Where do you stand on the Junior Doctors' strikes ?

the_twin

And the solution to people leaving to work abroad or retire is what exactly? Oh yeah, make their working life worse, reduce opportunities for training and flog the oldies until they drop.

Fretwired

the_twin said:

Fretwired said:

the_twin said:

Are you suggesting the NHS can provide the same level of elective service it does say on a Wednesday on a Saturday or Sunday, while not employing any more staff or spending any more on wages? How exactly is that supposed to work? The emergency service runs the same on every day. If you go to A&E on a Sunday it will be staffed and the ventilators in ICU don't get switched off at 5pm on Friday. If you need a scan or an operation it will be done.

Firstly the government are spending more on wages - they want to remove the complicated banding which the BMA agrees should go. Secondly the BMA actually agrees that having a 7 day service will relieve pressure during the week and lead to a smoothing of service provision - people who are ill over the weekend create a backlog for Monday. Obviously with a growing/ageing population this slack will be taken up so we will need more staff. A big issue at the moment is the generous pension and the fact the maximum pension pot size is one million pounds. The NHS is seeing experienced doctors and GPs retiring early. And we are currently losing a significant number of doctors a year lured to a better life in places like Australia.

They aren't spending more on wages - the agreement at the start of the negotiation was that the outcome would have to be cost neutral in terms of the juniors wage bill.

Yes they are as the basic salary feeds into pension payments so it costs the government more. The overtime payments are also guaranteed for existing doctors for three years. In real terms pay is rising. Only 1% of doctors may be worse off (BMA agrees with this). And there's a technical terms for your comments on pensions - bollocks. Each employee has a pension pot - fact. And there's no way that anyone in the private sector could get a pension as good as an NHS worker with similar contributions. It may not be as generous as it once was but don't insult people in the private sector who can't come close to such a pension.

There are plenty of doctors but up to 3,000 a year decide to emigrate. Why? My nephew and his wife have gone to Oz. She worked for the NHS and was poached by the Oz health service. Her reason for leaving was to get out of an over crowded stressed London with poor housing and give her kids a decent life. You can't complete with a £50K signing on fee, warm climate and small friendly town with manageable health services. They moved out of a London flat into a large detached house in Melbourne. Her decision was nothing to do with the state of the NHS .. doctors are in demand globally and there are plenty of countries that offer a much better life than the UK.

the_twin

I give up. You have clearly swallowed the government spin. I really have no idea what you want from the health service. A consumerist approach with outpatient appointments at 10pm on Sunday? But then you say the doctors are all leaving to work for better conditions abroad. What is the approach to that? Chain them to the wards? There are, by the way, not plenty of doctors. Vacancies cannot be filled and despite all the claims of being able to import labour from Europe or elsewhere, people aren't coming.

Drew_TNBD

I just want sexy nurses.

Sambostar

Free brain surgeoury..£20

Chalky

the_twin;1055124" said:

I give up. You have clearly swallowed the government spin. I really have no idea what you want from the health service. A consumerist approach with outpatient appointments at 10pm on Sunday? But then you say the doctors are all leaving to work for better conditions abroad. What is the approach to that? Chain them to the wards? There are, by the way, not plenty of doctors. Vacancies cannot be filled and despite all the claims of being able to import labour from Europe or elsewhere, people aren't coming.

Slight spin by you there? Last time I looked the vacancies that can't be filled are in areas and hospitals unattractive to your average doctor.

the_twin

Nope. There are gaps in rotas everywhere. The biggest bill for agency staff needed to plug some of the gaps was at Barts in London. Even if that wasn't the case, are you suggesting it doesn't matter if the population of the North West of England don't have access to local emergency care (to take a recent example of an A&E closing for lack of medical staff)?

Chalky

the_twin;1055387" said:

Nope. There are gaps in rotas everywhere. The biggest bill for agency staff needed to plug some of the gaps was at Barts in London. Even if that wasn't the case, are you suggesting it doesn't matter if the population of the North West of England don't have access to local emergency care (to take a recent example of an A&E closing for lack of medical staff)?

It matters. But it is not the fault of any government or the result of any spin. So don't include it in your evidence of government failure or spin just to bolster your argument.

the_twin

NHS workforce planning is the responsibility of government bodies. Decisions about numbers of nurse and medical training places are made by government bodies. Creating employment conditions in the NHS that drive away staff is the responsibility of government. For whatever reason, the Secretary of State is determined to continue the current dispute, and is likely to enter into further disputes with nurses,midwives, AHPs and senior doctors. This strategy is hardly likely to improve the current vacancy rates (9% for nurses and 7% for doctors).

Chalky

And you're implying its the responsibility of government to make people want to move to the North West to fill those vacancies? Sounds like you equate Any Problem = Government Fault.

CabbageCat

the_twin said:

And the solution to people leaving to work abroad or retire is what exactly? Oh yeah, make their working life worse, reduce opportunities for training and flog the oldies until they drop.

That, in essence, is what Hunt has to juggle. If he could still fill hospitals with qualified staff by paying them half wages and doubling hours then it would be irresponsible of him not to do so (he has a mandate to spend taxpayer dollar efficiently), but he can't because it will push the NHS past functional service. He clearly thinks that this current contract, while unpopular with the staff, will not cause it to cross that line. Time will tell (assuming the contract gets put in place) whether he's right.

the_twin

Chalky said:

And you're implying its the responsibility of government to make people want to move to the North West to fill those vacancies? Sounds like you equate Any Problem = Government Fault.

