Junior Doctor's contracts petition
Discussion
One of the hardest factors to comprehend until you see it close up is this topic of hours worked and the risks associated.
if Junior doctors were fitted with a tachograph so they had to take their brakes and stick to the max hours worked rules, and the trusts were fined for breaches, then the NHS would grind to a halt tomorrow.
Like most aspirant young professionals they turn up early, they work through their brakes and they leave late, and are happy to do so. 2 big differences most professionals are contracted and scheduled 9 to 5 Monday to Friday not 12 consecutive days or night shifts. If and when the young lawyer/accountant/architect..... screws up because they are over tired, it can be put right with an invoice. In the NHS it is put right with a law suit that swallows £20bn a year.
Can anyone explain how the government thinks saying we will negotiate but we will impose is not incompatible or inflammatory.
if Junior doctors were fitted with a tachograph so they had to take their brakes and stick to the max hours worked rules, and the trusts were fined for breaches, then the NHS would grind to a halt tomorrow.
Like most aspirant young professionals they turn up early, they work through their brakes and they leave late, and are happy to do so. 2 big differences most professionals are contracted and scheduled 9 to 5 Monday to Friday not 12 consecutive days or night shifts. If and when the young lawyer/accountant/architect..... screws up because they are over tired, it can be put right with an invoice. In the NHS it is put right with a law suit that swallows £20bn a year.
Can anyone explain how the government thinks saying we will negotiate but we will impose is not incompatible or inflammatory.
turbobloke said:
IanA2 said:
Hosenbugler said:
arp1 said:
There is a good debate here, but to the ones who oppose the doctors and the strike, we already have a 24/7 nhs. Doctors and nurses do work 25/7 and it is all the supporting staff and services that would let down a 'truly 24/7 nhs'. And like many have said before, private companies and businesses would lose a lot of staff if such changes were foisted upon their staff so why on earth should they not stand up for their rights and pay and conditions? Just because they may earn slightly higher than the average joe makes them a prime candidate to be railroaded? I think not!
It appears to be a fact that if you fall ill over a weekend, your prospects are not as good as if you fell ill in the week.. So no, the NHS is not 24/7 ,if it were, there would be no difference to patients prospects whenever they became ill. Numerous services have to , by law, take the action expected of them within very tight time schedules whatever the time or day, same service irrespective.
That is 24/7
Edited by IanA2 on Thursday 14th January 09:56
968 said:
The other papers that Hunt keeps quoting have similarly misleading statistics and highly confounding variables which have not been taken into consideration.
So please explain, if a weekend day is made identical to a weekday in terms of total NHS response, which of those variables will not be accounted for or i.e. at least improved possibly substantially from the NHS side?Even if there is a significant difference in the number of high-risk (mortality) conditions presenting at the weekend, and taking this on trust even though it has been suggested but without credible evidence in support, which NHS variable would not be addressed by making all days identical from the perspective of NHS provision?
No more could be expected, but no less either.
Will you be willing to pay more in taxes to pay for all the support staff and services to be open 25/7 also? I think we all know the answer to that. We do have a 24/7 nhs, hospitals never close and you will always be able to see a doctor. You also have nhs 24 as well so we are well covered. It is true that you may be more likely to succumb to your ailment on a weekend however this is due to the fact you are admitted as you are really really ill, not with something mild. And the weekend stat only takes into account those admitted on the weekend, but not necessarily dying on the weekend, so the stats are there to be manipulated any which way.
IanA2 said:
turbobloke said:
IanA2 said:
Hosenbugler said:
arp1 said:
There is a good debate here, but to the ones who oppose the doctors and the strike, we already have a 24/7 nhs. Doctors and nurses do work 25/7 and it is all the supporting staff and services that would let down a 'truly 24/7 nhs'. And like many have said before, private companies and businesses would lose a lot of staff if such changes were foisted upon their staff so why on earth should they not stand up for their rights and pay and conditions? Just because they may earn slightly higher than the average joe makes them a prime candidate to be railroaded? I think not!
It appears to be a fact that if you fall ill over a weekend, your prospects are not as good as if you fell ill in the week.. So no, the NHS is not 24/7 ,if it were, there would be no difference to patients prospects whenever they became ill. Numerous services have to , by law, take the action expected of them within very tight time schedules whatever the time or day, same service irrespective.
