General / Off-Topic junior doctors - any facts?

[beelbeebub]

I'm confused by the junior doctor row.
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The Drs are saying they are striking/unhappy because of patient safety, specifically the hours a jr Dr can work.
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The gov say the new contracts reduce the hours a jr Dr can work.
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The jr Drs say they increase the hours.
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Surely this is a simple matter to judge, but I can't find any actual data other than trite Facebook campaigns.
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Another thing that confuses me is that despite the sticking point being hour limits the latest bma letter to the gov doesn't mention them but does mention the pay structure for weekends as the final sticking point.
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I understand that jr Drs are a vital part of the NHS (although that goes for pretty much everyone in the NHS from cleaners to surgeons to nurses to maintenance) and agree that working too many hours is dangerous (in fact I'm pretty horrified that 56 hours per week is even considered safe, I'd peg it at around 40ish!). However, everyone working in the NHS must realise it's a 24/7 business not a traditional office job. Weekend working is just part and parcel of being in the NHS. Nurses know this, firemen know this, shop workers, cinema projectionists, bar men, waitresses, cooks, taxi drivers, bouncers, cleaners, tree surgeons, policemen all know that doing their job means that weekends are an abstract concept. Why should the upper levels of the NHS be different?

 

[Siobhan]

Junior doctors in the NHS earn about the same per hour as shelf stackers in Aldi, under the new contract.
It's just tricky language about hours. It does reduce the number of hours they CAN work, but increases the number of hours they HAVE TO work.

All part of the plan to make the NHS hated. We pay money for it, but the government trousers it instead of investing in said NHS.
Therefore the NHS struggles due to no money.
Doctors (and nurses and other staff) are therefore forced to work more hours for less money, which gets worse as less people train for medical services as the reward goes down.

Eventually the public complain.
The government says the NHS is useless and sells off the services to private companies (whom they have stakes in, of course).
We the sheeple therefore end up paying twice (the taxes for the NHS, since they won't stop of course and private bills)

The tories say thank you very muck and pocket the profits.

 

[samuelb]

The argument, as I understand it, is that the government wants to make all NHS services seven days as opposed to the five days they are now. That includes everything from GP services to surgical procedures. The junior Doctors argue this means they will end up working more hours to provide this service thus leading to patient safety being compromised. The BMA (British Medical Association) is being used as a scapegoat to redirect Jeremy Hunt's intentions. A good cogent argument on the side of the Doctors was given by Dr Rachel Clarke and can be found here https://www.youtube.com/watch?v=YHZYeKH6SV4. As someone who has a severely disabled child, I know that seven-day service is essential as currently weekend hospital care is a serious lottery and more people die at weekends as a result of the lack of staff (https://www.gov.uk/government/publi...kend-effect-on-patient-outcomes-and-mortality). The whole change would, however, become moot if the staff in question were overworked and tired. I have noted a few discrepancies on the junior Doctor's approach and arguments but, on the whole, it would appear the Tories are playing a dangerous game of spin for political gain with both the NHS and people's safety, this, of course, is just my opinion.

 

[beelbeebub]

First the patient safety issue (aka working too many hours).
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The JDs are saying the new contract will put patients safety at risk by making JDs work longer hours.
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From the Gov website:
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• The average amount of hours junior doctors work will remain the same, at around 48 hours per week.
• There will be a new absolute limit of 72 hours in any week, lower than the 91 hours that the current arrangements allow. Alongside this, we are removing the financial incentives in the current contract that encourage doctors to work unsafe hours.
• Junior doctors who opt out of the working time directive will not be able to work more than 56 hours per week on average over the course of a rota.
• No junior doctor will have to work more than 4 nights in a row or 5 long day shifts in a row and employers will be banned from scheduling any shifts over 13 hours.
• There will be a limit of 7 days or nights on call.

There are lots of bans and limits there. Can anyone compare these with the current limits?
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The limits above still seem rather high but are they better or worse than the current limits? The JDs imply they are worse than the current limits and therefore put patients at risk.
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To address Sibohan's point about being paid less than Aldi stackers:
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I too have seen the facebook post. This was one of the many trite FB campaigns I've seen. FB campaigns then to break complex things into simple soundbites that appeal to emotions.
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The poster takes the £23k starting salary and a working week of 56hours to get the £7.89/hr figure that is less than Aldi shelf stackers.
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The £23k is, as I understand it, the minimum for a JD. I'm not sure what the 56hours represents, is it the average for a JD? (Government claims this is 48hrs) or is it the maximum?
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It seems the poster is taking two ends of what is possible make a point. but lets assume that his point is valid, then under the new contract the JD's starting salary would be £25.5k, making his hourly rate £8.77. OK, not great but not the emotive "lower than a shelf stacker".
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On the face of it the governments proposal is (whilst not being where I would like it in terms of hors worked) not complete pie in the sky.
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What am I missing?

