NHS Rant

[chrcoluk]

There should be a point where you think of the greater good and not just about maximising your pay. I think taking £70 an hour from a public healthcare system in meltdown is pretty damn low personally. I would understand more if they were trying to grab say £7 an hour but not "seventy".

There is millions of people who work unsociable hours, doctors are hardly unique there.

You basically advocating a system of everyone for themselves if you trying to justify someone requiring that level of pay from a emergency healthcare service.

The sad thing is there is no quick fix. Because ultimately if a manager refuses to pay the £70 an hour and then no doctors turn up, he will soon be in the newspaper for letting people die etc. in a&e and the consequences would be huge poltically. So the ransom is paid and the doctor comes in, once the doctor knows they will be paid that they will ask again and again, the only way this can be fixed is if more doctors are found and more and more to the point that there is more doctors then demand and the doctors would soon be in a bidding war for the work, that is a long and painful expensive path.

However I could forsee a privatised ward refusing to pay those rates and with thick skin been prepared to take the negative press from it, they would probably turn the press onto the doctors and force them via that route to get them to work for lower pay, thats the advantage of privatisation.

 

[danielanthony]

I find this interesting. How much is the hourly rate for a lawyer or even a plumber?

A&E in particular pays a lot for staff because it’s awful work, antisocial shifts and there is a nationwide shortage of staff.

This is despite regional trusts banding together to try and cap locum costs and aggressive efforts by government to drive down costs of out of hours working.

Why is it wrong for doctors to know their worth?

Pay will only go one way if privatised.

Because doctors have job security, top pensions, subsidised training and a salary well beyond the reach of the majority of the people they work with and treat. Working in the public sector is a vocation, university lecturers are more academically qualified than doctors but work for much less, if the pursuit of wealth is your primary motivation then a career in the private sector would be more suitable (banking, for example).

 

[FortuitousFluke]

I find this interesting. How much is the hourly rate for a lawyer or even a plumber?

A&E in particular pays a lot for staff because it’s awful work, antisocial shifts and there is a nationwide shortage of staff.

This is despite regional trusts banding together to try and cap locum costs and aggressive efforts by government to drive down costs of out of hours working.

Why is it wrong for doctors to know their worth?

Pay will only go one way if privatised.

This is the thing, I work in the public sector in a reasonably well paid, permanent position (not health related). I know exactly what my boss charges other organisations for my time, and I know exactly what I would be worth if I chose to switch to interim and I can guarantee that there are people I know who would find it extremely unpalatable because I'm paid with public money.

At the end of the day though my industry is suffering a skills shortage in a similar vein to the one that exists in the NHS, that skills shortage could be addressed by the public sector if they wanted to take it on in the long term but the majority of the initiatives at the moment are predicated on trying to reduce those costs without addressing the actual reason behind them.

If the government choose to invest in the future of the health sector then they can reduce costs through increased capacity, however if they keep trying to just cap fees without addressing demand then they need to accept that the rates they're charge aren't obscene, they're indicative of the fact that a consultant could walk up to any number of trusts, name his or her price, and start that week.

Because doctors have job security, top pensions, subsidised training and a salary well beyond the reach of the majority of the people they work with and treat. Working in the public sector is a vocation, university lecturers are more academically qualified than doctors but work for much less, if the pursuit of wealth is your primary motivation then a career in the private sector would be more suitable (banking, for example).

So you're suggesting the conversation between a GP and their recruitment consultant should go a bit like this:

"We have a job available, A+E consultant so a tough gig, going rate that I can get you is around £70ph"

"Nah, I'd rather work for £40 ph"

Would that happen in any other industry? How many people do you know who would willingly work for significantly less than the market dictates they're worth? There'll be a few people who will, but not many.

 

[chrcoluk]

So you recognise the problem, in short they are fire fighting (short term fixes) rather than making long term corrective actions.

Hence e.g. the story of ace modders wife been offered some form of treatment designed to get her out the ward as quick as possible.

 

[Minstadave]

This is the thing, I work in the public sector in a reasonably well paid, permanent position (not health related). I know exactly what my boss charges other organisations for my time, and I know exactly what I would be worth if I chose to switch to interim and I can guarantee that there are people I know who would find it extremely unpalatable because I'm paid with public money.

At the end of the day though my industry is suffering a skills shortage in a similar vein to the one that exists in the NHS, that skills shortage could be addressed by the public sector if they wanted to take it on in the long term but the majority of the initiatives at the moment are predicated on trying to reduce those costs without addressing the actual reason behind them.

