Save the NHS!

Minstadave said:
The new contract drives towards a fall further fall in recruitment and even more reliance on agency work. The locum caps have all been broken already, so that didn't work, and this is before we start to provide "7 day care" which we still don't know what it will entail, how many staff we will need and how it'll be paid for.
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The new contract also reduces (not eliminates) the disincentives to schedule staff for evening and weekend work through the premium pay changes.

More staff may well be needed to meet the 7 day needs of patients, and we may need to change things to improve recruitment and retention of staff (not to mention looking at whether we have sufficient medical school places to meet future demand), but those changes should not take the form of practices with known consequences such as the current banding approach.
 
Dolph said:
More staff may well be needed to meet the 7 day needs of patients, and we may need to change things to improve recruitment and retention of staff (not to mention looking at whether we have sufficient medical school places to meet future demand), but those changes should not take the form of practices with known consequences such as the current banding approach.
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Yeah improve recruitment and retention of staff by making it less and less appealing to train as a doctor or work for the nhs. Good one
 
Dolph said:
The new contract also reduces (not eliminates) the disincentives to schedule staff for evening and weekend work through the premium pay changes.

More staff may well be needed to meet the 7 day needs of patients, and we may need to change things to improve recruitment and retention of staff (not to mention looking at whether we have sufficient medical school places to meet future demand), but those changes should not take the form of practices with known consequences such as the current banding approach.
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But, and this is important, we don't actually need more junior doctors on evenings and weekends - not unless you want to provide 7 day elective services at evenings and weekends - which it's absolutely clear we can't afford (and as far as I'm aware I sn't provided elsewhere by state run healthcare in Europe) and even the Government is distancing itself from over time. Even Keogh, the spineless Government puppet has come out of the woodwork about this earlier this week.

So we just have the same number of people working for less - with the negative consequences in tow.
 
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Minstadave said:
But, and this is important, we don't actually need more junior doctors on evenings and weekends - not unless you want to provide 7 day elective services at evenings and weekends - which it's absolutely clear we can't afford (and as far as I'm aware I sn't provided elsewhere by state run healthcare in Europe) and even the Government is distancing itself from over time. Even Keogh, the spineless Government puppet has come out of the woodwork about this earlier this week.

So we just have the same number of people working for less - with the negative consequences in tow.
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So someone who is admitted on Saturday gets the same treatment options, in the same time, as someone admitted on a Wednesday? Rubbish.
 
Dolph said:
So someone who is admitted on Saturday gets the same treatment options, in the same time, as someone admitted on a Wednesday? Rubbish.
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Want to back that up? Because the Government haven't got any evidence for the weekend effect being linked to JD staffing levels.

Certainly in my speciality (Paeds/Neonates) we absolutely provide the same treatment options and care for emergency admissions every day of the week. The only thing I can think of is smaller hospitals don't have MRI availability and sub-speciality opinions aren't always locally available over the weekend but if it's needed we would just transfer to a bigger centre and no number of extra JDs is going to help this. In fact weekends are often easier to get things done because you're not also trying not to run an elective service at the same time.

We certainly have much greater limitations at night than at weekends, so should we pay nights as plain time and increase staffing?
 
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Dolph said:
So someone who is admitted on Saturday gets the same treatment options, in the same time, as someone admitted on a Wednesday? Rubbish.
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Yes. Someone needs to see a doctor on a Saturday, they see a doctor. Someone needs an MRI on a Saturday, they get a MRI. Someone needs a operation on a Saturday, guess what? They have their operation. This is how the NHS works. It is based on needs.

The difference on the weekend is, there is less elective work taken place on a Saturday. If you want a 7 day NHS, I'd start with the patients pathway. Which starts with a GP. This will greatly ease the burden on A&E, which in turn will help with the hospitals pathway through the system.
 
Buddy said:
Hold on mate I thought Dolph said the NHS has a sufficient headcount? Also you're not allowed to complain because you work for a monopoly employer!
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You have to laugh at the faux intellectual troll that is Dolph .... never gives a straightforward response, obfuscates when losing an argument and is oft known to present his own opinion as fact.
 
Minstadave said:
Want to back that up? Because the Government haven't got any evidence for the weekend effect being linked to JD staffing levels.

Certainly in my speciality (Paeds/Neonates) we absolutely provide the same treatment options and care for emergency admissions every day of the week. The only thing I can think of is smaller hospitals don't have MRI availability and sub-speciality opinions aren't always locally available over the weekend but if it's needed we would just transfer to a bigger centre and no number of extra JDs is going to help this. In fact weekends are often easier to get things done because you're not also trying not to run an elective service at the same time.

We certainly have much greater limitations at night than at weekends, so should we pay nights as plain time and increase staffing?
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So there is no difference whatsoever in care between a Wednesday and a Saturday? Exactly the same level of observation, investigation and support is given? Before you answer, it's probably worth mentioning again that my mother in law has been in hospital coming up to three weeks now.

I may also have to raise a complaint that the consultant lied to me and my wife when we had our daughter when he apologised for my wife being left in pain for 30 odd hours because she came in early Saturday morning and she would have had the situation resolved before waiting for the baby going into distress if she had had gone in on a weekday.

The pure emergency service may be the same, the general standard of service and care is not, but then you have already acknowledged what is more important to you.

