Junior doctors

I have recently had a meeting with the Secretary of State for Health and other MP colleagues to discuss the dispute between the government and junior doctors.

I urged the Secretary of State to get talks started again, and am pleased that next week there will be meetings between the two sides.

I strongly support the idea of a seven day emergency service for the NHS, where similar staffing and service is available at week-ends to the rest of the week. The government is not proposing a seven day a week non emergency service. The government is rightly concerned about the poorer outturns to treatments on average in NHS hospitals at week-ends.

I also recognise that junior doctors carry an important workload and need sensible reassurances over hours of work and pay. These things are best thrashed out between the two sides in talks, however long they may take.

I have long argued that the public does  not understand what the main issue in this dispute is, and suggested  that talking is the better course of action. Ministers argue now that the main outstanding disagreement is the question of how much extra staff get paid for working Saturday shifts to provide better emergency service. This does not sound fundamental or unbridgeable.

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29 Comments

  1. Lifelogic
    Posted May 7, 2016 at 2:25 pm | Permalink

    Indeed the service Monday to Friday is bad enough at diagnosing patients in serious need of treatment anyway.

    The Government should also be rather concerned about the days in August when the newly qualified doctors start and death rates jump by 6-10%. Also the time when many senior staff are away on holiday. How many pointless and unnecessary deaths is that I wonder? Rather a lot I suspect.

    Avoid Casualty in August seems to be a good plan if you can.

    I know someone recently who went to casualty with acute cholecystitis (that could very easily have killed him), yet he was sent away with paracetamol and told to see a diabetic nurse!

    • Richard1
      Posted May 7, 2016 at 5:56 pm | Permalink

      Weekends in August must be particularly dangerous in the UK.

      I find it odd that any ‘professional’ should require higher rates of pay for work at weekends or at unsociable hours. Overtime pay is for people who are paid by the hour. Professionals are paid a salary and expected to work for as long as is needed in any 24 hour period and on any of the 365 days of the year as are needed to do their jobs. Should Mr Cameron have been paid time & 1/2 for negotiating his EU deal at the weekend? Doctors are paid enough – or have the prospect of being paid enough – not to need this.

      A better idea would be to pay bonuses based on performance. A bonus pool perhaps, available for hospitals which get rid of the extra weekend death risk, or for the health authority which matches international benchmarks in cancer or heart disease? Those doctors who make an effort to contribute to achieving these better oitcomes could be paid much more. Those who spend their time on strike or grandstanding on TV less. This wouldn’t be popular with the unions or leftists in politics and the media but should be a sure fire vote winner amongst tax paying patients and potential patients.

      (But I think we would need a PM like Michael Gove for such a policy).

    • Know-Dice
      Posted May 7, 2016 at 6:36 pm | Permalink

      LL – I don’t hold the NHS in such low esteem as you do, the doctors and nurses have saved my life twice…also I don’t think private heath care is the universal panacea ether. For true emergency medical attention would always head to the NHS.

      That said I have seen first hand the shortcomings of the NHS, “James Robertson Justice” style consultants, not mine I must say. You need to stand-up to doctors and query anything they say and push hard to make sure you get the best and correct treatment.

      I think Hunt et al are looking at the wrong part of the hospital to achieve 24/7 health care, maybe junior doctors were seen as an easy target. If you want true 24/7 then first look at Consultants, then 9 to 5 departments like radiology then the relationship and service (or lack of) offered by GPs out of hours.

      A&E is the only department that the public have access to without appointment, so it’s not surprising that many use it as a “first port of call”, work with this add better front end Triage and divert either to GP or out of hours service if A&E admittance is not required.

  2. Vanessa
    Posted May 7, 2016 at 2:55 pm | Permalink

    It is a shame that common sense did not prevail earlier and talks were continued to sort out the differences. Having been on strike for some weeks the “Junior” doctors must feel especially aggrieved and less inclined to “give” on anything now.
    The government has shown itself to be extremely arrogant when it stated it would push this through, stuff the doctors – maybe they will see the error of their ways!
    You need us more than we need you when “push comes to shove”.