That is 24/7
Both the government and the JDs are risking alienating the public; by continuing with strike action the suspicion has to be that the reservoir for JDs is going to run on empty sooner than the government's.
arp1 said:
Will you be willing to pay more in taxes to pay for all the support staff and services to be open 25/7 also? I think we all know the answer to that. We do have a 24/7 nhs, hospitals never close and you will always be able to see a doctor. You also have nhs 24 as well so we are well covered. It is true that you may be more likely to succumb to your ailment on a weekend however this is due to the fact you are admitted as you are really really ill, not with something mild. And the weekend stat only takes into account those admitted on the weekend, but not necessarily dying on the weekend, so the stats are there to be manipulated any which way.
labs and imaging are increasingly working full shift rotas rather than 'on call'basic CT operational competencies are now are requirement for diagnostic radiographers to qualify ...
Nursing has always been a 24/7 service , as has portering and hard FM ( and where hard FM was previously on call it;s full shift now)
Sir David Dalton who has just been parachuted in to cool down the talks, has just said that there's a muddled message from HMG on 7 day working. Points out that juniors are a small part of the overall ramping up required to offer 24/7. Seems to be downgrading the "demand" to "aspirational"
Given that juniors constitute around 40K of a 1.3M workforce you can see you how the bill for 24/7 services might grow.....
Given that juniors constitute around 40K of a 1.3M workforce you can see you how the bill for 24/7 services might grow.....
turbobloke said:
So please explain, if a weekend day is made identical to a weekday in terms of total NHS response, which of those variables will not be accounted for or i.e. at least improved possibly substantially from the NHS side?
Even if there is a significant difference in the number of high-risk (mortality) conditions presenting at the weekend, and taking this on trust even though it has been suggested but without credible evidence in support, which NHS variable would not be addressed by making all days identical from the perspective of NHS provision?
No more could be expected, but no less either.
For a start the junior doctor contract will not result in staffing levels in the hospital the same as a weekday. As has been said repeatedly, ancillary services, on which the doctors rely, will not be available on the weekend and unless Hunt has a magic additional 20% again of NHS funding to make those things available, the hospital will NEVER work at the same capacity on the weekend. So this whole debate is a nonsense from the beginning. Even if there is a significant difference in the number of high-risk (mortality) conditions presenting at the weekend, and taking this on trust even though it has been suggested but without credible evidence in support, which NHS variable would not be addressed by making all days identical from the perspective of NHS provision?
No more could be expected, but no less either.
It is well recognised that patients presenting on the weekend are generally more sick than those presenting in mid week, the credible evidence you cite is anything but that, and in all cases suggests that a weekend effect cannot be inferred from the data.
The only way a truly '7 day service' could happen is if all staff worked 7 days a week and that simply will not happen ever because it is not financially viable and there are not enough staff members to make it work.
The junior doctors contract is an attempt by Hunt to treat them as chattel to impose a contract which will force them to work longer hours for less pay and without safeguards to prevent hospital trusts exploiting them, which they already do, but this contract will remove even the very poor safeguards that exist and result in a negative CQC report as the only consequence of doctors being exploited. Since so many trusts get a negative report, it makes no difference to them, so they will use this new contract as carte blanche to increase the hours for less pay. This will result in more deaths and a less safe service.
968 said:
turbobloke said:
So please explain, if a weekend day is made identical to a weekday in terms of total NHS response, which of those variables will not be accounted for or i.e. at least improved possibly substantially from the NHS side?
Even if there is a significant difference in the number of high-risk (mortality) conditions presenting at the weekend, and taking this on trust even though it has been suggested but without credible evidence in support, which NHS variable would not be addressed by making all days identical from the perspective of NHS provision?
No more could be expected, but no less either.
For a start the junior doctor contract will not result in staffing levels in the hospital the same as a weekday. As has been said repeatedly, ancillary services, on which the doctors rely, will not be available on the weekend and unless Hunt has a magic additional 20% again of NHS funding to make those things available, the hospital will NEVER work at the same capacity on the weekend. So this whole debate is a nonsense from the beginning. Even if there is a significant difference in the number of high-risk (mortality) conditions presenting at the weekend, and taking this on trust even though it has been suggested but without credible evidence in support, which NHS variable would not be addressed by making all days identical from the perspective of NHS provision?
