Junior Doctor's contracts petition
Discussion
I agree that the last 2 points you make are very likely.
Ultimatley this is a cost cutting excercise regardless of how it is proposed.
Unfortunatley the NHS staff, are simply bundled into the perceived inefficiency and huge cost burden that many, myself see the NHS as.
Id be amazed if you could find more than a handful of people that would state the NHS is anything but fantastic overall.
But the NHS is a huge entity and unfortunatley the government is looking to make savings. Ultimatley that is very likely as in any organisation to be reflected in a reduction in wages or a pay freeze.
In this case its simply a reconfiguring of working hours, such that the overtime is reduced, and only partially offset by an increase in basic salary.
I can understand your frustration, but thats the way things are these days
I can honestly say i appreciate the work the NHS does.
Ultimatley this is a cost cutting excercise regardless of how it is proposed.
Unfortunatley the NHS staff, are simply bundled into the perceived inefficiency and huge cost burden that many, myself see the NHS as.
Id be amazed if you could find more than a handful of people that would state the NHS is anything but fantastic overall.
But the NHS is a huge entity and unfortunatley the government is looking to make savings. Ultimatley that is very likely as in any organisation to be reflected in a reduction in wages or a pay freeze.
In this case its simply a reconfiguring of working hours, such that the overtime is reduced, and only partially offset by an increase in basic salary.
I can understand your frustration, but thats the way things are these days
I can honestly say i appreciate the work the NHS does.
tdog7 said:
...and finally, just before you come back at me with 'the NHS is expensive and inefficient'....IT IS NOT, the OECD found it the most efficient healthcare system assessed, and we spend a lower percentage of GPD on healthcare than most developed countries.
It's a fair point to use relative performance in benchmarking, but absolute values matter as well. The amounts of money involved remain eye-watering.Depending on which source is chosen, the total fraud, waste and error in the NHS amounts to between £10bn and £25bn which is around 9% of the budget (min) based on approximately £115bn.
This is not the fault of Junior Doctors, but that's not the point when looking at overall NHS funding, efficiency and taxpayer vfm.
IanA2 said:
mikebradford said:
tdog7 said:
and finally, just before you come back at me with 'the NHS is expensive and inefficient'....IT IS NOT, the OECD found it the most efficient healthcare system assessed, and we spend a lower percentage of GPD on healthcare than most developed countries.
I thank you for giving me an informed response. This is simply my perspective based on nothing more than this thread, some media and hopefully a bit of common sense based on my own industry.Point 1 ) Considering the nhs has historically had a large degree of union members,) i would imagine that staff will feel reasonably confident to bring to light unsafe working practice etc.
point 2 ) For me its simply a change to the job. Many jobs / professions have a shift pattern. I accept you may consider this worse.
As long as your basic pay reflects this i see no issue. (in this case the basic increasing admitably masks the overall likely reduction in pay)
In reality the issue is that no matter which way the new contract is seen it results in a pay decrease. As is logical as ultimately they government is trying to save money, whilst altering your working hours.
point 3 ) makes complete sense
I also believe that their are likely to be substantial savings within the nhs that do not require any change to pay or hours for the NHS staff.
And to say the NHS is a 25h service is a bit misleading. it is not a FULL 24h service. A&E yes. But most of us have had patients, some of them elderly, who get carted out of the hospital on the Friday. The public wants..no needs MORE of the NHS on the weekend. Doctors, as they run the place are a good place to start. The management would be next on my list
mikebradford said:
I agree that the last 2 points you make are very likely.
Ultimatley this is a cost cutting excercise regardless of how it is proposed.
Unfortunatley the NHS staff, are simply bundled into the perceived inefficiency and huge cost burden that many, myself see the NHS as.
Id be amazed if you could find more than a handful of people that would state the NHS is anything but fantastic overall.
But the NHS is a huge entity and unfortunatley the government is looking to make savings. Ultimatley that is very likely as in any organisation to be reflected in a reduction in wages or a pay freeze.
In this case its simply a reconfiguring of working hours, such that the overtime is reduced, and only partially offset by an increase in basic salary.
I can understand your frustration, but thats the way things are these days
I can honestly say i appreciate the work the NHS does.
Your profile says you own a design and build company.Ultimatley this is a cost cutting excercise regardless of how it is proposed.
Unfortunatley the NHS staff, are simply bundled into the perceived inefficiency and huge cost burden that many, myself see the NHS as.
Id be amazed if you could find more than a handful of people that would state the NHS is anything but fantastic overall.
But the NHS is a huge entity and unfortunatley the government is looking to make savings. Ultimatley that is very likely as in any organisation to be reflected in a reduction in wages or a pay freeze.