 

[FuzzySpider]

What am I missing?

[video=youtube;VbrHp5Jjlzo]https://www.youtube.com/watch?v=VbrHp5Jjlzo[/video]

You are missing the fact that the government is lying to you.

The NHS is a service that delivers a health service which provides health coverage to UK citizens at no profit. It is hated almost universally by most of the free-market enthusiasts - those who back both the Conservatives and New Labour candidates. Hence it is under political assault. The government are saying one thing while providing another - longer hours for the same wages - putting patients at risk, increasing the likelyhood of mistakes, and trying to get doctors on the edge to quit (further straining the system). A couple of bad headlines and it will be time for "reform" once again.

Think about this logically. People don't get into the profession of medicine because they don't want to help people. Doctors are generally known for their ability to diagnose illness and injury - they understand that people get sick of a weekend or of an evening as much as during the weekday (of course they do!). They are striking ultimately for your benefit. They are striking because the government is trying to sabotage the current model of the NHS so they can rip it down and rebuild it in the image of the US free-market system.

Before you respond watch these two videos. These are filled with sourced facts.

Spoiler

[video=youtube;qMNuxPByEW0]https://www.youtube.com/watch?v=qMNuxPByEW0[/video]

Spoiler

[video=youtube;qSjGouBmo0M]https://www.youtube.com/watch?v=qSjGouBmo0M[/video]

Be VERY careful what you wish for. If these people succeed we will end up paying twice as much for an even worse service.

 

[Arry]

Junior doctors in the NHS earn about the same per hour as shelf stackers in Aldi, under the new contract.
It's just tricky language about hours. It does reduce the number of hours they CAN work, but increases the number of hours they HAVE TO work.

All part of the plan to make the NHS hated. We pay money for it, but the government trousers it instead of investing in said NHS.
Therefore the NHS struggles due to no money.
Doctors (and nurses and other staff) are therefore forced to work more hours for less money, which gets worse as less people train for medical services as the reward goes down.

Eventually the public complain.
The government says the NHS is useless and sells off the services to private companies (whom they have stakes in, of course).
We the sheeple therefore end up paying twice (the taxes for the NHS, since they won't stop of course and private bills)

The tories say thank you very muck and pocket the profits.

Excellent; very well put and spot on.

The author of the report that Mr. Hunt, is basing his claims and new contracts on; has said, that junior doctors are not the issue. It was down to the lack of consultants, not junior doctors. Also, most of the hospitals, that have read the report, have taken measures to resolve this issue. This is just another money saving scheme, by the Tories and as each trust, slip into special measures. The Tories can send in; hand picked, private management consultants, to prep for the real Tory plan, for our NHS.

 

[beelbeebub]

It's just tricky language about hours. It does reduce the number of hours they CAN work, but increases the number of hours they HAVE TO work.

Now we're getting somewhere.....
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By "...increases the number of hours the HAVE TO work....." what do you mean?
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The new contracts have a hard number of minimum hours e.g. some clause like "...your normal working hours are 48 per week..." when the previous contracts had something like "....your normal working hours are 42 per week....."
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Because of the differences in the way the pay is scaled a JD may have to work more hours to earn the same as they earned under the old contracts.
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Assuming the first, what hours are they contracted to now and what hours will they be contracted to? The number of "compulsory" hours going up is not necessarily a patient safety issue as long as the number of compulsory hours isn't unsafe. For example a contract with a normal of 35hours and a maximum of 100hours may be more unsafe than a contract of 45hours and maximum of 75hours (although I would still think a contract of somewhere around 40 (daylight)hours with a maximum in the low 50's would be a closer to safe.
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@FuzzySpider
I think I see the Dr's complaint. They are saying that the gov wants to effectively extend the NHS's "opening hours" to cover weekends but is not going to provide more money for more doctors to do it. Therefore the implication is the same number of doctors will have to cover more hours, therefore the number of hours per doctor will have to increase (to unsafe levels).
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That is a excellent point BUT, I'm not sure how exactly it relates to the current contract situation. Is there something explicit in the new contract that would make the "spreading thinner" of JD's easier? Wouldn't reducing the max time JD's can work per week actually make that harder? i.e. wouldn't it be easier to spread the JD's "thinner" on the current contracts?
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As I said, I'm trying to understand what the argument is about (as opposed to what people say the argument is about). I've not seen any rebuttal to the gov claims on working hours I posted earlier, other than "it's all lies". Siobhan came close to an explanation by saying the max hours had come down but the "hours they have to work had gone up" (paraphrasing).
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The BMA/JDs say it's about hours, yet they talk more of the pay differential between "core" times and Saturday working. It feels very much like the BMA want to keep Saturday/Sunday as "special days" when really the issue should be what time on any given day is "day" and what is "night" (currently 7 to 7 I think, the gov want to make it 6 to 9) and how many hours a doctor can work per week (plus things like max shift times, rest periods etc)
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here is a graphic from this bbc article (http://www.bbc.co.uk/news/health-35563301)
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For comparison with the current rate, the red is +11%, the pink is +47% and the light pink is +66%, the orange is +4-7% and the light orange is +56-60%, so the pay grades are very comparable it is clear that the BMA are very much wanting to keep the weekend the weekend. Essentially their offer takes the current system, shifts it to 8-8 from 7-7, ups the basic pay by a bit (4-7%) and sets a single "out of hours" rate. It's not really heading towards a 7 day NHS.
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Also note in the article

