Health troubles

The junior doctors and NHS management are locked in a struggle over hours, pay and productivity. The doctors complain that they will have to work week-ends and longer hours for less money. The NHS seeks to assure that the proposals do not include wage cuts or unreasonable hours.

At the heart of the row is the government’s wish to see better care at week-ends. People who fall ill or injure themselves at week-ends need good quality care there and then. The figures show that cover is not so good at week-ends, and the outcomes from treatment and surgery are not so good as a result. The aim of the reforms is to have a better balance of medical talent available throughout the week, as well as making sure there are enough doctors and nurses. The  government points out it has recruited more over the last five years, and will doubtless appoint more over the next five. The NHS budget continues to grow.

Mr Hunt is a patient and thoughtful Secretary of State driven by a wish to improve the NHS and to reinforce its best instincts and professional conducts.He has introduced a system of honest reporting  in the NHS, arguing that air safety improved when pilots and crew had to report every incident or near miss so the airline could learn from it and manage the error out of future flights or engineering. The  same is a necessary part of delivering first class health care. When people make mistakes they need to be reported, and improvements made to protocols, procedures and equipment.


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  1. Dame Rita Webb
    Posted November 1, 2015 at 5:57 am | Permalink

    The junior doctors (and especially nurses) would be apathetic not to take industrial action and if you want a value for money NHS you should support them too. It was only through industrial action in the ’90s that Australia got a rid of its version of the working time directive. That is why that country is such a draw for junior doctors from the UK today.

    JR says the government is recruiting more doctors however enquiring minds might like to have a read of 04.07.15 edition of “The BMJ”. An article in it covers how the GMC validates overseas medical schools. It also reports on the recent proliferation of foreign medical schools of the type that pays more attention to your ability to pay the fees rather than what grades you have. Last week the papers reported on NHS doctors who have problems with the English language. In the meantime many British doctors have approached the GMC to get their papers validated so as to work overseas.

    If you want an efficient NHS get the management off the backs of the medics. You know there is something wrong when they are paid often way in excess of a doctor, usually for what is only a Monday to Friday 9 to 5 job. If you do not believe me check out how busy your local hospital staff car park is on a weekend or even a Friday afternoon.

    Full disclosure my other half is a NHS doctor.

    • David
      Posted November 2, 2015 at 10:27 am | Permalink

      “If you want an efficient NHS get the management off the backs of the medics. You know there is something wrong when they are paid often way in excess of a doctor, usually for what is only a Monday to Friday 9 to 5 job. If you do not believe me check out how busy your local hospital staff car park is on a weekend”
      There are lot more managers who could replace the managers in the NHS then there are doctors.
      I don’t mind the reforms per se but to say after 7pm is not antisocial is not reasonable.

  2. john malpas
    Posted November 1, 2015 at 6:01 am | Permalink

    “When people make mistakes they need to be reported, and improvements made to protocols, procedures and equipment.” – what has this got to do with medical care over weekends?

    Reply Everything. More mistakes are made at week-ends. Protocols for caring for people would include proper cover at week-ends.

    • Mike Stallard
      Posted November 1, 2015 at 7:40 am | Permalink

      “Mr Hunt is a patient and thoughtful Secretary of State driven by a wish to improve the NHS and to reinforce its best instincts and professional conducts.”
      This is simply obvious from the TV. He comes over as a really decent, caring kind of chap who is determined to make the National Health Service work better.

      Mr Redwood, there are two kinds of pressure:
      1. Occupational pressure. It is no fun (I imagine) telling a nursing mother that she has breast cancer and will probably die in a couple of weeks. It is very difficult and embarrassing to treat haemorrhoids or prostate problems. Watching children die, slowly and in pain is a tremendous challenge too. All of this causes enormous stress. That is why, in the olden days, doctors like my grandfather turned out at 3 a.m. without a murmur.
      2. Managerial pressure: You get paid by us: we need to make sure that you deserve that money! Fill in the forms! Work when we say! Step up to our standards! Not enough? Work harder! We do not trust you. Prove your worth!

      Teachers, Vicars, Doctors, Nurses, Lawyers, Social Workers and ALL bureaucrats of whatever stripe are subject to an appalling amount of the second kind of pressure. The first kind is being sort of kind of taken over too by the authorities: You do this – and we pay you. You do what we say badly and you are in deep trouble. These people were once trusted professionals, now they are working for the government – not the patient, pupil, client, parishioner any more. Hence the anger.

      I have absolutely no idea what the cure is. Have you?

  3. Dame Rita Webb
    Posted November 1, 2015 at 6:16 am | Permalink

    If you are having trouble getting to see a junior doctor consider this little point on how the bureaucracy stops him from seeing you. While he is training to be a consultant he will have to move from hospital to hospital. You can bet that when doing so, even though the hospitals may be only a few miles apart, they will be in different trusts. From memory I believe Brum has at least three of them. So a move to a new trust involves a couple of days away from the patients. This is because he will need to present his qualifications again (even though the regional deanery has them anyway). If he wants to get paid he will need to hand over his banking details (the NHS has no central payroll function). Plus on top of that there will be compulsory lectures on the trust’s non smoking policy, commitment to equality and diversity etc. So as you can see a lot of people create work for themselves that stops you getting in front of a doctor.

