Where do you stand on the Junior Doctors' strikes ?

TimmyO

Fretwired;1041655" said:

TimmyO said:

It's the first public sector strike that I have supported 100% 





Not so. From today's Times:



Chris Kane, who works in palliative medicine in West Yorkshire, said a significant number of junior doctors did not support an all-out strike.



“We completely disagree with the contract, but the argument that the end justifies the means cannot apply when it comes to patients’ care,” he said.



It emerged last week that Johann Malawana, the head of the British Medical Association’s junior doctors committee, had warned in an internal email that an all-out strike would be “difficult to defend”. He proposed that junior doctors continue to provide emergency cover in paediatric services, but this was rejected by union colleagues.

You might want to re-read what I wrote...

CabbageCat

RocknRollDave said:

Steffo said:

I would agree with you with the exception that we are now in a global economy, people can move between countries for work fairly easily if highly skilled like doctors, engineers and scientists. Don't get me wrong, Hunt is having a laugh but strikes affect only people that need treatment, not that tosser.

Lovely. "Don't like your new contract? Eff off and live in a totally different country, then!". Good job junior doctors don't have children, partners, families etc, eh?

That's not ideal, obviously, and one of the downsides of having a single health provider that has a virtual monopoly. There is nowhere to turn for anyone who is unhappy with them, staff or customers. The situation we have now is that the NHS bosses can't evolve (change, destroy, whatever) the service unless it is an obviously good change for the staff. They can hold the health service - and therefore the country - to ransom since there is no alternative.

I can see why some people want to slim the NHS down. At the moment we are entirely dependent on a single massive entity.

Drew_TNBD

Waiting hours to see a nurse is just not cricket really. Our NHS is strained and it does need reforms, just not big business reforms imho.

Fretwired

TimmyO;1041738" said:

[quote="Fretwired;1041655"]TimmyO said:

It's the first public sector strike that I have supported 100% 





Not so. From today's Times:



Chris Kane, who works in palliative medicine in West Yorkshire, said a significant number of junior doctors did not support an all-out strike.



“We completely disagree with the contract, but the argument that the end justifies the means cannot apply when it comes to patients’ care,” he said.



It emerged last week that Johann Malawana, the head of the British Medical Association’s junior doctors committee, had warned in an internal email that an all-out strike would be “difficult to defend”. He proposed that junior doctors continue to provide emergency cover in paediatric services, but this was rejected by union colleagues.

You might want to re-read what I wrote...[/quote]


Indeed ... note to self .. don't make posts late at night when you're tired.

english_bob

Evilmags said:

senior consultants on 350,000 plus. 

In the interests of clarity, a senior consultant may earn that much, but more than two thirds of it will be from outside the NHS. 

A consultant's basic salary tops out at a little over £90k, as a cursory look at the NHS jobs website will tell you. They can and do work in private practice and earn more.

Chalky

Worth noting that other developed countries do not want an NHS. We are conditioned to think of it as a 'jewel in the crown' but other countries see it as a white elephant. And when you look at the statistics we may be the 4th largest economy but thats rather higher than our position on any world health stats (last time I looked).

Heartfeltdawn

Chalky said:

We are conditioned to think of it as a 'jewel in the crown' but other countries see it as a white elephant. 

Is that the royal We? Because you don't speak for me. 

EricTheWeary

Chalky;1042026" said:

Worth noting that other developed countries do not want an NHS. We are conditioned to think of it as a 'jewel in the crown' but other countries see it as a white elephant. And when you look at the statistics we may be the 4th largest economy but thats rather higher than our position on any world health stats (last time I looked).

Countries that don't have an NHS equivalent but still spend more per capita on health care like the USA for example? And despite that level of spending has almost no safely net for the poorest in society for their health care and has a private insurance system that leads to decisions about medical conditions based on short term costs so that only the wealthy can manage chronic conditions? OK, fair enough.

CabbageCat

EricTheWeary said:

Chalky;1042026" said:

Worth noting that other developed countries do not want an NHS. We are conditioned to think of it as a 'jewel in the crown' but other countries see it as a white elephant. And when you look at the statistics we may be the 4th largest economy but thats rather higher than our position on any world health stats (last time I looked).

Countries that don't have an NHS equivalent but still spend more per capita on health care like the USA for example? And despite that level of spending has almost no safely net for the poorest in society for their health care and has a private insurance system that leads to decisions about medical conditions based on short term costs so that only the wealthy can manage chronic conditions? OK, fair enough.

