[galpinos]

So saying 'staffing levels mirror patient spread' isn't telling you much at all - it's like the owner of a  shop that has never opened on Saturdays saying 'we don't ask our staff to work on Saturdays, in fact we don't open, because people aren't queuing up outside'.

I seem to remember when the GPs trialed weekend appointments they only had a take up of about a third, despite being fully booked through the week.

I would say, as did the research that Mr Hunt is basing his plan on, is that there IS a requirement for more doctors in SOME areas over the weekends, but the more important changes would be to have the full suite of support services available, i.e., scans, bloods, various analysis etc so the hospital can actually offer a full diagnostic service instead of keeping people alive until Monday. I see no reason to have knee replacements and the like on a Sunday.

What has baffled me is that there seems to be no provision in Hunt's plan to up the number of doctors. If the same number of doctors spread them selves over the weekend, doing similar shifts as they previously did through the week, there will either be fewer doctors available in the week or they'll have to work more hours, which, when the average week is 60+, doesn't seem a great idea.

[mrjonathanr]

If the endgame is public dissatisfaction to the extent that any improvement, including prvatised services, will be welvome it makes perfect sense to overstretch capacity.

[Wood FT]

So saying 'staffing levels mirror patient spread' isn't telling you much at all - it's like the owner of a  shop that has never opened on Saturdays saying 'we don't ask our staff to work on Saturdays, in fact we don't open, because people aren't queuing up outside'.

What has baffled me is that there seems to be no provision in Hunt's plan to up the number of doctors. If the same number of doctors spread them selves over the weekend, doing similar shifts as they previously did through the week, there will either be fewer doctors available in the week or they'll have to work more hours, which, when the average week is 60+, doesn't seem a great idea.

If the endgame is public dissatisfaction to the extent that any improvement, including prvatised services, will be welvome it makes perfect sense to overstretch capacity.

  So obvious

[GCW]

I get the end game. What I don't get is how they expect to run it with far fewer doctors.

[Oldmanmatt]

I get the end game. What I don't get is how they expect to run it with far fewer doctors.

A crisis in numbers, leads to "Agency" supply of cheaper (ie non-British trained) Doctors and, after all, if the "Agency" is supplying and recruiting already; why not let them run the provision too?
You know what? We could even lease them the buildings, they'd be paying us!
All we have to pay for is the care package, no managers, no doctors, no nurses, no support staff, no pensions, no training hospitals (we'll keep a couple of really high fee institutions of course for our spare heirs).

If your doctor is over worked, under qualified or dangerous; it's not our fault it's the agency.

I'm sure all the opening bids will be so low, it will be too good to be true.
The renewal might go up a bit, maybe.

Anyone have an idea how many MPs/ Ministers are already heavily invested in Nursing agencies?


Sent from my iPad using Tapatalk

[slackline]

If the endgame is public dissatisfaction to the extent that any improvement, including prvatised services, will be welvome it makes perfect sense to overstretch capacity.

I'm sure I've posted this before....

Anyone have an idea how many MPs/ Ministers are already heavily invested in Nursing agencies?

I'm sure its a rhetorical question but just in case anyone was in any doubt...

The Guardian : Companies with links to Tories ‘have won £1.5bn worth of NHS contracts’ - Unite research claims 24 MPs and peers who backed health reforms have links to 15 private healthcare companies

The Wall Street Journal : How the House of Lords mixes business and pleasure

The Mirror : 1 in 5 Tory MPs have links to private firms that could profit from NHS privatisation

[webbo]

Will it end before March 16th this year. If so I'd better get another sick note.

[Oldmanmatt]

If the endgame is public dissatisfaction to the extent that any improvement, including prvatised services, will be welvome it makes perfect sense to overstretch capacity.

I'm sure I've posted this before....

Anyone have an idea how many MPs/ Ministers are already heavily invested in Nursing agencies?

I'm sure its a rhetorical question but just in case anyone was in any doubt...

