General / Off-Topic junior doctors - any facts?

[beelbeebub]

Seriously! You understand that life or death decisions don't wait for a better paid person to turn up! I mean really, you think they can just say "Sorry can you just hold off on that heart attack whilst I get my manager"!

Firstly, right now one of the massive bottle necks inn the NHS is waiting for a senior person to "sign off" on things, say administering pain relief or discharging a patient. Of course if you suddenly started choking or squirting blood everywhere then the doctor would do everything they could (whilst calling for assistance). i'm talking about decisions like "should we discharge this patient", "is it ok to give drug X to this person given these medical records", "do we send this person for a scan or do we medicate first". There are many decisions that are "life or death" that don't actually require immediate action. Child with a rash turns up, meningitis or allergy? If the newly qualified Doc is unsure they should consult higher. I'm saying that a newly qualified doc shouldn't be making these big calls, if they are then the hospital management has things extremely wrong. Because the newly qualified doc (NQD) is not making these calls unsupported (if they are unsure they should always have a higher up available for consult) then it is less of an issue to work a 40hr week, whilst the more experienced do who is making these difficult decisions (that often come with experience) would be working the 32h weeks and so be even fresher than the NQD.
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Remember I was advocating the even the NDQ's would be capped in the low 40's per week, which is doable albeit hard. There could be some offset as well so nights count for more e.g. every hour worked at night counts as 1.5 hours towards the weekly total.

The truth is the NHS is being broken up because people can make vast sums from healthcare once privatised, just look at the obscene waste of money that the US healthcare has at its heart. Anything that can be targeted as wasteful or costly in the NHS is being targeted regardless of how favorably it compares to other countries health service.

This idea the NHS isn't 24/7 is utter nonsense. The difference is elective (pre-planned non urgent) care isn't carried out at weekends meaning a much lower level of staffing is required for safe levels. The report that Hunt et al are using to suggest more people die when admitted at weekends completely omits the fact that lack of elective care means only emergencies are dealt with at weekends. Even the reports authors have said the information is being used wrongly and out of context.

From an economic point we should be highly wary as well. Often companies that take over from the NHS are run from other countries meaning some of the money spent leaves our economy. This has already happened with things like rail transport. Tax payers are still funding the rail network but private companies are reaping in the profits. Some of these are even owned by foreign governments meaning their treasury gets money from taxation UK residents have paid.

Totally with you against the privatization of the NHS. I've seen first hand how badly batched some of the PFI/PPI stuff for hospital buildings was. That being said there is a place in the NHS for the NHS to use private companies BUT the NHS needs to really step up the calibre of it's contracts/negotiation teams (and stop the cozy relationships between senior management and service providers where people keep stepping across the fence as it were).
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I also agree about the death rate/weekend statistics being misused.
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However, there is definitely an issue with "out of hours care". A friend has been undergoing cancer treatment and had chemo over the summer followed by an op in early December. After the op the plan was to go with another dose of chemo to "sweep up" anything the surgery missed. He returned home mid December and the plan was to go with out patient chemo over the holiday period.
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Unfortunately there was a painful complication (twisted bowel) from the surgery and he was in agony from Christmas eve. Because of the holidays he wasn't able to get this sorted until the new year, he wasn't even able to get pain meds. The pain plus his inability to eat meant he had to skip the chemo until his bowel had been sorted. Once that was sorted he enquired about when he would kick off the chemo. "too late" was the reply. It needed to happen straight after surgery to be of any use, he was told. Because of the delay (down to the holidays) he's missed the chemo "window" and his overall chances of a relapse are now higher.
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Yes, elective surgery doesn't have to happen at the weekend (although that does mean expensive assets are being unused - maybe the NHS could hire them out to private companies at big rates...hummm) but the response from the NHS does seem to drop more than simply "no bunions or hip replacements on the weekend" would warrant.

 

[Gully Foyle]

Why is this post open has it to do with E.D why are u interrupting my leisure time with this rubbish

It's in the Off Topic section for that very reason.
You interrupted your own time when you clicked on it eh
o7

 

[Surfinjo]

Seriously! You understand that life or death decisions don't wait for a better paid person to turn up! I mean really, you think they can just say "Sorry can you just hold off on that heart attack whilst I get my manager"!

The truth is the NHS is being broken up because people can make vast sums from healthcare once privatised, just look at the obscene waste of money that the US healthcare has at its heart. Anything that can be targeted as wasteful or costly in the NHS is being targeted regardless of how favorably it compares to other countries health service.

This idea the NHS isn't 24/7 is utter nonsense. The difference is elective (pre-planned non urgent) care isn't carried out at weekends meaning a much lower level of staffing is required for safe levels. The report that Hunt et al are using to suggest more people die when admitted at weekends completely omits the fact that lack of elective care means only emergencies are dealt with at weekends. Even the reports authors have said the information is being used wrongly and out of context.

