Meeting with Jeremy Hunt, Secretary of State for Health

Last night Jeremy Hunt was the principal guest at the Wokingham Conservative Association annual dinner.

Mr Hunt explained what he is trying to do with NHS England. Backed by substantial extra money, he is seeking to raise the quality of work, reduce waiting times and move the NHS onto a 7 day a week service pattern.

The NHS of course has always had to work Saturdays and Sundays. Babies are born at the week-end, people have accidents at the week-end, serious illnesses can flare up at the week-end, so there has always been cover. We are all grateful to many dedicated health professionals who have worked long hours and been prepared to work at week-ends to provide care and cover.

It is also the unfortunate case that there is less cover and professional expertise available at week-ends. Results of medical and surgical interventions are often worse at week-ends. It is this issue which Mr Hunt is seeking to tackle by agreement with the professions. He is offering shorter hours for many doctors in return for more of those hours being at a week-end. He is offering pay rises for most from his new proposed contracts.

Mr Hunt regularly says that the airline industry got better at curbing and preventing accidents when it adopted the procedure of complete transparency, reporting anything that had gone wrong even where no damage was done and disaster was averted. The industry then analyses every incident to see how it can design out any future threat of a repeat which might occur with worse consequences happening. The NHS is adopting such an approach under Mr Hunt’s leadership. Every time a procedure goes wrong, the wrong procedure is applied or the results are poorer than expected the NHS needs to investigate and learn from the experience. The aim is not to have witch hunt against the nurses and doctors concerned, but to learn collectively from the incident.

I wish Mr Hunt every success in pioneering much stronger quality based reporting and analysis in our NHS.I hope the doctors will now talk through their disagreements with management over the new contract, understanding that it is not some crude attempt to cut costs or insist on work patterns that are unacceptable to talented professionals. In turn professionals do have to recognise that with the privilege of higher pay and status in our community comes the obligation to pursue quality at all times, and to be available through a system of proper cover when need arises.

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125 Comments

  1. JJE
    Posted November 28, 2015 at 5:16 am | Permalink

    It must be nice living in Mr Hunt’s world.

    • Lifelogic
      Posted November 28, 2015 at 8:58 am | Permalink

      It does not sound like a nice job to me. A sound person would refuse to do the job without the authority to start charging fees and sort the whole mess out. The NHS could, fairly easily, be sorted out but no one dares to try for political and ideological reasons. A new Doctor Beeching is needed.

      So it just gets worse and worse by the day, more and more people get shoddy treatment or queue endlessly and yet it costs more and more each year. Also the secondary costs of all the people unable to work while waiting for treatment and the legal claims.

      • Iain Gill
        Posted November 28, 2015 at 12:50 pm | Permalink

        Correct nobody with any decency would accept a senior job in the NHS. The whole idea that a sec of state can top down improve things like Sunday performance is a joke. The only way things will improve is if proper buying power is given to end patients, local negotiation is in place between hospitals and staff, and everyone is freed up to make the best compromises they can see all around. And accept the worst places shut if people with buying power take their buying power elsewhere. Allow proper out of hours clinics staffed by docs to emerge in big cities, where you can take a screaming child with ear ache in the middle of a long bank holiday. And so much more. So many of the treatments dished out by GP’s and the NHS routinely are now far removed from practise in the rest of the developed world. And so many entitlements under “NICE guidelines” are completely unenforceable as, for instance, the percentage of patients on insulin pumps varies so dramatically around the country when all are supposed to be given according to the same medical need defined by NICE. We have lots of A & E depts that rarely do what are now routine interventions like heart stents which can lead to many decades of happy life rather than the death the occurs routinely in many such patients here. The whole concept that the central management and politicians down in London can improve this is nonsense. The only ongoing optimisation that will work is handing power over to patients. See how long the crap GP’s last if patients really could take their business elsewhere, at the moment we have GP surgeries that have been rated poorly on the NHS choices for years that are still crap for all to see.

        The cost acceptance that the NHS is here to stay amongst the political class of all parties, and the ongoing propaganda from the media, is a joke, the patients in the waiting rooms up and down the land are cheesed off, and those that travel abroad frequently experience much better care all the time abroad. We really need to learn from the best of the rest of the world, and give the patients buying power.

        As it is the chancellor throwing more money at this shambolic NHS is crazy. If he had given funds to patients they have let down to take elsewhere that would have been much better.

        I despair that our supposed democracy has so little real debate about this.

      • Bazman
        Posted November 28, 2015 at 7:02 pm | Permalink

        No one dares to try for political and ideological reasons. Like massive subsidy to landlords by any chance?

        • Edward2
          Posted November 29, 2015 at 8:47 am | Permalink

          Presumably the massive subsidy enjoyed by tenants in social housing does not bother you Baz.

          • Iain Gill
            Posted November 29, 2015 at 10:24 am | Permalink

            Particularly those large social housing estates built to accommodate the workers in mines and shipyards which are long since closed, and where there is now no realistic jobs prospects for that volume of people within travelling distance. Why do all the politicians think it is a good idea to fund these estates for ever? When mostly the people themselves would prefer to move closer to the modern jobs market but are prevented by the way their housing subsidy is tied to the house they are in.

          • Bazman
            Posted November 29, 2015 at 11:18 am | Permalink

            Massive subsidy is the only way to put a roof over their heads due to the price of property and its not as though many are lazy and feckless as many would have us believe its just due to their age in most cases. You could say at one time where they lived too, but now that is everywhere. With large swathes of the population working to pay rent and little else despite this massive subsidy. Some Tories laughably tell them to save up and buy a house. As well as a pension, private healthcare, pay for their own sick and holidays, nannys, road tolls, Oh No they don’ say road tolls do they? I wonder why? All from a no minimum wage zero hour contract job. Thick nonsense.

          • Edward2
            Posted November 30, 2015 at 8:12 am | Permalink

            You totally miss my point Baz
            You go on and on about housing benefit being a subsidy to tenants but fail to understand that those who are poor or unwaged, cannot afford to pay rent either totally or to a large extent.
            Yet they have to have a roof over their head.
            So they either get a free home provided by the State social housing sector or the State gives the individual money to rent in the private sector.

            There is little difference in cost to the State.

          • Bazman
            Posted December 1, 2015 at 6:54 pm | Permalink

            The state extracted rent from their tenants via local councils now they have to pay massive rents to private landlords bleeding a housing shortage caused by state dogma. The problem spirals upward and in some way feeds off itself. Housing costs have never been higher for the state via the housing benefits system. To argue that are not is laughable.

          • Edward2
            Posted December 2, 2015 at 8:12 am | Permalink

            You miss out the huge costs of initially building and then maintaining social housing in your calculation Baz.

            Of course housing benefit costs have risen.
            There has been a huge rise in our population over the last 25 years and an even bigger increase in the numbers of people renting.

            And the State has not built very many council houses preferring to let housing associations charities and private landlords provide houses.

            My point which again you choose to ignore, is that whichever way you do it, costs are not much different.

        • Lifelogic
          Posted November 29, 2015 at 12:24 pm | Permalink

          Housing benefit is to provide housing for tenants it is not a benefit for landlords they get the market rate and often below.

