UKBouldering.com

The end of the NHS. (Read 193467 times)

drdeath

Offline
  • **
  • player
  • Posts: 92
  • Karma: +11/-0
#500 Re: The end of the NHS.
September 30, 2015, 05:25:24 pm
Yup 82,000 in debt, with a training contract that pays 20% less than it did five years ago...

and the promise of a sub-consultant bottleneck, pure service-provision post in a top-down reorganised, target-driven trust where you been 'integrated' with social services so you now answer to a social work manager...

Who could say no to that?


D

fatdoc

Offline
  • *****
  • forum hero
  • Posts: 4093
  • Karma: +100/-8
  • old and fearful
    • http://www.pincheswall.co.uk
#501 Re: The end of the NHS.
September 30, 2015, 10:14:31 pm
nail on the fuckin head there... i have 4 A stream kids.. not one has even thought of medicine as a sensible or viable career..


tomtom

Offline
  • *****
  • forum hero
  • Posts: 20282
  • Karma: +641/-11
#502 Re: The end of the NHS.
October 01, 2015, 07:36:59 am
82k in debt is alot. Medicine is an expensive degree to teach and for your 82k the Govt (and the taxpayer) will have paid 300-500k for your training. So in the UK a junior doctors (and ongoing) salary is going to reflect this debt to some degree.

Before any tea is spat out at the above - its a balance, and pay too little/make working conditions too bad (IE devalue the post), and people will leave after training ASAP to get a better deal elsewhere - leading to a shortage in doctors and therefore the balance is wrong..

Instead of reflecting some sort of balance, I suspect the Govt will next start mooting the idea of some sort of bond/contract making UK trained doctors work in the NHS for a set period of time etc...

*I may have explained the above badly - I disagree with the govts stance on this...

drdeath

Offline
  • **
  • player
  • Posts: 92
  • Karma: +11/-0
#503 Re: The end of the NHS.
October 01, 2015, 08:56:29 am
Indeed,

And the idea that that's a solution is bonkers...

We can't fill the posts as it is, so adding an onerous 'indentured service' clause is really going to drag bright young things into medical training.

I can imagine it now - going out to high schools and career fairs across the country:

'So you are academically in the top tier of your school and are looking for an attractive career with huge potential? Well, do we have a deal for you...we will graciously permit you to study your arse off for five years and then a further grinding few years of on the job training for relatively low wages, and in return we will mandate that you can't leave the country for ten years...literally.

Now, I know what you're thinking - that's too good to be true, where's the catch?

Wait, come back...I haven't finished...what do you mean you are off to the Corporate /Banking/IT/Creative Industries stands...'

Same as Fatdoc above, I would not and will not advise any young people to pursue a career in medicine, at least in this country...I'll fully support them if they decide its for them...but I can't honestly sell it the way it looks like it's headed..


D

GCW

Offline
  • *****
  • forum hero
  • No longer a
  • Posts: 8172
  • Karma: +364/-38
#504 Re: The end of the NHS.
October 01, 2015, 11:37:34 am
I'm getting out as soon as I hone my alternative skills.  GP is shockingly bad at the moment.

Will Hunt

Offline
  • *****
  • forum hero
  • Superworm is super-long
  • Posts: 7976
  • Karma: +631/-115
    • Unknown Stones
#505 Re: The end of the NHS.
October 01, 2015, 12:57:31 pm
And the problem is not just limited to doctors.
A recent ward merge between an elderly and a stroke ward (sounds like a fab idea that, doesn't it?) at the missus' place was driven not because there was insufficient money to fund two distinct wards, but because they simply can't recruit the staff to run them both. I wonder which is more cost effective: to ship in a Spanish nurse whose first language is not English; or to make nursing seem a more attractive prospect to a young school-leaver?

webbo

Offline
  • *****
  • forum hero
  • Posts: 5028
  • Karma: +141/-13
#506 Re: The end of the NHS.
October 01, 2015, 01:53:55 pm
I was a day out for senior nurses in our Trust yesterday about 80 people present and someone asked how many of you are able to retire by 2018. About 55 people stuck their hands up.
That might sort of have impact on the future of the NHS as this is a National issue.

petejh

Offline
  • *****
  • forum hero
  • Posts: 5781
  • Karma: +622/-36
#507 Re: The end of the NHS.
October 01, 2015, 02:40:13 pm
And the problem is not just limited to doctors.
A recent ward merge between an elderly and a stroke ward (sounds like a fab idea that, doesn't it?) at the missus' place was driven not because there was insufficient money to fund two distinct wards, but because they simply can't recruit the staff to run them both. I wonder which is more cost effective: to ship in a Spanish nurse whose first language is not English; or to make nursing seem a more attractive prospect to a young school-leaver?

