Save the NHS!

joeyjojo said:
VOX article doing the rounds:

These images show how quickly Jeremy Hunt has bankrupted healthcare in England

They include a BBC figure which I've tracked down:

Is enough being spent on the NHS?

Triggle absurdly suggests that "[the health service] is grappling with issues like the ageing population, obesity and the cost of new drugs".

Did these pressures just happen to appear suddenly at the same time as the Health and Social Care Act 2012?

Edit: would be useful to see the rate of budget increase over the same period. From what I can find:

Budget, Health Spending
2009, £119 bn
2010, £122 bn
2011, £126 bn
2012, £130 bn
2013, £137 bn
2014, £140 bn
2015, £141 bn

So it looks like average spending increases since 2012 have been about the same as 2009-11 (£3.5 bn/year). Suggests to me that the structural changes are to blame for the deficit, not spending or long-term trends (obesity, ageing, etc.).

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inflation?
 
Freakbro said:
Genuine question, but if the budget increase has been the same year on year, but since the Health and Social Care Act 2012 the financial performance has tanked, that would seem to me to be the fault of the people implementing the budget (CCG's - partly made up of GPs) rather than the ones setting it (Dept of Health), no?

Especially if when it was run under the PCTs and SHAs it didn't tank this quickly or badly.
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You mean maybe the CCGs are just irresponsible and are overspending? That could be, but I assume they know what services they need to provide and have more or less continued where the previous budgets finished.

My reasoning is that actual spending on services was probably similar 2012-present vs 2009-11 (no really large items of spending e.g. new treatments have appeared/been cut) and budget increases have been similar, so the difference is most likely to be administrative overheads from marketisation.

I shared a link a while back that the market (introduced in 2012) was estimated to cost £4.5-30 bn/year (depending who you ask). That would more than explain the sudden dip since 2012.

Diagro said:
inflation?
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I wondered this, but inflation has been lower p.a. 2012-15 than it was 2009-11. I.e. NHS should have had more spending power from budget increases recently than before.
 
Sat in A&E last night for my wife who has severe abdominal pain due to appendicitis surrounded by overweight, unhealthy work dodgers there for the third time in as many weeks because they have "breathing difficulties" or similar. They still have to get a full battery of tests before they get sent on their way but occupy a bed and doctor for a night. Bloody infuriating. Hunt is a knob but the public will kill the NHS before he does.
 
Minstadave said:
Yup A&Es getting busier, huge reliance on Locum staff but no-one will work locums now the rates are capped - well played Cameron/Hunt.
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We've had this conversation before and that is a disingenuous way of putting it

Because locums and agencys have been bleeding the NHS staff budget dry they have had to put a cap on the overall spend....it's not a bottomless pit of budget is it.

But of course, as we keep getting told, because you are all in this for the benefit of patients and it's not about the money, I guess there must be another reason 'no-one will work locums now the rate has been capped', right?
 
Locums aren't the problem though are they? They're the result of the problem.

Why are we so reliant on them? Because we can't recruit enough staff into ED because it's chronically understaffed/crap shifts/high stress. Simply removing locum spend doesn't sort the problem, in fact it makes it worse - if you saw some of the vacancy lists trusts are putting out currently the scale of the problem is clear.

I don't get why you find it hard to understand why doctors expect to be paid for locum work? If you pay peanuts for locums no one is going to do them. There's a finite number of doctors and currently a huge demand. It's not about the patients, it's simple market forces.

My own speciality currently has rota gaps and can't find locums to cover them.
 
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Minstadave said:
I don't get why you find it hard to understand why doctors expect to be paid for locum work? If you pay peanuts for locums no one is going to do them. There's a finite number of doctors and currently a huge demand.
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Who has said they shouldn't be paid?

What we are discussing is our differing views on the level of remuneration that we think is appropriate and what we class as 'peanuts' or not.

And then you guys blur the issue with safety claims (which is fundamentally more important). Which is where the confusion really sets in, because as you said previously, if you have already done a 60-80 hour week, then it's not great or safe that you are required to 'volunteer' to do more hours as a locum to fill a shortage - that is not safe for you or the patients.

So I, and others, just fail to see why paying you a considerable sum of money (whilst obviously making it more personally lucrative) makes it any safer.
 
I've never mentioned anything about safety.

It's very simple, like it or not you can't just pull a rate out the air and decide that's enough. That's exactly what the Tories have done and it's not worked because no one will work for them - you can't force them to (although the new contract tries but it won't work).

There is a safety issue if you have no staff - you can't magic them up out of thin air. So if you're running a trust win a half empty A&E rota what can you do but pay a rate that gets you the cover you want.