          • Bazman
            Posted December 1, 2015 at 7:02 pm | Permalink

            To quote Narrow Shoulders Posted November 27, 2015 at 8:31 am in Spending 4 trillion.
            No doubt your rents reflect market rates which are distorted by those in receipt of housing benefit. You are profiting from taxpayer largesse albeit indirectly.
            You did not reply to this. Or mine saying:
            The market rate is so high and climbing due to massive subsidy of the housing market. Rent never fall do they and any pressure made to landlords leads to threats of higher rents. ie passing the cost onto the customer. Try that in any other non captured business. £20 quid a pint as a pub landlord would see you being told to “drink it yourself” If you cannot understand this then there is no helping you.
            Answer these points please. You do not own the facts.

          • Edward2
            Posted December 2, 2015 at 8:16 am | Permalink

            Its not a subsidy.
            Rents rise because of demand for rental property from a growing population.
            And a lack of sufficient new builds.

            The return on capital for buy to let landlords is around 5% on average.
            Would you risk your life savings Baz instead of leaving it safe in some building society?

          • Edward2
            Posted December 2, 2015 at 8:21 am | Permalink

            Your point about the landlord and the cost of a pint is a false one
            When the Govt budget adds a few pence in duty on beer the next day all pubs have added it on.
            Same with fuel duty rises.
            If the State adds extra costs onto the whole of one sector of business then that sector will act as one, to recover that by raising prices.
            Especially where the industry has no foreign competition.

  2. Lifelogic
    Posted November 28, 2015 at 6:06 am | Permalink

    He is right to try to curb and prevent accidents by adopting transparency, reporting and investigations of incidents. Deaths due to NHS negligence, delays, misdiagnosis, rationing and incompetence almost certainly run at well over one thousand a month.

    The main problem with the NHS though is the absurd way it is funded through taxes. Huge sums wasted collecting the taxes than distributing the money though management back to doctor and nurses. With all taking a cut on the way. So much best to let the patient just pay the doctor, hospital or nurses as needed, cut out all the parasitic middle men and ensure the person who delivers gets properly paid and has no incentive to ration.

    On top of this problem we have the incompetent and hugely bloated and over paid management and the fact that it is run by the government for political, rather than health, reasons. The free at the point of use (or more likely delay & rationing) is a complete disaster. One point three million staff employed by government in a single, appallingly run & managed organisation is bound to be a complete disaster and indeed it is.

    You cannot it seems even book GP appointments. More than a quarter (about 14 million) of patients are struggling even to get through to receptionists according to the National Audit Office who say there are unacceptable failing in access to care. How may die as due to these delays in seeing a GP. The limited hours that are offered to book or see a GP are an outrage. But they are the consequence of not having to pay say about £20 for an appointment.

    We know that about 770 babies die each year due to the even worse weekend care given.

    Give tax relief for private medical insurance to decrease the demand on the NHS and charge something to anyone other than those very few who really cannot pay.

    The threat from terrorism is surely totally insignificant, relative to the deaths caused by the poor quality of the NHS.

    • Lifelogic
      Posted November 28, 2015 at 6:13 am | Permalink

      If you buy something for someone else, using other people’s money then you care not what you pay and you care not what value you get.

      That is the disaster that is NHS in a nut shell. Plus they now have another 336 thousand net migrants to cater for who have probably paid nothing in to the system at all yet.

      The NHS only really works at all because there are a proportion of well meaning and hard working staff doing their very best despite the idiotic and inept system they have to work with.

      • Bazman
        Posted November 28, 2015 at 7:07 pm | Permalink

        ‘If you buy something for someone else, using other people’s money then you care not what you pay and you care not what value you get?’ Your words. See above. You wrote this, read it back to yourself.
        Like the state paying housing benefit for millions with a quarter of them in work huh? Much of which is expensive and sub standard. Where does that fit in you free market small state world?

        • Bazman
          Posted December 1, 2015 at 7:03 pm | Permalink

          Where is your sensible reply to this comment lifelogic too?

    • Lifelogic
      Posted November 28, 2015 at 6:18 am | Permalink

      The NHS was supposedly Cameron’s priority in three letters. But the man has done nothing to sort out its huge & fundamental problems, it is clearly getting worse by the day.

      There is little reason for governments to be involved in heath care at all other than perhaps to fund treatment occasionally for the very few who really cannot fund or pay to insure themselves.

      • Lifelogic
        Posted November 28, 2015 at 6:27 am | Permalink

        I think he also said some thing about “no if no buts, reduce net migration in the tens of thousands” so it is hard to take anything he says seriously. But clearly his mind is mainly on bombing ISIL, to increase the risk of terrorism in the UK and the World generally. Doubtless driving net migration even higher.

        Clearly he has leaned little from the recent, counter productive, wars, or the huge harm he has personally caused to the population of Libya by his idiotic intervention.

      • Bazman
        Posted November 28, 2015 at 7:13 pm | Permalink

        The problem being massive cuts in many cases. Indeeey! What has he done to address this problem? Maybe he should write a letter to Hunt on why he is cutting and like all managers in the wrong hiding from the staff they persecute communication through the press in Hunts case. No private conversations on what can be done.
        He is going to come unstuck as doctors are not factory workers or cleaners.
        What do you propose to do if they just all quit en mass or go to Australia or America to find better money, respect and conditions. They follow the free market dream you are always telling us about. Except in property rental though.
        What laws will you put forward as you will.

    • dame rita webb
      Posted November 28, 2015 at 12:27 pm | Permalink

      LL instead of blaming the organization, although you are right on the money with regard to the management, try looking at yourself closer as a user. A receptionist at the hospital where my other half works told me the following. Of the general clinics that are run 50% of the punters fail to turn up for their appointments. Of those that do quite a lot of time is taken up with matters that could be sorted out by visit to a high street chemist e.g. Bed wetting. Most medics would agree that a fee would be a good way of deterring time wasters. Hunt should be concentrating on sorting out the management rather than concerning himself with Keogh’s highly contentious claims.

      • Lifelogic
        Posted November 28, 2015 at 3:46 pm | Permalink

        Charge a fee or a deposit for appointments then or charge for not turning up. Just as many other businesses do.

        Another reason (which I have experiences in the past) is they send you an appointment at a time they pick without bothering to ask you (and which you cannot make) but the appointment letter provides no properly answered phone or contact details line to rearrange. I had to drive to the hospital in the end to fine the right person to rearrange it.

        Or perhaps their card does not arrive or is perhaps incorrect. Why not ask the patient to confirm they will be attending.

        It is just management incompetence coupled with the free at the point of use and it not my money so what do I care mate syndrome.

        Also they are likely to order perhaps three diagnostic tests then a consultation on four different days when they could all easily have been booked for the same day one after the other. As they probably would have been in the private sector, again reducing the chance of a no show and saving money.

        • Iain Gill
          Posted November 30, 2015 at 5:52 pm | Permalink

          The NHS fakes the stats by recording people as no shows when they were there, its tractor production under Mao and managers simply lie. The NHS also cancels appointments at the last minute in vast numbers. And people who are inpatients are often listed as no show for their out patient appointments and and other nonsense.

    • Iain Gill
      Posted November 28, 2015 at 3:42 pm | Permalink

      If they want transparency they could free up medics to be honest and tell patients when they would be significantly better off seeking treatment elsewhere in the NHS or outside it.

  3. Horatio
    Posted November 28, 2015 at 6:15 am | Permalink

    All logical reforms, very similar to the discussion, on vastly improved outcomes in part privatised systems, on QT this week.

    Where i have some sympathy is with junior docs pay. We moan that they all receive world beating traing and then promptly emigrate to work. However, when even Turkey is paying theur junior docs more something is wrong. Solution: If the UK also purchased cheap oil from ISIS..