Training posts for junior doctors are recruited on a national or sometimes regional basis. You are then assigned a series of placements at different hospitals for your training rotation. There isn't individual choice beyond which specialty to apply for and perhaps which broad region. The issue comes when there are not enough doctors in these official training posts to fill the rotas across the various participating hospitals. Some hospitals may be relatively protected because they offer some unique training opportunity in a given area that each doctor will need to rotate through. However the gaps will need to filled by doctors who are outside the training programme but are still working at the junior level. This is where an element of choice in where to work comes in, although such jobs do not help to progress an individual's career. Interestingly fewer and fewer doctors have been applying for the official training schemes in past 3 years, particularly in areas such as A&E. Clearly not every problem is the government's fault, nor would any rational person with knowledge claim the NHS to be perfect, however some current problems are a direct result of government decisions and strategy.

the_twin

CabbageCat said:

the_twin said:

And the solution to people leaving to work abroad or retire is what exactly? Oh yeah, make their working life worse, reduce opportunities for training and flog the oldies until they drop.

That, in essence, is what Hunt has to juggle. If he could still fill hospitals with qualified staff by paying them half wages and doubling hours then it would be irresponsible of him not to do so (he has a mandate to spend taxpayer dollar efficiently), but he can't because it will push the NHS past functional service. He clearly thinks that this current contract, while unpopular with the staff, will not cause it to cross that line. Time will tell (assuming the contract gets put in place) whether he's right.

You can't double the hours because that would be illegal. Do you really want to be treated by a doctor who has to work an average 90 hour week? That sort of thing was common 30 years ago and was unsafe then. Since there are already thousands of vancancies, cutting the wages is hardly likely to draw in more applicants form overseas, which is what we continue to have to rely upon.

ToneControl

Ken Clarke says: 

http://www.telegraph.co.uk/news/2016/04/25/the-bma-cares-about-pay--not-patients/

your thoughts please

ToneControl

Fretwired

ToneControl said:

Ken Clarke says: 

http://www.telegraph.co.uk/news/2016/04/25/the-bma-cares-about-pay--not-patients/

your thoughts please

There would be a deal tomorrow if the pay issue were resolved. The BMA has put an offer on pay on the table which Hunt rejected.

However, I see no reason to strike over a threat (to implement a new contract) so I do suspect there are some political motives at play.

the_twin

The idea that the BMA is a Trotskyite body intent on the overthrow of the state, as was reported in the media last week, seems a little far fetched. However the government wanting to put the boot into health service unions is entirely plausible, given the need to save £20billlion from the cost of the NHS over the next 4 years.

Fretwired

the_twin said:

The idea that the BMA is a Trotskyite body intent on the overthrow of the state, as was reported in the media last week, seems a little far fetched. However the government wanting to put the boot into health service unions is entirely plausible, given the need to save £20billlion from the cost of the NHS over the next 4 years.

Bending the truth.

The NHS plan:

• £10 billion real terms increase in NHS funding in England between 2014-15 and 2020-21, of which £6 billion will be delivered by the end of 2016-17, and £4.8 billion capital funding every year for the next 5 years
• Transforming the NHS into a 7-day service and investing in new clinical strategies for cancer and mental health, and enabling the provision of up to 10,000 additional nursing and health professional training places this Parliament
• Integrating health and social care services by 2020, supported by a strong funding settlement for social care
• £22 billion of efficiencies to be made within the NHS by 2020-21, with savings reinvested into frontline health services, as set out in the NHS’s own plan, the Five Year Forward View, and actions to tackle deficits and ensure good financial management across the NHS

It's making £22 billion saving through efficiencies, not cutting the health budget by £22 billion. The money will be reinvested. The figure was arrived at by the NHS not the government.

the_twin

The £22billion is the difference between what it is estimated the cost will be of maintaining current levels of service and the money going in. The costs go up because there is more demand from an expanding and ageing population, while the investment in healthcare per head of population is now falling. No-one in NHS England has the first idea where efficiency savings of £22biilion are going to be found. The cost of drugs, equipment and building maintenance is hardly likely to fall. The low hanging fruit has been picked already. The major expense is wages - caring for people being a labour intensive business. If you cut the staffing to the bone you get Mid Staffs.

Fretwired

the_twin said:

The £22billion is the difference between what it is estimated the cost will be of maintaining current levels of service and the money going in. The costs go up because there is more demand from an expanding and ageing population, while the investment in healthcare per head of population is now falling. No-one in NHS England has the first idea where efficiency savings of £22biilion are going to be found. The cost of drugs, equipment and building maintenance is hardly likely to fall. The low hanging fruit has been picked already. The major expense is wages - caring for people being a labour intensive business. If you cut the staffing to the bone you get Mid Staffs.

Oh please. The efficiency savings report was compiled by the NHS. There are a whole range of measures from prescribing generic drugs, which has saved £7 billion since it was introduced, to creating care teams to improve initial treatment and so cut the incidence of patients returning for treatment due to poor care and outcome the first time they engaged with the NHS.

The target maybe be optimistic but it's NHS led not a Jeremy Hunt back of a fag packet government target. The 'Tories hate the NHS' rhetoric doesn't stand up to examination. The NHS is wasteful and inefficient by its own admission and can make better use of it's budgets.