If the government choose to invest in the future of the health sector then they can reduce costs through increased capacity, however if they keep trying to just cap fees without addressing demand then they need to accept that the rates they're charge aren't obscene, they're indicative of the fact that a consultant could walk up to any number of trusts, name his or her price, and start that week.



So you're suggesting the conversation between a GP and their recruitment consultant should go a bit like this:

"We have a job available, A+E consultant so a tough gig, going rate that I can get you is around £70ph"

"Nah, I'd rather work for £40 ph"

Would that happen in any other industry? How many people do you know who would willingly work for significantly less than the market dictates they're worth? There'll be a few people who will, but not many.

This is the reality.

 

[FortuitousFluke]

So you recognise the problem, in short they are fire fighting (short term fixes) rather than making long term corrective actions.

Hence e.g. the story of ace modders wife been offered some form of treatment designed to get her out the ward as quick as possible.

Absolutely, I don't know that the treatment decisions and the recruitment issue are comparable, I feel like with treatment there's an element of going through a process (cheapest - most expensive, simplest - most invasive) and that there's a tendency to get stuck in a loop at one end of the spectrum. In terms of recruitment though it's definitely short term thinking, mainly at the level of government. Until those priorities are fixed you won't see an improvement. But I'm not going to blame consultants and other staff for effectively charging what they're worth in the market they're in.

 

[danielanthony]

So you're suggesting the conversation between a GP and their recruitment consultant should go a bit like this:

"We have a job available, A+E consultant so a tough gig, going rate that I can get you is around £70ph"

"Nah, I'd rather work for £40 ph"

Would that happen in any other industry? How many people do you know who would willingly work for significantly less than the market dictates they're worth? There'll be a few people who will, but not many.

Because the wider conversation usually goes:

Doctor: "Gimme £70ph"
NHS: "No, we can't afford it, how about a slightly lesser amount most people can only dream of earning?"
Doctor: "No, I'm not going to work and you'll be to blame for endangering patients"
NHS: "Fine, I'll pay but I'll have to make cuts elsewhere to afford it"
Doctor: "Evil Tories starving the NHS of cash, save the NHS!"

 

[chrcoluk]

As I understand it the £70/hour was been haggled with over several hours whilst the shift was unmanned, so lower rates were initially quoted to the doctors but they refused to come in until £70 was offered.

So the conversation wouldnt have been, ok we will pay you £70/hour but we expect you to offer to work for less, it was more like a negotiation that lasted for several hours with £70 been the point the doctor agreed to come in. After the rate was agreed the manager apparently had to wait for his own boss to approve it as the £70/hour was way above the budget.

The way I see it that money has to come from somewhere else in the budget, some cleaners may get sacked and then patients die from infection, or perhaps some equipment gets sold, and patients die as a result. Patients my die in a&e whilst the doc negotiates so he can buy a new porsche or something.

Here is the long term problem of the actions.

Lets say the government announces they raising taxes and extra 20 billion a year for the NHS.

The doctors know this news.

What is stopping them suddenly demanding say £200 an hour to suck up that 20 billion? so same problems but just with a higher bill to the state.

If I was a minister in charge of the purse strings, I would make it a condition of releasing more money that there needs to be firm plan in place to cap pay of doctors, otherwise no money is to be released, in other words increases in budget cannot be used on increases in wages.

 

[Columbo]

People kicking off about doctors earning £70 per hour makes me laugh and those people should really be introduced to the reality of planet earth.

I pay some of our suppliers upto £300 per hour for some tasks so £70 sounds reasonable to me given the skillset.

 

[chrcoluk]

People kicking off about doctors earning £70 per hour makes me laugh and those people should really be introduced to the reality of planet earth.

I pay some of our suppliers upto £300 per hour for some tasks so £70 sounds reasonable to me given the skillset.

Your company is in a healthy financial state?

Is there a limit to your thinking for example would you be happy with doctors getting £1000 an hour from the government simply based on supply and demand because "they have the knowledge" whilst people are getting refused treatment, drugs get cancelled due to lack of money and so on.

 

[danielanthony]

People kicking off about doctors earning £70 per hour makes me laugh and those people should really be introduced to the reality of planet earth.

I pay some of our suppliers upto £300 per hour for some tasks so £70 sounds reasonable to me given the skillset.

My company charges clients $20,000 USD to send me onsite for a week, I get paid a %age of that but if the client declines our services nobody dies, I also don't think taxes should be raised to pay my wages.