    Off topic; does noone else feel that the amount we spend on foreign aix is utterly reprehensible?. Indeed, if a party at next elction offers to cut it in half i will vote for them!

    Reply The UK has no intention of buying oil from terrorists

    • Dame Rita Webb
      Posted November 28, 2015 at 8:56 am | Permalink

      Yes there have been some cracking reports recently about how our foreign aid has been well spent. Yourt taxes have been used to pay for such things as an Ethiopian version of the “Spice Girls” and PE lessons in Turkey. Does that not make you feel proud to be British?

      http://www.dailymail.co.uk/news/article-3130623/Ethiopian-Spice-Girls-project-line-16m-foreign-aid-despite-warning-waste-money.html

      • Lifelogic
        Posted November 28, 2015 at 1:58 pm | Permalink

        I am not remotely surprised, they care not.

        • Leslie Singleton
          Posted November 28, 2015 at 3:15 pm | Permalink

          The worst of it is that foreign aid is counterproductive because, First, it encourages dependency, Secondly, it divorces the dependents from the real world with (like it or not) its markets, and, Thirdly, and most important, we get to come across as colonial and paternalistic which causes a good many recipients to hate us (and ‘the system’) no matter how much we give them (perhaps more the more we give them) . I could perhaps begin to understand aid in the form of for example food but giving, often despots, large sums of money is seriously hard to understand.

          • Bazman
            Posted November 28, 2015 at 7:19 pm | Permalink

            Maybe not ripping them off with plundering their resources and scamming their tax take on them might be better than aid?
            Dependency is a two way street. How about dependency of private companies and landlords on this state too. How much do they ‘hate’ the state as we can see.

      • Gary
        Posted November 28, 2015 at 7:03 pm | Permalink

        follow the money and find out into whose bank account the bulk of that money landed.

        foreign “aid” is a club of kickbacks for pals, with some sideshow thrown in to fool the prols.

        see the Tanzanian “air traffic control system” for details.

    • Anonymous
      Posted November 28, 2015 at 9:29 am | Permalink

      Reply to reply: Does the Government have any plans to train up the thousands of fit young men who have come from Syria so that they may go back and fight ISIS ?

      Surely some of the foreign aid money could be spent on this rather than put in the hands of corrupt regimes.

  4. Lifelogic
    Posted November 28, 2015 at 6:43 am | Permalink

    Someone I know recently had a Laparoscopic Gallbladder Removal (Cholecystectomy) performed privately in London – It was all organised within two days, the surgeon’s fee was only about £600, rather less than many plumbers.

    The NHS had mucked about & delayed in fixing a date for surgery, leaving the patient at high risk a of a perforated Gallbladder for months. A complication which has a very high mortality rate. Clearly this was not really of much concern to the NHS.

    • JJE
      Posted November 28, 2015 at 9:03 am | Permalink

      And what was the anaesthetist charge, the hospital charge, the cost of drugs, etc, What were the costs for consultations and tests pre and post surgery.
      Telling us only about the £600 surgeons fee is very misleading.

      • Lifelogic
        Posted November 28, 2015 at 10:54 am | Permalink

        Total bills with scans, consultations, theatre, hospital, anaesthetist, follow up all in was about £6000, quite possibly saving his life and enabling him to fit it round his work and get back to work. Yet the NHS seemed unable even to offer this in a timely fashion.

        • Dame Rita Webb
          Posted November 28, 2015 at 4:09 pm | Permalink

          Again can we have a bit more detail on this bill please? The £6000 still does not sound right. Was it a co-payment to some sort of insurance plan? On reflection the £600 for the surgeon is ridiculous. What sort of surgeon is going to turn up for a couple of hundred quid, having seen more than half of it go in tax and he still has to pay for his own admin back up let alone the expenses of getting to from the hospital?

          • Lifelogic
            Posted November 29, 2015 at 12:27 pm | Permalink

            Those we the total bills in full. Similar to the BUPA agreed rates in fact. I suspect less than it costs the rather inefficient NHS to manage it. Just as many private schools are more cost effective than the state ones.

        • Bazman
          Posted November 28, 2015 at 7:27 pm | Permalink

          How much of this amount paid is subsidised by the NHS. Cost not shown. Many private services are hiding under the NHS logo. Why is this. I’ll tell you why. The public do not believe your efficient, cheap private healthcare dross as they have experienced other areas of privatised services such as rail and the utilities.
          Should any long and expensive complications arise from changing you tap washers then they will tell you that they did not agree to fit a new central heating system and no way can you prove they plumbed anything wrong flooding the house to boot. The council will have to fix that mate. Ten sugars and have you got any biscuits? Dave doesn’t like Garibaldi’s.

          • Anonymous
            Posted November 28, 2015 at 11:14 pm | Permalink

            Private companies hiding behind the NHS logo. Same with Notwork Rail.

    • Dame Rita Webb
      Posted November 28, 2015 at 9:06 am | Permalink

      £600 and the rest. Presumably the surgeon’s fee (and that seems remarkably low) came as part of a much larger insurance payment. £600 (in 1994 by the way) got me some stitches on my scalp and a tetanus shot at a private hospital in California.

    • Lifelogic
      Posted November 28, 2015 at 9:19 am | Permalink

      It would have been safer for the patient just to have been told to go privately in the fist place by the NHS due to the delays delays. But they cannot even be honest about that.

      • Iain Gill
        Posted November 28, 2015 at 3:27 pm | Permalink

        correct, those docs honest enough to tell you to get a taxi to a private clinic are in a lot of trouble if the NHS finds out, even when their advice is often a life saver. same as hospice docs openly saying how much longer the patient would have lived in another developed country. the NHS like to keep how bad it is a closely guarded secret.

      • Leslie Singleton
        Posted November 28, 2015 at 3:29 pm | Permalink

        There really is no comparison. I have a number of personal examples. Once I had some nasty symptoms and saw my GP (reasonably quickly I have to say) who ended up telling me he wasn’t happy but I would have to wait three months to see a heart specialist. He was upfront about my going private and arranged a private consultation the very next day (a Saturday as it happens). This brought dramatic action in that the consultant asked his nurse to ring 999 from his consulting rooms and I was immediately taken by ambulance to a heart ward where I lay on my back for the best part of a month. In my case at least the juncture between NHS and private was seamless and all I had to pay for was the initial consultation–the consultant himself didn’t think it likely I would want to go in to a private ward and routinely as it seemed to me transferred me back to the NHS.

        • Bazman
          Posted November 29, 2015 at 12:42 pm | Permalink

          Privately carried out in an NHS hospital by any chance? Just paid to jump the queue basically. A queue caused by cuts to NHS funding in order to facilitate further privatisation by showing how slow and inefficient the NHS is.

          • Leslie Singleton
            Posted November 29, 2015 at 4:07 pm | Permalink

            Actually, No, the private bit was carried out in a completely separate private hospital which is why the ambulance was needed

  5. Dame Rita Webb
    Posted November 28, 2015 at 7:03 am | Permalink

    “the privilege of higher pay and status in our community” Yes and this government and all the others previous to it certainly have their priorities correct. Consider this even with the £26k p.a. cap a family of welfare lifers pull in more than a junior doctor. and his/her basic wage. Who is making the more valuable contribution to society? If you keep driving medics to Australia do you think they will ever come back? In the meantime the NHS is now forced to recruit doctors from Mongolia.