From an economic point we should be highly wary as well. Often companies that take over from the NHS are run from other countries meaning some of the money spent leaves our economy. This has already happened with things like rail transport. Tax payers are still funding the rail network but private companies are reaping in the profits. Some of these are even owned by foreign governments meaning their treasury gets money from taxation UK residents have paid.

This.

When I was in intensive care a few years ago there were between 8 and 12 nurses continually sitting at a central desk, moving paper around. At one point, a young boy was wandering around smoking! Another, a mentally handicapped boy, stinking of **** was wandering around because the LD dept staff were too busy to watch any of their charges. Too busy with paperwork.

It is a joke. It is sabotage. But again, no information, just a lot obscure complaints saying they are over worked.

I can't pretend to really understand the current situation. When I worked in the NHS the unions were still quite strong, I was a steward myself for a while. The writing was on the wall then, largely because the unions had grown so big they were taking care of too many staff meaning management was able to play us off each other. (One of the most common tactics was to get 2 or 3 junior females to make a complaint against their supervisor for sexual harassment. It would be dragged out for several months, even a couple of years then dropped. The staff all being represented by the same union!)

But think of this? The drugs I've had from the NHS over the last few years alone would cost almost $100 a month in the US.

From the user's perspective, it's still incredible value and of the highest quality.

So, I have no actual information, no actual evidence. But what I get is keeping me alive at a cost that I can afford.

Unless one side or the other condescends to actually say what the problems are, with evidence and examples, where is my incentive to take a side?

 

[CMDR Heisenberg B. Damned]

Yes, elective surgery doesn't have to happen at the weekend (although that does mean expensive assets are being unused - maybe the NHS could hire them out to private companies at big rates...hummm) but the response from the NHS does seem to drop more than simply "no bunions or hip replacements on the weekend" would warrant.

First off. I sincerely hope you friend recovers - nothing more I can say on that other than wish them well. In that case, the required cover and work should have been available.

The problem with all the current suggestions, not just junior doctors, I note mental health services was under attack on the news this morning. Is that whilst it (the NHS) can be improved there's simply no evidence bringing in a for profit organisation will aid that improvement. None whatsoever. No system will be perfect as long as it involves us humans (private or public) - because we're not perfect but if they want full scale services 24 hours a day 7 days a week then it needs funding.

Now that sounds like it'll costs a lot but economics really doesn't work how it's portrayed in the media. This idea that hitting the magic money tree button (printing more money) will drive a country into Weimar Republic style downward spiral is nonsense. The reason that happens is the money being printed wasn't going into the economy that was printing it. In the Weimar case it was going on war reparations to other countries.

If on the other hand the money gets spent on wages within the economy then the multipiler effect recovers the addition money in taxation. That's why we should be wary of spending going out to the profit margins of companies outside the UK - we don't recoup the multipler and the tax take is lower next time leaving just the debt.

What printing money does do is make the current currencies value worth less. This doesn't really affect the majority of us but it does impact on people with millions of pounds in savings. For some reason this isn't popular with multi-billionaire media barrons. No idea why!

For politicians to say healthcare is un-affordable is just gibberish (at best). Inherently it's affordable as long the population are mostly in employment.

Yes it could be improved but not by turning it into a profit making system.

 

[beelbeebub]

I worked on a delivery device for a haemophiliac (failure to clot blood, so cuts just bleed) drug. This was for the most serious and rare type, where you never clot and you could bleed out from a paper cut.
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The disease is very rare (only a few tens in the UK), genetic and used to leave suffers housebound with a life expectancy in their early 20's.
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This drug would allow them to live a normalish life, go cycling, jogging, to work etc (ok kickboxing was probably a bad idea) and the projections were for a normal life expectancy.
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A years supply of drugs could cost $400,000.
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I asked the drug company rep how anyone afforded this as it was a pre-existing condition, surely it was impossible to get insurance for. and affording a $400k per year drugs bill is out of reach of pretty much everyone.
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He replied that you needed to be born to parents whose health insurance covered you, then by 21 (the usual age when you get moved off parental cover) you had to get a job with a firm that provided group insurance as part of the package. Then you had to hope you kept your job as losing your job (and insurance cover) could literally be fatal.
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The UK sufferers had this drug on the NHS (and presumably the NHS paid ales as well).
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That was one of the moments that really brought home to me how screwed up the US system is and how good the NHS was.

 

[CMDR Heisenberg B. Damned]

When I was in intensive care a few years ago there were between 8 and 12 nurses continually sitting at a central desk, moving paper around.

Whereas a competition based system will have several ambulances all turning up at the same accident (because - competition). It's less efficient - honestly it is.

