week when it's quieter to do what you need to do.
This doctor thing is about money predominantly... they currently get overtime for working a weekend, which will change to a flat rate on a Sat and less overtime for a Sun.
It's happened with most other professions, so there's a degree of inevitability to it.
You can't really argue against the principle of 7 day health care.
Plenty of other organisations are 7 day working now.
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>> I have no doubt... however, if you work in a job where 24/7 working is
>> required, what's the problem? You knew that when you started, didn't you?
Fair enough but even in 24/7/365 operations there can be premiums for unsocial hours or working (eg) Bank Holidays. If the employer tries to move the goalposts the employees are entitled to protest.
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>>
>> Fair enough but even in 24/7/365 operations
Pendant Corner
24/7/52.
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>> >>
>> >> Fair enough but even in 24/7/365 operations
>>
>> Pendant Corner
>>
>> 24/7/52.
BZZZZ WRONG
24/365
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personally I am ok with either 24/7 or 24/365 as representing constant hours
24/7/365 just means 7 years of hours
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>> >> Weekends are important to people, that's why double time exists.
>>
>> I have no doubt... however, if you work in a job where 24/7 working is required, what's the problem? You knew that when you started, didn't you?
See above, people's 'premium' time attracts a 'premium' price. Some work 24/7 but still get extra for unsociable hours.
>> It's happened with most other professions, so there's a degree of inevitability to it.
>>
>> You can't really argue against the principle of 7 day health care.
>>
>> Plenty of other organisations are 7 day working now.
>>
I think many parts are in the nhs including these junior drs are 7 days already.
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>> Shift premiums for sunday are slowly - actually faster than slowly - disappearing, we are
>> moving to a 7 day society, sunday is not what what it was.
>>
>>
Very much so. This thing about moving to seven-day working is actually more about productivity, and it's been going on in the manufacturing and distribution sectors for many years. It makes sense from one point of view; that you're utilising your expensive equipment to its maximum potential. That's one reason you see so many lorries on the roads at weekends now, it's because many drivers work on a "four on four off" system or similar; likewise for night working. The old days when you used to go past a haulier's premises on a Saturday afternoon or Sunday and see the whole fleet lined up in the yard have long gone. If they ain't working they ain't earning.
I suspect the junior doctors are going to have to get used to it. After all, many of their patients have to.
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But the seven day week is not just about the junior doctors who work at the coal face, whether it be in A&E or on the wards. Its about the the whole structure including ancillary services and back office functions.
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>> But the seven day week is not just about the junior doctors who work at the coal face, >>whether it be in A&E or on the wards.
>>Its about the the whole structure including ancillary services and back office functions.
>>
Most of the time this aspect seems to be completely missed.
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"24/7" NHS is soundbite crapola.
You/I have a 24 hours NHS. It works well.
If I develop crushing chest pain now (10.30pm) and call an ambulance do I wait until morning? Of course not.
Likewise if I have started to have a slightly sore throat and a cough with runny nose (which I have!), should I expect my GP surgery to be open for this "emergency"? - Of course not.
There is NO need for 7 day/24 hour service provision for every eventuality - I have done Saturday surgeries in the past and they aren't full of working age unwell: 2/3 of the patients were the usual elderly guys who can attend any time.
We provide around 600-700 routine GP appointments Mon-Fri (more or less due to holidays) and fill more than 95% of these. We used to have 16 Saturday morning appointments and on average only filled 12 of them.
The demand is just not there.
If I had to sit in my surgery from 8am to 8pm on a Sunday to see 5 or 6 patients I'd go bonkers.
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>> There is NO need for 7 day/24 hour service provision for every eventuality
Couldn't agree more.
However, If I go in to hospital as an emergency on a Sunday at midnight and need 'x' on the hurry up, I'd like the same chances of survival as a patient who did so at noon on a Monday.
So, not everything needs to be 24/7.... but some of it is needed.. and isn't properly available currently.
Most of this current argument is about the premium rate payments for Sat and Sun. Most other professions have had this sort of thing removed or dramatically changed downwards (cost wise) due to the need to balance the country's books. It's caused pain and people don't like it, but it's a necessary thing.
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>> >> There is NO need for 7 day/24 hour service provision for every eventuality
>>
>> Couldn't agree more.
Indeed there isn't. but economically it makes sense to make use of the facilities 7x24. Its indefensible to have waiting lists, and redundant facilities at the same time.
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> Indeed there isn't. but economically it makes sense to make use of the facilities 7x24.
>> Its indefensible to have waiting lists, and redundant facilities at the same time.
>>
I suppose it depends on if we can afford to run those facilities 24/7 that are under used ?
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>> I suppose it depends on if we can afford to run those facilities 24/7
>> that are under used ?
There will be some cost, but it should be less than that of opening new facilities and buying extra kit to operate 5 days a week to take up extra demand.
Nevertheless, I agree with Lygonos. Much of the NHS is 24/7 anyway, and not all of it needs to be.
The agenda here is not what it seems. Much soundbitery, electioneering, gimmickry and a pretext to move a large number of employees already working round the clock towards a flat rate.
The nicest thing I can think of to say about Hunt is that he is plausible. His record does not suggest he is trustworthy.
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>> There will be some cost, but it should be less than that of opening new
>> facilities and buying extra kit to operate 5 days a week to take up extra
>> demand.
Yes, but that supposes that either of those options are likely to be available. It's possible, and it is something I've heard, that a very minimal/no increase in budgets is likely, whilst still having to bring in this 24/7 working.
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>>However, If I go in to hospital as an emergency on a Sunday at midnight and need 'x' on the hurry up, I'd like the same chances of survival as a patient who did so at noon on a Monday.
2 issues here...
1. What do you want to cut back on during the week to enable more staff presence at the weekend?
2. The higher death rate of weekend admissions is skewed because admissions at the weekend are more likely to be emergencies at the point of entry (eg. 65% of Sunday admissions are emergencies, vs 30% on weekdays and 45% on Saturdays), and also to be more likely to be in the category of patients deemed at highest risk of death (30% at weekend, vs 20% on a weekday)
There is no evidence that shifting the workforce into the weekend and out of the midweek will have any benefit on patient survival rates overall.
My gut tells me that the Govt have just put the English NHS through a massive upheavel to enable local areas run by the CCGs to decide how services are to be provided, and thus hopefully deflect the NHS crises that we will increasingly see onto the CCGs and away from central government...
... yet the Govt still want to further massively poke around the workings of the NHS with no evidence and political dogma to create a "24/7" NHS that we already have, and try to take credit for (despite the likelihood it will overall be worse than before).
All the while tinkering around with privatisation.
I wonder which cabinet members will end up on the Boards of Serco, G4S, etc in the next 10 years.