"Like the USA for example" means "the USA". They have a pretty unique health service too and I certainly wouldn't want to emulate it. Some parts of their system are enviable - other parts really are not.

Fretwired

CabbageCat said:

"Like the USA for example" means "the USA". They have a pretty unique health service too and I certainly wouldn't want to emulate it. Some parts of their system are enviable - other parts really are not.

The US system is not one I'd like in the UK. An ex-girlfriend's father was refused medical treatment as the people running his health policy wouldn't pay for treatment due to his age (89). Unfortunately for them my ex is a social justice lawyer with a reputation for winning her cases so they quickly backed down. From her point of view the US should look at the NHS as the model - too many people in the USA go without basic healthcare. The US government can spend $100 billion on a new stealth destroyer but not provide healthcare to those in need.

The problem with the NHS is a lack of forward planning due to reorganisations and government meddling. People are living longer, more treatments are now available along with new expensive drugs and immigration has fuelled the population.

chillidoggy

Having had to avail ourselves of the healthcare system in the U.S. recently, I can say that the treatment was first class. But the costs.................oh my giddy aunt! Serious, serious money involved.

eg - The wife fell over, splitting her forehead open right the way across. Total cost of the hospital, head scans, and the doctor doing the 22 stitches?

A whopping $14,000!

NHS would have been free, although of course we'd have had to wait in A&E for ages which is the downside, but I wouldn't want to move to the U.S. system

Troy

chillidoggy said:

Having had to avail ourselves of the healthcare system in the U.S. recently, I can say that the treatment was first class. But the costs.................oh my giddy aunt! Serious, serious money involved.

eg - The wife fell over, splitting her forehead open right the way across. Total cost of the hospital, head scans, and the doctor doing the 22 stitches?

A whopping $14,000!

NHS would have been free, although of course we'd have had to wait in A&E for ages which is the downside, but I wouldn't want to move to the U.S. system

Isn't that the case whenever Insurance companies are involved, they jack up the price as the punter isn't paying. Similar to Vet prices nowadays...

chrispy108

CabbageCat;1042144" said:

"Like the USA for example" means "the USA". They have a pretty unique health service too and I certainly wouldn't want to emulate it. Some parts of their system are enviable - other parts really are not.

Exactly. I love how any conversation remotely critical of the NHS in this country turns into "well, at least we're not America", as if that is what anyone is suggesting. There is certainly a happy medium between the NHS and the US system, which seems to be where most of the rest of Europe sit quite happily.

EricTheWeary

I didn't not mean the USA, I meant 'like' as in 'for example.' I don't know what country could be held up as an example of a privatised healthcare system that works?

chillidoggy

Troy said:

chillidoggy said:

Having had to avail ourselves of the healthcare system in the U.S. recently, I can say that the treatment was first class. But the costs.................oh my giddy aunt! Serious, serious money involved.

eg - The wife fell over, splitting her forehead open right the way across. Total cost of the hospital, head scans, and the doctor doing the 22 stitches?

A whopping $14,000!

NHS would have been free, although of course we'd have had to wait in A&E for ages which is the downside, but I wouldn't want to move to the U.S. system

Isn't that the case whenever Insurance companies are involved, they jack up the price as the punter isn't paying. Similar to Vet prices nowadays...

Very probably true, Troy.

And there's a coding system for every medical procedure above which they cannot legally charge. A travel insurance company will know this (actually ours employs a woman specifically to fight their corner with U.S. cases). My guess is that the 'proper' bill should have been a bit less, maybe 60%, but shit, that's still a huge amount of money to pay.

quarky

Don't the Governments of the US and the rest of Europe spend more on healthcare than we do?

Paul_C

Dr Ravi Jayaram, via FB:

"I have kept quiet on here until now about the junior doctor's strike but the time has come to stand up and say what needs to be said. Apologies in advance for the long essay, I will try to keep it simple. This is aimed at those of you who are not medical; those who are will know exactly what I am talking about.

If you simply believe what is said in the media, you might think that this is all about Saturday pay or even that junior doctors don't want to work at nights or weekends. It is depressing to overhear people express these views but hardly surprising given the public coverage of the issue.