    If as a tax payer you are fed up after reading that the NHS is paying a fortune to locum agencies get on to your MP and ask why the NHS has no central HR function? As I have written before, from memory a city like Brum has at least three trusts. Hospitals may be only a few miles from each other though they may operate under a different trust. Being under a different trust, a hospital that may have a shortage staff is unaware of the availability of who could be spared at a different trust hospital. If it is supposed to be a “National” Health Service why has it been balkanised with a duplication of functions and a surplus unnecessary non medical staff?

  6. Margaret
    Posted November 28, 2015 at 7:17 am | Permalink

    The way that clinical nurses have been professionally abused for many years for tiddly winks taking responsibility for the doctors having their clinical expertise attributed to Dr’s leaves me cold.I have little sympathy with the posers who take all the hard work and theoretical input as theirs.

  7. David Cockburn
    Posted November 28, 2015 at 7:19 am | Permalink

    While I do understand the value of transparency and the importance of weekend work which you highlight, I understand there are some other problems:
    Under EU rules, while doctors often work more than 48 hours they are only allowed to be paid for the 48.
    The NHS has a reputation as a lousy employer, many hospitals treating their employees badly and inconsiderately. As a monosony buyer of medical labour it seems they feel they need not behave well and any problems which arise can be sorted by going to the Treasury for more money.
    It does look as though there is a real revolution in attitudes needed at the NHS.

  8. Mike Stallard
    Posted November 28, 2015 at 7:22 am | Permalink

    My wife is in great pain at the moment. Do you know what? Nobody could give a damn. It takes 3 weeks to see an uncaring doctor. Her own GP is having a baby. The hospital has treated its consultant so very badly that he has gone off in a huff – as have others too I learn.
    Meanwhile I read in the Mail of hospital managers who are taking socking great salaries and I hear from a friend who knows, that their behaviour towards both doctors and consultants is arrogant, out of touch and inefficient.
    The last operation she had was in a hospital where English was the second language and small details were overlooked.

    But – hey! – let’s chuck some more taxpayers’ money at it! You know it makes sense!

  9. CHRISTOPHER HOUSTON
    Posted November 28, 2015 at 7:55 am | Permalink

    The BMA and countless young doctors have indicated if young doctors were to go abroad they will receive infinitely better conditions of work and massive doubling, tripling and quadrupling of their salaries.Actually much more later in their careers with decreased housing costs, environmental improvements for themselves and their children.

    So, why is Mr Hunt Secretary of State for Health still willing to employ these people and make British people suffer their attentions when clearly they are unutterably stupid not to have emigrated? If they cannot make sensible decisions for themselves and their families then why should they be felt to have the necessary intellectual and basic commonsense skills to treat anything but a mild case of sunburn?

    • Dame Rita Webb
      Posted November 28, 2015 at 8:57 am | Permalink

      And what valuable contribution to society do you do apart from your daily bon pensants here?

      • CHRISTOPHER HOUSTON
        Posted November 28, 2015 at 1:32 pm | Permalink

        Replies to my comments on here are always like added mint sauce to the beef and Yorkshire pudding dinner which I provide or, are akin to a further shot of exquisite whisky to a single shot. Your reply is no exception.

        • bluedog
          Posted November 28, 2015 at 7:24 pm | Permalink

          Mint sauce with beef? Really!

          • CHRISTOPHER HOUSTON
            Posted November 29, 2015 at 9:19 pm | Permalink

            Red wine with fish too!

          • CHRISTOPHER HOUSTON
            Posted November 29, 2015 at 9:26 pm | Permalink

            But one must add a little sugar to the malt vinegar based mint sauce to give it the sour/sweet effect as was intended.

    • JJE
      Posted November 28, 2015 at 9:12 am | Permalink

      My friend in the US supported his exceptionally talented daughter through med school about twelve years ago. It cost him then about $300k. But that was OK because after qualification she could expect to earn $1m per annum.

      Perhaps our doctors have family ties and some patriotism. Maybe they even value the NHS ideals. But when a junior consultant can’t buy a house and raise a family of their own in London something has to give.

      If you want them all to act rationally in an economic sense, get ready to pay the price.

      • Lifelogic
        Posted November 28, 2015 at 11:04 am | Permalink

        Media pay for doctors in the USA seems to be a little under 200,000$ US. So it might be a while before she hits that Salary.

        • Lifelogic
          Posted November 28, 2015 at 2:00 pm | Permalink

          “Median” pay I meant to say.

      • CHRISTOPHER HOUSTON
        Posted November 28, 2015 at 1:51 pm | Permalink

        There can be few people living in London requiring NHS treatment as opposed to expensive private treatment if those of a doctors salary and below cannot afford to reside there. Perhaps doctors should flit to an area commensurate with their salary level and where they can actually find working class and middle class people dwelling.
        A medical education and training does not necessarily imbue a person with an overdose of patriotism nor love of some abstract called “NHS ideals” . The salary levels were obvious to these intelligent people long before they reached the age of 18.
        ‘Tis a wonder indeed with their apparent values they did not chose to become men and women of the cloth. The Church no doubt is the poorer for the loss of their devotion and self-sacrifice. We should all put small items of food into shoe boxes and send them to the BMA in London for their distribution to these doctors-in-need.

  10. Ian wragg
    Posted November 28, 2015 at 8:22 am | Permalink

    Regardless of Mr. Hunts wishes, The Soviet style health service is bound to fail. Letting 850,000 new customers in the country, many with serious conditions means that it will eventually collapse. I can see in my lifetime an Australian type system in place where the government provides basic A& E with extra cover being insurance based.
    We cannot afford to treat the whole world but the medics don’t care as it allows them to bleat about lack of resources etc etc.
    If there was an element of insurance they would have to up their game because paying customers wouldn’t put up with the crap which is the NHS.

    • Dame Rita Webb
      Posted November 28, 2015 at 9:12 am | Permalink

      Can you be a bit more precise on how funding by insurance is going to make things better? If you want the American version try get a quote on one the policy exchanges and see how “affordable” Obamacare is. You might want to consider the German model too. Regardless of how they are funded, German and American hospitals still have problems common to the NHS e.g. “superbugs”, malpractice lawyers hovering over their heads, illegal immigrants turning up at the trauma room demanding treatment etc

      • Ian wragg
        Posted November 28, 2015 at 11:28 am | Permalink

        Margaret
        I assume you work for the NHS. If you part fund it by insurance it puts the patient in charge. I appreciate that NHS employees are ideologically opposed to any form of payment as this would disturb the cosy take it or leave it cartel.
        Last year for the first time in my life I needed the NHS. I was treated abominable. I was on the point of incontinence and the GP basically said at 69 you’ve been lucky and will have to learn to live with it.
        I spent £200 on a private scan and consultation which indicated an acute kidney problem. I had an emergency drain and catheter and after my kidney function returned to normal I was operated on.
        Cost me 5k but best money ever spent.
        Our local NHS trust is in special measures and they are literally burying their mistakes.

    • Anonymous
      Posted November 28, 2015 at 10:18 am | Permalink

      Ian – To that unspoken problem of the 850,000 – I note that the promised house building targets did not mention the building of hospitals, schools, roads and power stations to go with them.

      Trust me. A new estate built near you will be a drain on resources and bring gridlock on your roads.