The Guardian : Companies with links to Tories ‘have won £1.5bn worth of NHS contracts’ - Unite research claims 24 MPs and peers who backed health reforms have links to 15 private healthcare companies

The Wall Street Journal : How the House of Lords mixes business and pleasure

The Mirror : 1 in 5 Tory MPs have links to private firms that could profit from NHS privatisation

.

Nope, genuine question, thanks. [emoji3]


Sent from my iPhone using Tapatalk

[psychomansam]

I get the end game. What I don't get is how they expect to run it with far fewer doctors.

A crisis in numbers, leads to "Agency" supply of cheaper (ie non-British trained) Doctors and, after all, if the "Agency" is supplying and recruiting already; why not let them run the provision too?
You know what? We could even lease them the buildings, they'd be paying us!
All we have to pay for is the care package, no managers, no doctors, no nurses, no support staff, no pensions, no training hospitals (we'll keep a couple of really high fee institutions of course for our spare heirs).

If your doctor is over worked, under qualified or dangerous; it's not our fault it's the agency.

I'm sure all the opening bids will be so low, it will be too good to be true.
The renewal might go up a bit, maybe.

Anyone have an idea how many MPs/ Ministers are already heavily invested in Nursing agencies?


Sent from my iPad using Tapatalk

Levels of medical staff are at crisis levels in various areas already. Agency staff are more expensive, but are used as a last resort, required due to a huge lack of doctors being trained up. Yes, we have retention issues, but we're still taking far more in than we're losing. We're just not training nearly enough, haven't been for a long time, and can't even fix that in the term of any government coming in to replace the tories. (5 years to train a doctor. Another 5 to have them trained into any specific specialty.) We need to invest in training. In the meantime, we're attempting to plug gaps with Advanced Nurse Practitioners and Physicians Associates, with mixed results.
Still, if you know any Biomed, Biology or similar graduates looking for a worthwhile career, tell them to look into PA courses.

But yes, gap-filling rather than solutions. Privatisation of staffing to create a flexible (though more expensive) workforce. Enforced financial destruction of trusts. And I'm currently asking a trust for something essentially amounting to £1m of funding. Wish me luck. 

Lots more to be said, but...

[GCW]

[Wood FT]

Never mind all those sensible questions, these money grabbing fizz guzzling doctors want to kill my gran on a sunday!

[Oldmanmatt]

I think, the stats tend to suggest "Granny" did something to herself that caused her to die within 30 days, or "people fuck themselves up at weekends" and doesn't have any bearing on or draw any causation from; treatment received.



I admit, Mark is a Zoologist, so not sure if he can read anything not written in Latin.


Sent from my iPad using Tapatalk

[webbo]

As much as the current situation with the junior doctors will likely bring the end of the NHS here are a few other examples that may speed its demise.
A trust employs a new chief executive so they want a new management structure. They employ an interim Nurse Director through an agency they are paid £30,000 a month for 8 months.
 A trust decides it needs more lower level managers as in it recent restructuring it got rid of them so they offer staff secondments on a pay scale of up to £40,000 per annum. These are staff currently paid £30,000. In order for one staff member to take up the secondment they employ agency staff to cover his old post costing £60,000 per annum.

[Footwork]

They just don't have a fucking clue do they

[webbo]

I'm currently off sick due to my ruptured Achilles. My manager wants to do some work from home which is ok.
When she rings me she tells me she has offered the secondments mentioned above and the job title is team leader. I say hang on a minute that's my job, it sounds like you given my job to someone while I'm on sick. When I said I would be speaking to the union she accused me of being paranoid
When I see the job description for the new posts it turns out to be my old job description from 12 months ago when I got put at risk and had to move to my current job as they no longer needed those posts.
It's a classic case of new manger and someone brought in as a consultant to transform services both of whom have no idea about the history of the service.
I'm sure this will not be unique to my area of work.

[GCW]

Interesting survey and discussion.