    • Dame Rita Webb
      Posted November 1, 2015 at 7:46 am | Permalink

      JR why have you not published my earlier comment on who the GMC allows to practice in the UK and why so many British trained doctors are leaving? Its not as if the BMJ is such an obscure publication or do you just want a load of NHS bashers on today?

      Reply Anything with a link or cross reference to another publication will take longer to moderate as I do often need to check it.

  4. Lifelogic
    Posted November 1, 2015 at 6:27 am | Permalink

    The NHS service during the week is usually very poor indeed too. It is more about delay and rationing than the provision of any real service to the public. Patients, to the NHS, are a nuisance and a cost, to be deterred, delayed and pushed away wherever possible.

    The real solution is to start charging all who can afford to pay, give tax relief for those who take medical insurance and make the money follow the patient. Make sure all who come to the UK have insurance or pay for their own treatments. Get rid of insurance tax on medical cover too. Is it not enough to pay taxes and for your own insurance without having this IPT too?

    The way the NHS is structured in a top down, command economy structure is a complete disaster and can never work efficiently. Thousands die and suffer as a result, many cannot work while waiting months for simple operations. It is driven by artificial targets rather than real & worthwhile outcomes. Get the money and power back to the patient.

    • Dame Rita Webb
      Posted November 1, 2015 at 7:52 am | Permalink

      How do you know what its like during the week? Do you use the NHS? Do you even live in the UK still or is this just what you perceive from what you read on the tabloid websites?

      • Iain Gill
        Posted November 1, 2015 at 1:57 pm | Permalink

        he is correct don’t kid yourself

        • Dame Rita Webb
          Posted November 1, 2015 at 6:42 pm | Permalink

          And you work inside the NHS?

          • Iain Gill
            Posted November 1, 2015 at 7:37 pm | Permalink

            I don’t work in the NHS and I wouldn’t put up with working there either. I have however been in enough that the security guards scream abuse at me accusing me of parking in the publics slots when they imagine I am staff as they see the car so often, charming considering the rip off prices for car parking they charge. And that’s just one hospital, I have been to more, lots more. I have had hospice doctors openly tell me my relative would have lived “at least a decade longer in any other developed country” and that for me says it all. Please don’t defend this crap.

          • Dame Rita Webb
            Posted November 1, 2015 at 8:03 pm | Permalink

            Actually why not get down to the nitty gritty and mention Mid Staffs? This was caused by Labour replacing the Conservatives internal market with a set of targets. Unfortunately Labour and the NHS management that set about ruthlessly enforcing them forgot that human beings are not like machines. A hopital is not like a production line at Ford’s. I have spent many an hour waiting for my other half because he has been delayed trying to get a line into a sick baby. As anybody who reads the “M.D.” column in “Private Eye” knows that many a medics career has been ended when they come into conflict with the management. Its not worth it to end up with a year’s pay and a gag order on you. Hence thats why you saw what went on at Mid Staffs.

            (Unchecked allegations about a contracting company deleted ed)

          • Lifelogic
            Posted November 2, 2015 at 12:34 pm | Permalink

            Clearly there are differences between cars and patients but in many ways a good hospital should be rather more like an efficient car production line, with scans, blood tests, prompt diagnosis, the efficient use of staff’s time and the efficient use of all the many capital assets, test facilities, beds and theatres. With any treatment performed promptly and efficiently. It should actually respond to the customer (the patient) and their needs efficiently quickly.

            Pretty much this is the opposite of what the NHS provides. Largely this is because it is centrally controlled, top down, free at the point of non provision and rationing and spends much of its time covering up its own mistakes & incompetence, avoiding legals claims and responding to daft centrally dictated targets.

    • fedupsoutherner
      Posted November 1, 2015 at 10:04 am | Permalink

      Lifelogic. Fully agree with your sentiments that foreigners should have medical insurance before they enter the UK. When booking through a travel agent to travel outside Europe we were asked who we had insurance with. This seemed to be a mandatory requirement to finish our booking. If everyone was made to have medical insurance then we would not end up footing the bill for all and sundry.

      We have people in charge of hospitals now who have never had an medical experience being paid a fortune to get it wrong. We need to revert back to matrons running their own wards and people with experience overseeing hospitals.

      Just how is the NHS going to manage with the projected figures on immigration, much of it being illegal? Most of the people coming in will go on to have lots of children because that’s just what their culture allows them to do. Where are all the midwives going to come from especially when as soon as they are trained they want to leave for foreign shores? Teresa May just couldn’t quite bring herself to admit that we cannot do anything about immigration all the time we are in the EU and the news from Farage that a further 75 million are eligible to come in from Turkey was a frightening prospect. Hopefully we will see a full breakdown of the EU and soon.