As for evenings, the timescale of reduced service is smaller than starting the weekend at 7p on a friday and continuing it until 7am Monday morning.
 
xaldub said:
You have to laugh at the faux intellectual troll that is Dolph .... never gives a straightforward response, obfuscates when losing an argument and is oft known to present his own opinion as fact.
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And yet the ad hominem attacks as an alternative to actually debating are always directed at me, rather than coming from me...
 
Trifid said:
Yes. Someone needs to see a doctor on a Saturday, they see a doctor. Someone needs an MRI on a Saturday, they get a MRI. Someone needs a operation on a Saturday, guess what? They have their operation. This is how the NHS works. It is based on needs.

The difference on the weekend is, there is less elective work taken place on a Saturday. If you want a 7 day NHS, I'd start with the patients pathway. Which starts with a GP. This will greatly ease the burden on A&E, which in turn will help with the hospitals pathway through the system.
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Much of my comment to Minstadave also applies here, with the addition of pointing out that fixing the gp problem and fixing the hospital problem are not mutually exclusive. Getting the GPs of the ridiculous contract new labour created is going to be difficult though, as entitlement is sure to take priority over patients when the bma gets involved.
 
Ask any GP if they feel their contract is even ok let alone ridiculously good Dolph. It is a terrible contract for the doctors. It had some increase in pay because the pay had been so poor and recruitment in free fall, and was needed to keep the service alive, and every subsequent year the deal has been eroded and Hunt has even stated the contract negotiations. Since then have been punitive in penance for previous deal. Primary care is in just as bad a situation as the hospitals and financially practices are falling left right and centre. Doctors are reducing their sessions per week as it simply isn't possible to continue working the way we have been in most parts of the country. You seriously need to speak frankly with some working on front line to understand how they feel before simply rattling off the rubbish spouted from conservative headquarters. I personally don't feel that the NHS is save able in a form most would recognise, probably under any government now, but definitely not this government
 
heeeed said:
Ask any GP if they feel their contract is even ok let alone ridiculously good Dolph. It is a terrible contract for the doctors. It had some increase in pay because the pay had been so poor and recruitment in free fall, and was needed to keep the service alive, and every subsequent year the deal has been eroded and Hunt has even stated the contract negotiations. Since then have been punitive in penance for previous deal. Primary care is in just as bad a situation as the hospitals and financially practices are falling left right and centre. Doctors are reducing their sessions per week as it simply isn't possible to continue working the way we have been in most parts of the country. You seriously need to speak frankly with some working on front line to understand how they feel before simply rattling off the rubbish spouted from conservative headquarters. I personally don't feel that the NHS is save able in a form most would recognise, probably under any government now, but definitely not this government
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Ask anyone if their contract is good and they will tell you they want more money etc. Personal feeling is not a good indicator of relative reward.

Unfortunately, a publicly run monolith can never be anything other than politically managed.
 
An all you can eat buffet with no limit on work for 136 per patient per year. It is not a good contract to work in and is seeing increased amount of doctors burning out trying to prop it up. GP average pay is dropping because most are choosing to reduce their sessions to be able to continue working 12+ hour days with lunches at a desk dealing with admin and no real breaks. it offers no control on your workload, it is not as lucrative as the daily mail would have you believe. If you look at the effective hourly rate, the stress and responsibility then it really isn't a good contract, but by all means feel free to judge something of which you have no knowledge
 
heeeed said:
An all you can eat buffet with no limit on work for 136 per patient per year. It is not a good contract to work in and is seeing increased amount of doctors burning out trying to prop it up. GP average pay is dropping because most are choosing to reduce their sessions to be able to continue working 12+ hour days with lunches at a desk dealing with admin and no real breaks. it offers no control on your workload, it is not as lucrative as the daily mail would have you believe. If you look at the effective hourly rate, the stress and responsibility then it really isn't a good contract, but by all means feel free to judge something of which you have no knowledge
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I would prefer to judge it from the patient's point of view, and it doesn't do very well there either. The problem is that the bma will oppose any contract constructed with the patient at the centre.
 
xaldub said:
You don't debate though, you just troll. A more eloquent one perhaps ... but a troll nonetheless.
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I don't think that's true at all - Dolph has his point of view which isn't shared by many these days, and normally debates it annoyingly well.
 
xaldub said:
You don't debate though, you just troll. A more eloquent one perhaps ... but a troll nonetheless.
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Holding an unpopular view isn't trolling. I want to see the nhs reformed to be much more patient outcome focused. That is my driver in this debate. Calling people out when they put their own wants over patient needs isn't going to go down well, but that doesn't make it a troll, it's a very valid position to hold and argue for.

scorza said:
I don't think that's true at all - Dolph has his point of view which isn't shared by many these days, and normally debates it annoyingly well.
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Thanks, I know we don't agree on many methods (even when we want the same outcome) but a good debate helps shake out any flaws in positions on all sides, when the participants are actually debating a position that is based on evidence (filtered through starting assumptions or positons), less so when people are defending their privilege.
 
scorza said:
I don't think that's true at all - Dolph has his point of view which isn't shared by many these days, and normally debates it annoyingly well.
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He's perfectly entitled to have his own point of view. However, lets be clear ... he is in no way offering reasoned debate. Most of the facts he presents in this thread are at best half-truths, but more often than not just simply false. Given the articulate manner in which he otherwise presents himself I can only assume he is in fact "trolling" rather than being incredibly ignorant.
 
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