Last edited by: Lygonos on Wed 13 Jan 16 at 15:19
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>> 2. The higher death rate of weekend admissions is skewed because admissions at the weekend
>> are more likely to be emergencies at the point of entry (eg. 65% of Sunday
>> admissions are emergencies, vs 30% on weekdays and 45% on Saturdays), and also to be
>> more likely to be in the category of patients deemed at highest risk of death
>> (30% at weekend, vs 20% on a weekday)
Why is that?
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>>Why is that?
Lots of weekday admissions are planned ones, diluting the number of emergencies (as a proportion - ie. 10,000 emergency admissions and 90,000 planned ones = 10% emergencies, 10,000 emergency and 10,000 planned ones = 50% - same number of emergency patients, hugely skewed proportion).
At the weekend there will be some Saturday operating lists to keep waiting lists down. Sunday planned operating lists are quite uncommon but do happen.
I bet the contents of my scrotum that the clinical management team of a hospital are better at understanding when to have the staff available, than a Hunt diktat.
(And I'm not a huge fan of hospital management)
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Dr Lygonos, what method of appointment booking do you use in your surgery?
Mine seems to change every other month but current process is you can only phone on the morning and get an appt for that day . So cant plan an appt for when you know you are on a different shift or whatever.
Absolutely totally no use system to anyone who works a normal 9-5 routine.
They used to do some advance and some on -the-days but that would appear to now have changed!
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Our lot used to do that but moved onto a system whereby you call and tell the receptionist what's up and they decide whether the doctor calls you or you need to go in. (Or maybe the doc decides, not sure...). They also have an online appt booking system but it seems the appointments available in that are a lot further off.
It works OK for me but SWMBO isn't keen as she doesn't seem to get to the doc as easily as I do. (I hadn't been for years up to last March when he found a raft of stuff to treat me for, so we are still working on balancing drugs...)
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My GPs surgery has two types of appointment, emergency and standard. The aim with emergency is to see you on the morning/afternoon you call, and you can only book them 1/2 day in advance.
Non urgent is to see a named doctor (usually your own) and can be several days ahead.
Seems to work.
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>>Dr Lygonos, what method of appointment booking do you use in your surgery?
Can pre-book up to 2 weeks in advance.
Any emergency seen same day but hell mend you if it's abused for trivia.
On an average week one doctor will be on holiday/study leave and there will be just about enough appointments so people will usually be able to get an appointment within 48 hours (often same day).
If no-one is on leave there is usually a handful of unused appointments each day.
If 2 or more docs are off then it can be up to 4 to 5 days for a routine appointment but this is rare.
The last time I made an appointment with my own GP it was 10 days until the soonest available routine appointment - not impressed!
There are telephone appointments available if patients want them, and patients can register to be able to book their own appointments thru t'interweb (again hell mend you if you do that and don't show up).
As I've said before, GPs basically get more pay for having more patients - this causes a conflict of interest between having enough doctors and how much you earn.
I'd rather provide a good service and go home at a decent time for a reasonable income, than provide a crappy service and go home late for much more.
As demand is going to increase and the number of GPs is not, you will see more practices using the "phone up at 8am and if you're lucky you'll get an appointment - otherwise try again tomorrow" system.
Also nurses are increasingly going to be the first port of call for patients (this is not necessarily a bad plan as using GPs to see coughs and sneezes is a gross waste of our skills, although a significant part of my enjoyment of the job is developing relationships with patients rather than simply being a diagnostician and prescription pad)
Last edited by: Lygonos on Thu 14 Jan 16 at 10:06
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>>you're utilising your expensive equipment to its maximum potential.
The truly expensive equipment in the NHS is its staff. Spreading the same number of guys over a wider number of hours may not increase the amount of work done, and for teams may be counterproductive.
Staff work more efficiently in a routine environment where everyone has a good idea where everyone else is.
Shiftwork causes premature death and disease and should only be used when necessary.
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Huge difference between private and public sector here, and indeed between large and small businesses.
No defending it but many people work far longer hours than those with the protection of a public sector or large employer's contract.
You don't get cheap consumer goods without exploitation in the supply chain and not all of that occurs offshore. It's right here, under our noses.
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>> No defending it but many people work far longer hours than those with the protection
>> of a public sector or large employer's contract.
Both of them changing, large employers are getting pretty ruthless
>> You don't get cheap consumer goods without exploitation in the supply chain and not all
>> of that occurs offshore. It's right here, under our noses.
And while the buying public care only about the price, long will that continue.
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Absolutely correct, we're all guilty at some level of perpetuating that situation.
How many of us ( myself included ) ever ask ourselves how that item we bought so cheaply possibly came to be available at that price? We simply choose to not care or at best, choose to ignore the cold hard truth.
Ethically produced and supplied goods are of course available, but in the cold light of day price is the factor most taken into account.
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Weekends are important to people, especially for those who want to spend time with their school age children. When I used to employ people in a retail capacity they received the same hourly rate for working Sat or Sunday as working on a Wednesday. In my three retail jobs since then, the past 8 years, it was exactly the same for me.
And no extra payment for working Good Friday, Or any other public holidays when the shops were open. In a rural area where jobs are scarce, take it or leave it. At least two out of my three jobs paid over the minimum wage!
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My big take on it is that I have yet to read anything that is in favour of the BMA's position (other than some rants on Facebook from doctors). So if they do have a valid case, then they've been very poor at getting it over to us.
Zero summed up my view so well that it bears repeating:
"Junior doctors work immensely long hours now for not much money. Under these proposals they would actually work less hours, for not much less money. I'm confused."
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How you or Zero infer that they will work fewer hours, I don't understand. There isn't going to be any less work per doctor, whether or not the cap on total weekly hours is reduced.
What will logically happen is that additional hours will need to be staffed at weekends, and those hours will not attract the same level of extra payment that they do now. Hunts promise that 99% will be better off is probably based on what they work now, which clearly isn't what is intended for the future.
The BMA's reasoning is probably "if Hunt thinks it's a good idea, it must be bad for us", based on experience.
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I agree except it should be 'fewer hours'. Or am I in the wrong pedant thread?
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Maybe we should put all the MPs on seven day week and see what the response is. What a waste having Parliament sitting idle for all those weeks, Parliamentary Recess they call it. What a laugh.
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Lucky us - we have a drop-in service from 0830 to 1130 and from 1400 to 1530.
The Health Centre is 5 minutes from home by car.
Depending on stated symptoms to the receptionist, plus one's medical history, one is seen either by a nurse-practitioner or a GP.
If the nurse practitioner deems it necessary, a referral to a GP is made, which might mean a shortish further wait, or a visit by the GP into the examination room one is in.
Our local hospital is less than 5 minutes away from the Health Centre and in our experience, if it's necessary, one can be there for further assessment quite quickly.
E.g. My wife had a sore and swollen lower leg and was seen in the hospital in less than an hour from the referral from the GP. (it was a DVT).
Total time from going to drop in, to being seen in hospital - about an hour and a half.
The longest "sitting around" wait was for the hospital's dispensary to provide the medication - about an hour.
