Save the NHS!
- Thread starter scorza
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Spreading both demand and resources isn't a bad idea. You forget that the current demand pattern is influenced by the restricted supply pattern, as is successful outcomes.
The real question that needs to be asked is who is the NHS run for, patients or staff? The answer should be obvious, but it runs counter to both current structures and objections to change.
He wants to recruit more yet pay less. It's all very well to claim to plan on recruiting more, but the reality of what he is doing is the polar opposite.
72 hour weeks are ridiculous. The intensity of those 72 hours is obscene also. This is not 72 hours with long lunch breaks and Facebook sessions. This is 72 hours of making very important assessments and decisions. I did the start of my training on old shift systems that are now illegal and the hours were even more silly (120 hours was my very first week at work) but the intensity wasn't as bad. For any juniors reading, don't let consultants tell you it's easy compared to their day. It is different but not easier. Neither are safe ways of working for the doctor or the patient. I nearly crashed after a shift driving home through exhaustion as a junior.
The fact that 72 hours will be stated as max also is rubbish. There has always been a culture of being bullied into lying about max hours worked when compliance checks are being done. The consultants tell you what you have to put down and you know your reference relies on you having "played the game". The consultants themselves are bullied by the senior management. The employment culture in medicine is toxic and always has been, but the difference now is that there is no good will left to counteract this. I thoroughly support any action from juniors and if it wasn't considered secondary action I would certainly strike with them if it does go to industrial action
Of course it needs to be run for patients, but you also need to have staff on board with plans for change. If you can suggest to them how something is beneficial to patient care and won't negatively impact them they will be on board. If you do something which worsens their terms of employment you need to expect a pushback and either offer them something else to counteract the negative or accept there reaches a tipping point when they will strike or leave. when you change terms that those working see as negatively impacting both patients and themselves and purely appears as a cost cutting exercise at their expense then you should expect a very large pushback. The market works both ways. You can't just assume that abusing something because it's a vocation can go on indefinitely
If your spread your resources too far gaps appear, does that sound good to you?
The simple fact is the NHS should be run for the benefit of both patients and the staff supporting it but you just think it is a case of the doctors looking after themselves.
What do you have to say about the doctors who have commented in this thread?
If you spread them too far, gaps appear, if you concentrate them as we do now, gaps are made and people die unnecessarily.
You talk as if we don't already have patients dying as a result of working practices, we do. Things have to change go eliminate the gaps that exist now. That will probably require more staff. But it will also require changes from the existing ones. The NHS should be run with the patients as a priority, not for the benefit of the staff, and the staff certainly shouldn't be allowed to let patients die to get the working hours they want.
To the doctors in this thread, I would say they have a vested interest, and therefore like any employee objecting to change, their views should be considered but only with a huge shovel of salt and with a focus on the end goal of improving patient care.
This view starts with the position that the current terms of employment are the correct ones. Logical from an employee point of view but not from any other standpoint.
Admittedly, the NHS is a monopoly employee which does make it more complicated, but do you really think that enough staff will leave to cripple the service if the change is pushed through? I am not so sure. What is far more likely is that the staff are trying to take a greater proportion of the fixed budget for themselves instead of for the patients.
If you are referring to the 11,000 Hunt bands around than the research did not look into why they died.
No, but it does correct for mortality risks, which means it makes a good compariosn as the key variable is when the hospital admission occurs. Still, happy staff are more important aren't they, best to ignore the increased risk of death.
Caporegime
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I don't think doctors have an issue with weekend working. We would all like to provide full round the clock care and although the data for increased mortality at weekends is pretty weak and the effect small (mortality at 30 days is somewhere around 1.5-2% so a 16% increase is an extra 0.2% on the actual figure - sounds far less sexy that way) there is definite difference in weekend care compared to weekday care in some areas.
But where does this stop? If you staff weekends like weekdays should you not also staff nights like days? Because your care at night is significantly different to days too.
To me I don't mind working weekends, but I expect to be paid for my time properly. I already have to make life and death decisions, put my career on the line regularly and work evenings and weekends. If you want to pay me peanuts to do it I'll go elsewhere.