No more could be expected, but no less either.
It is well recognised that patients presenting on the weekend are generally more sick than those presenting in mid week, the credible evidence you cite is anything but that, and in all cases suggests that a weekend effect cannot be inferred from the data.
The only way a truly '7 day service' could happen is if all staff worked 7 days a week and that simply will not happen ever because it is not financially viable and there are not enough staff members to make it work.
The junior doctors contract is an attempt by Hunt to treat them as chattel to impose a contract which will force them to work longer hours for less pay and without safeguards to prevent hospital trusts exploiting them, which they already do, but this contract will remove even the very poor safeguards that exist and result in a negative CQC report as the only consequence of doctors being exploited. Since so many trusts get a negative report, it makes no difference to them, so they will use this new contract as carte blanche to increase the hours for less pay. This will result in more deaths and a less safe service.
IanA2 said:
968 said:
turbobloke said:
So please explain, if a weekend day is made identical to a weekday in terms of total NHS response, which of those variables will not be accounted for or i.e. at least improved possibly substantially from the NHS side?
Even if there is a significant difference in the number of high-risk (mortality) conditions presenting at the weekend, and taking this on trust even though it has been suggested but without credible evidence in support, which NHS variable would not be addressed by making all days identical from the perspective of NHS provision?
No more could be expected, but no less either.
For a start the junior doctor contract will not result in staffing levels in the hospital the same as a weekday. As has been said repeatedly, ancillary services, on which the doctors rely, will not be available on the weekend and unless Hunt has a magic additional 20% again of NHS funding to make those things available, the hospital will NEVER work at the same capacity on the weekend. So this whole debate is a nonsense from the beginning. Even if there is a significant difference in the number of high-risk (mortality) conditions presenting at the weekend, and taking this on trust even though it has been suggested but without credible evidence in support, which NHS variable would not be addressed by making all days identical from the perspective of NHS provision?
No more could be expected, but no less either.
It is well recognised that patients presenting on the weekend are generally more sick than those presenting in mid week, the credible evidence you cite is anything but that, and in all cases suggests that a weekend effect cannot be inferred from the data.
The only way a truly '7 day service' could happen is if all staff worked 7 days a week and that simply will not happen ever because it is not financially viable and there are not enough staff members to make it work.
The junior doctors contract is an attempt by Hunt to treat them as chattel to impose a contract which will force them to work longer hours for less pay and without safeguards to prevent hospital trusts exploiting them, which they already do, but this contract will remove even the very poor safeguards that exist and result in a negative CQC report as the only consequence of doctors being exploited. Since so many trusts get a negative report, it makes no difference to them, so they will use this new contract as carte blanche to increase the hours for less pay. This will result in more deaths and a less safe service.
Where is there detailed credible evidence that weekend admissions inherently involve greater mortality risk - this is fine to offer as a critique of a paper which allegedly doesn't account for all the variables that it could or should, but that's the privilege of a critic, it doesn't make the case. If there is such a case, could it be indicated / re-indicated?
In particular, there was no mention of any variable on the NHS side not addressed by making a weekend day identical to a weekday. I didn't qualify this by claiming it was or wasn't Hunt's immediate intention. In my view, which I already gave, it ought to be the long-term intention.
If a postcode lottery is seen to be unacceptable, which it is, then admission day of the week lottery is also unacceptable and needs to be eradicated at some point.
turbobloke said:
But it doesn't answer my question, it addresses another.
Where is there detailed credible evidence that weekend admissions inherently involve greater mortality risk - this is fine to offer as a critique of a paper which allegedly doesn't account for all the variables that it could or should, but that's the privilege of a critic, it doesn't make the case. If there is such a case, could it be indicated / re-indicated?
In particular, there was no mention of any variable on the NHS side not addressed by making a weekend day identical to a weekday. I didn't qualify this by claiming it was or wasn't Hunt's immediate intention. In my view, which I already gave, it ought to be the long-term intention.
If a postcode lottery is seen to be unacceptable, which it is, then admission day of the week lottery is also unacceptable and needs to be eradicated at some point.