 

[FortuitousFluke]

Because the wider conversation usually goes:

Doctor: "Gimme £70ph"
NHS: "No, we can't afford it, how about a slightly lesser amount most people can only dream of earning?"
Doctor: "No, I'm not going to work and you'll be to blame for endangering patients"
NHS: "Fine, I'll pay but I'll have to make cuts elsewhere to afford it"
Doctor: "Evil Tories starving the NHS of cash, save the NHS!"

Then go and find a cheaper doctor. But you can't. Because there's a national shortage and as such everyone is charging similar amounts. If you want an even more accurate picture:

"We will pay £50 ph"
"I want £70ph"
"Okay we can do that just about."
"I've just spoken to another trust and they've offered me £80ph"

I'm not saying it's an ideal situation, I'm saying that the NHS is the majority employer of doctors, the Government have mechanisms for increasing supply, and none of the trusts are working together on this issue. Don't complain that the market's broken when the people who have the power and ability to manage the market steadfastly refuse to do so. I can tell you right now if I were a GP I would be looking to be paid what the market dictates I'm worth for the job I'm interested in doing, if that's £50k p/a cool, but if it's £70ph also cool, I wouldn't be in control of the market, but I would be working within in.

What is stopping them suddenly demanding say £200 an hour to suck up that 20 billion? so same problems but just with a higher bill to the state.

If I was a minister in charge of the purse strings, I would make it a condition of releasing more money that there needs to be firm plan in place to cap pay of doctors, otherwise no money is to be released, in other words increases in budget cannot be used on increases in wages.

That's exactly the problem, even if they chose to work for say £20ph, there still aren't enough doctors, so that's why the prices get pushed up. You increase supply, you push down price. You have price caps in place in the NHS already, the stark reality of it is though that with not enough doctors available trusts will compete with each other and inevitably breach the cap. The consequences of breaching the pay cap are probably much less concerning that those related to breaching A+E wait targets for instance.

You can't manage this on an individual level, the work needs to happen either above the NHS or as a whole system but you can place all the caps you like, until you tackle the supply you won't have much impact and due to a lack of investment that's a case of years or in some areas decades (pathologists apparently take 11 years to train entirely for instance).

 

[chrcoluk]

Yes thats why I said its going to be a long and expensive train ride until its fixed. I feel more could be done to to restrain the pay demands but there would be pain politically, I feel doctors would be willing to let patients die for the pay, and the ministers and managers would need to ride that out which they not prepared to do. It sounds aweful but I honestly feel these pay demands are causing people to die so the way I see it as taking a bit of pain for the greater good and ultimately more lives would be saved in the long run.

I definitely believe the NHS needs more money but with the current state of staff running the shop, the worst thing that could be done is to release funds only for it to be all sucked up by existing staff in pay increases.

 

[Columbo]

Your company is in a healthy financial state?

Is there a limit to your thinking for example would you be happy with doctors getting £1000 an hour from the government simply based on supply and demand because "they have the knowledge" whilst people are getting refused treatment, drugs get cancelled due to lack of money and so on.

Yep, one of the most stable companies in the UK, going from strength to strength and what has any limit to thinking go to do with anything?
I'm talking about reality, facts and just how it is, not from some sort of moral standpoint or my personal views on anything.

Every single one of us that has to choose to pay the going rate for something or not have it or except a lower standard for less.

If £70 per hour is the going rate for a doctor then simply that is that, not having a doctor or excepting a lower standard isn't really an option here is it?

 

[FortuitousFluke]

Yes thats why I said its going to be a long and expensive train ride until its fixed. I feel more could be done to to restrain the pay demands but there would be pain politically, I feel doctors would be willing to let patients die for the pay, and the ministers and managers would need to ride that out which they not prepared to do. It sounds aweful but I honestly feel these pay demands are causing people to die so the way I see it as taking a bit of pain for the greater good and ultimately more lives would be saved in the long run.

I definitely believe the NHS needs more money but with the current state of staff running the shop, the worst thing that could be done is to release funds only for it to be all sucked up by existing staff in pay increases.

To be fair you're not really talking about the vast majority of doctors here. I don't have anything to back this up but I would imagine the majority of the doctors working for the NHS are on banded salary and then any of the various uplifts etc that they get paid, and for the work they do this probably isn't a massive sum of money. That's a completely different world to your interim/bank consultants who are the ones who charge the higher rates for temporary work. It's not really accurate to bundle them all in together.

 

[chrcoluk]

Columbo It has a lot do with it.

The NHS is not exactly in a healthy state so cannot be compared to a company in a healthy state.

