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Should NHS doctors and nurses be paid more?

Discussion in 'Speaker's Corner' started by ver01@, Mar 7, 2019.

  1. jjgreenwood

    Gangster

    Joined: May 21, 2010

    Posts: 461

    Unfortunately punitive tax on the rich doesn't work - they just move elsewhere.

    The problem in my view is the provision of healthcare doesn't increase with local population. IE someone builds a bunch of housing for over 55's bringing in 200 new old people into the area but nobody increases NHS support accordingly. In our area vast amounts of new houses are going up but healthcare provision hasn't been increased. These are basics but there just doesn't seem to be the money to do it. Existing facilities are now not big enough, waiting lists increase, hospitals don't get any bigger etc etc etc.
     
  2. jjgreenwood

    Gangster

    Joined: May 21, 2010

    Posts: 461

    Exactly and unfortunately the Rich are not really those with big incomes. There are plenty of Rich doing nothing and escaping vast amounts of tax by shoving money elsewhere in the world. Those earning those incomes quoted are not really rich but just earning a lot. £100k a year sounds like a massive wage but really equates to taking home less than £1500 a week which can easily go after a decent house and a decent car is paid for.
     
  3. Dolph

    Man of Honour

    Joined: Oct 17, 2002

    Posts: 46,406

    Location: Plymouth

    The problem is more fundamental than that, the structure of the nhs is such that patients, rather than being the engine of the machine, are the weights the machine is pulling. As a result, the NHS is great in emergencies, but terrible at routine or preventative care, tending to ignore or delay treating things until they become emergencies.

    What we should be doing is looking at the successful systems with much better outcomes, looking at how they are structured and managed, and replicate them, but we won't, because the nhs is a sacred cow to uk politics. We would literally rather it killed people unnecessarily than actually change it.
     
  4. Teh_Next

    Hitman

    Joined: Nov 3, 2018

    Posts: 596

    Location: The other side of The Gap

    The NHS ignores and delays treatment until they become emergencies?
    What a load of utter piffle.
     
  5. Minstadave

    Capodecina

    Joined: Jan 8, 2004

    Posts: 24,071

    Location: Rutland

    Not entirely. Health promotion, illness prevention is not as well funded or driven in the NHS as it could be.

    Delaying treatment is an inherent part of NHS rationing. There will be a natural attrition on any waiting list (some will get better, some will change their mind, some will die).

    We regularly delay treatments that are non urgent to prop up the failing acute services (look at elective surgical cancellations in winter pressure months).

    There is an overt focus on acute care in the NHS and I think we will end up with a two tier system like NZ, where the state funds acute care and elective care is private.
     
  6. neviditelny

    Hitman

    Joined: Oct 15, 2015

    Posts: 917

    The problem with health promotion is that it doesn't matter how much we try to promote better living etc when people are in general very unwilling to follow advice to get better/decrease chances of getting unwell.

    It's a pretty sad state when for example my Trust have been on internal incident/black alert most of the year as there is a much bigger demand for beds than we can discharge patients due to various reasons/problems.
     
  7. Orionaut

    Soldato

    Joined: Aug 2, 2012

    Posts: 6,523



    From a talk some years ago...

    Typically 50% or more of all hospital admissions are via A&E

    This is why people who have attended for minor elective procedures (And even major, though not immediately life threatening, ones such as heart bypasses etc) can find themselves bumped even as they are being prepped for surgery because somebody fell off their bicycle and broke their wrist.

    There is an argument that all elective surgery should be contracted out to the private sector. It would actually save a load of money and provide a better service overall
     
  8. Deus Ex

    Hitman

    Joined: Aug 22, 2013

    Posts: 921

    Location: North East

    training wages are low. Last year I cleared after tax, pension and student loans £4.5k/month locuming in A&E for ten months.
    Now Im back int training I am getting £2200/month after tax, i.e half pay.

    Its all fine to say when you are a consultant and your salary goes to £77k/annum that its fine, but I will be in my late thirties, sacrificed relationships, health, my 20s and more. I will have to commute for the next seven years of training to about a dozen hospitals, all spread out making it impossible to buy a house, making stupid commutes the norm.
    My younger brother in a generic graduate job outearns me. My ex GF who was five years younger out earned me in her second year of work.

    It is not about money, but I want enough that I can have a nice house, nice holidays and not worry about that stuff in the time I have out of work.
     
  9. Dolph

    Man of Honour

    Joined: Oct 17, 2002

    Posts: 46,406

    Location: Plymouth

    OK, I probably should have been clearer. The NHS uses multiple gateway processes and multiple waiting lists as a means to ration care, as confirmed by Minstadave above.

    One of the unintended consequences to this is that many people don't get treated for the original condition, but for the preventable emergency deterioration that occurs while on the waiting list.

    The NHS uses artificially extended wait times to ration access to care and manage demand because it doesn't have the facility to use other common means such as price, and because supply capability in the NHS is not linked to demand or demand management effective (eg the NHS doesn't receive more money the more work it does). Effectively the demand for the NHS is unlimited, because there is no incentive for patients to do anything else,so the NHS uses the limited demand management techniques available to it, even though those techniques are frequently detrimental to the patients long term outcome, either directly or indirectly, and supply is directly limited because the financial supply is set independent of success in managing demand, or worse, the inverse of that success (failing hospitals get bailouts where successful ones get more cuts).