    • Hope
      Posted May 7, 2016 at 7:41 pm | Permalink

      Disagree look at the inflation busting pay rises of MPs who work part-time (£75,000), not qualified, huge expenses, other interests and Osborne exempted them from money laundering! If any body of people need closer scrutiny it is MPs or have they forgotten 2009, the empty promises of Cameron who also warned us of Lobbying and last week he sold the Tory manifesto, changed the union bill in exchange for cash from the trade unions after mocking Labour for the same thing! Still pledged to stop child be fit to foreign children in the EU who never set a foot in this country. Instead he stopped child benefit to tax paying citizens of this country!

      Reply MPs are not exempt from Money laundering regulations!

  3. CHRISTOPHER HOUSTON
    Posted May 7, 2016 at 3:04 pm | Permalink

    True, the public does not understand what the main issue is.

    They know that if referred by a GP to hospital 0n Friday afternoon where an X-Ray is required they can either wait until Monday or join a Young Doctor’s NHS picket line for Saturday and Sunday where they may learn to recite loudly and possibly dance in time: “You ought to go to hospital for an X-Ray, what do we want, we want an X-ray, when do we want it, now, the workers united will never be defeated, long live Ho Chi Minh, Ho Ho Ho Chi Minh.”
    There will be placards written on hospital cardboard saying “I’m a doctor, don’t make me leave the UK to live in Fort McMurray Canada” “Don’t make me leave the UK for Southern Sydney and New South Wales.”
    Such compulsive desires for self-destruction in intelligent minds is not understandable or by the public. We should call a doctor to find out, but not at weekends, and not if they are aged under 55 years. And chant, shouting at traffic and waving.

  4. Antisthenes
    Posted May 7, 2016 at 3:23 pm | Permalink

    Right from the inception of the NHS doctors have had to have their palms crossed with silver for them to cooperate. The Original concept of the NHS was born out of good intentions but as usual not enough thought was put into how the service was to operate. The mind set at the time was socialist so a socialist solution was used with the inevitable consequences.

    We are paying dearly now as the culture that goes with a not for profit monopoly has caused the NHS to become top heavy in non essential staff and the use of practices that are not in the patients best interests. Rights and privileges have been established by employees that only more silver crossing palms will ever make them be relinquished.

    This state of affairs will continue ad infinitum until the systemic problems of the NHS are solved and the only way to do that and make the funding sustainable is a root and branch reorganisation. The monopoly has to be broken and the individual will have be made to contribute more to the funding not through tax but by purchasing healthcare insurance. Certainly the state can continue to subsidies the funding but how much and for how long will depend on future circumstances.

    • Jerry
      Posted May 7, 2016 at 6:58 pm | Permalink

      @Antisthenes; “The mind set at the time was socialist so a socialist solution was used with the inevitable consequences. “

      Had the 1945 Labour government stuck true to their “socialist” principles then many of the problems that have faced the NHS since its creation would never have existed, it was trying to placate the BMA and doctors pre-war practices that caused and still causes many problems.

      “We are paying dearly now as the culture that goes with a not for profit monopoly has caused the NHS to become top heavy in non essential staff and the use of practices that are not in the patients best interests.”

      That is not the fault of the NHS per se, it is the fault of the political paymasters, it is not top-heavy in front line or even secondary medical staff (if only it was…), it has become top-heavy with all the various levels of administrators the politicos demand.

      “The monopoly has to be broken and the individual will have be made to contribute more to the funding not through tax but by purchasing healthcare insurance.”

      But what of those who can not afford such health care insurance, those on limited incomes (or non), those with uninsurable pre-existing conditions that no commercial underwriter will chose to take on, what are such people meant to do, plead for treatment from a charity or see the local quack like many did before WW2.

      • Antisthenes
        Posted May 8, 2016 at 11:06 am | Permalink

        Jerry take your blinkers off and see the NHS for what it is. A dysfunctional communist like organisation that works in nobodies interests except for some who are employed in it.

        If it was not in the public sector and provision and funding was different political interference would not be such an issue and there would not be the opportunity for empire building as so many of the NHS staff now indulge in.

        Not to be able to afford health care insurance is absolute rubbish. The French follow that system and I can assure you that no one is disadvantaged by it. There is more than one way to skin a cat so do not be so quick to condemn until you have all of the facts.