The issue is also that working for the NHS is complicated by the fact that they are a monopoly employer and the government can impose whatever contract terms they like when negotiations break down. Then you're stuck striking which only hurts the public you're duty bound to protect. What can you do?
But where does this stop? If you staff weekends like weekdays should you not also staff nights like days? Because your care at night is significantly different to days too.
To me I don't mind working weekends, but I expect to be paid for my time properly. I already have to make life and death decisions, put my career on the line regularly and work evenings and weekends. If you want to pay me peanuts to do it I'll go elsewhere.
The issue is also that working for the NHS is complicated by the fact that they are a monopoly employer and the government can impose whatever contract terms they like when negotiations break down. Then you're stuck striking which only hurts the public you're duty bound to protect. What can you do?
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I am looking for a huge shovel of salt right now, Dolph says so.
Soldato
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So maybe like you say there doesn't have to be total uniformity including certain elective surgeries, but wouldn't more uniformity help redress that stat? It doesn't seem cool if you're significantly more likely to die if you get taken to hospital on a Sunday rather than a Wednesday, y'know.
And I just mean that in terms of weekends this change doesn't affect the pay/it being classed as unsociable on Sunday... it's just changing it so Saturday isn't classed as unsociable all day, right?
Conceptually you might think what you are saying is correct, but the main issues isn't the lack of junior staff. The issue is mainly the consultants have the weekend off, and are doing cover, and various cover rota options, and that surgery doesn't run at full speed.
This new contract will address the junior staff, and make them into one bland mess of timed covered, rather than support where it is necessary.
If you want a truly 24/7 NHS, then you need to employ more staff at all levels, and stick them all on continental shifts. Significantly more staff.
Changing junior doctor contracts to make them work more hours is just plain madness unless you bulk the numbers and they haven't spoken once about educating more, (the occasionally spout some **** about recruiting more, not educating them) and until they open up more university places, then the problem won't be solved.
wonder if you could use production style shifts?
to up production in one section they've just introduced a new 6 day pattern that means instead if there being 3 shifts (morning, afternoon and night) and 2 overtime days theres 4 shifts and only 1 over time day.
its now mon-tues-wed each 12 hours then 4 days off while the other shift does thurs-fri-sat, same for 2 night shifts leaving just sunday as an over time day.
to up production in one section they've just introduced a new 6 day pattern that means instead if there being 3 shifts (morning, afternoon and night) and 2 overtime days theres 4 shifts and only 1 over time day.
its now mon-tues-wed each 12 hours then 4 days off while the other shift does thurs-fri-sat, same for 2 night shifts leaving just sunday as an over time day.
Soldato
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Yes the current system could be improved but the vast majority of doctors agree the new contract will merely spread doctors more thinly over the 7 days meaning longer working hours and thus putting our patients at risk. And as for recruiting more doctors Jeremy Hunts claim is frankly laughable, where are we going to find 5000 doctors from? It take 5 years to train at medical school and they'll be paid £4K less than the UK average salary on top of having a minimum of £50,000 debt.
Caporegime
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Every department in every hospital does their own thing with shifts currently.
I think the current system is already essentially crippled. There are not the numbers of staff to do what is being asked and yes I really do think that enough staff will leave to make the situation much worse. We live in such a global world these days that people really don't fear emigrating in the same way they did in past. Were I in my mid 20s without a family I would certainly be thinking about leaving. I have thought very seriously about taking my family to oz in the last couple of years even at my stage in life/career. I see loads of my old juniors leaving the country when they qualify
But as I already mentioned, doctors have a vested interest in this and hence their opinion should be treated like any other employee's contribution during consultation about changes they consider detrimental to them,, eg with care.
The NHS has long been focused on things other than patient care, it needs to change, and the chances are the staff as a collective are not going to like it. That doesn't mean it shouldn't go ahead.
The NHS has problems, it spreads resources too thinly, has an excess of demand due to the myth that healthcare is free (because patients don't see the costs directly) and has the focuses all wrong, but that doesn't mean the ideas driving the patient to the centre of the operation is wrong, on the contrary, the biggest problem with the NHS is that the patient is not at the centre of operations.
I would argue that problem doesn't stem from doctors but multiple levels of management.
Any doctor I have spoken too, they just want to get on doing what they do best, treating patients.