In this case its simply a reconfiguring of working hours, such that the overtime is reduced, and only partially offset by an increase in basic salary.
I can understand your frustration, but thats the way things are these days
I can honestly say i appreciate the work the NHS does.
Just imagine if you said to your staff I'll give you an 11% pay rise but I'll not pay you overtime unless you work passed 10pm, and I'll cut your rate for working weekends, but you'll have shorted hours and you'll end up earning less overall.
I suspect you wouldn't have many staff left after 6 months!
eccles said:
Your profile says you own a design and build company.
Just imagine if you said to your staff I'll give you an 11% pay rise but I'll not pay you overtime unless you work passed 10pm, and I'll cut your rate for working weekends, but you'll have shorted hours and you'll end up earning less overall.
I suspect you wouldn't have many staff left after 6 months!
But doesn't the proposal offer to protect pay for the next 3 years?Just imagine if you said to your staff I'll give you an 11% pay rise but I'll not pay you overtime unless you work passed 10pm, and I'll cut your rate for working weekends, but you'll have shorted hours and you'll end up earning less overall.
I suspect you wouldn't have many staff left after 6 months!
eccles said:
Your profile says you own a design and build company.
Just imagine if you said to your staff I'll give you an 11% pay rise but I'll not pay you overtime unless you work passed 10pm, and I'll cut your rate for working weekends, but you'll have shorted hours and you'll end up earning less overall.
I suspect you wouldn't have many staff left after 6 months!
That dependsJust imagine if you said to your staff I'll give you an 11% pay rise but I'll not pay you overtime unless you work passed 10pm, and I'll cut your rate for working weekends, but you'll have shorted hours and you'll end up earning less overall.
I suspect you wouldn't have many staff left after 6 months!
If i was to change my staffs contract it would be for a reason. To reduce their wage would be as a cost cutting exercise likely only to be a response to my company not being financially viable if it continued with the existing wage structure.
The building industry at my level is very liquid, in that good staff are worth paying for. As such if i dont they simply will move on.
When construction is depressed, everyone sees their wages reduced. Including myself.
The irony being my wage fluctuates the most dependent on work load. Whereas my staff wages are generally kept the same.
Overtime is something that happens, but usually as a result of jobs not going to plan.
Jobs are priced tight, and a small allowance for running over that is usually eaten up with overtime pay. As such we try not to have staff working outside the typical weekday hours.
Interestingly it seems in my industry that pay reduction is something that is expected when times are hard. Obviously not directly comparable to something like the NHS
I know many good quality skilled tradespeople that have spent time sat at home waiting for the phone to ring when times are hard. As such they work hard when work is plentiful.
williamp said:
IanA2 said:
mikebradford said:
tdog7 said:
and finally, just before you come back at me with 'the NHS is expensive and inefficient'....IT IS NOT, the OECD found it the most efficient healthcare system assessed, and we spend a lower percentage of GPD on healthcare than most developed countries.
I thank you for giving me an informed response. This is simply my perspective based on nothing more than this thread, some media and hopefully a bit of common sense based on my own industry.Point 1 ) Considering the nhs has historically had a large degree of union members,) i would imagine that staff will feel reasonably confident to bring to light unsafe working practice etc.
point 2 ) For me its simply a change to the job. Many jobs / professions have a shift pattern. I accept you may consider this worse.
As long as your basic pay reflects this i see no issue. (in this case the basic increasing admitably masks the overall likely reduction in pay)
In reality the issue is that no matter which way the new contract is seen it results in a pay decrease. As is logical as ultimately they government is trying to save money, whilst altering your working hours.
point 3 ) makes complete sense
I also believe that their are likely to be substantial savings within the nhs that do not require any change to pay or hours for the NHS staff.
And to say the NHS is a 25h service is a bit misleading. it is not a FULL 24h service. A&E yes. But most of us have had patients, some of them elderly, who get carted out of the hospital on the Friday. The public wants..no needs MORE of the NHS on the weekend. Doctors, as they run the place are a good place to start. The management would be next on my list
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!
A comment from the perspective of a private sector individual...as a general public sector point, having some input into discussions over pay and conditions is entirely reasonable, but thinking that those who get the pay can determine their pay and conditions including via coercion, won't go down well outside the public sector and there are still a lot of people not employed there despite Gordon Brown's best afforts.
The position being adopted gives the impression that there's no difference in context when times are good and the economy is in reasonable shape, and when the economy has been trashed by Labour and the new government is doing something about it when no longer hog-tied by LibDems. As Liam Byrne told everyone including doctors who have ears, there is (was) no money left and there isn't much more now.