I went on a course called Just In Time Total Quality Management years ago - it basically whittled everything down to bare basics to reduce costs. It fails with massive human consequences with the first major incident when applied to health care. You have to have some slack for emergency services and I'd also argue I'd much rather have the person who's about to slice me open as fresh as a daisy rather than at the end of 16 hour shift. Just me maybe!

 

[xyphic]

I'm not convinced that the "unsafe" working hours is really the issue here. The issue is that currently any hours outside of 7am-7pm Mon-Fri are considered as unsociable hours, and are therefore in a higher pay band. The change to the contract extends the sociable hours to 10pm on a weekday, and adds Saturday until 10pm (concessions have changed this to 7pm). This affects the work-life balance of junior doctors
[*] as they won't be able to choose not to work a weekend, and won't be given suitable recompense when they're rota'd in. The government have attempted to rectify the issue of pay by offering an 11% increase in basic pay (i.e. during sociable hours) but are putting more limits on working hours so that they're effectively paid the same per-week but now also have to work on a weekend.

These changes are being made unilaterally. Doctors have little choice in the matter other than to leave the NHS, and given that these contracts are supposed to increase doctor availability that feels somewhat counterproductive. I'm all for a 7-day NHS, but it needs to be done through investment, not by changing the terms of employment of vital staff. Unfortunately the only places that extra funding could come from (increased taxation, decreased defence spending) the current government are too weak to consider. It seems that they'd prefer to run the NHS into the ground (which also suits them as they can build it back up in a shiny new privatised form).


[*] It also irks me that we continue to use the term "junior doctors". These are highly qualified medical staff who are out of further education (that they'll have been in for ~6 years), but aren't yet qualified as a GP or consultant. They'll typically work for 5-15 years performing vital functions in hospitals (e.g. the people who see you when you visit A&E) all the while continuing to train, study, take tests and usually pay for those out of their own income.

 

[Asp Explorer]

Whereas a competition based system will have several ambulances all turning up at the same accident (because - competition). It's less efficient - honestly it is.

This might be OT - but I honestly feel it's relevant.

One incident I personally witnessed - a guy on a scooter made a poor decision and dumped his machine to avoid hitting a solid object. At about 10mph.

Three police cars, two fire engines, two ambulances and a paramedic van attended.

 

[Surfinjo]

xyphic

If the issue really is the loss of antisocial hours payments then frankly the Drs havn't a leg to stand on.

The antisocial hours nonsense was always not much more than a scam to get extra pay, like Bank Holidays for example.

 

[xyphic]

xyphic

If the issue really is the loss of antisocial hours payments then frankly the Drs havn't a leg to stand on.

The antisocial hours nonsense was always not much more than a scam to get extra pay, like Bank Holidays for example.

Disagree. If my contract stipulates that I work a particular set of hours for a particular level of remuneration then when I'm required to work outside of those hours I expect adequate compensation. It is, after all, just a job and there are other important things in life such as family to worry about. Most contracts will include clauses that allow employers to require their employees to work outside their contracted hours for no extra pay, but with the caveat that it should be under exceptional circumstances. If my employer were to unilaterally force a change in contract on me that meant a detrimental change in working hours for me (e.g. if they decided to change my hours so that I had to work the weekend but had a couple of days off during the week instead thus impacting negatively on my family life) I would be mightily peeved and would quit my job and go elsewhere. Unfortunately it's not so easy for doctors and other medical professionals; they *could* go work abroad but that's a huge life change, and so in the majority of cases the gov't have them over a barrel. The only protection they have from changes in contract like this is that they have a union, and I support their right to exercise their options to the fullest.

The vast majority of medical professionals are interested mainly in providing the best medical care they possibly can. This issue isn't about money, it isn't about them wanting to get paid more for unsocial hours (otherwise we'd have the best service on a weekend as all doctors would want to be working then). The issue is that if the government want to provide a 7-day service they have to recognise that it doesn't come for free. Medical professionals are people like you and I, and like you and I they would prefer to not have to work on a weekend because that's when they get to have family or social time. So where they *are* encouraged to work unsociable hours there *should* be appropriate remuneration. It's in everyone's best interest that we keep our medical professionals happy.

 

[Surfinjo]

NHS contracts never specify the actual hours, just the number. Since the NHS is a 24 hour service, all staff are expected to be available as required by the needs of the hospital. Nurses for example can and are often assigned to work early shift, late shift and night shift, all in the same week.

I appreciate your point but as I said, the issue of unsocial hours payments are a relic of the old perks.

What I do find sad though are the number of perks being retained by senior managers. Company cars for example, plus their extraordinary expense accounts.