Also as someone else has pointed out to you, their decision doesnt cost people'e lives and their pay isnt funded by taxpayers.

To be fair you're not really talking about the vast majority of doctors here. I don't have anything to back this up but I would imagine the majority of the doctors working for the NHS are on banded salary and then any of the various uplifts etc that they get paid, and for the work they do this probably isn't a massive sum of money. That's a completely different world to your interim/bank consultants who are the ones who charge the higher rates for temporary work. It's not really accurate to bundle them all in together.

Yeah I never said every single doctor is like this. End of the day everyone is their own person.

 

[Minstadave]

As I understand it the £70/hour was been haggled with over several hours whilst the shift was unmanned, so lower rates were initially quoted to the doctors but they refused to come in until £70 was offered.

So the conversation wouldnt have been, ok we will pay you £70/hour but we expect you to offer to work for less, it was more like a negotiation that lasted for several hours with £70 been the point the doctor agreed to come in. After the rate was agreed the manager apparently had to wait for his own boss to approve it as the £70/hour was way above the budget.

The way I see it that money has to come from somewhere else in the budget, some cleaners may get sacked and then patients die from infection, or perhaps some equipment gets sold, and patients die as a result. Patients my die in a&e whilst the doc negotiates so he can buy a new porsche or something.

Here is the long term problem of the actions.

Lets say the government announces they raising taxes and extra 20 billion a year for the NHS.

The doctors know this news.

What is stopping them suddenly demanding say £200 an hour to suck up that 20 billion? so same problems but just with a higher bill to the state.

If I was a minister in charge of the purse strings, I would make it a condition of releasing more money that there needs to be firm plan in place to cap pay of doctors, otherwise no money is to be released, in other words increases in budget cannot be used on increases in wages.

Locum caps have been capped. Nobody worked.

Then what do you do?

 

[chrcoluk]

You wait it out, because the docs can choose to not to work but eventually they will realise the NHS is the only mass employer in the country so would back down.

Of course I wouldnt have let this situation arise in the first place, as someone should have seen gradual shortages come in, I would also have never changed the GP contracts in the 2000s like blair did removing their obligation to work out of hours.

This hourly rate conundrum is probably a major factor in the lack of NHS budget increases, the current government seen what happened when labour added money in the 2000s only for a big portion of it to be swamped up by wage increases to existing staff. This issue is probably holding the entire NHS back. As I expect if I can recognise the probem the big bosses will have recognised it in where by you cannot add more funds when you can be poached on by your own staff to swallow it all up, and suppliers to the NHS may also do the same thing unless the contracts are locked down well to existing prices. But knowing the short termism of the decision makers the contracts are probably not locked down.

 

[Columbo]

Columbo It has a lot do with it.

The NHS is not exactly in a healthy state so cannot be compared to a company in a healthy state.

Also as someone else has pointed out to you, their decision doesnt cost people'e lives and their pay isnt funded by taxpayers.

No it doesn't, the fact that the NHS is not a healthy state is not the doctors / nurses fault.
Taxpayer funded or not is irrelevant, why should someone earn less than they can elsewhere just because its taxpayer funded?

We need to attract people to the NHS not force them out and the offer is that the hours are garbage, the work life balance is garbage, the stress is garbage and compared to other regions the salaries are garbage. The 10's of thousands of vacancies that exist in the NHS today are there for a reason, it is not an attractive place to work.

I'm not saying that doctors don't earn enough, there just needs to be an acceptance that they need to be paid the market rate expectation, if thats £20, £50 or £70 per hour then fine but people shouldn't shocked by whatever that number is.

 

[chrcoluk]

Columbo we have a different mindset and as such will never agree.

To me if one works, they contribute to society, thats the reason for working, the fact you get paid for working is just so you have the means to survive.

Whilst you see it as maximising one's own wealth based on what they can negotiate from an employer.

You ask a child why they want to be a doctor, the reason is not usually "because it pays well". Society has lost track of good values, I feel which were lost in the thatcher years.

I am the type of person who would take a pay cut or even work for free if it meant keeping my employer afloat for the wider good.

If I worked for the NHS I would be grateful for the job security that working for the state gives, and that would reflect the pay I would consider reasonable, I probably would never ever demand a pay rise from them knowing that they struggling to provide a proper health service to the public. But thats me, its who i am. I am someone who has written to the government asking them to increase my taxes, not many people are like me, who are willing to share, and think of those less well off, I accept that, but it doesnt mean I cannot fight for change.