Junior doctors' strike

[Andrew 4220]

All governments try and do their best

 

 

Why are you lot bothering?

[Dr Gloom 19825]

The NHS is being privatised, the 2010 NHS White Paper described this process very clearly.

 

 

 

The position staff are being placed in is deliberately untenable in order to assure either their desertion or their failure, this neatly sets up privatisation as the solution to a collapsing NHS. A solution we are being engineered to welcome if we accept messages such as how greedy and unreasonable the staff are, combined with stories (true or manipulated) about the underperformance of a deliberately starved entity.

 

This is a further wrestling of nationally owned infrastructure from the hands of the people who made it into the hands of the establishment who seek control and profit, we will not be paid back for what we put in, we will merely be expected to pay much, much more to use it in future - it is double, perhaps triple jeopardy. How this manipulation is not understood is a tragic measure of both their cunning and 'our' ignorance, wilful or otherwise.

 

The NHS does need reinventing as people live longer, but doing it in such a devious and profiteering manner is, indeed, sickening.

 

The establishment in this country view the masses as their meal ticket. Sadly many of the masses seem to think this is somehow okay.

 

Ignorance is bliss, I guess.

Good post

[The Fish 8989]

Without rehashing old pages, loggerheads = dispute over Saturday pay for junior doctors.

 

 

Well, before I do anything else, lets address this.

 

At loggerheads means "engaged in a disagreement or dispute", so I'm not sure where your confusion lies? Hunt has overseen the first full walkout in NHS history! How can you view this as anything but being at loggerheads? Is it possibly because it's a tory?

 

If you honestly think governments try to do their best, you're a naive fool.

[Kevin Carr's Gloves 3205]

 

You're a thick cunt aren't you.

 

A totally ignorant shit spreading muck raking wind up ,ercahnt with the charisma of a maggot ridden turd. you know your'e a cunt and you revel in it. You're a cunt about football you're a cunt about politics and you're a cunt about everything else. Do like it because it's the only thing you're good at?

 

So to sum up, you're a cunt.

 

fyp

[Dr Gloom 19825]

spot on as usual

 

[The Fish 8989]

spot on as usual

 

Nah, it's about Saturday pay. This tory taxi driver wind up merchant from sunderland told me so.

[Tom 13847]

The NHS is being privatised, the 2010 NHS White Paper described this process very clearly.

 

 

 

The position staff are being placed in is deliberately untenable in order to assure either their desertion or their failure, this neatly sets up privatisation as the solution to a collapsing NHS. A solution we are being engineered to welcome if we accept messages such as how greedy and unreasonable the staff are, combined with stories (true or manipulated) about the underperformance of a deliberately starved entity.

 

This is a further wrestling of nationally owned infrastructure from the hands of the people who made it into the hands of the establishment who seek control and profit, we will not be paid back for what we put in, we will merely be expected to pay much, much more to use it in future - it is double, perhaps triple jeopardy. How this manipulation is not understood is a tragic measure of both their cunning and 'our' ignorance, wilful or otherwise.

 

The NHS does need reinventing as people live longer, but doing it in such a devious and profiteering manner is, indeed, sickening.

 

The establishment in this country view the masses as their meal ticket. Sadly many of the masses seem to think this is somehow okay.

 

Ignorance is bliss, I guess.

This basically.

[Christmas Tree 3997]

Nah, it's about Saturday pay. This tory taxi driver wind up merchant from sunderland told me so.

 

This is the deal being offered. Tell me which bits jump out as horrific. Really, a simple answer without going off on a tangent.

 

 

 

Then read this from the boss of the BMA (the doctors union).

 

We could not reach agreement on some key points. These centre on the boundaries for plain and premium time.

 

If you still don't get it, I give up.

[Rayvin 4964]

For the sake of informed debate, is the above post by CT accurate? And if so, can someone please advise on the current pay conditions so that it's easier to compare?

[The Fish 8989]

 

This is the deal being offered. Tell me which bits jump out as horrific. Really, a simple answer without going off on a tangent.

 

 

 

Then read this from the boss of the BMA (the doctors union).

 

We could not reach agreement on some key points. These centre on the boundaries for plain and premium time.

 

If you still don't get it, I give up.

Cool. That is exactly what I said. I said it was horrific. I didn't say that it was a trajectory towards privatisation, I didn't say that anecdotally, my friends are concerned about about their work-life balance and they are worried about their pay. No I said it was horrific.

 

Fuck Off CT you typical tory wum.

[Christmas Tree 3997]

For the sake of informed debate, is the above post by CT accurate? And if so, can someone please advise on the current pay conditions so that it's easier to compare?

From yesterday

 

[Christmas Tree 3997]

Cool. That is exactly what I said. I said it was horrific. I didn't say that it was a trajectory towards privatisation, I didn't say that anecdotally, my friends are concerned about about their work-life balance and they are worried about their pay. No I said it was horrific.

 

Fuck Off CT you typical tory wum.

You've ranted like a little girl and said it was about everything but the one actual thing it is about. (Unless you know better than the union boss in the negotiations), Saturday daytime pay.