The hospital also provides a drop in blood sampling service, when samples are required by the Health Centre. Quick & efficient with at least two phlebotomists on duty and waiting controlled by a ticketing machine.
Parking at the hospital is reasonable at 60p for the first hour and then increasing at £1 steps hourly thereafter.
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In my last three houses, I've signed up with a doctor's practice, in all cases they gave an MOT type examination on registering and in all instances told me I was fine. The first of those three houses was occupied by us for 6 years and I never had occasion to trouble them further, the second we were in for 8 years and apart from that initial visit, again I never needed to go back and in this one we've been here nearly 14 years and I've never been to see or felt the need to see a doctor since we registered with them back then.
Sure, I've had an odd cold, maybe even a flu type thing a couple of times but never enough to make me feel it was something I couldn't deal with myself.
Maybe I should go, get my money's worth sort of thing!
Having said that, my wife is such a regular visitor I'm surprised she doesn't get invited to their Christmas parties.
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I wasn't a "regular" so thought I'd pop in when I stopped work last March.
Four individual problems have now been identified and it seems I'm on pills for the rest of my life, as well as the monthly blood tests and visits to the doc.
I know you are fitter than I ever was but I must admit, with hindsight, I wish I'd known about and therefore been in a position to fix some of these things sooner. I'd say if you can get your doc to do an MOT you should.
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Howl old/young are yoos smokey? .. I always intended to have a well man check up when I reached the grand age of 60. That was over 3 years ago now. Praps I'll hang on now 'til I'm 70, if I'm still around.
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I think I'm a bit like my dad. He never had a day's illness in his life, fit as a butcher's fiddle, until one day, he died.
That'll do me.
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My dad was like that - never a days illness until one day he died ... 54.!
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I'm far from ready to check out yet but I'm not too keen on the thought of being really old either. Women seem to cope better with old age than men in the main. Everything I enjoy doing (more or less) involves a necessity for at least a degree of physical and mental agility. The thought of sitting moribund in an armchair watching telly or something for a pastime fills me with dread.
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I've seen really old, and it's a place I don't want to visit either but, as my ole mum used to say "no one knows what's just around the corner".
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Almost certainly for the best too. It must be quite depressing to have advance notice of impending demise as indeed those with terminal conditions do.
But you know, I really don't care what tomorrow brings, I hope it's something good of course but I'm not relying on it.
I just try to do something every day to make it a good day ( just in case ! ) it doesn't have to be anything big, just something pleasing like walking the dog, eating something nice, kissing the wife, normal little things that add up to a pleasant day.
One day there won't be a tomorrow for all of us so enjoying today is probably my philosophy without expecting every day to include fireworks and streamers.
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You sound like an OK geezer Runfer, for a Jock ;) .. your wife is very fortunate in being married to someone like you - tell her I said so!
>> One day there won't be a tomorrow for all of us
Yep! - live for today, or, The Power of Now (Eckhart Tolle)
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60 last November. Gave up the fags just after I was 59 but I've piled the weight on since and I wasn't a slim jim before! New Year resolution to lose some of it... but some is quite likely to be the result of one or two of the medical conditions which cause weight gain, but once under control they don't cause weight loss!!
At 60 you automatically get a bowel cancer test which is fun (not). That was all clear, but a buddy (aged 57) had to have a fairly extensive op last year as a result of late discovery of the same. Also my prescriptions are free, which is just as well as I'm now on 4 separate daily drugs and this could increase to 5 next week.
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Up to you of course how you handle it smokie, but for what it's worth, we never diet as such and just follow the regime of eat less, move more really if the belt is getting tight.
For years now we have alternated our evening eating habits so that one night we have a "normal" meal without worrying even slightly if it's fattening and the next night just having a light snack. The following evening we go back to a regular meal and so on. That and making sure that no more than 48 hours passes without some form of exercise.
Fad diets ( unless you have condition which demands it ) are a hiding to nothing in my view. It's about lifestyle mainly.
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>>60 last November.
Getting on then :)
I didn't take up the offer of a bowel cancer test, but I think I'd go for a scan of my aorta when I'm 65 as I know at least 4 people (who reside in urns) that died from a burst aortic aneurism - good way to go though as it's quite prompt.
I get my old age pension next year (haha!) fancy that, the government giving money away to young people!
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"I didn't take up the offer of a bowel cancer test, "
I know I'm repeating something that I put on here last month, but I saw a former (mid 60s) work colleague early in December. He informed me that he'd got to go into hospital for investigative surgery following alarm bells after the bowel-cancer test. He had not been aware of any symptoms of anything going wrong.
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Speaking as someone without a bowel (ulcerative colitis in my thirties, not cancer) I would urge everyone to take up the offer. As far as I know, you just send a sample of poo in a bottle to be checked.
Neil
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In Scotland the bowel cancer screening test is offered every 2 years after age 50.
Basically you get a card with 6 little windows on it - on 3 occasions you wipe some poo with the supplied card spatulas (2 windows per plop). This goes in an envelope and is sent to Dundee for testing - I can't think of anything more appropriate than envelopes containing faeces heading to Scumdee ;-)
The test itself looks for traces of blood in the poo.
If it is positive you are invited for a colonoscopy.
When I went to an update meeting a couple of years ago it seems if you were recalled for a scope, about 6% had a bowel cancer detected (generally early stage), 30% had a non-cancer cause for blood found, and the rest had normal scopes.
Poo testing will pick up about half of cancers present as some don't bleed much (or do so intermittently) so a negative screen should never be used to rule out cancer if there are any suspect symptoms (much like breast/cervical screening).
Uptake in our practice for patients returning the sample card to Dundee, is around 55% which is a little above Scottish average.
They are starting to roll out a scope test age 60 and my understanding they will gather data and work out which is the best way to detect cancer early (or a combination of both screens).
Last edited by: Lygonos on Thu 14 Jan 16 at 15:52
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If you've a family history of colon cancer they'll call you up for coloscopy on a regular basis. Ex work pal goes every two years as her father and sister both had it.
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When I hit 60 a few months ago I received the poo screening pack. Returned it fairly quickly. All ok. Why wouldn't you? Apart from stupidity.
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(The doctor got there first.)
Last edited by: Focal Point on Thu 14 Jan 16 at 15:51
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I would be interested to know why 45% of people did not return the test. It's not a particularly pleasant thing to do, but not as bad as picking up my dogs poo.
Maybe there are more stupid people around than I thought
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>> It's not a particularly pleasant thing to do, but not as bad as picking up my dogs poo.
Yoos must be feeding 'em the wrong grub then LL. My two horrors go mostly in my garden/drive and they crap kickable stuff usually, unless they've managed to gulp something they didn't oughta.
They are both on Millies 'Obedience' tucker.
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Iwent to see the practice nurse, Sarah, last week. She took me bloods and did a BP, which was a bit up. The local pederast looks after me trotters...£35 every 6 months.