So what exactly is going on? A junior doctor is any doctor who is not a GP or consultant who is in training to be one of those two. Most doctors spend 8-9 years as a junior but many stay as juniors for longer, especially female doctors who may take time out for families, academics who take time out to do research and doctors in specialities where training in two specialties is needed such as paediatric intensive care. I myself spent 14 years as a junior doctor so was still one aged 37. Junior doctors are the doctors you will see first when you go to A&E or get admitted to a ward and will be responsible for delivering your day to day care when you are in hospital. Junior doctors are covering the hospital 24/7, 365 days a year and always have done. And contrary to what you might believe from the papers, they don't have any choice in the matter, their contracts say they have no choice in working evenings, nights and weekends.

So what is all the fuss about? Well it is about being able to be safe. When I was a JD, I used to work ridiculous hours. In one job in my 1st year, every 3rd weekend I would go to work at 9am on a Saturday and leave at 5pm on a Tuesday. That was 80 hours in a row with sleep grabbed when the chances arose. It was dangerous and dehumanising and the even crazier thing was that I was actually paid at a lower rate for the unsocial hours than basic pay (1/3 of basic in fact).

Fortunately my generation of juniors was amongst the last to have to do that and things slowly changed. Now junior doctors get paid at a higher rate than basic for unsocial hours, that rate determined by the intensity of work in that specialty e.g. emergency room work would be a higher rate than dermatology. Standard hours are defined as 7am-7pm Monday to Friday (which are not exactly standard working hours for most people) and there are rules on the maximum number of hours per week and consecutive hours that can be worked. There are also safeguards in place so that if employers are consistently making juniors work beyond these rules, they can be fined; hence there is a disincentive for employers to overwork junior doctors, therefore they are not tired and dangerous 1990-style.

But work done outside standard hours is NOT overtime. These hours are contracted hours and have to be worked and, quite rightly, are paid at a higher rate than basic pay. In specialties where there is not a lot of emergency work, the majority of work is in routine hours, but areas like A&E, paediatrics, intensive care have a lot of work done in unsocial hours and attract a higher rate of pay for those hours. I stress again that this is not overtime; overtime is work done in addition to contracted hours. All doctors and nurses do overtime - staying late to complete work and ensure patient safety and very rarely if ever does anyone claim for these overtime hours.

But Jeremy Hunt wants to change the contract for junior doctors, his logic being that doing this will help to deliver the “7-day NHS”. Nobody is really sure what exactly this means. It may mean that he wants routine services such as outpatient clinics and planned surgery or scans for non-urgent problems to take place on Saturdays and Sundays, not just Monday to Friday. If this is the case then changing the juniors’ contract is not going to make this happen as without doing the same for (deep breath) consultants, nurses, porters, receptionists, pharmacists, operating department assistants, radiographers, physiotherapists and many other staff these things won’t be able to happen at weekends.

Paul_C

The 7-day NHS may refer to emergency work. If this is the case then it already exists. Junior doctors are already there at night and at weekends. The proposed contract changes are not going to change the numbers who are there as there is no plan to increase the total number of junior doctors. What is proposed is that the definition of normal time changes from 7am-7pm to 7am-10pm Monday to Friday and from 7am to somewhere between 5pm and 10pm on Saturday. This means that employers could make junior doctors work more unsocial hours as they have redefined as standard hours. It is true that the basic rate of pay for standard hours will be increased by 13%, which sounds great doesn’t it? Except that for the emergency specialties as above that routinely have a lot of evening, night and weekend work, what is currently paid at an enhanced rate will be paid at standard rate; even at 13% higher for standard rate, total pay for junior doctors in these specialties will drop considerably, maybe by as much 30% for some. Doesn’t sound so good now really.

And, of course, there will be the same number of doctors but spread over 7 days rather than 5 so there will be weekdays where there will be fewer juniors than there are now. A great analogy I heard was to imagine that you have a 10-inch pizza cut into 5 slices. You decide that 5 slices isn’t going to fill you up so your mum cuts the same pizza into 7 slices and tells you that you’ll be full with that. But she won’t get you a bigger pizza.

So same number of junior doctors spread more thinly is going to reduce cover on weekdays as compared to now. And weekdays are when not only emergency work but also routine planned work that also needs input from junior doctors takes place so this will have a detrimental effect on waiting lists for clinics and operations as well.

Junior doctors with children will be hit particularly hard, especially those who have junior doctors spouses, as more unsocial hours will be worked. Childcare is generally difficult to get hold of outside of 8-5 on weekdays; the department of health have actually said (with no hint of irony) that in this situation, family members who are non-medical and don’t work evenings or weekends should be asked to provide child care to get over this problem! It is very likely that couples could go several days without actually seeing each other or their families if rotas do not coincide.