And if the Spanish nurse has perfectly good English, what then? Because they too would be as cost effective in your example. I imagine.

We're part of Europe, with all the opportunities for working in other countries that the EU brings.

And 'ship in' implies a cargo, not a person with aspirations.

Offwidth

Offline
  • *****
  • forum hero
  • Posts: 1767
  • Karma: +57/-13
    • Offwidth
#508 Re: The end of the NHS.
October 01, 2015, 05:35:33 pm
someone asked how many of you are able to retire by 2018. About 55 people stuck their hands up.
That might sort of have impact on the future of the NHS as this is a National issue.

A lot of public sector pensions are index linked based on past pay. Mine for instance is based on the average of the best three years in the last ten, index linked and hence being at the top of a scale, like a lot of my age group, my pensionable pay is now nearly 20% more than my real pay. There is hence a larger financial incentive to retire early soon, as beyond 2018 the gap between real pay and pensionable pay starts to close. When combined with flat pay for the forseeable future, and ever increasing workloads, and reduced union rights,  the public sector is facing a demographic perfect storm. A classic unintended consequence.

In the meantime if you are a medical student you better not kick up a, fuss.

http://www.theguardian.com/society/2015/oct/01/medical-schools-accused-of-stifling-protest-at-junior-doctors-contract

petejh

Offline
  • *****
  • forum hero
  • Posts: 5781
  • Karma: +622/-36
#509 Re: The end of the NHS.
October 01, 2015, 10:09:47 pm
Quote from: Offwidth link=topic=21748.msg501350#msg501350 date=

In the meantime if you are a medical student you better not kick up a, fuss.

[url
http://www.theguardian.com/society/2015/oct/01/medical-schools-accused-of-stifling-protest-at-junior-doctors-contract[/url]

 :-\  Doesn't read as particularly 'threatening' to me, just practical advice from people who've 'been there done that'.
What are the facts of this new contract? So I can get a clear idea. Rather than the overwhelming sayers of 'nay' on this thread.

For instance - what is the hourly rate for
'Standard time'. And will the new
Contract continue with the 48 hour per week rule?


GPs - 'gatekeeper' roles are under threat everywhere due in part
to the democratisation of information. Media for e.g. That's
not to undervalue the importance of medical care but this isn't 1970 and deference toward GPs and other other gatekeeper professions is at an all time low for a reason.
« Last Edit: October 01, 2015, 10:17:07 pm by petejh »

Offwidth

Offline
  • *****
  • forum hero
  • Posts: 1767
  • Karma: +57/-13
    • Offwidth
#510 Re: The end of the NHS.
October 02, 2015, 08:56:18 am
It's just as if veiled threats are not a common establishment  tool in institutions that are supposed to be bastions of independant thought. Anyhow since information is democratised; if you go to sites run by both sides of the argument you can get the details you asked for. I'd suggest they are not going to help much as they are not the details causing the dispute. My concern is the service already has massive shortages and this sort of contractural brinkmanship is unnecceesary and dangerous.

tomtom

Offline
  • *****
  • forum hero
  • Posts: 20282
  • Karma: +641/-11
#511 Re: The end of the NHS.
October 02, 2015, 09:13:51 am
The govt and media language is often subtle but pervading.

Take this mornings headlines for example "GPs given bonuses to stop referring people for ops" etc.. another way of writing the same headline is "Govt NHS trusts bribing GP's to stop referring people for operations"...

Amazed higher education has not been subject to quite as much devaluation

"two-a-penny Profs spout shit on the internet" - oh..... ;)

psychomansam

Offline
  • *****
  • forum hero
  • Posts: 1179
  • Karma: +66/-11
#512 Re: The end of the NHS.
October 02, 2015, 09:32:07 am
Quote from: Offwidth link=topic=21748.msg501350#msg501350 date=

In the meantime if you are a medical student you better not kick up a, fuss.