      • alan jutson
        Posted November 1, 2015 at 12:03 pm | Permalink


        If you are fortunate enough to be able to go on a cruise, then you will know you have to inform them in advance which Company your holiday insurance is with, and give the telephone number and contact details of that company in advance, and before you are allowed to board.

        Do not understand why our Immigration officials cannot ask for similar proof on entry.

        No Insurance no entry simples.

        • fedupsoutherner
          Posted November 1, 2015 at 9:10 pm | Permalink

          Alan, no I am not fortunate to go on a cruise but did recently book a 4 day trip to Venice and they insisted on seeing insurance. I know from friends that this is needed when travelling outside of Europe too. Surely it is not too much to ask of people coming to the UK??? Why all the excuses? We always make everything seem so difficult but other countries manage sensible ways.

    • Lifelogic
      Posted November 2, 2015 at 5:24 am | Permalink

      I do not live in the UK now but did until about 7 years ago. Mainly in North London. There are many dedicated individuals doing their very best in the NHS but as a whole the system simply does not work. Is is very inefficient and dysfunctional. Endless operations delayed or cancelled at he last minute and many mistakes being made. Disorganised administratively, you could easily die in the casualty waiting room without anyone even looking at you.

      Yet still they find money for alternative treatments and vanity operations!

  5. Lifelogic
    Posted November 1, 2015 at 6:38 am | Permalink

    Much talk on the BBC about how employers are “exploiting the tax credits to pay or subsidise low wages. But employers have to pay the going rate or they will become uncompetitive and go out of business. Anyway, why pay higher wages to someone who will only keep perhaps 5% of the increase, after tax, NI and benefits are withdrawn. Employers are behaving entirely rational given the bonkers system the government has put in place. Just get the halfwitted government out of the dam way, they are the problem as always. Get some real incentives to work and get rid of incentives not to work and relax employment laws, simplify and reduce taxes and kill all the red tape.

  6. Antisthenes
    Posted November 1, 2015 at 7:14 am | Permalink

    Whilst the NHS remains a monopoly putting in place a system that puts patience first is going to be costly and the incentives for do so will always be lacking. It will always be top heavy with administrative staff that drains resources away from front line services because that is the nature of that type of system.

    I know this because I have first hand knowledge of a healthcare system where doctors, hospitals, laboratories even nurses compete for patience. Patience have a real choice and medical practitioners can only make a living if they work efficiently, expertly and always in the best interests of their patience.

    Here in the UK it is imperative that the public’s perception that the NHS is a holy cow, envy of the world and should only be provided by the state be revealed for what it is. Completely wrong and that these beliefs are stopping the UK from having a healthcare that is fit for purpose which it certainly is not now and has not been for some decades.

    • stred
      Posted November 1, 2015 at 7:58 am | Permalink

      Words can have strange meanings. NHS patients have to be very patient, or have lots of patience, when waiting 2 weeks to see the doctor. Doctors and managers may be doctoring the waiting list statistics by having mass appointment times, then making patients wait patiently. Have I got this right?

      • stred
        Posted November 1, 2015 at 8:09 am | Permalink

        I saw Jeremy Hunt in the debate in parliament and thought he put the case well. The doctors should negotiate and do what they used to in the days when their oath put patients first. The main reason for excess deaths at golfing times is that consultants are not available. If a junior doctor is available it may be hit or miss. Hunt seemed to think that the BMA had wound up junior doctors by exaggerating the pay changes and working times.If this is true, the seniors may be using them to scupper any changes to their own hours. The NHS only functions at all well because many consultants are very hard working and work all hours. The BMA needs to follow their example. If the BMA says yes to any proposals, look very carefully at what is proposed. They are the strongest union in the UK.

  7. Cheshire Girl
    Posted November 1, 2015 at 7:26 am | Permalink

    That may all be so, but what worries me is that if pressure continues to be applied to our Doctors, we will soon have a very serious shortage, as they will vote with their feet. Some are already doing so, choosing to go abroad, and it is well known that we already have a shortage of GPs. I know we need to save money but it is about time that a way was devised to charge those timewasters, who turn up at weekends under the influence of alcohol, and all those who come into the UK expressly to access our health care because it is free. I read yesterday that the second group are to be charged, but there were so many exemptions quoted that I dont think that it is going to work.

    • Dame Rita Webb
      Posted November 1, 2015 at 8:00 am | Permalink

      Its dead easy to charge and it will not involve the medics in anyway if my experience of the American system is anything to go by. You enter the trauma room after handing over your credit card to the clerks on the desk at the hospital entrance. The paperwork is even faster on the way out, if you have your travel insurance docs and passport at hand. This Summer I also needed some first aid from a German village doctor. I was in and out in 40 mins, with a prescription too, and it cost thirty odd euros cash. The E111 card was a waste of time.

    • JoeSoap
      Posted November 1, 2015 at 8:58 am | Permalink

      Not going to work because the first presumption of this government, as with all socialists, is that somebody else will pay. Why not make the first presumption that the patient will pay, then find exceptions who don’t have to?