      • bigneil
        Posted November 28, 2015 at 11:10 am | Permalink

        On those new estates who will be in those new houses? – Syrians? Asylum seekers from who knows where? so-called refugees who have lied from the day they arrived? – illegals who have crossed from Calais in a lorry? – All of whom will be straight onto benefits and free NHS. Once one of them is here, the rest of the family will follow soon after to be a further financial drain( Are the “family followers” actually checked to see if they are family – or are they just taken as suddenly being honest? ) . . .None of them will be coming to a “contributing” job. I would love to see govt figures for how many have come here in the last 5 yrs – -and contributed more in taxes than what they have cost us – -somehow I don’t think those figures will ever be shown.
        And the govt should stop calling it the NHS – -rename it the UK taxpayer funded free-to-everyone-else-in-the-world health service.

      • bigneil
        Posted November 28, 2015 at 11:30 am | Permalink

        Who is going to be in the shiny new houses ?? Syrians? fake asylum seekers coming here after committing crime? so-called “refugees” who aren’t from where they say they are, but coming for a free life? illegal from Calais lorries? – -all coming to no jobs and straight on benefits?
        There is a program in the next few days – “Homeless at Christmas” – – but the govt can import 20,000 ( and the rest ) Syrians into guaranteed free lives, houses, money and healthcare. Disgusting priorities.

      • Lifelogic
        Posted November 28, 2015 at 2:02 pm | Permalink

        Bring gridlock? Do we not have that already due to all the bus, bike lanes, anti car traffic lights, the duff roads and poor road junctions.

    • Lifelogic
      Posted November 28, 2015 at 10:33 am | Permalink

      Exactly paying customers and some real competition and choice of providers is what is needed.

      The governments approach is to tax to the hilt first then ration, delay and offer a second rate care if you are lucky when they feel like it. It kills far more efficient providers as they cannot compete easily with free at the point of use NHS.

      Take it or leave it, we will do it if and when we feel like it, we already have your money so tough mate.

    • Lifelogic
      Posted November 28, 2015 at 10:39 am | Permalink

      If you take private medical insurance in the UK you pay many times over. First you pay for the NHS for others, then you pay income tax and NI on the money used to pay the premiums, then you pay insurance premium tax on top too (and higher now too thanks to Osborne). Then the premiums are higher than they need to be due to the NHS killing much of the private competition preventing economies of scale. Osborne should be encouraging people to opt out of the NHS.

      • Bazman
        Posted November 28, 2015 at 7:46 pm | Permalink

        This is absolute drivel. Private healthcare is much more expensive. See the USA with millions having none and some working just to pay for healthcare premiums.
        You are in the land of takeaways and the plumbing trade.

        • Iain Gill
          Posted November 29, 2015 at 10:29 am | Permalink

          I’ve lived in the States, all levels of income except the very lowest do much better in their health system than they do here, and even in the lowest level they often do much better than here. The propaganda spouted by the left about life over there is nonsense. But the US is not the best country to copy, copy instead from New Zealand, Australia, Belgium, Italy all of which do healthcare a million times better than we do.

        • CdBrux
          Posted November 29, 2015 at 10:39 am | Permalink

          I suspect you know well that other insurance based models, such as many found in Europe, are far more efficient and treat the less well of for free / very minimal costs than the USA. But it suits those against to deliberately compare vs the worst example.

          Having said that most other countries do put a higher %GDP into their healthcare systems than UK.

        • Lifelogic
          Posted November 29, 2015 at 12:31 pm | Permalink

          No one sensible is suggesting the US system are they? Loads of better systems. A national health service free at the point of non delivery is perhaps the worst.

          If we had one for food we would all be starving.

        • Bazman
          Posted November 29, 2015 at 4:53 pm | Permalink

          The United Kingdom is consistently high ranking and if you think that an insurance based one or an ability to pay is going to improve it you are living a dream world. Whatever other countries use. Its like comparing the UK to Switzerland and Germany. Not the same.

    • graham1946
      Posted November 28, 2015 at 11:44 am | Permalink

      The last thing we need is insurance companies involved – they ca’t be trusted. There are people in Somerset still not back in their homes from the flooding of 2014 due to bitching over costs. They always try to get out of paying any claim on technicalities and their pension annuity rates are a rip off. May the Lord preserve us from Insurance Companies. Never, ever, in the NHS. Things will just get worse.

      • Lifelogic
        Posted November 28, 2015 at 3:55 pm | Permalink

        Some truth in that I tend to self insure in the main and pay if and when I need too. That way you do not have to carry the costs of some higher risk patients and the overheads of the insurance company plus Osborne rip off rates of insurance IPT tax.

        • Dame Rita Webb
          Posted November 28, 2015 at 8:29 pm | Permalink

          LL if as you said the other day that you have not lived in the UK for seven years, why are you so persistent in getting your healthcare in the UK? Whats wrong with the health service where you live now?

          • Lifelogic
            Posted November 29, 2015 at 12:34 pm | Permalink

            It works very well here indeed we pay about £20 to see the doctor and you can always get to see one the same day, usually at a time of your choosing. A small payment for about casualty too.

          • Bazman
            Posted November 29, 2015 at 1:56 pm | Permalink

            You have been pulled about the costs of paying for a doctor leading to very expensive treatments in the future due to delay. and in some cases contagious diseases not being detected.
            See the sate of the nations teeth due to dental fees.
            £20 is more than 2 1/2 hours NMW. Got that?

        • Iain Gill
          Posted November 29, 2015 at 10:34 am | Permalink

          Self insurance can be a good way ahead, especially if large extended families do it. In some countries they allow tax perks on savings funds (rather like a pension pot here) that can only be used for medical care for the extended family. With enough people in the fund, the more the better, a large family can take most of the risk that an individual self insuring would struggle to cope with. They can even insure the residual risk of the fund running dry. In this way the family themselves become the arbiter of where the money gets spent rather than the state or insurance companies. Its a very good system for those lucky enough to be in a large extended family.

      • Lifelogic
        Posted November 28, 2015 at 5:55 pm | Permalink

        Also making insurance claims is tedious, time consuming and they usually short change you one way or another.

  11. Ian wragg
    Posted November 28, 2015 at 8:23 am | Permalink

    850,000 annually.

  12. Richard1
    Posted November 28, 2015 at 8:45 am | Permalink

    Did he address the specific concerns of the BMA, which seems to be claiming (1) that most doctors will get a pay cut not a pay rise under his proposals and (2) that the new scheme will mean unsafe long hours? It should be possible to establish clearly whether these claims are true or false. If false the BMA’s actions are disgraceful and a shameful betrayal of the high professional standards of the medical profession. Strikes would be a betrayal of the Hypocrtic Oath.

    Unfortunately the root problem is having a state owned monopoly providing virtually all health care. In the end it’s the same as every other nationalised industry: however talented and professional the employees, unions become politicised and there is constant pressure under threat of strikes to run it in the interest of providers not patients / consumers.

    Reply Yes he dealt directly with this, as he has done many times before. He is putting the base pay up by 11% and reducing excessive hours of work. Most doctors will be better off, depending on their current pattern of shift working on week-end shifts which pay more.