Called me back for a retest this week and said my bloods were ok, blood sugar and HBa!c fine. Cholesterol fine and a fresh BP test was good. She thought my previous higher BP was because I'd not seen her for a while and I was pining with lust. I said she was right but I'd transferred my affections to the 50yr old, blonde, single, manager at my opticians ! We had a good chuckle.
I normally only see her having a fag with the secretary in the front porch of the practice.
My poo test was OK last time although, unbeknown to me, I wasn't finished with plop yet. Today, dismantling the old bathroom at home, I pulled the toilet bowl out of it's connections. I moved it across the room, turned round and found two smallish nuggets of poo on the floor. One of the grandkids must have gone up and used it just before I sealed it up with tape.......I just wish whoever it was had flushed it !
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Furious junior doctors deliver giant 'statistics for dummies' book to Jeremy Hunt
www.mirror.co.uk/news/uk-news/furious-junior-doctors-deliver-giant-7221155
Junior doctors are so furious at Jeremy Hunt they have delivered a giant 'statistics for dummies' book to his door.
The medics descended on Whitehall today in their blue scrubs - with temperatures close to freezing - to blast the Health Secretary's use of death figures.
Their attacks came after 59 of Britain's top stroke doctors accused Mr Hunt of "misrepresenting statistics" to justify his seven-day NHS.
Professors and prize-winners said the Health Secretary's statement that stroke patients were 20% more likely to die on weekends was "out of date" due to NHS improvements.
David Cameron repeats 'inaccurate' stroke death claims that led to fury at Jeremy Hunt
Today junior doctors rammed that point home - with an 8ft mocked-up copy of a book called How to Read a Paper.
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www.bbc.co.uk/news/uk-england-kent-35430698
Health Secretary Jeremy Hunt was ordered by a judge to delete a "highly inappropriate" tweet he sent during a landmark manslaughter trial.
The minister posted a link to a news report of the Frances Cappuccini trial, saying it was a "tragic case from which huge lessons must be learned".
Mr Justice Coulson ordered the tweet be removed immediately.
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The man is really an idiot isn't he.
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Yes, he is.
But I don't quite grasp why that tweet of his was *so* inappropriate. I guess I am missing something?
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Nor me really. Probably seen as detrimental to the trial in some way or another. Still an pillock though.
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No reporting on the BBC of yesterdays march ! Obviously not important news.
Jeremy still not listening even when doctors on the front line tell him what the situation is today.
Still blaming the BMA .
see video clip
www.bbc.co.uk/news/uk-35515732
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He has picked a fight he can't win - the BMA are not going to go away - when he ultimately has to negotiate (and be seen to make concessions) with them he'll look weak.
If he forces through a contract, consequences be damned, he'll further ruin any remaining goodwill between doctors and the DoH.
He should have remained openly concilliatory even if behind closed doors he's playing hardball.
I expect he'll be gone at the next reshuffle.
Probably to a large private medical corporation.
Last edited by: Lygonos on Sun 7 Feb 16 at 13:49
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My daughter called round this morning with my son & DiL.
Daughter is absolutely shattered after giving a long teaching session.
I am trying to get her to ease off the work/sleep/work cycle.
She freely admits to coming home to her flat and just crashing out.
( This is without any family ).
Obstetrics can be life and death every shift. I worry about her.
Hunt has cloth ears.
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Hunt is a berk.
When negotiating, think twice and then again before backing anybody into a corner, and never do it publicly.
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Sorry to hear about your daughter henry.
My daughter is a mental health nurse,She used to enjoy the job but it is becoming more and more stressful.She is married with one child and like to cut her hrs to four days a week.
There are not enough acute centers in this area and mental health patients are increasing.
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Mine too. She was, till recently, on secure wards - where people have been sectioned, or are otherwise there against their will. She did that for a number of years and although she won't tell us much about stuff there were occasions when it sounded like all hell broke loose on the ward and there were just a few (mostly female) nurses to restore order. Brave people.
That job was shift based but she recently moved to a community based job which is Mon - Fri 9 - 530 and she is dealing with people in their homes. She's loving it for the change and less stress but there is still risk, considerable in some cases, in a single female doing a home visit. They do have emergency processes but help isn't waiting just around the corner...
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One indication of the value society puts on us is pay. An article in the current LRB by a junior doctor reminds us that "five or six years of a medical degree are followed by two foundation years..." These are served in hospitals and for pay but the starting salary in the first year is £22,626.
This is about what I was earning as a middle-ranking "polyversity" lecturer 25 years ago. Allowing for inflation, that equates to about half today in real terms. There is of course much else in the grievances of junior doctors but they seem to have a point over pay.
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When I started as a junior in mid-90s my basic (for 40 hours) was £15,800 - I was contracted to do another 32 hours 'on-call' at half-pay (so I got about £22,000 for a 72 hour week)
Not great, but at least I wasn't starting with 1-2 years' pay worth of debt unlike many juniors nowadays.
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My daughter has seen one of the new rosters ( created by a clerk obeying all the new rules)and she says it is a killer for the junior doctors.
It seems that the mood is not improving so thy are not going away.
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There's a fundamental problem with Hunt's logic in that he wants 7 day non-emergency provision with the same people - fewer people potentially if the numbers heading for Oz & NZ increase.
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>> My daughter has seen one of the new rosters ( created by a clerk obeying
>> all the new rules)and she says it is a killer for the junior doctors.
>> It seems that the mood is not improving so thy are not going away.
>>
The Independent is the only paper I have seen so far to cover the proposed new rotas. "Junior doctors are furious after updated "example" rotas showed them working as many as three consecutive weekends - despite politicians promising "no doctor will be ever be expected to work two weekends in a row"."
18 Feb: tinyurl.com/zwbtad4
Today: tinyurl.com/z6zsamf
Mr Hunt promised in his speech to Parliament : “With the new contract, the maximum number of hours that can be worked in one week will be reduced from 91 to 72, the maximum number of consecutive nights doctors can be asked to work will be reduced from seven to four.
“The maximum number of consecutive long days will be reduced from seven to five; and no doctor will ever be rostered consecutive weekendsâ€.
However, the new rotas show junior doctors will in fact be expected to work consecutive weekends or one weekend a fortnight, to which junior doctors are said to have "reacted with fury".
NHS Employers released a statement following the uproar saying current guidance stipulating junior doctors working consecutive weekends “should be avoided where possible†but there was no guarantee.
So Hunt says "no doctor will ever be rostered consecutive weekends" but the Emploers have changed that to "working consecutive weekends “should be avoided where possibleâ€."
Last edited by: BrianByPass on Mon 22 Feb 16 at 19:04
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It seems that a cap on hourly rates for locum hospital doctors has been introduced.
There is an exemption in extreme circumstance.
Guess what ? It appears that hospitals are having to invoke that clause as locums are not prepared to work for the lower fees.