But what about the increased deaths at weekends we have been hearing about? Actually, the statistics have been completely misrepresented and even the authors of the research paper that gets quoted regularly have pointed this out. The statistic was that if you are admitted to hospital on a weekend, your risk of dying within 30 days of that admission was higher than if admitted midweek. Your risk of dying is very low anyway and that very low risk is marginally higher (but still very low) if admitted on weekends. This is probably because admissions to hospital in the week consist of not only sick people but also well people coming in for routine things, whereas at weekends you would tend to avoid hospital unless you were desperately unwell and most likely would leave things as long as possible and so be sicker when you got there. Interestingly they also showed that if you were already in hospital on a weekend, having been admitted in the week, your risk of death within 30 days was lower than it would have been. Either way, there is no evidence of cause and effect in terms of numbers of junior doctors around at weekends. The so-called weekend effect has also been seen in the USA and Australia too so it isn’t peculiar to state-funded health as opposed to private insurance-based systems.

Interestingly the misrepresentation of this study has led to ill people actually avoiding hospitals on weekends and delaying presenting till Monday with potentially devastating consequences. Have a look online for the ‪#‎hunteffect‬. Scary.

Another worrying thing about the proposed new contract is that it takes away the safeguards against juniors being made to work ridiculously long hours. Whereas currently there is a mechanism that makes it in the interests of an employer to ensure the hours are not exceeded, the new contract removes these safeguards. It does suggest that each hospital trust has a “guardian” to whom junior doctors can flag up concerns about their hours but this “guardian” will also be a senior member of the trust who has no obligation to actually do anything about these concerns. I think back to my days as an exhausted junior doctor and it scares me to think that such unsafe and dangerous hours could make a return.

The pay scales are also changing. There has been automatic pay progression as you gain experience and seniority until now. The new system means that there are fewer points where pay is raised. This is not necessarily a bad thing as it can be argued that you shouldn’t get a pay rise unless you deserve it. But remember that over 10 years can be spent as a junior doctor in which time you are likely to acquire husbands, wives, children and mortgages; many existing junior doctors have made their financial plans for the next few years based on the expectation that there will be pay progression. One part-time junior doctor who has worked with me told me that if the new contract came in she would no longer be able to pay her mortgage and would have to sell her home. Bear in mind that these are young people who have spent at least 5 years at university accruing debts from both student loans for living expenses and now also £45000 in tuition fees before even starting work. The new pay scales do not reflect the levels of responsibility taken by junior doctors at different stages of their training at all which makes no sense whatsoever. For female doctors who are likely to take time out to have children and then return to work part-time, the consequences on their income will be huge. The department of health actually acknowledged that women would be hit unfairly but suggested that this had to be accepted as an unfortunate consequence.

The BMA junior doctors committee walked out of talks with the department of health because the DH’s definition of negotiation was that they would reserve the right to do what they wanted if they didn’t agree with what the committee was suggested. In other words, they did not want to negotiate so there was not point in the BMA trying. This is why industrial action was proposed because there was no other way to try to get Jeremy Hunt to talk. Sadly, even when negotiations restarted, he could not see that without a bigger pizza nothing was going to improve patient care and in fact things would be worse and so talks stopped. He has now said he is imposing the contract and that is that, he won’t talk anymore. When a strike ballot (of, let’s face it, intelligent reasonable and educated people) has a 75% turnout and 98% vote in favour, it is clear that there is a serious problem with the DH’s thought processes and they need to listen. It is highly improbable that a small bunch of radical lefties have brainwashed 50000 intelligent doctors who have been trained to analyse information and draw conclusions, much as the press like that idea.

Paul_C

If you have read this far, please take it on board and share with your friends. I’ve tried to keep it simple (even though it may not seem that way!) The public is not getting the full story from the TV and newspapers and if this contract is imposed then we will all be on the receiving end of the consequences eventually.

I’ll stop there for now but will write some more about what will happen on the days of the full strike (April 26th and 27th) and why you should not have to worry about what may happen on those days if you or your family have to come to hospital."

CabbageCat

quarky said:

Don't the Governments of the US and the rest of Europe spend more on healthcare than we do?

I've seen that on facebook. It's a little skewed it appears (http://www.iea.org.uk/blog/the-envy-of-the-world-a-closer-look-at-the-commonwealth-fund-healthcare-study). This is a more neutral one: https://en.wikipedia.org/wiki/World_Health_Organization_ranking_of_health_systems_in_2000. We're 18th (though 25 pay more than us so it's not all bad news).