      They are now talking about a madcap scheme to tax pensions (as enforced) on the contributions, then release the money tax free later in retirement. How mad is that? For most people, it is worse than having no pensions system at all.

  8. alan jutson
    Posted November 1, 2015 at 7:28 am | Permalink

    Just a few simple observations.

    Clearly an efficient 7 day safe working NHS should be the norm, not some sort of hope/wish depending on who will volunteer to work.

    When employment is offered to Nurses, Junior or Senior Doctors, do the terms and conditions of that employment make it very clear that weekend working IS and WILL be REQUIRED If not why not.

    Some non clinical management and staff should also be expected to work days other than Monday-Friday, again it should be in their contract.

    Expensive equipment should be available to be used 24 hours a day including weekends, to maximise its use, and efficiently treat patients rapidly.

    Hospital car parks and waiting rooms are full 09.00 – 17.00 but empty in the evenings.

    Clearly the above will require more staff, and hence more cost, but patient care should improve, waiting times should reduce.

    Some of the more minor, regular, simple, and routine operations should be contracted out to the private sector after diagnosis by the NHS to improve patient through put should theatre capacity be compromised with the above.

    All staff should be able to communicate with good English language skills and should all be qualified to an acceptable UK standard BEFORE BEING EMPLOYED.

    • Dame Rita Webb
      Posted November 1, 2015 at 3:17 pm | Permalink

      A few points … if you want to work even now in A&E, neo-nates etc you will not get a job if you are unwilling to work unsocial hours. My other half has tried offering Saturday appointments but the public do not seem to want to take them up. If the public feels it is getting a raw deal it could help by bothering to turn up for appointments that are made during the week. Incidentally the people who never seem to miss them and are VERY apologetic if they are late, are those who have recently come to the UK. Also unlike what the tabloids are telling you they always seem to be in work too.

      What JR is not telling you is that the research on the so called “weekend effect” is very contentious, just like that on “man made global warming” which is always contested on this blog too.

      • a-tracy
        Posted November 3, 2015 at 12:50 pm | Permalink

        “My other half has tried offering Saturday appointments but the public do not seem to want to take them up. If the public feels it is getting a raw deal it could help by bothering to turn up for appointments that are made during the week.”

        If I were a Manager in the NHS this would be one of my first investigations, my family and I have taken full advantage of an evening investigation and a Saturday appointment recently and really appreciate the NHS making these slots available, but if someone refused an appointment I’d want to know why, are they retired or car less and unable to get public transport to the hospital at the weekend perhaps because of poor bus runs? I’d also investigate every cancelled appointment by calling the patient, if I had regular patients who didn’t turn up I’d send them a warning letter about cancelling their slot at my clinic and put them on notice they’d need to find another practitioner.

  9. JoolsB
    Posted November 1, 2015 at 7:32 am | Permalink

    You are only talking about the NHS England, as that’s all UK MPs including 117 Scottish, Welsh & NI ones have any say over, so please say say so.
    Slightly off topic but we are told there is a shortage of doctors and the NHS would fall apart if it wasn’t for foreign doctors. Why not make tuition fees for medicine free provided they make a commitment to work for the NHS for at least 10 years? Any chance of Liberal Dave and Gideon coming up with such a sensible idea to keep our doctors in this country? Nope, didn’t think so!

    • sm
      Posted November 1, 2015 at 8:03 pm | Permalink

      Increase the supply of UK trained Doctors & Nurses via traditional routes.
      and via non traditional routes, with new qualification pathways, same with lawyers, break the qualification cartels.

      Fully fund and repay the loans for shortage area doctors who stay with NHS for a set period. (1o years) . (JoolsB above).

      Pay more earlier if needed.Explain more, but still bring on more supply.

      Use our aid budget to setup training facilities abroad, to train locals and train Doctors through non traditional routes.

      Do not poach poor countries of talent, spend the effort increasing UK supply. Who is responsible for matching supply and needs.

      Reduce demand, reduce immigration.

    • fedupsoutherner
      Posted November 1, 2015 at 9:12 pm | Permalink

      Not just doctors. My friend’s daughter is doing her nursing training and is already planning to go to Australia as soon as she can. This should be stopped. We pay for their training and they should give a number of years to the UK before they can leave.

  10. alan jutson
    Posted November 1, 2015 at 7:37 am | Permalink

    Once again your Party seems to have a problem with communication John.

    If Junior Doctors and other staff are not having a wage reduction, then show some examples with factual figures to back up your argument.

    Explain clearly why it is necessary for 24 hour 7 day week working is required (although perhaps obvious to many) as some people still do not seem to understand.

    Explain by how much NHS spending is rising year on year and show figures to prove it !

    You have to slay this austerity/spending cuts nonsense which your opponents keep on sprouting.

  11. agricola
    Posted November 1, 2015 at 8:33 am | Permalink

    Problem is, the NHS is a public service, and much less likely to respond to market requirements than would a supermarket chain. It also lacks the imperative to minimise waste, or increase profit, depending how you look at it. I can imagine it being choked with the box ticking culture of health and safety which in many cases just covers the backsides of the box tickers.