The BMA had been adamant all along that Saturdays should not be classed as a normal working day. The union wanted any doctor working on a Saturday to get 50% extra above basic pay.

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As I said, I have every sympathy with JD about not having to work too many hours (IMHO they really shouldn't be working much above 40hrs a week, ideally 35 or so), but that doesn't seem to be the sticking point, and so far (Siobhan's assertion above excepted) I've not seen any rebuttal of the gov positon that the new contract increases protection against overwork (albeit not to the level I'd like).

 

[Asp Explorer]

I kind of miss the NHS.

Here in the states, I pay $100 a week for "health insurance" to a private company that will cover 60% of any incurred medical expenses, once an addtional $6000 payment has been made and 25% "co-pay" of the remaining 40% has been coughed up. It's legally mandated by the government, and if I don't pay it they'll take 10% of my annual pre-tax income as punishment.

Forget Star Citizen or lotteries - health insurance in the USA is the biggest scam of all time

 

[FuzzySpider]

Now we're getting somewhere.....
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By "...increases the number of hours the HAVE TO work....." what do you mean?

Simple mathematics.

If I own a company, and employ 10 people each working a 50 hour week at 10 hours a day, how many man hours of work do I have at my disposal? 500 hours per week. Easy peasy.

Now I want my company to start producing at weekends as well as weekdays. How am I to accomplish this?

1. I hire more people.

2. I reduce the hours of people working the weekday shifts and move them to the weekends.

3. I make people work even more hours.

There are no other alternatives.

Now look at the situation. The government are NOT hiring more junior doctors to do the job. So 1 is out. That leaves us with 2 and 3, either of which compromise patient safety and the position of those doctors who are responsible for that safety.

If the government announced that they were taking on an extra 5000 doctors to cover more weekend/evenings then who would complain? The government is instead looking to renegotiate the contracts of junior doctors. Why? It has to be for the reasons I've outlined here.

 

[beelbeebub]

Simple mathematics.

If I own a company, and employ 10 people each working a 50 hour week at 10 hours a day, how many man hours of work do I have at my disposal? 500 hours per week. Easy peasy.

Now I want my company to start producing at weekends as well as weekdays. How am I to accomplish this?

1. I hire more people.

2. I reduce the hours of people working the weekday shifts and move them to the weekends.

3. I make people work even more hours.

There are no other alternatives.

Now look at the situation. The government are NOT hiring more junior doctors to do the job. So 1 is out. That leaves us with 2 and 3, either of which compromise patient safety and the position of those doctors who are responsible for that safety.

If the government announced that they were taking on an extra 5000 doctors to cover more weekend/evenings then who would complain? The government is instead looking to renegotiate the contracts of junior doctors. Why? It has to be for the reasons I've outlined here.

Yeah, I get that argument, and agree with it. I just don't see how it intersects with the new contracts. IF the new contracts offer greater protection against "overwork" than the old ones as the Gov claims, then surely that would make it easier for the gov to push it nefarious scheme of making the JD's work longer hours by keeping them on the old contract.
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There is a 4th case that I could make my hypothetical company work weekends. If I cut the cost of the 10 people who work for me so that I can afford 14 people on the same wage bill, I can provide weekend working, with no over worked hours and no increase in cost (but clearly my workforce might be annoyed at that).
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To be honest, that is what I suspect the game is, reduce the cost per doctor to help pay for the extra doctors needed. AFAIK the government hasn't said it won't hire extra doctors, it's just not earmarked any cash for more doctors.
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Please don't misinterpret my arguments as me being pro-government or anti BMA. I'm just tired of never been given the facts, just spun stuff (from both sides). If the BMA fears the situation I've shown above, or want's doctors to have weekends, then just say it and we can thrash it out from there. Likewise if lowering the per-doctor-cost to allow more doctors for the same wage bill is the governments plan, then just slap that on the table for us to bicker over.