 

[beelbeebub]

I have to say, Xyphic, if the issue is simply that JD don't want to be compelled to work Saturdays that's not really acceptable. Some careers are 9-5 Monday to Friday. An accountant, an insurance salesman, an architect. Some careers are by default 7day. Firemen, police, barmen, waiters, hotel reception, fast food etc. Many jobs have no concept of a weekend or are biased towards odd hours. My sister ran pubs and bars for years. Imagine if she said i want extra for weekends and evenings. Her entire job was weekends and evenings. If the NHS is to pull away from this dip in weekend care (and I know the death rate is misleading but there is no doubt there is a tangible difference between weekdays and weekends then doctors of all stripes will have to get over the idea that there are weekends.
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This means contracts that are "day blind" need to be in place for a sizeable chunk of the doctors. I suppose one way would be to impose the contract on new hires going forward, but I can imagine that wouldn't be popular with the bma either. I bet "two tier" would be bandied around.
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I have much sympathy with the argument that JDs work too many hours and that is unsafe. I have much sympathy that these long hours make the per hour pay of JDs poor. However I have no sympathy with the idea that, for doctors or the NHS in general, some days should have special status.
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Edit: I should also say that I also have sympathy with the point Xyphic raised about changing the contract unilaterally. That is bad practice, but if the BMA are "keep weekends special" that is not what their public spin is, they say they are striking because of long hours and therefore patient safety.

 

[Arry]

xyphic

If the issue really is the loss of antisocial hours payments then frankly the Drs havn't a leg to stand on.

The antisocial hours nonsense was always not much more than a scam to get extra pay, like Bank Holidays for example.

The bottom line is simple: The wage bill will be less. Therefore, some one is getting paid less etc.

Hunt keeps saying: '75% of JDs will be better off.' No one is asking about the other 25%.

 

[FuzzySpider]

The bottom line is simple: The wage bill will be less. Therefore, some one is getting paid less etc.

Whilst at the same time increasing the coverage of comprehensive medical care to weekends and evenings. So more doctor-hours for less money. It defies logic.

From the governments point of view it's a win/win. If the doctors knuckle down and deal with it they get to be the government that squeezed even more productivity out of the health service. If doctors are overworked and make mistakes it only shows how our health service needs "modernization" (to be sold off to G4S, Serco, Unum, and whoever else wants to make money out of human misery).

The only way this could possibly fail is if the public don't fall for the monstrous level of propaganda hurled at doctors and actually object to what's happening. If we don't want to be paying twice as much for worse healthcare (read) it's really important we don't let them win this.

 

[Siobhan]

to be sold off to G4S, Serco, Unum, and whoever else wants to make money out of human misery

Virgin, I believe.

 

[Jon flint]

Junior doctors in the NHS earn about the same per hour as shelf stackers in Aldi, under the new contract.

The bitter irony is that I actaully trained and worked as a medical professional (anesthetist) within the NHS. But thanks to job cutting/restructuring i now work for a discount retailer, and while it's not accurate that "shelf stackers" earn more than a Jr Doc, middle managers like myself most definately do. Certainly a sad state of affairs.

Edit* didn't initially spot that you said per hour. With that in mind, you may be right(ish).

 

[Surfinjo]

I believe trainee solicitors also work for practically nothing.

Just saying. The rewards at the end of it all are a career with enormous prestige and influence.

Certainly more than a shelf stacker.

 

[Parmo]

What's a 'junior' doctor? Is this an official NHS pay grade?
Is there an official 'senior' doctor grade?
What are their current contracted hours?
I'm a salaried software engineer; I often put in more hours than the nominal hours stipulated in my employment contract / manual. In the latter there is a clause that states that I am required to work extra time above the nominal hours as required by the company. I don't get paid for this 'extra' time.
This is normal in the IT world and I dare say in most other professions.
People get ill etc. 24/7. The NHS must provide a managed 24/7 service.
The NHS management, the BMA and government (of all political colours) are all petty minded.
And the public of the UK have too great expectations / wants of any state provided medical provision.
But privatising the NHS is no magic wand either.

 

[metatheurgist]

Look at it this way, what is safer?
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Pay 1 doctor £100k and expect him to work 100hours per week
or
pay 3 doctors £33k and expect each of them to work a 33hour week.
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The number of hours is the same but the work load has gone from dangerous to very doable.

My solution is better. The JDs should approach a footballer and say - "Hey! How'd you like a personal physician for a year for one week of your salary? I'd do your mistresses and family too!". That'd have to be a much easier workload.

 

[beelbeebub]

I don't know, have you seen how many injuries those footballers pick up during a game. Sometimes it seems like they are badly injured every other tackle.
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Mind you their recovery is impressive, only a seconds after what could only be a broken leg, given how they are rolling around the pitch, they pick themselves up and play on as if nothing had happened.
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Not like those rugby wusses who have to go off the pitch and have stitches and bandages for their little knocks.