    Junior doctors not being amenable to working five days out of any seven is probably only part of the problem. Are they being consulted as to how this might be made to work. The whole hospital, management, technical services, porters, needs to work five days out of seven on a watch system. Look on it as a fleet warship and the impracticality of it dropping anchor off a beach for two days a week. The NHS is in a permanent state of war against disease and the frailty of man and should organise itself as such.

    When you have a very expensive capital assets like oil rigs, airlines, or the NHS, they only work profitably if in continuous use, even if the crews are rotated. The NHS should start to think of profitability, or in their case the best possible return, in quality and quantity, for the assets employed.

    Dame Rita Webb seems to be much closer to the coalface. If the NHS’s problems are half as bad as she suggests, and I do not doubt her, then it is an administrative and management nightmare. If you could borrow one senior manager from Tesco/ Toyota and put him in one hospital to assess it’s running, it could well highlight the main problems across the whole organisation.

  12. Richard1
    Posted November 1, 2015 at 8:57 am | Permalink

    Another demonstration that however excellent and altruistic NHS doctors may be, in a state owned monopoly service the producer interest comes first and the patient / customer interest last. Mr Hunt should stick to his guns. international comparisons, including the anaecdotal evidence of anyone who has used health services in other countries, shows that the NHS is far worse by comparison than it – and just about all UK politicians – claim it to be. Of course we need a 24/7 health service, anything else is an absurdity.

    • Anonymous
      Posted November 1, 2015 at 5:56 pm | Permalink

      NHS doctors leave Britain in droves to go to Australia and New Zealand where they are snapped up.

      Why ?

      Because the pay and time off is better as are the conditions.

  13. The Prangwizard
    Posted November 1, 2015 at 9:01 am | Permalink

    He has my support, locked as he is in a struggle with an intransigent and backward-looking union in the BMA, which is determined to put its own narrow vested interests before those of patients, using them as a shield and a weapon. Many doctors and their leaders have no conscience and expect praise for everything they do. Many people, sadly, are afraid to complain about their inadequacies and incompetencies as the doctors have such power over them, and the government has another determined opponent in the BBC which tends to take the side of the BMA and defends the NHS regardless of unpleasant facts. Many GPs sadly show little interest in their patients and are happy to fob them off as often as they can get away with it. They need to be confronted and defeated, in the same way as the miners were confronted and defeated.

    And let’s hope that Mr Hunt, Secretary of State for England, can successfully implement the plan to get foreigners to pay before treatment – but here again we find doctors refusing to co-operate. They say they will not become ‘border guards’, an outrageous statement, but the kind of inflammatory and threatening stance which has been seen endless times, and has too often been successful.

    The trouble is, as has been said before, there will be many in surgeries and hospitals who will deliberately ‘stretch’ their judgement of what is of urgent and serious to the extreme to get round the stated exception that no-one who has such problems will be turned away, payment being deferred in such cases.

    How will those who come here deliberately with a serious problem, and who know the rules and ways to get round them, be caught and stopped? And there is also the problem of threats of violence to get their way – how is that to be countered? Strict rules must be designed and enforced.

    • Qubus
      Posted November 1, 2015 at 4:59 pm | Permalink

      Isn’t it about time that we got real about the NHS? It is a shambles and, apart from a few world-leading centres, a disgrace; the present doctors’ salary affair is just one facet of it. Envy of the world? Envy of the third world !

      Let’s face it, apart from the money-grabbing locums, these guys are only trainees after all. it isn’t as though they are on these salaries, or required to work long hours, for ever. What other trainee can expect to make upwards of £40k before qualifying as a consultant to make at least twice that amount? There are no almost permanent positions in NHS hospitals for these people; they are just en route, in transit, to highly paid jobs. Try doing a job as a post-doc in a top British university and see how many years they have to work before being able to get tenure.

      There is a shortage of these people. However, there is not a shortage of well-qualified school-leavers, perfectly capable of becoming doctors. There is such a demand for places that entry to medical school has to be restricted by A-level grades, even though 2 Cs at A-level are perfectly adequate preparation for a degree in medicine. Access to medical schools should be greatly increased. And why isn’t it? Well, it’s because that well-organised trade union, the BMA, masquerading as a learned society, wants there always to be a big demand for doctors, that they are virtually guaranteed a job as soon as they qualify and that they should never be out of work. Why should that be the case for doctors, but not for, for example, engineers?

      Isn’t it strange that the Working Time Directive were both opposed by senior doctors, probably including the BMA, because they said that these long hours were necessary in order for these trainees to get the required experience in a suitably short time. Don’t forget, they are still classified as being working, even when they are on-call lying on their beds in their hospital quarters.
      And who opposed the establishment of the NHS in 1948 in the first place? Why, the doctors. What was it that Nye Bevan said about stuffing mouths with gold?

      We have the worst health service in Europe couple with the highest paid doctors. As I said initially, a disgrace.