    • dame rita webb
      Posted November 28, 2015 at 10:58 am | Permalink

      A top grade at A level maths is part of the requirements to get into medical school. So why are all these junior doctors getting their sums wrong in saying they will be worse off? In the meantime despite attending an expensive school we have a chancellor who had problems in attaining an o level in maths

      • Qubus
        Posted November 28, 2015 at 4:05 pm | Permalink

        No, it isn’t. The ideal A-levels for medicine are biology, chemistry and physics. They need no mathematics and you will generally find that medics are relatively innumerate; this, indeed is one of the problems for medics who have to drop out of their course, for one reason or another. They very often cannot join a different science course at their university because they simply don’t have the mathematics. Conversely, there are often transfers to medicine from non-biological “hard” subjects after the first year at university. However, I think you will find that they are often the weaker brethren, frequently coming from medical families.
        I know whereof I speak.

        • Dame Rita Webb
          Posted November 28, 2015 at 8:46 pm | Permalink

          Really this is what Oxford wants ….

          https://uni-of-oxford.custhelp.com/app/answers/detail/a_id/504/~/what-a-levels-do-i-need-to-apply-to-study-medicine-at-oxford%3F

          Maths “A” level was required of my other half before he got into medical school

          • Qubus
            Posted November 29, 2015 at 11:23 am | Permalink

            I quote from your website:
            “One A-level must be Chemistry, the second should be Biology, Physics or Mathematics”.

            So, Mathematics isn’t required, it is an option; get your facts right.
            Perhaps I should take this opportunity to remind you that Medicine is not an especially academic subject, it is more practical. That is why you will find that successful surgeons frequently have a hobby of woodwork, a lathe in the garage or tinker with old cars.

      • Lifelogic
        Posted November 28, 2015 at 6:03 pm | Permalink

        A lack of logic and maths would perhaps explain why he seem to thinks the UK will magically will move to a high wage economy just by his passing a higher national minimum wage law.

        This while all his other policies seem to be clearly designed to make the private sector less efficient and less competitive.

        Does he think he also can pick himself off the floor by pulling on his shoe laces too?

        • Lifelogic
          Posted November 29, 2015 at 1:03 pm | Permalink

          When we had mathematically challenged John Major as Chancellor & later PM is was a complete disaster too with the ERM predictably costing millions of jobs, homes and even lives as I recall.

          Mind you it was a disaster too with the supposedly bright (double first Greats & 98% income tax) Denis Healey. Nor was it any good with “no return to boom and bust” Gordon Brown. Not that I know how good at maths they both were.

          I think A* in maths, physics and further maths would be a good minimum requirements for chancellors. Though it would be highly discriminatory against women, this as so very few of them seem to choose these subject.

          • Lifelogic
            Posted November 29, 2015 at 1:03 pm | Permalink

            At A level that is.

          • Lifelogic
            Posted November 29, 2015 at 3:05 pm | Permalink

            Would they find any in the house though?

      • Bazman
        Posted November 28, 2015 at 7:51 pm | Permalink

        They are not. You are. They are its true not losing money in most cases but losing money in the fact that they have to work more unsociable hours for the same pay. How sacred is a managers weekend and bank holiday, so do not pull that they chose the job catch all.
        Remuneration compensation benefit packages all the way for them for being inconvenienced by their Lordships having to do some work it seems.

  13. Lesley
    Posted November 28, 2015 at 9:14 am | Permalink

    I have always wondered why a normal lenght working week can’t be staggered by staff so that there are are always different workers working a normal day over a weekend every so often.

    • bigneil
      Posted November 28, 2015 at 11:36 am | Permalink

      People have children, who are at school 5 days a week – -the other 2 days cause massive problems. I saw my ex-workmates at our non-stop 24/7/52 factory have family chaos with other (retired) family members having THEIR lives totally ruled by having to get their grandkids to/from school while BOTH parents had to work to pay bills etc.

    • Bazman
      Posted November 28, 2015 at 7:54 pm | Permalink

      It called shift work most do not work shifts and the ones that do are paid more, or they were until conditions were ‘modernised’. Schools do not work 6-2 2-10 10-6 or continental shifts.
      Managers work 9-5 in general with no weekends have a think why.

      • Edward2
        Posted November 29, 2015 at 8:59 am | Permalink

        Managers and supervisors have to work shifts these days Baz.
        This is a normal feature of modern manufacturing industry, retail, logistics, hotels, restaurants, hospitality, transport, tourism and warehousing jobs.
        Im puzzled where you think its different.
        Customers want a 24/7 service and management have to also be on site.
        Recent surveys show managers and business owners working longer hours than their staff.

        • Bazman
          Posted November 29, 2015 at 11:24 am | Permalink

          Managers are in some cases called directors though they are not and giving a manager executive powers is not a good thing, in the main this caused the banking crash. My experience of managers is they are out of the door like a shot at one minute before five whilst trying to get the workforce to work longer hours for free.

          • Edward2
            Posted November 30, 2015 at 8:18 am | Permalink

            No examples given to refute mine I notice.
            The whole world is not the same as your rather blinkered personal experience in your job.

          • a-tracy
            Posted December 2, 2015 at 5:34 pm | Permalink

            Well you’re wrong Baz all my Managers and fellow directors work longer hours than the staff and later shifts and have done for 34 years!

  14. Anonymous
    Posted November 28, 2015 at 10:15 am | Permalink

    One didn’t think that higher pay and status was a ‘privilege’. These things are hard earned and fought for mixed with ability and talent.

    To get to this position one has had to pass an awful lot of exams, forgo a lot of opportunities to earn money and have fun and to beat off an awful lot of competition to get there.

    £23k a year (with student debt to pay) leaves many of these people below the poverty line depending on where they live. I know single mums who have never worked taking more than this.

    No. There isn’t a magic money tree but this simply can’t be right.

    (How many of the weekend deaths are owing to GPs shunting their work on to General Hospitals and overloading their system ?)

    • dame rita webb
      Posted November 28, 2015 at 12:36 pm | Permalink

      Read the critiques of Keogh’s findings. It relates to patients admitted at the weekend rather than the treatment they receive per se over that time period. It also fajls to recognize that anyone coming in over a weekend is going to be usually an emergency case with the associated higher risk. Hence the “weekend effect”

  15. mike fowle
    Posted November 28, 2015 at 10:17 am | Permalink

    There is an interesting debate on the IEA website about the NHS, even if it comes to the depressing conclusion that you can’t alter a religion.

  16. Antisthenes
    Posted November 28, 2015 at 10:39 am | Permalink

    The NHS is suffering from the usual state unionised monopoly mind set. The rules of that are restrictive practices and self interest before the customer in this case patients. A belief that having made the effort to gain the necessary qualifications to work in their profession although not necessarily the necessary skills that go with them as I have found out all to often that they are now entitled to a well paid job done in absolute comfort.

    Jeremy Hunt has a cliff to climb and he will never scale it whilst the monopoly mindset prevails. Money or concessions will not do it as the professionals will take them but nothing much will change as as happened so often in the past.

    The answer is for them to have to compete with each other for their standard of the living as the French medical practitioners do. Then you would see a difference. Then patience would be given quality care at a place, time and manner that is best for them and not the other way around.

    • Anonymous
      Posted November 28, 2015 at 5:21 pm | Permalink

      “… state unionised… blah blah…”

      Well let me say this. I took my dog to a private vet (is there any other ?) and she charged me £40 for a 7 minute consultation and a small tube of eye cream.

      Did I need a vet for this service ? In law probably yes – if I were to avert prosecution for animal neglect/cruelty. So why isn’t there a lower tier of service available ? The equivalent of a Boots chemist to which I can go and state the symptoms and pay a couple of quid for something over the counter.