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It's like the Julian Assange thread again. Each side says it's about one thing, but their actions seem to indicate it's about something else.

 

[Surfinjo]

Has anyone notice that Jeremy Hunt is the latest target for Tory ridicule?

Remember when it was Michael Gove? Before him, someone else.

Labour manipulated us in similar ways, alternately holding up one of their own for ridicule while the rest of them got on with lining their pockets.

 

[metatheurgist]

The average weekly pay of an EPL player is £31000. The junior doctors should just all go watch football until the public works out who deserves support and what they want out of life.

 

[beelbeebub]

There are few better wealth redistribution systems than a premier league footballer. Each footballer will be supporting a micro economy of agents, hairdressers, mistresses, sports car dealers, car body repair shops, drink driving lawyers, aged hookers, dog groomers, estate agents, gardeners, cocaine dealers, sti doctors, divorce lawyers, wedding planners and a whole host of other trades.

 

[Andy Kappa]

Just as a point of order and without taking sides one way or the other, it may be worth pointing out that the term 'Junior Doctor' is not quite the same as the term 'Young Doctor', and that medical staff can still be classified as Junior Doctors well into their 30s (by which time they could easily have been practising for 10 years or more). It's not unknown for a doctor to still be classified as a Junior Doctor when they hit 40 years of age.

Granted the usual caveat in relation to Wikipedia articles, here's something that sets it out in more detail

 

[Surfinjo]

..................................................................................
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Please don't misinterpret my arguments as me being pro-government or anti BMA. I'm just tired of never been given the facts, just spun stuff (from both sides). ............................................................

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It's like the Julian Assange thread again. Each side says it's about one thing, but their actions seem to indicate it's about something else.

This is it in a nutshell.

We don't actually know what is happening.

The real question is, why?

Like the Assange case, both sides have ample access to media and are more than capable of using it. But instead of telling us the facts they expect us to make an essentially emotional decision.

If we don't support the Drs they might decide take revenge and let us die! If we don't support the gov. they might take revenge and cut other services.

Oh to choose, Oh to choose.

 

[beelbeebub]

Here's a thought: JD's are paid above the national average wage (which is a median of around £21-22k IIRC) and their issue is the number of hours they work being unsafe.
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The JD who posted of FB recently claiming he was the only doctor in the hospital at night said he earned £18/hr for the 48 hr a week he was paid, This equates to a salary (depending on how he accounted for holiday etc) in the £45k region. A pretty good salary for anyone.
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However, his issue was with the hours worked rather than the pay. This is a common theme amongst JDs "we don't do it for the money", "we are paid less than shelf stackers", "it's about unsafe hours".
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OK, here's a though experiment. Say we said a JD's pay, which at the moment is between £23k and £70k was in fact between £23k and £35k. That is to say the progression for expertise and time served is very much shallower. So we have cut JD's pay roughly in half. Now we put an absolute cap on hours worked by a JD of (say) 35hours. This means that rather than having a JD costing £70k and working 60+hour week we have 2 JDs costing £70k and providing 70 man hours a week.
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A further twist could be that the pay structure is flattened a bit more but the starter "junior" junior doctors have a cap of 40hrs and the cap reduces (say to 32hrs) as they become more senior. this would have several effects:
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1. A "junior" junior doctor shouldn't be making "life or death" decisions anyway, so the longer hours aren't going to be such an issue (remember we still have a cap at around the 40hr mark)
2. As the JD progresses their decision making becomes more critical, they start to manage teams etc. therefore their alertness becomes more critical and their hour cap reduces.
3. This also means the hourly rate of the more experienced, older JD's is higher, even though their annual wages are not much higher than a new starter (40hrs @ 24k = £11.50, 32hrs @35k = £21/hr nearly double).
4. Older doctors (in their late 20's/30's) are starting to have families, so the extra time from the lower caps becomes more useful plus sleep becomes a more valuable commodity.
5. The lower caps mean that returning mums (or dads) who can't commit to lots of hours can effectively come back to the profession (there might be real scope for having 16hr/week "two shift" doctors for £10-15k)

The idea is that we get the same or more "man hours" for a similar wage bill, but with more people.
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What it would mean would be a huge cultural and expectation shift for the public and the profession.
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At the moment people see "Doctor" and think well paid, BMW, golf, big house, private school etc, and that applies to people coming into the profession who have a certain expectation that towards the end of their career they will be in the upper portion of the pay curve.
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This would have to change. A doctor would be a person who had a decent (above national average) wage, like a store manager or similar, but (crucially) had a lot of free time.
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Would you work 4 x 8hour shifts a week (sometimes night shifts) for a mid £30k salary?