So it appears to me it is all smoke and mirrors from Mr Hunt. It looks good to announce he has stopped hospitals paying higher hourly rates but in reality the same rates are still being paid
So market forces prevail.
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If I was paid what junior doctors are paid I would be jumping up and down in happiness.
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Why not train to be a dr?
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>> If I was paid what junior doctors are paid I would be jumping up and down in happiness.
>>
You might be on your own.
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Whatever the issues any doctor who refuses to do his job services in an emergency situation doesn't deserve the title Doctor in my opinion
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Wonder how a junior doctor would feel if their house caught fire and the fire brigade were on strike?
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>>Wonder how a junior doctor would feel if their house caught fire and the fire brigade were on strike?
People have the right to strike. If you don't want them to strike then give them the hours package that they need.
Consultants will be working in A&E over the period of the strike and in the last strike junior doctors attended incidents close to the picket lines.
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>>People have the right to strike
Yes they do. And generally that is a good thing.
Doesn't mean that their demands should be met though.
Last edited by: No FM2R on Wed 23 Mar 16 at 22:29
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Their is a middle ground FM2R.
People can meet each other halfway not do as you are told.Does anything ever change regarding
negotiation skills? In my working live I have been to a few meetings and often the tone and attitude from both parties are way out of line.
It is up the the negosiator to set a platfrorm where people can come to a reasonable agreement.
I suggested years ago to works councils similar to the German model at my place of work.
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>> >>Wonder how a junior doctor would feel if their house caught fire and the fire
>> brigade were on strike?
>>
>>
>> People have the right to strike.
Indeed they do. Employers should also have the right to get rid of them if they do.
Freedoms work both ways
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Yes, let's sack all the junior doctors, that will solve the problem.
And the firemen did go on strike, more than once.
Hunt is an idiot, from the same sort of background as the odious Osborne. What everybody seems to have overlooked is that there is already a doctor shortage and he intends to introduce the 7 day services without addressing that.
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>> And the firemen did go on strike, more than once.
>>
And achieved nothing.
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No difficulty recruiting for fire training though.
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For me there comes a time when you have to do as you are told.
Many professions have had austerity thrust upon them... and haven't liked it, but have had to soak it up, because the bigger picture is stable finances for the whole country.
The junior doctor dispute is mainly about money... i.e. the loss of premium hours for the weekends.... with admittedly a few extras bunged in.
If you've had a good moan, shown the country how strongly you feel, yet the elected government tells you to get on with it.... you should get on with it.
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>> For me there comes a time when you have to do as you are told.
>>
And I would think likewise there are people that believe in what they say and believe they have to do what is right. I would imagine many of the docs think that.
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Pushing people into a corner with no way out will create a reaction.There comes a time you have to do as you are told?
Pay rises MP'S 11% Junior doctors 7 days work for 5 days pay it ain't going to work.
Nurses 1% pay rise.
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>> Pay rises MP'S 11% Junior doctors 7 days work for 5 days pay it ain't
>> going to work.
You cannot compare them.
Traditionally MPs salaries were fairly low in the big scheme of things, certainly when you consider the financial packages other senior managers/leaders in other fields receive (they are after all running our country)... and it became an accepted practice to up the remuneration by grabbing more out of expenses...well that should never have been allowed.
So, rightly, the fiddling had to be stopped.
A pay review suggested giving them an appropriate pay package, so that expenses could be reined in.
An MP's salary was very near my own police inspector's salary when I was in London.... that's just foolish and IMO showed how incorrect an MP's salary was/is.
>> Nurses 1% pay rise.
>>
.... along with most if not all other public sector workers
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"And I would think likewise there are people that believe in what they say and believe they have to do what is right. I would imagine many of the docs think that."
They have the right to protest all they like. When it comes to refusing treatment to patients they will have crossed the line and lose all respect in my mind and I suspect that of a lot of other members of the public. Do they really want their image to be "me first I'm really in it for the money like everyone else" ?.
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The walk-out from emergency services is probably a mistake, even if it will be covered by consultants.
NHS staff generally receive a high level of public sympathy, which acts on the government as much as the industrial action, and they would benefit more from the public support by confining the walk-out to non-emergency work.
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>> The walk-out from emergency services is probably a mistake, even if it will be covered
>> by consultants.
>>
>> NHS staff generally receive a high level of public sympathy, which acts on the government
>> as much as the industrial action, and they would benefit more from the public support
>> by confining the walk-out to non-emergency work.
>>
I think this is a valid point. A&E is the front line of the NHS and even one bad outcome will impact public sympathy.
The uni that my daughter attends has told medical students not to attend hospital on strike days under any circumstances because consultants have a habit of getting them to do things that they are not qualified to do.
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The way I see the situation.
There are far more applications than places at Med schools
Some new med schools have been created but we still need more doctors.
We do not have enough doctors to satisfy the still rapidly growing demand.
There is supposedly a five day a week " full ? " roster of doctors in hospitals.
There is a reduced number of doctors covering shifts on weekends.
Mr Hunt please borrow a proverbial fag packet or envelope to do some very simple arithmetic.
Divide the number of doctors on the roster by seven and you will see the five weekdays will not be manned to current required level.
Are you telling Joe Public. " We are going to have a worse weekday service but you can get seen on Sunday afternoon ?"
A one word reply will do.
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>> Mr Hunt please borrow a proverbial fag packet or envelope to do some very simple
>> arithmetic.
>> Divide the number of doctors on the roster by seven and you will see the
>> five weekdays will not be manned to current required level.
I was beginning to wonder if I was the only one who had spotted that.
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> They have the right to protest all they like. When it comes to refusing treatment to patients they will have crossed the line and lose all respect in my mind and I suspect that of a lot of other members of the public. Do they
>> really want their image to be "me first I'm really in it for the money
>> like everyone else" ?.
>>
Who knows how the winds of public favour will blow. I'm more minded to think how they felt they had to strike even for a&e for the first time ever.
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>> For me there comes a time when you have to do as you are told.
>>
>> Many professions have had austerity thrust upon them... and haven't liked it, but have had
>> to soak it up, because the bigger picture is stable finances for the whole country.
>>
>> The junior doctor dispute is mainly about money... i.e. the loss of premium hours for
>> the weekends.... with admittedly a few extras bunged in.
>>
>> If you've had a good moan, shown the country how strongly you feel, yet the
>> elected government tells you to get on with it.... you should get on with it.
>>
>>
So, if the Govt offered something extreme, like getting rid of police pensions or insisting that police officers worked 12 hours per day without extra pay because it is needed for the economy, would the police want to strike or should they just accept it, after all it is good for the country.
The fact that they are not allowed to strike makes them a potential target.
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>> So, if the Govt offered something extreme, like getting rid of police pensions or insisting
>> that police officers worked 12 hours per day without extra pay because it is needed
>> for the economy, would the police want to strike or should they just accept it,
>> after all it is good for the country.
To some extent, that has already happened.
I went to a local football match the other day with a mate who has retired from the Met.. and his son.