  5. Iain gill
    Posted May 7, 2016 at 3:28 pm | Permalink

    Contracts should be negotiated per hospital and not nationally. Then hospitals have to compete for staff like they should have to for customers.

    • Lifelogic
      Posted May 7, 2016 at 5:36 pm | Permalink

      Indeed wage levels can vary hugely across the country and should do give supply and demand.

      • Hope
        Posted May 7, 2016 at 7:45 pm | Permalink

        Like MPs? Still policing themselves, still the scandals and no changes of substance after 7 years. Is this the sort of reform Cameron is talking about in the EU? Anyone stupid enough to beleive him?

  6. Colin
    Posted May 7, 2016 at 3:36 pm | Permalink

    Yes, it’s funny how the BMA say it’s all about “patient safety” and “saving the NHS”, but these concerns will magically disappear if they get a bigger pay rise…

    • alan jutson
      Posted May 14, 2016 at 5:39 pm | Permalink

      Colin

      Exactly.

  7. Philip Begley
    Posted May 7, 2016 at 3:40 pm | Permalink

    I cannot understand why he chose consultant trainees for 24/7 care. I’ve been frequent user of amongst others of A&E along with assessment unit over last 17 years.

    At all times the consultant trainees have been working, along with consultant in A&E, to cover admissions and outcomes on assessment unit.

    What’s needed is more appointments Mon-Fri, plus Saturday mornings. Again it’s consultants responsibility to ensures this happens, not trainees.

  8. Margaret
    Posted May 7, 2016 at 4:14 pm | Permalink

    My feedback during the strike was that patients were exceptionally pleased with the levels of care which was far superior than the usual attention they received .Tw0 patients asked a why more senior personnel could not be permanently placed in these areas. Waiting times were down and the service they received was first class.

    • Jerry
      Posted May 8, 2016 at 7:25 am | Permalink

      Margaret; “Two patients asked a why more senior personnel could not be permanently placed in these areas. Waiting times were down and the service they received was first class.”

      I wonder how many Private hospital appointments/operations had to be cancelled, or at least rescheduled, as a result of these “senior personnel” having to do such extra shifts within the NHS?

  9. Bert Young
    Posted May 7, 2016 at 4:29 pm | Permalink

    I have a fair amount of contact with Oxford medics and I have often raised the questions of the pay and conditions with them . The consensus seems to be that there is cause for concern but , unanimously , they are against all Doctors striking . John raises the point that the NHS should offer a 7 day effective service , my discussions support this . What seems to be a gripe is the level of pay of Junior Doctors in the first two or three years after they have qualified ; compared to others of similar academic achievement and considering the length of their training , they do come off badly . Doctors do seem to be satisfied with their remuneration once their careers are established , so , the inference is negotiate with the Junior Doctors to settle the problem of their level of remuneration in the first few years of their service .

  10. forthurst
    Posted May 7, 2016 at 5:19 pm | Permalink

    What is the government going to do about people turning up at A & E at weekends or at other times out of GPs’ surgery hours, rather than contacting their GPs, or having contacted them, being told to present at A & E, as a matter of course? GPs should be performing triage and only advising patients to present at A & E, without seeing them first, if their symptoms implied a potential medical emergency. If the NHS is to be a 24×7 operation, that should apply across the board.

  11. JoosB
    Posted May 7, 2016 at 5:21 pm | Permalink

    “I strongly support the idea of a seven day emergency service for the NHS”

    John, as you well know, 650 UK MPs sitting at Westminster, including 117 Scottish, Welsh & NI MPs (thanks to the undemocracy that is England), only have any control over the NHS in England. The junior doctors’ strike and plans for a 7 day NHS therefore only apply to England. Unlike Cameron and the Cameroons, please at least pay England the courtesy of saying England when talking about something which only applies to England.

  12. acorn
    Posted May 7, 2016 at 6:08 pm | Permalink

    I have not studied this Junior Doctor working problem, but I did have explained to me from a bunch of Doctors, that they would have to work “three week-ends out of four” on the new Hunt shift pattern. Apparently, such rostered Doctor working is unknown in the NHS, which I find difficult to believe???

    If they worked in an Operations and Maintenance job at one of our 24/7 utility industries, like gas; electric, water, and telecoms etc; you would find that common practice. Typically a four cycle, three shift, 42 hour week average, or variations that include 12 hour night shifts and standby rotas etc. You know way in advance, when you will get Christmas Day off next.