If pay and conditions get to be out of kilter to a sufficient degree, doctors will start to leave in bigger numbers i.e. bigger than now, and recruiting will drop fast, meaning faster than now. At which point pay and conditions will be addressed to attract and retain more doctors, otherwise the government of the day will face widespread severe censure, unlike when dealing with strikes which inconvenience the public and potentially carry even graver outcomes, and the risk of alienating themselves from the voting public. The same type of risk that junior doctors currently face even with a reservoir of goodwill and support on tap, as this won't last forever.
That type of process needs to be gone through in order to prevent any public sector body with clout-by-numbers holding the public purse to ransom. There are more taxpayers than there are junior doctors, even though each should recognise that they need the other.
The position being adopted gives the impression that there's no difference in context when times are good and the economy is in reasonable shape, and when the economy has been trashed by Labour and the new government is doing something about it when no longer hog-tied by LibDems. As Liam Byrne told everyone including doctors who have ears, there is (was) no money left and there isn't much more now.
If pay and conditions get to be out of kilter to a sufficient degree, doctors will start to leave in bigger numbers i.e. bigger than now, and recruiting will drop fast, meaning faster than now. At which point pay and conditions will be addressed to attract and retain more doctors, otherwise the government of the day will face widespread severe censure, unlike when dealing with strikes which inconvenience the public and potentially carry even graver outcomes, and the risk of alienating themselves from the voting public. The same type of risk that junior doctors currently face even with a reservoir of goodwill and support on tap, as this won't last forever.
That type of process needs to be gone through in order to prevent any public sector body with clout-by-numbers holding the public purse to ransom. There are more taxpayers than there are junior doctors, even though each should recognise that they need the other.
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
Hosenbugler said:
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
Genuine question...are the type / numbers / ratios of "illnesses" being treated at weekends more or less the same as weekdays? Could it be they are more likely to be life threatening hence skewing the figures?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
For example let say weekdays 20% of admissions are potentially life threatening as against say 30% at weekends would it not follow that the prospects of dying after weekend admission would be higher?
Hosenbugler said:
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
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.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
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
ETA: Fill your boots http://www.bmj.com/company/wp-content/uploads/2014...
Edited by IanA2 on Thursday 14th January 09:51
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
spaximus said:
How you can also compare a supermarket worker to Doctors is laughable. I am sure your wife is wonderful but a supermarket is not a hospital yet. It may be when you have lost the NHS and you then have to choose what treatment you can afford, branded quality care, or poundland surgery?
And one final point, when seven day opening was first allowed, staff would not be forced to work, were paid over time and would not be disadvantaged, guess what they lied about all that and now nothing is out of bounds.
The entitlement is strong in this post.And one final point, when seven day opening was first allowed, staff would not be forced to work, were paid over time and would not be disadvantaged, guess what they lied about all that and now nothing is out of bounds.
The world changes. It is not just supermarket workers who work a working week that does not differentiate between "weekends" and "weekdays". As long as people have the same number of days off as everyone else I cant see the problem myself and quite why Doctors think they should be paid more for working a Saturday than any other day is quite beyond me.
Where Junior doctors are calling for fair pay for a decent working week they have my sympathy.
Where they are defending antiquated working practices and demarcation rules like 70s union dinosaurs and pretending this is about "saving the NHS" they do not.
Hosenbugler said:
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
This is not actually true. The spin that Hunt keeps spouting is just that. It's an utter lie to try and justify his desire to introduce elective (ie non urgent) NHS work on weekends which will make no difference to mortality.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
For example, quoted from David Curtis who has debunked many of these political lies:
"Here is the soundbite which Hunt has been repeating ad nauseam: "And at the moment we have an NHS where if you have a stroke at the weekends, you're 20% more likely to die. That can't be acceptable."
Sounds quite impressive? I tweeted him to ask for evidence and got no reply so I decided to look for my own. It wasn't hard to find. I'll deal with the best and most recent example. The headline finding from this paper is that patients admitted at weekends with a stroke diagnosis have an increased 7-day mortality of 19%, apparently just as Hunt claims:
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC448725...
The 7-day mortality for week-end admissions is 12.9% and for week-day admissions is 11.1% and if you factor in comorbidities etc. this gives you an adjusted mortality odds ratio of 1.19. Just as Hunt says.
But let's look more closely. At some numbers buried in the text of the paper and not even given a p value, even though they are probably the most statistically significant thing in the paper: "The overall admission rate for stroke was higher on normal week days (111 per 100 000 population; 95% CI = 110–113) than on weekends (88; 86–90) and public holidays (95; 88–102)."