      Ditto dentists – private. Who can charge me a fortune for a dental impression and false teeth. In practicality a dentist is not needed in this process, only a dental technician.

      If you want to see where the real swizzes and sharp practices are it’s in the private sector.

      With NHS nurses and junior doctors we are looking at wages that are clearly exploitative. There are problems with the NHS – mainly the innumerable amount of patients and treatments they demand.

      • Antisthenes
        Posted November 29, 2015 at 7:14 am | Permalink

        There are no flawless systems or methods that produce things for human consumption or use. However the trick is to use the ones that work the best. Capitalism is deeply flawed but the alternative socialism in the end does not work at all or at the least is very much worse. So it is between free markets and monopolies. The former has been proven time after time to work the best for consumers and the latter to be of little benefit to consumers.

        Certainly you can point out that a service you get under one system produces results that you dislike but that is true of all systems none produce 100% satisfaction. It is only when it is possible to compare systems and/or have them compete can a true measurement of there worth be possible.

        The NHS monopoly provision and the French with a large degree of private provision are two healthcare systems that can be used to measure which works best and therefore should be adopted. I have been able to do so and the French system I found was considerably better and the NHS would do well to adopt many of it’s practices for the sake of it’s patience.

  17. Bert Young
    Posted November 28, 2015 at 10:47 am | Permalink

    I am a fan of the NHS – have always been . I have also very serious concerns . Years ago my organisation were asked to comment on the proposed new Head of the NHS appointment ; before doing so we consulted his former boss – an extremely well known and successful industrialist . He did not mince his words in his comments – he said he had the highest praise for this individual as a functional specialist , but , followed up with the observation that he would never trust him to run a profit centre !. These comments were passed on , however , the individual concerned still got the job and eventually a Knighthood . His reign was considered a poor one .

    Therein lies the biggest problem the NHS faces , now as it has done , in the past . It is far too large a concern for it to be managed the way it is . Reaching out the tentacles every day to control and direct the services it has to maintain in a profit centred mode is an impossibility ; each specialist on the job has to make decisions that are not encrypted in a management logic , he/she can only decide on what to do with what is confronted before their eyes .Medical training does not include financial controls ; occasionally when a medic assumes a management role , they usually do not last long .

    The NHS should be returned to a “Regional Control” basis . There are many differences in the country that cannot be drawn into a “one size fits all” organisation ; the standards that are achieved in one centre cannot be automatically assumed to fit into another . The attempts to fit management styled people alongside the professional medics in day to day operations is a bad mistake ; the management staff believe they are in control of the medics ; the medics are confused – should they turn to their medical supervisor for guidance , or , to the “management” ?

    Above all attempting to superimpose a political mantle over such a diverse and dynamic operation is an impossibility . Of course there have to be financial limits to what the NHS can and cannot do , but , beyond that , it must be left to medical direction and initiative whose desire is only to achieve the best professional results . Putting it back to a Regional basis is likely to yield the best standards and results .

  18. Atlas
    Posted November 28, 2015 at 11:14 am | Permalink

    I thought the problem with working an even 7 days a week is not the junior doctors, rather it is the lab and other support staff (eg X-ray) who are also needed. So why is Hunt picking a fight the doctors?

    • Atlas
      Posted November 28, 2015 at 11:23 am | Permalink

      Ooops, a correction: So why is Hunt picking a fight with the doctors?

  19. graham1946
    Posted November 28, 2015 at 11:26 am | Permalink

    There is one glaring problem with the transparency aim like the airlines – litigation. With a plane if there is a problem, it can be reported, noted and rectified for the future. With human beings, if a doctor admits even the slightest aberration, the freeloaders want to sue for free money. We should return to the idea of Crown Immunity and put a stop to it. If a doctor is properly qualified (which the NHS has to make doubly sure of) and is working properly that should be enough. No doctor sets out to damage a patient, so unless there is a clear case that someone (even a nurse or any other medical professional) has performed a procedure for which they are not qualified, it is a risk we must accept as grownups. No-one is perfect. How many times have you taken your car to a reputable garage only to find that the problem has not been adequately fixed, or another one has been created? With cars, it may not matter much, but with health, it does. Unless this is tackled, you are asking too much of people to own up to mistakes, especially when their insurer makes a condition of his policy that there must be no admission of culpability. With Crown Immunity in the NHS, there would be no insurers creaming off the top. The NHS could then just self insure for the rare and genuine cases.

    Regarding 7 day working, this of course should be a norm. However, it cannot be done just by government wishful thinking and just making trying to push it all on to junior doctors as seems to be the case here. . There must be a huge increase in the number of staff to do it and not just junior doctors. Consultants, nurses laboratories, operating theatres, radiographers, testers of all kinds, even down to receptionists are just as, or maybe more important than junior doctors and must all be available 24/7. People often need tests done if they are ill on a Saturday, but the labs are shut until Monday. Ludicrous. Similar for all the expensive equipment the NHS uses – they must all be sweated, not left idle. Then of course we need far more GP’s. Even with their current good salaries, there is something wrong if we can’t get enough. Lansleys re-organistion is at the bottom of it.

    Of course this will take money – a lot more than Dave and his merry band would consider allocating. Why is income tax a sacred cow? Put a few pence on it and ring fence it for this purpose and those that can afford to pay will, automatically. The government must admit its error (they won’t of course. too many precious egos at stake) and get rid of Lansleys cock-up of a re-organisation and make it one health service instead of hundreds of competing CCG’s and get rid of the pen pushers telling doctors they can’t spend twopence on drugs, whilst they waste millions on salaries, pensions etc. Trust the real professionsals, not the politicians and the managers. Get the top clinical staff out of the offices and board rooms and back into the operating theatres. Employ proper accountants to oversee value for money, not the amateurs we have at present. Doctors never trained for or wanted to be business managers and most are not much good at it.

    Then we can have a full 24/7 world class health service. Where to get the money? Start by cutting the absurd Overseas Aid budget by 2/3rds and our payments to the EU similarly. There it is in one go. Maybe not much need for income tax increases if these two things were done.

  20. formula57
    Posted November 28, 2015 at 11:40 am | Permalink

    It is highly commendable that Mr Hunt is adopting the airline industry approach to analysing <i""every incident to see how it can design out any future threat of a repeat" but let us see if he believes in it enough to subject his own approach on junior doctors to the same. Perhaps exposure to ACAS will suffice.

    My understanding of the effect of his proposal is that:

    – the 11 per cent. pay rise is illusory since by dispensing with the banding arrangements, the actual outcome is a pay cut.

    (As you will know, additional to basic salary doctors receive a ‘banding’ which is dependent on the amount of out of hours requirements they are currently required to work. This varies from specialty to specialty. So any doctor currently contracted to work after 6pm and before 8am weekdays and all day weekends will receive some banding. The banding varies depending on the burden, but ranges from 20-50% of pay. There is no pay for ‘overtime’. Any extra hours worked past finishing of your contracted shift is unpaid. Mr Hunt’s proposal for contracts scraps the banding altogether, but increases basic pay by 11% and with a small increase in pay for each hour worked out of hours. But the out of hours times are to be changed to 10pm-7am, 7 days per week (essentially just for night time working, and no longer for weekends or evenings.))

    – present staff attendance reflects the predictable workload, which is higher during routine hours, and thus Mr Hunt’s sought for outcome of more doctors working at unsociable hours risks mismatching demand and supply;

    I acknowledge that making needed improvements to the NHS is a complex and difficult task (one that completle eluded Mr Lansley of course) but Mr Hunt on this matter of junior doctors contracts seems to be behaving less adroitly than needs require.