 

You're a typical lefty drama queen.

[The Fish 8989]

You've ranted like a little girl and said it was about everything but the one actual thing it is about. (Unless you know better than the union boss in the negotiations), Saturday daytime pay.

 

You're a typical lefty drama queen.

I've given anecdotal evidence from the people who're actually striking, who're actually involved and said that I believe they know more about the subject than some attention seeking cunt who gets his opinions from a google search or mumsnet.

[Renton 17782]

If this deal is such a minor issue, ask yourself why we are we at the stage where doctors are going on all out strike for the first time EVER. Something even Thatcher avoided. Why haven't the government or union, with complete support from its members, backed down.

 

It's simple, it's a matter of principle. NHS staff have been shafted by the government now for six years. Pay for most staff including doctors has fallen by 15%. My pay is actually going down this month again as I pay more for a worse pension which I might not live to benefit from. Morale is rock bottom. Services are getting worse by every metric going. A&E is turmoil. There is a huge staffing crisis as we swap our UK educated doctors for foreign ones. Hunt is absolutely detested because we all know what he stands for (on record as saying he wants an end to the nhs.

 

As I said, this is a line in the sand. Forget the money, that's not what it's about. It's about saving the nhs from a self confessed saboteur. We should pray the doctors win this, because if they don't, the nhs is history.

[Kid Dynamite 5908]

Fish man, behave arguing with the board WUM

[Christmas Tree 3997]

If this deal is such a minor issue, ask yourself why we are we at the stage where doctors are going on all out strike for the first time EVER. Something even Thatcher avoided. Why haven't the government or union, with complete support from its members, backed down.

 

It's simple, it's a matter of principle. NHS staff have been shafted by the government now for six years. Pay for most staff including doctors has fallen by 15%. My pay is actually going down this month again as I pay more for a worse pension which I might not live to benefit from. Morale is rock bottom. Services are getting worse by every metric going. A&E is turmoil. There is a huge staffing crisis as we swap our UK educated doctors for foreign ones. Hunt is absolutely detested because we all know what he stands for (on record as saying he wants an end to the nhs.

 

As I said, this is a line in the sand. Forget the money, that's not what it's about. It's about saving the nhs from a self confessed saboteur. We should pray the doctors win this, because if they don't, the nhs is history.

You can wrap yourself up in as many things as you want, but the only reason the strike is taking place is down to the disagreement on Saturday pay.

 

That's where the deal fell down. Had the government agreed to the Saturday pay issue there would be no strike. Even the BMA admit this.

 

If you still don't understand this I give in

[Renton 17782]

You can wrap yourself up in as many things as you want, but the only reason the strike is taking place is down to the disagreement on Saturday pay.

 

That's where the deal fell down. Had the government agreed to the Saturday pay issue there would be no strike. Even the BMA admit this.

 

If you still don't understand this I give in

If the government had backed down instead of imposing a pay deal the union and members had rejected there wouldn't have been an all out strike? I think we can agree on that.

 

There's no flies on you is there?

[catmag 336]

Here you go CT - from the keyboard of an actual doctor...

"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 wont be able to happen at weekends.

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 doesnt 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. Doesnt 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 isnt going to fill you up so your mum cuts the same pizza into 7 slices and tells you that youll be full with that. But she wont 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 dont 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 isnt 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 shouldnt 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 DHs definition of negotiation was that they would reserve the right to do what they wanted if they didnt 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 wont talk anymore. When a strike ballot (of, lets 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 DHs 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.

If you have read this far, please take it on board and share with your friends. Ive 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.

Ill 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."

[Dr Gloom 19825]

Where's that from Cath? I'd like to share it

[Gemmill 34464]

Really good read. Thanks for posting. Blobby will be along shortly to show off his reading comprehension skills again, no doubt.

[Monkeys Fist 38767]

If Boldon Slim can't get it after the pizza analogy, he's thicker than whale spunk.

[NJS 3978]

So it's about Saturday pay then?

 

What's good about that is its very "practical" and avoids the politics of the whole thing which I think is a huge factor but can be left out and still present a winning case.

[ewerk 26348]

The NHS is shit anyway.

 

[catmag 336]

Where's that from Cath? I'd like to share it

It's by Dr Ravi Jayaram, a paediatric doctor from Chester. The link from Facebook is.. https://www.facebook.com/DrRaviJ/posts/1699644203631626 Feel free to share.

[ewerk 26348]

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.

 

 

This isn't true according to what I've read. The following restrictions will be in place:

 

• 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.
• We will introduce a new system of ‘work scheduling’ agreed between the doctor and their employer, with regular, routine reviews agreed with educational supervisors. Doctors will have the ability to trigger an urgent review if there is significant or regular variation from the work schedule.

 

 

How does this compare to existing restrictions? I'm still confused as to why junior doctors are talking about safety when these restrictions appear to have been agreed by both sides.

 

Oh and anyone who thinks that a pizza is cut into five or seven slices needs to be treated with suspicion.