      And finally in my rant, why does the gullible public always insist that nurses are all latter-day Florence Nightingales? They are just the same as anyone else: doing a job that they are relatively well -paid for.

      Get rid of the NHS, the biggest employer in the world, apart from the Chinese army, and introduce an insurance scheme. The trouble is that no politician is brave enough.

      I think that I shall have managed to upset a few people !

      • Dame Rita Webb
        Posted November 1, 2015 at 6:54 pm | Permalink

        No you are just a mug. If you think insurance is the way try Obama’s “Affordable” Care Act. The first year premium reviews are now coming in with double digit percentage increases. Try and go on one of the state insurance exchange websites and see how much private healthcare is in the US.

        With regard to anyone working as a locum consider this. The job comes with no guranteed hours so in effect its a sort of zero hours contract. The work usually will not be in your area so you are going to have arrange your own transport and overnight accomodation. The trusts do not pay you any sick pay or pension contributions. So on the whole they may be marginally cheaper than a full time doctor on the pay roll. Remember they are usually used because doctors fall ill too. Or do you want patients with impaired immune systems, like someone on chemo, being treated by someone who is infectious?

        • Qubus
          Posted November 1, 2015 at 8:31 pm | Permalink

          Perhaps, Dame Rita, you should get out a bit more. Why not explore the German health service; and why do people like you always have to fall back on the situation in the USA? No one wants that.

          • Dame Rita Webb
            Posted November 2, 2015 at 10:36 am | Permalink

            Qubus you should have read the comment I made earlier about my real life experiences of the German and American systems

          • Dame Rita Webb
            Posted November 2, 2015 at 10:38 am | Permalink

            Qubus you should have read the comment I made earlier about my real life experiences of the German and American systems. What is your experience of the German service?

          • Simon
            Posted November 2, 2015 at 11:13 am | Permalink

            I agree, the evidence is all around: Germany, France, Switzerland all have more sophisticated systems, based on insurance with better outcomes. One problem is that no-one knows what they actually pay for the service as the charges are hidden in National Insurance contributions etc.. Swathes of people assume that “free at the point of use” means free! Small wonder that the NHS is treated as the national religion.

  14. Ian wragg
    Posted November 1, 2015 at 9:02 am | Permalink

    The problem is that the NHS has always operated as a 9 to 5 organisation run entirety for the benefit of the employees
    Very expensive equipment is redundant after 5pm and at weekends
    Productivity is abysmal.
    I had an operation in a private hospital last year and it was done at 9.30pm by the consultant who was head of department at our local NHS hospital.
    I think they should made to choose if they want to practice privately.
    I work in the power industry. Imagine the furore if we shut down for the weekend.

    • Dame Rita Webb
      Posted November 1, 2015 at 3:27 pm | Permalink

      Does it only operate Mon to Fri 9 -5? What about all the unpaid over time that goes on? I do not expect my other half home till about 8 pm. Its an “on call” tomorrow so he will be working through the night and will be back on the go again from Tuesday 9am. You also forget the amount of paperwork that has to be produced after the last appointment. That may be the reason you think everything closes down at 5 they have their heads down at something else.

    • Anonymous
      Posted November 1, 2015 at 6:01 pm | Permalink

      Ian – I had an NHS operation at near midnight.

      Our doctors go to Australia and New Zealand because the pay and hours are better, not because they are worse.

      The GP weekend issue is a problem but this does not include junior hospital doctors.

      • a-tracy
        Posted November 4, 2015 at 10:20 am | Permalink

        I’d be interested to know how New Zealand and Australia organise their weekends and evenings and staff them. I’d like to compare the pay rates, out of hours payments for each grade, we hear “Our doctors go to Australia and New Zealand because the pay and hours are better, not because they are worse.” but its no wonder if they don’t have to pay near quarter of a million pounds training per doctor by just poaching ours and is the pay higher because they just take specialists and not trainees? Is this even true? I wonder what % of specialists in Australia were trained in Australia compared to those in working and trained in England?
        We should tie in a pay out clause to recover some of the expensive training costs that our British trained specialists transfer free gratis and stop poaching qualified staff from poorer economies by freeing up our training numbers, better to have a glut of Doctors than a glut of expensively trained graduates in an area there is no work .

        • Iain Gill
          Posted November 5, 2015 at 10:44 am | Permalink

          I lived in New Zealand and mixed with British docs out there socially and as their customer 🙂

          As a patient in Auckland there are several 24/7 GP clinics where you can get seen by a proper doctor (not a nurse as here) any time you need. No wait just turn up and get seen. Sure a modest fee is charged but its trivial.

          As a patient in Auckland for regular GP appointments I never even bothered with an appointments system as the times I turned up at the surgery planning to make an appointment (thinking like a Brit) they surprised me by just ushering me in and seeing me straight away.

          I did have a minor problem and needed to see a consultant, I chose the consultant and time and location. I spoke directly to his secretary to organise. I was not held waiting at the appointed time either I was seen on the dot of the time arranged.