  21. Qubus
    Posted November 28, 2015 at 12:42 pm | Permalink

    Slightly off-topic, but what worries me about all these well-trained junior doctors leaving the UK, is the immigrant doctors who replace them. How exactly is their clinical competence checked? I get the impression, from the names of the medical UK workforce that about 40% of them are immigrants, of one sort or another.
    About a year ago, I had to take my wife to hospital and the young doctor who saw her was not properly in command of the English language. Sometimes, it is even difficult to understand what they say.

    • Dame Rita Webb
      Posted November 28, 2015 at 3:20 pm | Permalink

      The GMC website has a break down of where non UK doctors come from. With regard to their comptence, the GMC considers that if the medical school is OK by the local government then thats fine by them. I have previously mentioned here before, an article that appeared in the 04/07/15 edition of the “BMJ”. This covered the recent proliferation of overseas medical schools that work on the basis that grades are not a problem as long as you can come up with the fees.

    • M Davis
      Posted November 28, 2015 at 7:50 pm | Permalink

      Reminds me of the immigrant Staff Nurse, who could not read my Son’s’ hospital record and had to ask the Auxilliary, (who, indeed, was marvelous – being a REAL Brit, of course!), to interpret and read them for her!

      • Anonymous
        Posted November 28, 2015 at 11:23 pm | Permalink

        And if that nurse were as good as the one we lost to Australia she would be there too.

        We are not getting like-for-like in this cascade of medical staff. We are not getting what we’ve paid for.

  22. Iain Gill
    Posted November 28, 2015 at 12:59 pm | Permalink

    Any “business” that puts up posters telling customers to kindly go away, that has security staff in their car parks that scream abuse at their customers for having the nerve to park in the car park, that has such wide and obvious corruption and bias in the way the best treatments are handed out… its bound to fail. The NHS I see in regular visits with family and friends is sub 3rd world, and I say that having been to the 3rd world. The notion that we can keep kicking the can down the street and avoid the obvious changes to healthcare in this country are ridiculous. EVEN IN THE LABOUR HEATLANDS PEOPLE ARE REALLY CHEESED OFF WITH THE RUBBISH CARE THEY SEE IN FRONT OF THEM and consequently there are votes to be won in giving patients a chance to flex their buying power and make the healthcare providers respond.

    The complaints system is also broken and corrupt, the idea that this is being used as a force for good is nonsense too. There may as well be no complaints system for all the difference it makes. Let patients vote with their feet!

  23. CdBrux
    Posted November 28, 2015 at 1:12 pm | Permalink

    Bringing in the extra transparency and learning without recrimination is a key step to achieving safety, it’s not an easy culture change in any organisation.

    I am a little sceptical about the better outcomes during the week. Does this take account that weekend admissions are presumably more oriented to emergencies which may, no mater what day of the week, have worse outcomes anyway vs the average which can include more straightforward interventions?

  24. Tom William
    Posted November 28, 2015 at 1:20 pm | Permalink

    Slightly off topic but I have a South African cousin who is an obstetrics consultant who wanted to stay in the UK but had to get a visa every six months, despite being offered a permanent job. Because of this he could not get a mortgage so he and his British wife emigrated to Australia.

    ‘Rules are rules”…. crazy.

  25. Iain Gill
    Posted November 28, 2015 at 1:21 pm | Permalink

    John,

    The other thing you should really note is the ridicule being heaped on the Chancellor in professional IT circles for throwing money at the Government Digital Service. A fraudulent bunch of incompetents if ever there was one. Their party trick of putting a beta web front end on anything and everything, walking away when its obviously not going to meet non functional requirements like performance and security, and having negative idea how to make the back end systems better… This department of the Cabinet Office has been responsible for more crap advice to people buying IT and business change programmes for the public sector than anyone else in recorded history. All their outpouring are like beginners essays from an MBA course. Madness sheer madness.

    Is this really the best the Conservatives can do?

  26. Leslie Singleton
    Posted November 28, 2015 at 3:37 pm | Permalink

    Dear John–Are you going to tell us whom you hope wins in Oldham?

  27. Leslie Singleton
    Posted November 28, 2015 at 3:41 pm | Permalink

    Dear John (again, assuming you publish my last), I read that “Government ministers set to call Labour MPs for support” on Syria. Is this a good idea? I seem to disagree with just about everything this Government does. Surely infinitely more sagacious to leave well alone.

    • Leslie Singleton
      Posted November 28, 2015 at 10:48 pm | Permalink

      Postscript–With a choice between Labour and UKIP I sincerely hope you’d prefer UKIP

  28. Iain Gill
    Posted November 28, 2015 at 3:46 pm | Permalink

    If the NHS wanted to save money it could stop all the admin around forcing insulin dependant diabetics having to apply for prescription exemptions. The amount of patient time wasted, the amount of GP time wasted filling in the forms, the time wasted when the forms go missing in the post, the admin people in the NHS dealing with the forms. The reality is if you are insulin dependant you are exempt from charges, the prescription form should really just have a tick to confirm that on the back, all the rest of the admin overhead is a waste. Anyone fraudulently claiming free prescriptions when they are not insulin dependant will be easy to spot.

  29. Qubus
    Posted November 28, 2015 at 4:20 pm | Permalink

    The problem is that there will never be enough money for the NHS, whilst ever it is free at the point of use. We are all mortal and, as technology improves the medical procedures and drugs available to us, we all make greater and greater demands and the expense increases and increases. It is a bottomless pit. The only feasible way forward is to require at least co-payments at the point of access, with special arrangements for the chronically ill, some pensioners and the very poor. Tell me, why should we have to pay through the nose for dental treatment and optical care, but medical treatment is free. A pair of bog-standard spectacle frame costs just about the same as a modest bicycle, but we just seem to accept it and cough up.
    The problem is that tampering with the national religion is electoral suicide for all politicians.
    Go figure.

    • Iain gill
      Posted November 29, 2015 at 4:16 am | Permalink

      At 10 quid to park its not free at the point of use.

  30. Lindsay McDougall
    Posted December 1, 2015 at 4:34 am | Permalink

    I wish Mr Hunt every success in his negotiations with junior doctors. I think that he will discover a difference in attitudes between female junior doctors and male junior doctors.

    The females won’t want to work at more anti-social times because of family commitments. The male junior doctors will be willing to if rewarded well.

    The NHS could have two different types of junior doctor contract, one for males and one for females. That might be practical but it wouldn’t be politically correct, so it won’t happen.

  31. Margaret
    Posted December 1, 2015 at 2:46 pm | Permalink

    Take 2 people , one who has been doing a task for many years which is dangerous in the wrong hands and one who has not even done the same task once , Which one would you trust with your life.?
    Now put Dr in front of the one who has never done this before and he/ she is far superior and has an unspoken judgement that it will be carried out for the best interests of the patient. You wonder why the NHS is going down the swannie

  • About John Redwood


    John Redwood won a free place at Kent College, Canterbury, and graduated from Magdalen College Oxford. He is a Distinguished fellow of All Souls, Oxford. A businessman by background, he has set up an investment management business, was both executive and non executive chairman of a quoted industrial PLC, and chaired a manufacturing company with factories in Birmingham, Chicago, India and China. He is the MP for Wokingham, first elected in 1987.

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