[url
http://www.theguardian.com/society/2015/oct/01/medical-schools-accused-of-stifling-protest-at-junior-doctors-contract[/url]

 :-\  Doesn't read as particularly 'threatening' to me, just practical advice from people who've 'been there done that'.
What are the facts of this new contract? So I can get a clear idea. Rather than the overwhelming sayers of 'nay' on this thread.

For instance - what is the hourly rate for
'Standard time'. And will the new
Contract continue with the 48 hour per week rule?


GPs - 'gatekeeper' roles are under threat everywhere due in part
to the democratisation of information. Media for e.g. That's
not to undervalue the importance of medical care but this isn't 1970 and deference toward GPs and other other gatekeeper professions is at an all time low for a reason.
I have to say I agree the email was probably supposed to be encouraging and supportive but was just worded stupidly.
I also would like to know the details of the new contract. I suspect the current situation is as it is for a reason - the government are trying to see how much screwing they can get away with while keeping the media on side. Sadly only the indie and grauniad appear to the care. The BBC appears to be using a barge pole. I have to say I'm increasingly hating bbc news. They are increasingly just the government news outlet. The result of all this probably means quite a lot of screwing over of Dr's.

Could you please explain your cryptic final paragraph?

Offwidth

Offline
  • *****
  • forum hero
  • Posts: 1767
  • Karma: +57/-13
    • Offwidth
#513 Re: The end of the NHS.
October 02, 2015, 10:20:48 am
I've worked with pragmatic aims with some of these buggers who run our august institutions and know many others in my situation. With the odd honorable exception modern VC's are craven when it comes to challenging even some of the most idiotic government policy and are terrified of bad press. If support was intended they could have quickly changed the message. Campaigning on campus used to be a widespread student sport showing intellectual freedom was in rude health; these days things are horribly quiet and the noisy exceptions are sometimes arrested.

Oldmanmatt

Offline
  • *****
  • forum hero
  • At this rate, I probably won’t last the week.
  • Posts: 7097
  • Karma: +368/-17
  • Largely broken. Obsolete spares and scrap only.
    • The Boulder Bunker climbing centre
#514 Re: The end of the NHS.
October 02, 2015, 12:20:29 pm

I've worked with pragmatic aims with some of these buggers who run our august institutions and know many others in my situation. With the odd honorable exception modern VC's are craven when it comes to challenging even some of the most idiotic government policy and are terrified of bad press. If support was intended they could have quickly changed the message. Campaigning on campus used to be a widespread student sport showing intellectual freedom was in rude health; these days things are horribly quiet and the noisy exceptions are sometimes arrested.

Because there seems little spirit in that generation.
The pursuit of minor celebrity on Farcebook/twitter/what ever is far more important.


Sent from my iPhone using Tapatalk

a dense loner

Offline
  • *****
  • forum hero
  • Posts: 7165
  • Karma: +388/-28
#515 Re: The end of the NHS.
October 02, 2015, 12:32:29 pm
And 8a

Offwidth

Offline
  • *****
  • forum hero
  • Posts: 1767
  • Karma: +57/-13
    • Offwidth

petejh

Offline
  • *****
  • forum hero
  • Posts: 5781
  • Karma: +622/-36
#517 Re: The end of the NHS.
October 05, 2015, 03:16:17 pm
Could you please explain your cryptic final paragraph?

Wasn't meant to be cryptic - just have a think about possible reasons why there may be less deference towards the medical profession comapred to 40 years ago, it isn't a difficult exercise. Note I'm not saying there's widespread disregard.


This thread is unbalanced.

In the context of the received wisdom about there not being enough doctors to staff the NHS, has anybody on here mentioned the reports about A&E departments staffed with one-third of expensive agency-hire doctors? And the reported extra £2billion per year figure this is reported to cost the nhs over using normal staff?

Or is that not relevant/untrue?

It seems pretty clear to me that there are enough doctors around in theory, or at least not exactly the shortage that some media portrays. But, like so many other skilled workers in the UK, doctors have acquired the taste for low-comittment high-pay short-term working at greater cost to the client - i.e. the health service.
Seems a bit rich to me to pin all the blame at the door of governemnt policies when a large and very expensive portion of the workforce are acting (quite within their rights) with the sort of monetised motives that defenders of the NHS want to protect it from - private contractors (n this case employment agencies) with profit motives first. That contract looks partly to be a reaction to this, maybe hamfistedly it's hard to tell..