There isn't any, that I thought was the point......Where is there detailed credible evidence that weekend admissions inherently involve greater mortality risk - this is fine to offer as a critique of a paper which allegedly doesn't account for all the variables that it could or should, but that's the privilege of a critic, it doesn't make the case. If there is such a case, could it be indicated / re-indicated?
In particular, there was no mention of any variable on the NHS side not addressed by making a weekend day identical to a weekday. I didn't qualify this by claiming it was or wasn't Hunt's immediate intention. In my view, which I already gave, it ought to be the long-term intention.
If a postcode lottery is seen to be unacceptable, which it is, then admission day of the week lottery is also unacceptable and needs to be eradicated at some point.
turbobloke said:
But it doesn't answer my question, it addresses another.
Where is there detailed credible evidence that weekend admissions inherently involve greater mortality risk - this is fine to offer as a critique of a paper which allegedly doesn't account for all the variables that it could or should, but that's the privilege of a critic, it doesn't make the case. If there is such a case, could it be indicated / re-indicated?
In particular, there was no mention of any variable on the NHS side not addressed by making a weekend day identical to a weekday. I didn't qualify this by claiming it was or wasn't Hunt's immediate intention. In my view, which I already gave, it ought to be the long-term intention.
If a postcode lottery is seen to be unacceptable, which it is, then admission day of the week lottery is also unacceptable and needs to be eradicated at some point.
The problem then is that mortaliy rates were found to be significantly (in a statistical sense)higher on a Wednessday, Thursday and Friday too. The DoH seem to have missed that point.Where is there detailed credible evidence that weekend admissions inherently involve greater mortality risk - this is fine to offer as a critique of a paper which allegedly doesn't account for all the variables that it could or should, but that's the privilege of a critic, it doesn't make the case. If there is such a case, could it be indicated / re-indicated?
In particular, there was no mention of any variable on the NHS side not addressed by making a weekend day identical to a weekday. I didn't qualify this by claiming it was or wasn't Hunt's immediate intention. In my view, which I already gave, it ought to be the long-term intention.
If a postcode lottery is seen to be unacceptable, which it is, then admission day of the week lottery is also unacceptable and needs to be eradicated at some point.
turbobloke said:
But it doesn't answer my question, it addresses another.
Where is there detailed credible evidence that weekend admissions inherently involve greater mortality risk
There isn't. There's lots of papers which have suggested a link but have qualified their statements with huge riders that suggest that many confounding variables haven't been taken into account such that a link cannot be demonstrated. This is not my view only, but the view of the authors of the papers. These same papers also show an increase in mortality on other days of the week as well, but strangely that seems to be forgotten by the politicians and yourself.Where is there detailed credible evidence that weekend admissions inherently involve greater mortality risk
turbobloke said:
In particular, there was no mention of any variable on the NHS side not addressed by making a weekend day identical to a weekday. I didn't qualify this by claiming it was or wasn't Hunt's immediate intention. In my view, which I already gave, it ought to be the long-term intention.
Sorry but I don't understand this paragraph, perhaps because it's written in a very strange way. However if you want a 7 day service where the NHS runs to the same capacity every day of the week, in terms of elective services and investigations/ancillary services, then you will have to pay an additional 20% of the total NHS expenditure on top, over and above what is currently spent. Where will the money come from for that?There is no money for that and actually no need. The vast majority of patients do not want elective services run out of hours or on weekends. What they want is an improvement in emergency services. However this improvement can only be delivered by a large increase in expenditure, not the cut in NHS funding which has occurred. The junior doctors contract will not achieve or help this issue because it will simply cause tired doctors to be working excessive hours doing more work for less pay. The govt has no desire to employ additional doctors, they might say they do, but the reality is, they don't. They want a huge increase in capacity with existing staff who are already overstretched massively. I know that will mean nothing to you, but perhaps it will when you come in contact with one of them one day.
To be honest I think the idea of a 7 day NHS is a good one and should be commended, however I think the execution seems a little bit half cocked, becuase as far as I can tell, most Junior Doctors work 7 days a week anyway, so the current contract negotiations seem a little bit misguided in all honesty.
Purely as a layman looking in, where I think we would get one of the biggest benefits of a 7 day NHS is GP Surgeries. Basing this on our local surgery the opening times are seriously limited (8 - 6), which if you work full time, can make getting to the doctor's a bit of a pain, and can lead people straight to A n E if the GP isn't open. I would have thought more evening and weekend appointments would help those in work, and hopefully take a load off A n E at the weekend?