The son has 9 years service and is waiting for his promotion to Insp to come through fairly imminently. Whilst chatting to him, he told me he has no idea when he can retire, it might be in 31 years time... so he may still have to yet serve the time that I did, despite already having 9 years in the bag. The uncertainty is not ideal.. and the goal posts have changed a lot since he joined.
A lot of people didn't like those sorts of changes, some talk of leaving, some talked of campaigning for the right to strike.
However, it remains the case that they still work in a (mostly) rewarding, well paid job with a good pension and there's no sign of a recruitment problem... and those decisions were made for the good of the country.
I accept I had my time when it was better, but I cannot change when I was born... and my view remains the same.
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Henry and Manatee are on the mark.
The Govt are spinning some serious whoppers/lying through their teeth.
The weekday service will suffer.
All the other services required to make a fully equivalent weekend service are not/will not be in place (physiotherapy, laboratories, operating theatres/staff, XR/scanning, pharmacy, social work, care services, psychological services, district nursing, etc etc).
The government are using smoke and mirrors to satisfy their pre-election pledge about a 7-day NHS (which is, of course, what is currently in existence) and I am pretty sure the outcome will be an inferior weekday service (when coincidentally the majority of admissions/procedures take place) with no guarantee at all that much of an improvement will be noted on Sat/Sun.
All of this as a time when there is expect to be £22bn of efficiency savings (ie. ~15-20% of the current NHS budget) over the next 5 years.
Ha.
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The whole demand for a 7 day elective service doesn't fit in with what I see in practice. We often put on extra evening and Saturday waiting list initiative operating sessions, because of the short staffing these are staffed by mainly agency, the DNA rate is high or we struggle to find patients who want to come in at those times, very inefficient and I can't see how there is the real demand for it.
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very inefficient and I can't see how there is the real demand for it.
>>
I think that's the difference between a one off offer and a general availability.
I think there might be a different take up if (say) Saturday was to be offered as an available date for out patient appointments / minor ops etc.
I think you might find some patients who would opt for Saturday rather than lose a day's work
Certainly that is why there is a fairly big take up for private appointments in the evening or weekend for those who have that option
The same "there's no demand for it" was used for Sunday shopping years ago
Not that there is any other similarity between the two situations.
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>>I think you might find some patients who would opt for Saturday rather than lose a day's work
>>Certainly that is why there is a fairly big take up for private appointments in the evening or weekend for those who have that option
>>The same "there's no demand for it" was used for Sunday shopping years ago
My local surgery started Saturday morning appointments and the take up certainly has not been great.
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>>My local surgery started Saturday morning appointments and the take up certainly has not been great
We used to do Saturday mornings - even with just a single GP at 16 or so appointments they wouldn't always be full, and even if they were 2/3 were pensioners.
On a typical Monday we will have 120-150 appointments.
Instead of Saturday mornings we now offer early morning appointments from 7.30 and the uptake is way higher.
Anyone who thinks your average working person wants to ruin their weekend going to the GP needs their head examined.
The demand is and likely always will be skewed towards weekday appointments.
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Lygonos, that to me sounds really strange. If I'm ill, I will try to get an appointment at my local surgery ASAP. I think there are around half a dozen GPs working out of it, and when the receptionist asks which one I want to see I always say anyone. If it means going at 2am I'd be there! I can understand females wanting some sense of continuity with a familiar face, but if I'm ill I'll see anyone, anytime. As for not wanting to go on a Saturday morning, they can't be that poorly if they pick & choose appointments.
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Most GP patients are not acutely unwell.
Most have chronic conditions that need managed/may flare from time-to-time.
If you were so unwell that you'd happily go to a GP at 2am, it might not be a GP you need to see....
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It's the difference between urgent and important.
For people who only ever go to their GP when they are worried, it's always urgent!
Equally if I want seeing, and as in the case of a doctor's appointment it is entirely for my benefit, I'll go when it suits them if I can.
Re Hunt; well presumably he has a brain and a lot of professional advice, and unless there is a hidden agenda I would expect him to be doing mainly sensible things.
What makes me suspect that he isn't is his apparent obsession with 7 day working and winning the argument. Once you start trying to win the argument rather than get agreement, you are generally focusing on the wrong things.
If May has left him to sort out his own mess she has made a mistake and he will present her with a bigger mess in due course.
The absolute worst result now would be for him to win by legal and coercive means, because a lot of doctors will just leave. Not all at once, but when it suits them, so the consequences will last a long time. A volunteer is worth ten pressed (wo)men.
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Talking to my daughter it seems that the morale of doctors is now very very low.
She has never seen it so low.
She says J Hunt and his wonder schemes are really hacking many people off especially as the public has absolutely no idea what termoil is happening in hospitals.
She says they want foreign doctors with their skills in the NHS and not to alienate them.
Not just rosters but wonderful new ideas like increasing the number of trainees buy 25% just will not work. It is the same situation as seven day NHS , background support is also needed.
She is involved with recruitment of students. Quite a few have glowing A*s etc but have no other attributes to be a doctor so the search goes on for good applicants or standards are lowered.
The PR machine from government does not inform the public re tuition fees/ living expenses for medical students. No short terms like Oxbridge and the option of holiday job/earnings but 4/5 or even 6 years slog which makes it very expensive. My daughter trained before fees were introduced but it was a lot of funding from me topping up loans.
It appears that more medical students are doing their 4/5/6 years of Uni and then saying no to the NHS and going into industry. The plan for a four year lock in is also not a good idea so early in a career before specialisation. She went to Aus for a year for experience and then returned to the UK but that will not be allowed in future.
From someone who is so dedicated to the NHS it all sounded very worrying.
Many feel Mrs May has copped out, left J Hunt with the poisoned chalice and let them all stew.
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Not that long ago the N.H.S was started to pick itself up by it's boots.I felt that things where going the right way.
Waiting list going down and extra money was going into the system.Some people will say the N.H.S is a bottomless pit maybe it is when it comes to money.
But to bring moral down the way this government is going about it takes some achieving.
If they want to privatise the N.H.S let's get it out before there are any doctors left to look after us.
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Eldest is in year 5 and is currently on placements all over the Southern Region.
The student loan balance is currently £90,000 and accruing interest from 2012! That puts a downer on things even before work starts!
It seems inequitable to take £90k then say by the way that's not enough now work for us for 4 years or else. What about other university graduates - will they be given the same ultimatum - of course they will not.
Bringing in doctors from abroad has advantages - shared best practice for one and the same for ours going there, they will come back with experience of how other health systems work and hopefully implement best practices here.
As for working abroad, Eldest has already received an unsolicited offer subject to qualifying from New Zealand, based on the grading achieved at the end of year 4. Someone got hold of the info even before Eldest knew!
On top of all of the hard work at hospital, for one month the placement was in an A&E department within commuting distance from my house so eldest stayed with me.