GCW

Offline
  • *****
  • forum hero
  • No longer a
  • Posts: 8172
  • Karma: +364/-38
#518 Re: The end of the NHS.
November 19, 2015, 10:28:59 am
Quote from: Pulse
There has been almost unanimous support from junior doctors for strike action, with a turnout of 76%, the BMA has announced.

The results of the ballot have revealed that 99.4% of junior doctors voted in favour of industrial action short of a strike, while 98% voted in favour of strike action.

aly

Offline
  • **
  • addict
  • Posts: 129
  • Karma: +6/-0
#519 Re: The end of the NHS.
November 20, 2015, 01:47:27 am


In the context of the received wisdom about there not being enough doctors to staff the NHS, has anybody on here mentioned the reports about A&E departments staffed with one-third of expensive agency-hire doctors? And the reported extra £2billion per year figure this is reported to cost the nhs over using normal staff?

It seems pretty clear to me that there are enough doctors around in theory, or at least not exactly the shortage that some media portrays. But, like so many other skilled workers in the UK, doctors have acquired the taste for low-comittment high-pay short-term working at greater cost to the client - i.e. the health service.
Seems a bit rich to me to pin all the blame at the door of governemnt policies when a large and very expensive portion of the workforce are acting (quite within their rights) with the sort of monetised motives that defenders of the NHS want to protect it from - private contractors (n this case employment agencies) with profit motives first. That contract looks partly to be a reaction to this, maybe hamfistedly it's hard to tell..

I disagree with this.
I currently work in an A&E department and yes, a proprotion of the doctors working at any time will be locums but certainly not a third of them, and most of them will be working on the SHO (lower grade junior doctor) rota or occasionally on the middle grade (registrar) rota.  Having said that I don't doubt that in some hospitals and some departments it could reach that level.  Locums are also extensively used through the hospital, to cover on-call shifts on the wards.  Most of this work is on an ad-hoc shift-by-shift basis to cover gaps in the rota and the vast majority of the locums I have worked with are working for 'trust rates'.  That is, they are or have been working for the trust on training programmes, and are contacted directly by the trust to fill the gaps.  From memory the rate for an FY1 locum was ~£20-25/hr at trust rates so not exactly a fortune.  If the hospital cannot fill the gaps they will have to use an agency which costs considerably more.

Now I haven't read up on the figures you mention but I don't doubt that locum doctors cost trusts a lot of money.  I suspect that number is significantly smaller than the amount the NHS spends on locum/bank nursing staff or support workers who are used far more frequently and the hourly rates are not dissimilar than for doctors.

The reason for all these locums?  It is absolutely about a shortage of doctors.   Every department has to recruit a certain number of doctors into training programmes to fill their operational rota and lots of specialties are struggling.  Emergency medicine, GP, psychiatry, even core medical and surgical jobs are going unfilled by trainees which leaves hospitals with big gaps in their rotas.   They either need to get locums to cover the shifts, or not have enough medical cover.  After completing medical school, doctors complete the first two years of their junior doctor career on series of 4-month rotations in different specialties (FY1 and FY2).  These two years come as a 'block' in the same area and the vast majority of posts are filled as you need to complete both years to be fully registered as a doctor and to (realistically) have enough experience to a)work elsewhere and b)know what you want to specialise in.  After these two years you apply to a training programme which could be emergency medicine, hospital medicine, GP training for anything from a further 3 to 8+ years.  It is these post which are simply not being filled, and it's not because of an "'acquired' taste for low-comittment high-pay short-term working".  On the contrary all doctors need to complete such training posts to ever become a consultant/GP and taking time out is ultimately prolonging, and possibly detrimental to, their career.