Purely as a layman looking in, where I think we would get one of the biggest benefits of a 7 day NHS is GP Surgeries. Basing this on our local surgery the opening times are seriously limited (8 - 6), which if you work full time, can make getting to the doctor's a bit of a pain, and can lead people straight to A n E if the GP isn't open. I would have thought more evening and weekend appointments would help those in work, and hopefully take a load off A n E at the weekend?
IanA2 said:
There isn't any, that I thought was the point......
Putting aside the well-known habit of researchers to end with 'boilerplate' that more work needs to be done for this or that reason - more grants will then be paid and jobs remain safer - then the same points I made in reply to 968 apply here. It's easy to claim missed variables, harder to pin them down and demonstrate significance. As 968 concedes, in effect.
968 said:
turbobloke said:
But it doesn't answer my question, it addresses another.
Where is there detailed credible evidence that weekend admissions inherently involve greater mortality risk
There isn't. Where is there detailed credible evidence that weekend admissions inherently involve greater mortality risk
968 said:
turbobloke said:
In particular, there was no mention of any variable on the NHS side not addressed by making a weekend day identical to a weekday. I didn't qualify this by claiming it was or wasn't Hunt's immediate intention. In my view, which I already gave, it ought to be the long-term intention.
Sorry but I don't understand this paragraph, perhaps because it's written in a very strange way. ucb said:
The problem then is that mortaliy rates were found to be significantly (in a statistical sense)higher on a Wednessday, Thursday and Friday too. The DoH seem to have missed that point.
May I enquire as to whether that means higher actually on those days, or arising from admissions on those days? Who found that, if you recall? Did they miss any variables?!This ^ isn't irrelevant but getting back to the JD strikes, as time goes by this activism risks playing into the govt's hands in terms of public opinion swinging against JDs as more operations are cancelled and more bad press emerges associated with that. To most people, JDs are well-paid.
The Junior Drs campaign is very dishonest. They had all their carefully worked out answers (i.e. propaganda).
Saying that w/e deaths were not a result of Drs not working w/e because no operations are done at w/e was just dishonest. My uncle had a colostomy reversal done on a Thursday, and there was no Dr around the following w/e when he started to complain of lung pain the nurse brushed him off, then he died of a clot the next day - completely avoidable if a skilled Dr had seen him.
The fees the Drs pay to train do not even cover 1/3 of the actual cost. The starting salary may not be amazing, but they aren't much use for the first few years anyway - lacking real experience, they are really still in training. With post grad. specialism the salary can become very rewarding very quickly.
We all know it is about politics and money/greed, and NOT patient safety primarily.
Saying that w/e deaths were not a result of Drs not working w/e because no operations are done at w/e was just dishonest. My uncle had a colostomy reversal done on a Thursday, and there was no Dr around the following w/e when he started to complain of lung pain the nurse brushed him off, then he died of a clot the next day - completely avoidable if a skilled Dr had seen him.
The fees the Drs pay to train do not even cover 1/3 of the actual cost. The starting salary may not be amazing, but they aren't much use for the first few years anyway - lacking real experience, they are really still in training. With post grad. specialism the salary can become very rewarding very quickly.
We all know it is about politics and money/greed, and NOT patient safety primarily.
bodhi said:
To be honest I think the idea of a 7 day NHS is a good one and should be commended, however I think the execution seems a little bit half cocked, becuase as far as I can tell, most Junior Doctors work 7 days a week anyway, so the current contract negotiations seem a little bit misguided in all honesty.
Purely as a layman looking in, where I think we would get one of the biggest benefits of a 7 day NHS is GP Surgeries. Basing this on our local surgery the opening times are seriously limited (8 - 6), which if you work full time, can make getting to the doctor's a bit of a pain, and can lead people straight to A n E if the GP isn't open. I would have thought more evening and weekend appointments would help those in work, and hopefully take a load off A n E at the weekend?