    I understand some Health Trusts are adopting standardised shift patterns for Nursing, involving four overlapping shifts per day type rotas, to fit costumer peak demand periods. I need someone to tell me why this is unacceptable for Junior Doctors.

  13. Denis Cooper
    Posted May 7, 2016 at 6:10 pm | Permalink

    Off-topic, there seems to be a very belated and still rather slow dawning here:

    http://www.telegraph.co.uk/news/2016/05/07/the-migrant-crisis-will-never-end-it-is-part-of-the-modern-world/

    Today’s wars generally create far more refugees than previous conflicts. It may sound strange, but that is not necessarily bad news. After all, the biggest reason is simply that even the most volatile countries have also experienced rapid population growth.

    Had civil war broken out in Syria in 1970, the refugee crisis would have been a fraction of today’s catastrophe. Back then, Syria had only six million people, compared with at least 20 million today.

    If Boko Haram had swept across northern Nigeria in 1970, the Islamist gunmen would have been ravaging a country with barely one quarter of today’s population. The refugee camps across the border in Chad would have been tiny by our standards.

    There are more refugees because there are more people – and, in turn, there are more people because the world has broadly succeeded in reducing infant mortality and raising life expectancy, even in the poorest countries.”

    But the world has had much less success in reducing birth rates in those poor countries, in stark contrast to the wealthier countries.

    • getahead
      Posted May 7, 2016 at 7:17 pm | Permalink

      Your last sentence sums it up.
      I have always said, instead of providing aid, provide contraception so that the population can be reduced to a level that the land can support.

    • CHRISTOPHER HOUSTON
      Posted May 7, 2016 at 8:58 pm | Permalink

      It is politic to pronounce wars beget migration/refugees, and let’s get used to it by laying back and thinking of England: a question of what came first the chicken or the egg.
      Migration from Europe to America avoiding religious wars and bestialities did not make halcyon days for Native Americans…and not for the canal makers of Arizona who some call ancient Mexicans or the Mexicans of Texas or for the French and British settlers in Canada who took turns to get Native Americans to murder one another’s families down to the newborn babes as well as fighting amongst themselves when running out of Native mercenaries.
      Migration of Germans to Namibia and Rhodesia did not lead to calm relations between the British and German farmers ..not many of the latter survived the intellectual arguments. The Dutch and French migration to South Africa, some as refugees due to religious persecution, led to one or two disputes, the last one certainly was not involving Mandela’s lot.
      Africa as a whole and Asia has had refugees, displaced persons, and there have been the odd tiff or two which are again not politic to mention. Oh let’s stop being so terribly British. Massive bloody wars have followed migration and refugee displacement all over the planet.Do we learn nothing?
      It is a matter of sovereignty.

  14. The PrangWizard
    Posted May 7, 2016 at 6:21 pm | Permalink

    There’s nothing like the usual dose of weakness from the usual sources – snatching defeat from the jaws of victory, as they say. And guess who will claim success. All that effort by Mr Hunt only to find the rug pulled from beneath his feet.

    There’s no way back now, the next time the government wishes to make a change we know who will back down first.

    reply What victory?

  15. Iain gill
    Posted May 7, 2016 at 6:53 pm | Permalink

    There is no real emergency service at the weekend in most places as scanners are not staffed, skills to put an optical fibre into the bladder do not work weekends, etc

    There is only emergency care for cases where simple x-ray is enough, but many die where it’s not

    • Lifelogic
      Posted May 8, 2016 at 4:45 am | Permalink

      Indeed and a lack of competent staff to interpret scans correctly sometimes too.

      • Lifelogic
        Posted May 8, 2016 at 4:48 am | Permalink

        Lots of well paid admin staff, PR staff, gagging staff and people covering up or defending legal claims, though – mainly Monday to Friday.

  16. Jerry
    Posted May 8, 2016 at 7:41 am | Permalink

    @Mercia; Unlike you it seems some people are able to leave their personal opinion at home when going to work, the clue is that these people you cite are former heads of our security departments – and whilst I would dispute that there has been anything, it might be what they learnt by way of their work that has lead to their current personal opinions.

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    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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