          I saw friends in hospitals which were clean, friendly, prompt, polite, and where the patients had significant amounts of say in their care.

          Secondary care could refer to each other, and did not send patients back to GP’s to be referred to another secondary care professional.

          New Zealand docs are not just there for the money, they are also there because they do not have to answer to stupid political management and they are judged much more on patient satisfaction as patients can vote with their feet and simply go elsewhere at any point if they want.

  15. Alan Wheatley
    Posted November 1, 2015 at 9:31 am | Permalink

    Fewer mistakes means more efficiency and improved health care without increasing cost.

  16. Bert Young
    Posted November 1, 2015 at 9:54 am | Permalink

    Last week when discussing career objectives with a post-grad student , I learnt that the starting pay for a young doctor was £23,000 . Bearing in mind the length of a doctor’s training , the intelligence and skill level required , the accumulated debt during the period of their training and the cost of accomodation where the education occurs , £23,000 ( if that is the correct figure ) is a very disproportionate sum . Some serious thinking is required in the settlement of this claim .

    • alan jutson
      Posted November 1, 2015 at 12:10 pm | Permalink



      Understand your point, but what you state is the starting rate.

      After a few years of gaining experience, what can a fully Qualified Doctor really earn.

      It is reported that “some” GP’s are getting up to £250,000 per year !

      We hear reported that some Locum Doctors are being paid £2,000 for a single day.

      • Dame Rita Webb
        Posted November 1, 2015 at 3:31 pm | Permalink

        Locums may make a bit but that is without guaranteed hours, holiday pay, a pension etc. The starting rate for a consultant is around £75k. A GP would tell you the £100k pay packet is a load of BS. They get around £75 per patient on their books and that has to pay for everything inc the receptionists wages.

      • Anonymous
        Posted November 1, 2015 at 6:06 pm | Permalink

        Alan – A GP earning £250k a year is very rare and will be a practice partner running a full-on business with staff.

        The £2k-a-day locum is caused by junior doctors quitting to work where pay and conditions are better for them – and doctors opting to work part-time to raise families.

        • alan jutson
          Posted November 3, 2015 at 7:51 am | Permalink


          I agree I have quoted the Higher reported rates, but that was done because Bert chose to highlight the lowest rates.

          Hence the need to balance the argument.

          Dame Rita
          Millions of people do not get guaranteed work hours, like wise they do not get the very large sums that are often paid to Locums.

          What I can never understand is why we cannot produce enough Doctors in our own Country, to work in our Country, why is it we have to import them from abroad, where sometimes the standards are lower than those who we train.

  17. JJE
    Posted November 1, 2015 at 9:58 am | Permalink

    I know that medical staff at the Royal Berks are routinely working twelve hour night shifts without any break during the week and at weekends.

    Perhaps the thoughtful Mr. Hunt might like to visit and share his thoughts with the staff there, say at 03;00 next Saturday?

    Remember there aren’t any private A&E units and very few private maternity units, so you may be disappointed if you think your private health cover insulates you from having to deal with the reality.

  18. MickN
    Posted November 1, 2015 at 10:09 am | Permalink

    The situation cannot change since the National Health Service has become the International Health Service. It also has to cope with over 300,00 more patients every year. No wonder it is bursting at the seams and this is not going to change anytime soon.

    Posted November 1, 2015 at 11:15 am | Permalink

    Pub landlords and landladies possess the highest organisational, ethical and moral standards throughout the planet.It has been the case for so many years that no-one can recall when Weekend Working and pay was a matter of national or even regional debate.

    Why is it necessary for someone as high on the social ladder as Mr Hunt to sort out Junior Doctor work rotas? Why is there a need for him to negotiate?

    In the past when car, coalmine, steel and powerstation workers many of whom worked weekends and crazy hours asked for extra money then their actual wage slips showing their hours and pay were shown frequently on TV and in newspapers.Usually to show how very mean, selfish and greedy they were. Also unpatriotic: “holding the country to ransom”

    Interesting, it is said Junior Doctors are thinking of going abroad to work. But as far as the Labour Party is concerned they already ARE abroad. Since the “NHS would fall apart if it were not for migrant staff” Of course they will not return to Spain or serve under the junta in Portugal.

    The medical staff number required by the USA. Canada, Australia and New Zealand is finite. And guess what guys, Americans and the rest fall ill and have car accidents, take drug overdoses weekends too. And yes, yes, yes their pubs provide a steady stream of casualties at weekends!!!

    • Anonymous
      Posted November 1, 2015 at 6:18 pm | Permalink

      Christopher – Perhaps junior Doctors would be better paid and treated and still here were our governments not so ready to ship in cheap replacements.

      We often here “Our NHS couldn’t manage without immigration”

      Oh yes it could. The general policy of mass immigration means higher accommodation costs with downward pressure on wages – and (I’m afraid) a lower standard in the NHS… seeing as the immigrated medics aren’t sought after by the countries poaching our own (otherwise they’d be going there instead.)