The pilot schemes trialling seven day access failed as there was insufficient use/demand. That said I think there might be a case for localised expansion, say perhaps in parts of large cities. Purely as a layman looking in, where I think we would get one of the biggest benefits of a 7 day NHS is GP Surgeries. Basing this on our local surgery the opening times are seriously limited (8 - 6), which if you work full time, can make getting to the doctor's a bit of a pain, and can lead people straight to A n E if the GP isn't open. I would have thought more evening and weekend appointments would help those in work, and hopefully take a load off A n E at the weekend?
In any case I suspect that it is DH's intention is to corral GP's into salaried hospital based positions under the thumb of managers. Having said that, the impending GP exodus may well stymie any possibility of any access expansion plans.
Mr GrimNasty said:
The Junior Drs campaign is very dishonest. They had all their carefully worked out answers (i.e. propaganda).
Saying that w/e deaths were not a result of Drs not working w/e because no operations are done at w/e was just dishonest. My uncle had a colostomy reversal done on a Thursday, and there was no Dr around the following w/e when he started to complain of lung pain the nurse brushed him off, then he died of a clot the next day - completely avoidable if a skilled Dr had seen him.
The fees the Drs pay to train do not even cover 1/3 of the actual cost. The starting salary may not be amazing, but they aren't much use for the first few years anyway - lacking real experience, they are really still in training. With post grad. specialism the salary can become very rewarding very quickly.
We all know it is about politics and money/greed, and NOT patient safety primarily.
Really? I guess that depends on your definition of: "..very quickly".Saying that w/e deaths were not a result of Drs not working w/e because no operations are done at w/e was just dishonest. My uncle had a colostomy reversal done on a Thursday, and there was no Dr around the following w/e when he started to complain of lung pain the nurse brushed him off, then he died of a clot the next day - completely avoidable if a skilled Dr had seen him.
The fees the Drs pay to train do not even cover 1/3 of the actual cost. The starting salary may not be amazing, but they aren't much use for the first few years anyway - lacking real experience, they are really still in training. With post grad. specialism the salary can become very rewarding very quickly.
We all know it is about politics and money/greed, and NOT patient safety primarily.
ETA: It takes around seven years post grad training to get a CCT.
bodhi, great idea, just one question, where are you going to find these extra GPs, from leaving school it takes at least 12 years and we don't have enough GPs as it is. They have been shat upon by HMG so many times that there are far more retiring than entering.
Doctors are a finite and valuable resource that HMG totally fail to understand.
Doctors are a finite and valuable resource that HMG totally fail to understand.
IanA2 said:
Mr GrimNasty said:
The Junior Drs campaign is very dishonest. They had all their carefully worked out answers (i.e. propaganda).
Saying that w/e deaths were not a result of Drs not working w/e because no operations are done at w/e was just dishonest. My uncle had a colostomy reversal done on a Thursday, and there was no Dr around the following w/e when he started to complain of lung pain the nurse brushed him off, then he died of a clot the next day - completely avoidable if a skilled Dr had seen him.
The fees the Drs pay to train do not even cover 1/3 of the actual cost. The starting salary may not be amazing, but they aren't much use for the first few years anyway - lacking real experience, they are really still in training. With post grad. specialism the salary can become very rewarding very quickly.
We all know it is about politics and money/greed, and NOT patient safety primarily.
Really? I guess that depends on your definition of: "..very quickly".Saying that w/e deaths were not a result of Drs not working w/e because no operations are done at w/e was just dishonest. My uncle had a colostomy reversal done on a Thursday, and there was no Dr around the following w/e when he started to complain of lung pain the nurse brushed him off, then he died of a clot the next day - completely avoidable if a skilled Dr had seen him.
The fees the Drs pay to train do not even cover 1/3 of the actual cost. The starting salary may not be amazing, but they aren't much use for the first few years anyway - lacking real experience, they are really still in training. With post grad. specialism the salary can become very rewarding very quickly.
We all know it is about politics and money/greed, and NOT patient safety primarily.
ETA: It takes around seven years post grad training to get a CCT.
Yes it is very quick and very generous, and unlike most careers, there's defined paths and it's almost guaranteed.
And you just ignored everything else I said, so you agree, they don't even pay 1/3 of their training costs, the rest is paid by the taxpayer.
PS: You also undoubtedly know that Drs substantially boost their earnings with other work/shifts, and this dispute is only about Jnr Drs anyway.
Edited by Mr GrimNasty on Thursday 14th January 12:58
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