There was a dreadful incident of a toddler being brought in and the team fought to save the child for ages and eldest was given the task of arranging transfer to a major London hospital. It wasn't a happy ending and everyone was visibly shaken, even the usually hard nosed consultant. No pay is enough for that and that's why it takes a certain type of dedication.
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We had free education, but then we insisted that everybody should go to university, even those unsuitable or unwanting, and then we couldn't afford it. So then we made everybody pay, therfore the unsuited and unwanting don't go, so we're back to just the deserving and suitable, but now they're paying.
Mostly because Brits don't want to contribute a penny more than they absolutely have to and even that they begrudge; they just want free education, healthcare, expanded services, nuclear weapons and no taxes.
And then everybody is surprised about all the budget pressures.
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>> and even that they begrudge; they just want free education, healthcare, expanded services, nuclear weapons
>> and no taxes.
>>
>> And then everybody is surprised about all the budget pressures.
The British want the social and healthcare benefits of Scandinavia, the weaponry of the USA, the Army the size of Turkey's and the tax bill of Lichtenstein.
It will never work!
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I've been the lone voice (and often treated as the Bad Guy) on a local discussion forum for saying what No FM2R said. People are demanding more and more of the local council(s), who they consider inept at best, yet complaining when payments are increased or introduced (e.g. we now have to pay a modest amount for rubble waste at the tip, and car parking charges of £1 overnight have been introduced in the town's car parks). And I live in what has often been cited as one of the wealthiest areas of the country!!
Mind you, £90k student debt is a mountain. Both of mine were quite heavily subsidised by us, and due to no course fees the mental health nurse daughter is free of student debt after about 9 years but her older sister still has around £15k outstanding, but has been in a job where she has been (and will be) paying it off for quite some years..
Last edited by: smokie on Fri 7 Oct 16 at 08:13
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>> I've been the lone voice (and often treated as the Bad Guy) on a local
>> discussion forum for saying what No FM2R said. People are demanding more and more of
>> the local council(s), who they consider inept at best, yet complaining when payments are increased
We are led to believe that Scandinavians are happy to pay income tax because they see the connection between what they pay and how they benefit from it. I don't know how true that is.
If it is, then I suspect it is not a genetic or even a cultural difference, rather that we in Britain trust our politicians less, and perhaps suspect that some are complicit in the tax avoidance and evasion they condemn. A fish rots from the head.
When it reaches the point where Donald Trump, to the suggestion that he might not have paid any federal taxes for at least 6 years, can say "That makes me smart!" there is a problem with the social contract.
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I've always been confused by the "fish rots from the head" thing. Surely they decompose from the gut outwards, just like us?
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>> I've always been confused by the "fish rots from the head" thing. Surely they decompose
>> from the gut outwards, just like us?
It refers to a specific species of fish that rots from the head for the purpose of the proverb.
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This kind of rotten fish:
www.bbc.co.uk/news/uk-england-37588815
Gone at last.
£190k well spent.
Wonder if her created position falls foul of laws/governance rules: the rest of the Board must have OK'd it.
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>>£190k
Better than chopped liver.
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Re Trump - if the losses were genuine and claiming relief against them is legitimate I don't see too much of a problem. (The genuineness is what is unlikely).
I've often thought it a bit one sided that the government is quite happy to take tax on my investments which are going up but not give me some back on those which go down.
Last edited by: smokie on Fri 7 Oct 16 at 17:01
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>> We had free education, but then we insisted that everybody should go to university, even
>> those unsuitable or unwanting, and then we couldn't afford it. So then we made everybody
>> pay, therfore the unsuited and unwanting don't go, so we're back to just the deserving
>> and suitable, but now they're paying.
>>
...if only it were true.
Unfortunately, the the unsuited and unwanting still go into further education, to study for largely inapplicable and irrelevant qualifications, funded by loans which they will never repay as they will not cross the earnings threshold before the repayment limitation term kicks in.
A situation greatly exacerbated by the huge rise in tuition fees, and causing "write-off" proportions to rise to a staggering, purported 45%.
All funded by the taxpayer, of course (or apparently, until you start to dig underneath the desire to sell the debt off to the private sector - and the, admittedly smallish, proportion that already has been).
Being lucky enough to be able to do so, and horrified at the rates of interest that (would) accrue, both my kids have been funded through University by "bank of dad" and have/are starting their working life largely debt-free.
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Forty odd years ago I went to a school where one of the most, if in fact not the most, figure was the % of A level students going to Uni, or better still Oxbridge candidates. The vast majority of my friends went to uni. I considered it but decided not to. For many of them it was a waste of time academically. Degrees which were of no use in the real world, and then a few years down the line they became office juniors... Estate agents, local govt, that kind of thing. By which time my friends who began on the bottom rung immediately after A levels, were establishing themselves on the career ladder, or had moved jobs & industry and finally found a line of work they enjoyed, whereas several of the uni guys, after three years partying and a not very good degree or resits, still had no idea what they wanted to do in life.
Tbh, very few 16 & 18 yo people know what they want to do, apart from drink ( decreasing so I'm told in young people which is good) travel & lay plenty of pipe. I would have thought that with tuition fees today it would focus the mind of potential graduates into looking more closely as to whether uni was the place to go, although obviously for friends of mine in law, medical & other subjects it was!
For far too many youngsters it's still the 'thing to do'... Maybe we should drastically reduce the number of uni places available & convert halls of residence into low cost starter homes?
Last edited by: legacylad on Fri 7 Oct 16 at 09:10
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Zippy
All good points and well done for you support
.
Sometimes my daughter will mention the struggles she has had to save a patient/s or show a little of the downsides that occur. I could not deal with it.
When we visited her in AUS we were rear ended in her car and called A&E. UK friends were there and advised us to go to another A&E where other UK friends were also there. Lots of temptation to work down under with so many experiencing life there. She has had invites to return to AUS.
I have never heard her so very angry at what is going on to her and the NHS.
Many/most of her friends from med school are consultants. She has chosen to do research in her speciality so that has delayed her training. She has chosen her present job that has further delayed " promotion". She now tells me it will be further delayed due to "insane" rosters that mean she needs even more time to complete her training.
It is now 20+ years since she left sixth form, with no gap year,so she has been hands on since leaving med school. I would estimate that she is by far the most qualified, in all senses, junior doctor in her speciality but only two more years to tick all the training boxes.
I suggest Joe public has absolutely no idea about what is going on in the NHS.
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"the struggles"
Yes - and there are people out there, working full-time, earning £13kpa.
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www.bbc.co.uk/news/health-37787586
Makes very sad reading. The latest, imposed, rota changes have made things much worse for many, just as my daughter predicted.
One of the top consultant that we see privately, when he treated my wife, within a week,
stated that sadly this treatment has a FOUR year waiting list of his NHS patients.
The actual treatment within the consultation meeting took 5/10 minutes.
And Hunt still ploughs on.
The public need to understand that in spite of more doctors being trained the drop out rate
will increase.