So the admission rate for stroke is substantially lower at week-ends. 88 versus 111 per 100,000. See those confidence intervals? They imply that the standard error of the mean is around 1. Which means that a comparison of the two means would give a t statistic of around 13, which would give a p value so tiny that most statistics software would not even be able to calculate it.
Given that there is no earthly reason for the incidence of stroke to fluctuate wildly by the day of the week, what is obviously happening is that fewer patients with stroke are getting admitted at week-ends and that the ones who are admitted then are more severe, and hence have a higher mortality.
In fact, we can go further and quantify things. We'll make a couple of assumptions. One is that the incidence of severe stroke, i.e. one with a chance of killing you, is constant for each day of the week. Unlike, say, RTAs, alcohol poisoning or whatever. The second assumption is that somebody with a severe stroke is going to present and get admitted the same day. Strokes happen suddenly, unlike say pneumonia, appendicitis, whatever.
If we accept this, then the day of admission is the same as the day the patient has their stroke.At week-ends, 88 per 100, 000 people have a stroke and get admitted to hospital, of whom 12.9% die within 7 days, which is 11.4 people. On weekdays, it's 111 per 100,000 people having a stroke and coming in, of whom 11.1% die within 7 days, which is 12.3. So out of 100,000 people, every week-end day 11.4 get a stroke which will kill them in 7 days compared with 12.3 for every week-day.
So Hunt is lying. If you have a stroke at the week-end you're not 20% more likely to die. In fact, according to the best evidence, you're less likely to die. Out of people admitted to hospital more die, but that can only reflect their increased severity.
The main point about all this is not just that he is misleading people on this particular issue. It is that this is the best he can come up with. The DoH is packed with people smarter than us whose only job is to find stuff to support the minister. If this is the best they can come up with it doesn't reflect their incompetence. It means that there really is no evidence at all for a "week-end effect". It means there is no problem that needs fixing. It means that Hunt is deliberately picking a fight with the medical profession over a complete non-issue, presumably to further his own political ends."
The other papers that Hunt keeps quoting have similarly misleading statistics and highly confounding variables which have not been taken into consideration.
Banding is not overt time for medical staff the greatest proprtion it is a shift allowance , it;s slightly confused by the fact unbanded posts work an average of 40 hours a week 'in hours' and banded posts can average to 48 hours / week
banding 'near doubling' pay is part of the issue - even the most onerous in terms of out of hours posts (i.e. those which consist solely or mainlty of unsocial hours ) under AFC recieve supplements of 25 % (ambulance staff model of USH) 30 - 40 % for professional grades ( 'hospital' unsocial hours model 30 % for nights and saturdays and 60 % for sunday and BH ) ...
the way junior doctor pay is cost attributed is also a factor which discourages adequate OOH cover - the basic salary costs of the training posts are out of the control of the employing trust - being determined and funded by the deaneries but the unsocial hours bill is down to the trust as they control the rotas ...
this can also lead to a situation where the minimum cover of junior doctors OOH is tied up on 'service' tasks becasue it;s cheaper to pay the banding than it is to provide a proper clinical support / criticla care outreach Nurse / AHP service ...
banding 'near doubling' pay is part of the issue - even the most onerous in terms of out of hours posts (i.e. those which consist solely or mainlty of unsocial hours ) under AFC recieve supplements of 25 % (ambulance staff model of USH) 30 - 40 % for professional grades ( 'hospital' unsocial hours model 30 % for nights and saturdays and 60 % for sunday and BH ) ...
the way junior doctor pay is cost attributed is also a factor which discourages adequate OOH cover - the basic salary costs of the training posts are out of the control of the employing trust - being determined and funded by the deaneries but the unsocial hours bill is down to the trust as they control the rotas ...
this can also lead to a situation where the minimum cover of junior doctors OOH is tied up on 'service' tasks becasue it;s cheaper to pay the banding than it is to provide a proper clinical support / criticla care outreach Nurse / AHP service ...
JagLover said:
Where Junior doctors are calling for fair pay for a decent working week they have my sympathy.
Same here, but it rapidly evaporates when they wave banners proclaiming gooey diversionary crap such as 'Save Our NHS' when despite protestations this is all about JD's pay and conditions. This suggests to me that all along the JDs and their Union puppeteers knew from the outset that public support for relatively well-paid JDs striking over pay and conditions would be fragile. Being overtly political by suggesting (wrongly) that the NHS is only 'safe' in Labour hands is a high-risk strategy that people will see through.By all means regard medicine as a route to job satisfaction and a 911 Turbo deposit, but if it means waiting longer after the economy was scuppered by a previous government, such is life.
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