 

[CMDR Heisenberg B. Damned]

1. A "junior" junior doctor shouldn't be making "life or death" decisions anyway, so the longer hours aren't going to be such an issue (remember we still have a cap at around the 40hr mark)

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.

 

[FuzzySpider]

OK, here's a though experiment. Say we said a JD's pay, which at the moment is between £23k and £70k was in fact between £23k and £35k. That is to say the progression for expertise and time served is very much shallower. So we have cut JD's pay roughly in half. Now we put an absolute cap on hours worked by a JD of (say) 35hours. This means that rather than having a JD costing £70k and working 60+hour week we have 2 JDs costing £70k and providing 70 man hours a week.

You can't cut hours without cutting patients. If the aim of this proposal is to provide around the clock health coverage (which it isn't, that's a lie so blatant I feel dumb even reciting it myself) then it can't be done by cutting doctor hours can it?

Some doctors are currently working around 87 hours per week.

Your proposal to have 2 JDs working half the time is a great one. However, that would double the doctors bill at a time when the NHS is trying to make 10% "efficiency savings". Question; how do you double staff at the same time as slashing costs?

There are certain topics (do fossil fuels cause global warming? is evolution real? did man ever walk on the moon?) which are not matters for debate or opinion, as much as detractors might like to pretend otherwise. There are not always two sides to every story and this is one such story. This chapter of the NHS is just the latest in a book on how to destroy the "evil" of socialized healthcare. Nothing more nothing less.

 

[Arry]

You can't cut hours without cutting patients. If the aim of this proposal is to provide around the clock health coverage (which it isn't, that's a lie so blatant I feel dumb even reciting it myself) then it can't be done by cutting doctor hours can it?

Some doctors are currently working around 87 hours per week.

Your proposal to have 2 JDs working half the time is a great one. However, that would double the doctors bill at a time when the NHS is trying to make 10% "efficiency savings". Question; how do you double staff at the same time as slashing costs?

There are certain topics (do fossil fuels cause global warming? is evolution real? did man ever walk on the moon?) which are not matters for debate or opinion, as much as detractors might like to pretend otherwise. There are not always two sides to every story and this is one such story. This chapter of the NHS is just the latest in a book on how to destroy the "evil" of socialized healthcare. Nothing more nothing less.

The biggest problem is, the NHS managers, touching their forelocks to the government and saying; 'yes sir, of course I can work within the funds you are providing.'

 

[beelbeebub]

You can't cut hours without cutting patients. If the aim of this proposal is to provide around the clock health coverage (which it isn't, that's a lie so blatant I feel dumb even reciting it myself) then it can't be done by cutting doctor hours can it?

Some doctors are currently working around 87 hours per week.

Your proposal to have 2 JDs working half the time is a great one. However, that would double the doctors bill at a time when the NHS is trying to make 10% "efficiency savings". Question; how do you double staff at the same time as slashing costs?

There are certain topics (do fossil fuels cause global warming? is evolution real? did man ever walk on the moon?) which are not matters for debate or opinion, as much as detractors might like to pretend otherwise. There are not always two sides to every story and this is one such story. This chapter of the NHS is just the latest in a book on how to destroy the "evil" of socialized healthcare. Nothing more nothing less.

2 JDs paid 35k for 35hr weeks would provide the same man hours (2x35=70) as 1 JD paid £70k and working 70hr weeks.
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the aim of my above thought experiment wasn't about a "24/7 NHS", it was more specifically addressing the perennial complaint of doctors working unsafe hours (as illustrated by your 87hour example)
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Right now we pay doctors quite a bit in absolute terms. Salaries of £40k and up seem typical, even the starter salary of some £22k is around the national average. Of course when you look at the hourly rate it's rubbish, because they work lots of hours which is also dangerous.
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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.
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it would require a shift in the expectations of JDs and doctors in general. at the mo they are expected to work extremely hard (even dangerously hard) but are paid (in absolute terms) well above the national average, more than double or even triple the national average after the early stages of their career.
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With my thought experiment Dr's would be well paid at around 1.5-2x the national average but would be working much shorter hours, in the low to mid 30's.