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No idea how he managed to keep his job. Thought at the last reshuffle he would have been the first out the door.
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>> And Hunt still ploughs on.
>> The public need to understand that in spite of more doctors being trained the drop
>> out rate
>> will increase.
If there are too many downsides, whether pay, conditions, hours, targets or micro-management people will rebel and/or walk.
See also the teaching profession.
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>> See also the teaching profession.
>>
Also the military and police. I would not contemplate them as a career with the current conditions of service.
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Also the fire fighters.
Guy I know got out this year at 50 to protect his pension.
Working conditions/ requirements and also options after 50 have gone.
Not a happy fella. What a waste of skills.
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Thing is if it's for new employees they don't know any different.
Just to take up ON's point, I see the RN are so short of people they had to 'lend' them in from the US Coast Guard, they are chronically short of engineers.
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No shortage of applicants for the police,fire brigade or the militiary come to that.
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Might want to double check some of your assumptions CGN.
Last edited by: sooty123 on Thu 27 Oct 16 at 19:43
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In the 70s and 80s nuclear trained navy engineers got huge retention bonuses. In 85 I was offered a ten year extension to my service time because of a critical shortage of people with my training, ten years on my pension, mortgage paid off and a desk to drive, thank you very much! Military personnel shortages are not new, they are down to short sighted policies, and moving goalposts.
Last edited by: Old Navy on Thu 27 Oct 16 at 21:20
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nuclear trained navy engineers got huge retention bonuses.
Still the same now I think, certainly was a couple of years ago.
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>> Might want to double check some of your assumptions CGN.
There is not a shortage of applicants in all those state sector jobs.
However, there is a shortage of vacancies.
Indeed at times unions such as the FBU have claimed that it is the lack of vacancies which prevents the employers recruiting enough BAME employees to reflect the diversity of the populations they serve.
Last edited by: BrianByPass on Thu 27 Oct 16 at 23:50
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>> There is not a shortage of applicants in all those state sector jobs.
>>
Nope, some of them do have a shortage of people of looking to join
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I believe the army is actively recruiting and is currently understrength as regards troops rather than officers. Strangely the end of the Afghan war saw a drop in the number of recruits. Apparently it is always easier to recruit when there is a prospect of active service.
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>> Nope, some of them do have a shortage of people of looking to join
>>
Yep, there is a shortage of vacancies.
Nope, there are not enough applicants.
Yep, I am right.
Nope, you are wrong.
It's a pantomime.
Oh no it isn’t!
Oh, yes it is!
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Don't worry brian we got there in the end.
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It is a bit off the subject of doctors but why aren't we investing more in Technical Schools?
There must be plenty of youngsters who have no interest in A levels or Universities.So many leave with no qualifications or training in any kind of skill.
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>>And Hunt still ploughs on.
Junior doctors' training under threat, says GMC
www.bbc.co.uk/news/health-38162855
An official said: "The health secretary has announced plans to improve junior doctors' training,
Not a lot of use if you are not allowed time to do it!!!.
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Maybe some of the 335,000 net migrants in the last year are junior doctors?
BEANO.
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France used to have a good way to deal with strikes. Practically the whole rail network came out in the later 19th century. France conscripted all 150,000 rail workers, thus placing them under military law. Service was quickly resumed.
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I think I am right in saying that 10% of all UK doctors are from the EU. The total number of non U.K. Doctors is around 25%. I guess we need to hope that for them the UK remains a welcoming place to work.
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>> I think I am right in saying that 10% of all UK doctors are from
>> the EU. The total number of non U.K. Doctors is around 25%. I guess we
>> need to hope that for them the UK remains a welcoming place to work.
I suggest that CGN means that 10% of all UK doctors are from the EU outside of the UK.
But to continue in similar vein:-
What percentage of UK residents are from the EU?
What is the total percentage of non UK citizens who are resident in the UK?
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My big operation was by a surgeon from the Sudan and British an Polish nurses looked after me with the chemo.The one who hurt me with a small operation was a Asian doctor and his crew.
Maybe I'm predigest but I'm weary of doctors from that continent.To many mishaps and a bit of neglect by these doctors.
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>> And Hunt still ploughs on.
Jim Naughtie called it right, IMO.
www.youtube.com/watch?v=YS5mVoqJpUk
Last edited by: DP on Thu 10 Aug 17 at 19:47
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Today.
Eldest is not impressed. Arrived at change over, found out they were the only doctor on the ward.
So no introductions. no this is how it works here, no "what do you actually know about the illnesses we treat here" etc. Not good considering this is the first day of work after leaving university!
All other doctors had made excuses and were elsewhere.
Has had to tell patients they have cancer, patients screaming that they are not being seen quickly enough etc.
Nurses have been a godsend as was a registrar from another ward who came and helped with "what happens next" advice for the cancer patient.
The doctors on the next shift didn't turn up until 40 minutes after eldest's 12 hour shift for the change over briefing.
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This is pretty much the same scenario that I found with every new outfit or new branch or department I worked in, whether in commerce or education. It seemed to be a tradition to give a newcomer a bad time.
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From what my daughter tells me these seems to be unusual in one key area.
I hear complaints at every change of hospital re wasting time with a CYA exercise re Elf & Safety when she wants to get on with seeing patients.
Also noted that there is no standardisation on some basic activities/ forms.
Considering all the paper filling re career it is surely already logged " Been there, done that".
Oh No! we need a CYA process else the lawyers will be on our backs.
I hope she continues to enjoy things and not get out as quite a few of my daughters friends have done.
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Medical school places to increase next year.
www.bbc.co.uk/news/health-40863448
These folks will repay the tuition fees - normally 5/6 years, rarely 4 years.
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" NHS launches £100m drive to recruit foreign GPs
NHS bosses are also in the process of increasing the number of training places for GPs - but last year 7% of spots went unfilled.
Tuition fees etc deterring many unless bank of mum and dad can fund it ?
"Contracts have been put out to tender that could see half of the extra 5,000 GPs promised by 2020 brought in from abroad.
It comes as the NHS continues to struggle to train and retain its home-grown GPs."
Last edited by: henry k on Thu 31 Aug 17 at 17:49
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Surely they can use some of the £350m per day or whatever it was, to pay for it?
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>> Surely they can use some of the £350m per day or whatever it was, to
>> pay for it?
>>
...surely not if they're trying to bring them in from abroad........
;-)
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Oh well, worth the cost I'm sure.
Last edited by: No FM2R on Thu 31 Aug 17 at 22:17
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...most definitely PWP....
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Besides the conversation about doctors my wife has been waiting for months to see a specialist again.She suffers with severe or chronic pain and there is supposed to be a operation available for her when the time arrives.I don't want to be political again but over the last years our health service has gone backwards.
It is a shame we can find money for other things but the health service is slowly but surely underfunded.She has been waiting for four months onwards we go..
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Junior Doctors on strike. - No FM2R