    Posted November 1, 2015 at 12:22 pm | Permalink

    Australian Health Minister, Sussan Ley, is being accused of cost cutting by doctors there. The Australian economy is in decline due to oversupply issues relating to commodities. The American health care systems are also in deep trouble due to failures of ObamaCare and other matters. Canadian doctors especially in the province of Ontario are having their fees cut. Of course they are “threatening to leave”.

    I hear some people believe Spain or Germany healthcare is really good. Despite their no doubt honourable personal experiences, they perhaps should consider finding out in detail just how this is really possible and probable given Spain’s economic position as a whole and Germany’s increasing population unless one assumes German doctors have been sitting around smoking, drinking beer, reading front to back copies of Der Spiegel with nothing to do for the last two decades. ( Not really the way Germans organise things is it )
    So, the lands of milk and honey for Junior Doctors, in reality, are shrinking.
    The British Government could make a killing with our Junior Doctors as it still has a grip on banking. Offer the Junior Doctors relatively cheap long term loans to emigrate somewhere else and then give them in the next 3 years bigger loans with massive interest charges when they return tails and stethoscopes between their legs! But not before they re-sit their medical examinations to test their intelligence and advising them not to take “The Guardian” seriously. A one-off free copy of “The Daily Telegraph” ( still suffering very badly from not having Auberon Waugh on its staff ) would be a sensible and welcome contribution to their further education and mental equilibrium.

    • Anonymous
      Posted November 1, 2015 at 6:12 pm | Permalink

      Christopher – So £23k for a qualified doctor is OK with you, is it ?

  21. Roy Grainger
    Posted November 1, 2015 at 1:37 pm | Permalink

    If as seem likely a significant number of Tory MP vote to oppose and so defeat the relaxation of Sunday trading rules it would by hypocritical to then vote for the NHS to provide extended service on a Sunday wouldn’t it ?

  22. Iain Gill
    Posted November 1, 2015 at 1:52 pm | Permalink

    Sorry John out here in the real world the NHS like immigration is one of those topics where the political and journalistic bubble is completely and utterly out of touch. Real people in the real world are appalled at the rubbish service they are rationed by the worst health service in the developed world. Playing around with it like this is so insignificant given the massive magnitude of the problems with what we have in front of us. We need real radical steps, and that means giving patients buying power in their relationship with healthcare providers. We need to copy from the best of the rest of the world and stop trying to reinvent the wheel. The NHS is one of the worst parts of being in this country its demise couldn’t come quickly enough for me, and indeed if a proper response to the concerns of ordinary people in the waiting rooms up and down the land was put together a massive electoral mandate would be possible for implementing healthcare the way the best countries do it.
    Lansley attempted some reform, but made some fundamental mistakes, he tried to give power to GP’s but replicated PCT’s in all but name as CCG’s, he should have handed power over to patients and realised GP’s are half the problem. Sure hospitals are sub 3rd world at the weekend, but they are hardly better on a weekday.

  23. mike fowle
    Posted November 1, 2015 at 3:57 pm | Permalink

    Earlier this year I read Do No Harm by Henry Marsh, a leading neurosurgeon. It was a fascinating account of his experiences, written with great compassion and unflinching honesty. but he describes a great deal of non-cooperation and animosity between management and consultants. This is probably understandable when you think that we ask surgeons and doctors to back their judgment in life or death situations. It is not surprising if they don’t take kindly to being told what to do, especially when the management directives reflect not what patients want but what is handed down from on high by ministers/civil servants. The professional bodies, the royal colleges etc are trade unions with a 1970s outlook. There is obviously even to this layman something basically wrong when we have to staff hospitals with so many practitioners from abroad. I don’t know what the answer is. It is not in the glib comments we often hear.

    Posted November 1, 2015 at 7:14 pm | Permalink

    The first duty of government as Mr Cameron says is the safety and security of its people. That means food too plus safe and secure accommodation. Failed.

    Massive rent inflation reduces many families to less safe and secure habitable and affordable accommodation. Causes greater commute times.Less to spend on food.

    The statistics point to decreasing food prices. Tell that to the Marines. Those who have a taste for basic processed canned stewed steak have seen it first disappear from from supermarket shelves about 6 months ago when I wrote and asked them why. No reply except theee was a “temporary ” disruption and would be back on the shelves,( hopefully ) around about now, They told the truth but it is well over 25% higher in cost. Daft to buy it.

    Well our TV dieticians, 6 months ago warned against nasty fried fish and chips only to advise an own brand of fried sausages the following week. But now, sausages, bacon and “stewed steak” cause cancer. Hmm. Wouldn’t it be easier for HM Government to tell us the West is selling all the hogs, Beef, Mutton, Lamb, to a growing Chinese population and leaving us to eat nothing but nondescript iffy “beef” burgers and mush that looks like dog meat (even that is mostly ash ). One better, tell us rice…is full of vitamins, amino acids, things that give you an ardent time with the opposite sex, cures after two small portions heart disease, diphtheria, sunburn and chlamydea. Or have I just second guessed the highlights of tonight’s BBC and Skynews Press Reviews?

  • 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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