Locums aren't just internal doctors offering to work beyond EWTD hours, there are plenty of full time locums that work for agencies. These are the guys staffing almost all A&Es.
 
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Minstadave said:
Yup A&Es getting busier, huge reliance on Locum staff but no-one will work locums now the rates are capped - well played Cameron/Hunt.
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Sadly this isn't surprising. Our A&E is under huge stress at present. I'm regularly seeing this on the front line seeing patients on the wards who have unfortunately spent hours and hours waiting on trolleys in corridors for beds. :(

Freakbro said:
Who has said they shouldn't be paid?

What we are discussing is our differing views on the level of remuneration that we think is appropriate and what we class as 'peanuts' or not.

And then you guys blur the issue with safety claims (which is fundamentally more important). Which is where the confusion really sets in, because as you said previously, if you have already done a 60-80 hour week, then it's not great or safe that you are required to 'volunteer' to do more hours as a locum to fill a shortage - that is not safe for you or the patients.

So I, and others, just fail to see why paying you a considerable sum of money (whilst obviously making it more personally lucrative) makes it any safer.
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I think you are missing the point. There are a substantial portion doctors who are not in training posts. This means their work can either be through a contract directly with the hospital or as a locum through an agency for example. For doctors in training, they will already be on a full rota which includes long days, nights, weekends and from my experience very few will ever locum beyond this. Sure there will be exceptions but the vast majority will stick to their rota and not do addition shifts as they're already overworked as it is. So somebody working (training) in cardiology or surgery for example, probably won't go to ED at the weekend to locum.

Many understaffed departments such as ED are staffed by non-training doctors, particularly locums. They will be the ones who will decide not take up as many shifts as locum rates are slashed. Sadly this will just hit hardest on the already struggling departments. Remember, as locums, you employment rights aren't as rigid either, shifts can be cancelled at the last minute often, no annual leave or study leave entitlement, hap-hazard rotas often moving between trusts and hospitals etc.

Safety is of course one of the issues. Doctors in training as mentioned above already work a full rota including antisocial hours and nights. What the government has imposed in the new contract lacks a number of protections that are currently in place. Trusts will no longer be penalised for overworking doctors, staff will be spread thinner throughout the week, lack of continuity for patients just to name a few.
 
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Minstadave said:
I've never mentioned anything about safety.
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Maybe not you personally in this thread but that is the message coming loud and clear from these strikes

“Tired doctors make mistakes.” This slogan is being displayed on placards around England as junior doctors go on strike for the second time.

The 24-hour industrial action involves more than 160 pickets. Doctors voted for it after talks between the government and the doctors’ union, the BMA, broke down again last month.

Many of the strikers and their supporters are keen to get the message across that their grievances are about patient safety rather than just pay and conditions.
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Minstadave said:
There is a safety issue if you have no staff - you can't magic them up out of thin air. So if you're running a trust win a half empty A&E rota what can you do put pay a rate that gets you the cover you want.

Locums aren't just internal doctors offering to work beyond EWTD hours, there are plenty of full time locums that work for agencies. These are the guys staffing almost all A&Es.
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I know, my ex-partner is a Nurse and was in A&E for the last 3 years, so I know all about the staffing pressures and need for locums (and to be fair the poor quality a lot of them were) and how much agency Nurses & Doctors were on.....so I wasn't using the term 'bleeding the budgets dry' hyperbolically.

Obviously this is a structural issue that should have been addressed a long time ago, but it wasn't and we have let the issue of, what I would class, as excessive payments go on too long and this needs addressing in the short term while hopefully things would be implemented to address the issue for the long term.
 
But that's not what's happened. The government has brought caps in which are decimating staffing levels, and we're not even at the lowest rate of the caps yet.

On top of that they've imposed a ludicrous contract that will only hurt recruitment further and has forced strikes.

I'm all for a long term plan to improve understaffing and under recruitment but imposing a contract based on no evidence or planning just because you want to appear "deeply muscular" and stick one to the BMA is going to break the system further.

The NHS needs fixing, trying to break it further with a fantasy 7 day service and crushing it's staff is not a sound tactic.
 
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The NHS Reinstatement Bill came up today, but was cut short because of time. Possibly because of some time-wasters earlier in the day, I'm not sure.

Not a bad SNP and Labour turnout, but nowhere near good enough. Everybody should be hassling their MPs to go to the next one. (I asked mine and he was there, even made a comment.)

Watch here http://parliamentlive.tv/event/index/0aa3c938-4b3b-4911-9a80-c968b8f7ebe0?in=14:12:55

Debate will be resumed 2 April if I understand parliamentish.
 
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