    The whole fundamental setup is broken as a result.
     
  10. Dolph

    Man of Honour

    Joined: Oct 17, 2002

    Posts: 46,406

    Location: Plymouth

    I suspect your perspective on this is somewhat skewed, and probably wouldn't get much sympathy out in the wider world. The average uk salary is about £560 a week before tax. The lowest figure you mention above is roughly £650 per month, or around 20% more.

    Now, I'm not saying you're not necessarily justified in expecting more, but you may not get the sympathy you think if you move out of your immediate circle.
     
  11. Minstadave

    Capodecina

    Joined: Jan 8, 2004

    Posts: 24,071

    Location: Rutland

    Don’t even think the consultant job is the end of it, the pension rules are so complicated you can end up paying 5 figure tax penalties for pension growth you won’t see until 30 years down the road, if you live that long.
     
  12. WJA96

    Capodecina

    Joined: Jul 13, 2005

    Posts: 13,748

    Location: Norfolk, South Scotland

    This is an interesting thread.

    I don’t believe paying someone more money makes them happier at work. If you’re unhappy at work a huge pay rise will buy you nicer stuff, a bigger house, a more exotic holiday but at the end of the day the job is as unhappy as it was before the extra money.

    So, NHS staff need something, but I don’t think it’s money per se.
     
  13. Minstadave

    Capodecina

    Joined: Jan 8, 2004

    Posts: 24,071

    Location: Rutland

    The year on year whittling away of pay, pension rewards and working conditions is significant though. A holistic approach would be sensible. Moment doesn't fix the problem in isolation.

    At the moment colleagues are dropping work and trying to reduce their pay to avoid being caught out by the pension taper and annual allowance.
     
  14. heeeed

    Hitman

    Joined: Dec 11, 2002

    Posts: 658

    Location: Newcastle

    but that's the same with every job. If you can't improve the job in some undefined way then you can make people feel valued and feel better about themselves with the way modern society measures it. Money.

    What do you do that makes it better in other ways? The old things that existed eg as place in society, respect as "one of the professions", how patients treat those looking after them has all moved on from decades ago. Some of this is good in some ways eg it's not necessarily a healthy set up to be put on a pedestal (although I imagine it's nice at times). There are also more negative changes from patients eg not accepting opinions demanding 2nd, 3rd, 4th opinions is much more common than it ever used to be at beginning of my career (I'm not talking about times when this is appropriate which do exist, but those that waste resources when there isn't medical doubt, because they don't like the answer). These hard to define things that made health professionals feel good about themselves are worsening not getting better in modern society. I would be very interested in what might replace them.

    I earn quite well and don't complain about my pay, but that's because of a lot of hard work within my team to make the business run effectively to give a reasonable pay. If you constantly make changes that are the detriment to my life then I equally want this to be paid for. Nobody in any job wants their terms and conditions to worsen without recompense.
     
  15. Teh_Next

    Hitman

    Joined: Nov 3, 2018

    Posts: 596

    Location: The other side of The Gap

    I've never heard of artificially extended waiting times. If anything NHS trusts are severely scrutinised if they breach any wait times and actioned via inspectorate and placed under special measures if it continues.
    There can be deflection at times, where a patient's care and the cost is bounced around, perhaps to a local authority, another trust etc.
    I'm not sure failing trusts or hospitals bailouts either, again they are placed under special measures and are subjected to a Single Oversight Framework that will ultimately drive efficiency.
    Maybe will result in a bailout, I can't say, each case will be different but, I don't think it's as simple as just getting an initial bailout.
     
  16. Teh_Next

    Hitman

    Joined: Nov 3, 2018

    Posts: 596

    Location: The other side of The Gap

    That sounds entirely different to delays and "ignores" care but yes, I see what's being said now.
    I do experience it as I work in orthopaedics and work with both acute and elective. Our electives are of course at a lower amount in the winter months as the elderly and frail take up our beds with their hips! I don't think that's a artificial extension, it's just fact that the acute patient is in immediate need.
     
  17. Dolph

    Man of Honour

    Joined: Oct 17, 2002

    Posts: 46,406

    Location: Plymouth

    If the delay in treatment is not medically necessary, then the waiting time is being artificially extended it created to fulfil something other than the patients need.
     
  18. Deus Ex

    Hitman

    Joined: Aug 22, 2013

    Posts: 921

    Location: North East

    Yep but the average population don't actually understand what high performing graduate salaries are. I earn less than the guys I went to school and uni who went into finance and software development. They bang on about python and bonuses.

    Also the average public do not do a volume of night and weekend work.

    The majority also make the hardest life and death decisions on the commute by car, the rest of the time they get little opportunity to royally screw up and bump someone off. If I mistakenly give a whole 10mg vial of metaraminol and I and the patient more importantly is ******.
     
  19. Teh_Next

    Hitman

    Joined: Nov 3, 2018

    Posts: 596

    Location: The other side of The Gap

    Lol, it's being extended by circumstance, I don't see what's artificial about it.
     
  20. Dolph

    Man of Honour

    Joined: Oct 17, 2002

    Posts: 46,406

    Location: Plymouth

    And that is part of the problem...