Doctors aren't filling these posts because they become disillusioned with 2 years of highly stressful work, antisocial hours, countless hours (indeed daily) of starting early and staying late outside your hours, being treated badly by their employers while the government tries to dismantle the health service they're trying to resuscitate around them.  Well I do anyway.  And all for what is really not that much money.  And that's why me and so many of my colleagues are going abroad, compounding the problem further.  And the irony is that I really love the job I'm doing at the moment, and I want to train in emergency medicine but there's no way I can work almost constant night shifts, 60-hour weeks, and most of my weekends for the next 6 or 7 years without it ruining my life.  So the recruitment crisis will continue.

And then the public wonder why we get upset when we're told we are having imposed upon us a pay cut, an increase in those unsociable hours, the removal of the limited protection against us being overworked and multiple other terms detrimental to career progression and equality.

The rota is not a hamfisted way to address these problems with the NHS, it's a calculated move to break the NHS.  By imposing a the contract on junior doctors they will either accept the pay cut/hours increase and the govt wins, or they will leave the NHS is even more fucked.  Then you cap locum rates, and locums will either continue to cover the shifts for a huge pay cut (and the govt wins), or they will go elsewhere and...you see where I'm going here?

Sorry for the rant, I guess I don't really disagree with you that much, but the problem is caused by crap working conditions pushing doctors out of training, which a) makes it worse for everybody else, and b) requires the use of locums to cover the gaps.  We live in a market economy and the only way to retain staff is to give them a lifestyle that they want.  Money isn't the issue for the vast majority of doctors, they enjoy their work, most likely don't even know how much they earn but I think that to say they want 'high pay, low commitment, short term working' does us all a disservice.

webbo

Offline
  • *****
  • forum hero
  • Posts: 5028
  • Karma: +141/-13
#520 Re: The end of the NHS.
November 20, 2015, 10:04:31 am
Good post that.

GCW

Offline
  • *****
  • forum hero
  • No longer a
  • Posts: 8172
  • Karma: +364/-38
#521 Re: The end of the NHS.
November 20, 2015, 11:52:15 am
Quote from: GP Online
Health secretary Jeremy Hunt has rejected the BMA's offer of conciliation talks with the independent arbitration service Acas ahead of planned junior doctor strike action

Hilarity.

lagerstarfish

Offline
  • *****
  • forum hero
  • Weapon Of Mass
  • Posts: 8810
  • Karma: +812/-10
  • "There's no cure for being a c#nt"
#522 Re: The end of the NHS.
November 20, 2015, 12:01:18 pm
The rota is not a hamfisted way to address these problems with the NHS, it's a calculated move to break the NHS.  By imposing a the contract on junior doctors they will either accept the pay cut/hours increase and the govt wins, or they will leave the NHS is even more fucked.  Then you cap locum rates, and locums will either continue to cover the shifts for a huge pay cut (and the govt wins), or they will go elsewhere and...you see where I'm going here?

it'll be interesting to see how low thay can go before doctors from developing countries feel that they'd rather stay in the country where they were trained (and are still needed)

Wood FT

Offline
  • *****
  • forum hero
  • Posts: 2951
  • Karma: +162/-8
#523 Re: The end of the NHS.
November 20, 2015, 12:04:23 pm
Quote from: GP Online
Health secretary Jeremy Hunt has rejected the BMA's offer of conciliation talks with the independent arbitration service Acas ahead of planned junior doctor strike action

Hilarity.

Well, he has been told to be 'deeply muscular' with Doctors by high command

http://www.theguardian.com/society/2015/nov/19/nhs-bosses-pressure-hunt-arbitration-junior-doctors

Quote
“Number 10 sees this as a miners moment and wants him to look tough,”

Footwork

Offline
  • ****
  • forum abuser
  • Posts: 634
  • Karma: +63/-0
  • Living With Wads
    • Living With Wads
#524 Re: The end of the NHS.
November 20, 2015, 12:06:53 pm

The rota is not a hamfisted way to address these problems with the NHS, it's a calculated move to break the NHS.  By imposing a the contract on junior doctors they will either accept the pay cut/hours increase and the govt wins, or they will leave the NHS is even more fucked.  Then you cap locum rates, and locums will either continue to cover the shifts for a huge pay cut (and the govt wins), or they will go elsewhere and...you see where I'm going here?


This.

The awful thing is watching interviews and media reports completely (intentionally?) missing the point and failing to tell the public that their health service they take for granted is being fvcked over by dave and his mates.


 

SimplePortal 2.3.7 © 2008-2024, SimplePortal