[GCW]

Interesting back story

There are some who would rather see the junior doctors’ contract dispute as a straightforward workplace dispute about terms and conditions (1). Others see it is as a key battlefront in efforts to save the NHS. If the battle to destroy/save the NHS can be likened to a chess match, then the junior doctors’ contract dispute marks the beginning of the 'end game' and its outcome will determine the survival of the NHS. 

In 2010, KPMG’s head of global health stated that ‘in the future, the NHS will be a state insurance provider and not a state deliverer of healthcare’ and that the 'NHS would be shown no mercy' (2). If we are not careful, the battle to save the NHS as the dominant provider of universal healthcare is about to be lost. The three stages of this battle are/were as follows:
 
The Opening Game:

The creation of an internal market within the NHS (2002) was an apparently benign opening gambit, followed by a much needed but poorly thought out hospital building programme. The PFI intiative was worth £12 billion but turned out to be a hopelessly expensive mortgage that would eventually cost the NHS £80 billion in repayments (3).

Once elected in 2010, the present government began an expensive top down NHS reorganisation, dismantling PCTs (Primary Care Trusts) while appearing to hand over power to GPs in the form of CCGs (Clinical Commissioning Groups). This poisoned chalice would come into play during the end game.

In 2012, the Health and Social Care (HSC) Act removed the Secretary of State’s legal obligation to provide healthcare for everyone and meant that the NHS became subject to EU Competition law. This compelled CCGs to invite bids for ALL health services from ALL willing providers, leading to a free market based system where expensive tendering processes would consume much of the CCG budgets and time. The architect of this act, Andrew Lansley, now works for Bain and Company to ‘improve its odds of gaining access to £5.8 billion of NHS work that is commissioned to the private sector’ (4).

To add insult to injury, NHS funding almost froze after 2010 (rising by only 0.7% per year compared to the long term average of 3.7% per year). ‘Efficiency targets’, a pseudonym for funding cuts, brought NHS hospitals to their knees. Significant cuts in social care and district nursing budgets as well as the privatisation of NHS 111 led to increasing hospital activity and a critical shortage of hospital beds. As a percentage of GDP, UK healthcare spending (8.5% of GDP) fell even further below the average for OECD countries (below Slovenia and Finland) (5).

The Middle Game:

As predicted by many (see my ‘election plea’), the flavour of the contest changed after the 2015 election and the government chose to directly attack frontline staff. On 16 July 2015, the Health Secretary Jeremy Hunt declared that ‘6000 people lose their lives each year because we do not have a proper 7 day service in NHS hospitals’ and that ‘by the end of this parliament, the majority of hospital doctors will be on 7 day contracts’ (6). The implication was that hospital consultants were opting out of weekend work (later proven to be a wildly exaggerated claim), being overpaid if they did work weekends, and directly responsible for excess patient deaths. He also accused doctors of lacking a sense of vocation and professionalism. For reasons that are not clear, his attack then shifted onto junior doctors (consultants should not assume that we are off the hook). In a ‘shock and awe’ approach, the government has also removed training bursaries for student nurses.

Weekend mortality data was distorted (7) to justify what the government described as a ‘7 day NHS’. No mention was made of world class 24/7 emergency services that the NHS already provides and it is still not clear what the government means/meant by a ‘7 day NHS’. Provision of elective (non-emergency) services over 7 days instead of 5 would require a 40% increase in resources (at an extra cost of £900 million), yet the government insists on a ‘cost neutral’ approach that would stretch existing 5 day resources over 7 days.

At the same time, significant amounts of money were being spent on a number of chaotic, poorly thought out vanity projects including the creation of a ‘paperless NHS’.

By this stage of the contest, the ‘save the NHS’ camp was/is on the backfoot (Did I mention that the line between middle and end game is blurred?).
 
The End Game:

This stage of the contest probably began a while ago but media attention has been poor if not misleading, and most of us have been kept in the dark.

With CCGs struggling to cope, CCG support services run by companies like KPMG, McKinsey and US health insurer United Health will now carry out many of the ‘back office’ jobs (eg. the design of future services), previously done by the NHS for the NHS (.

Following the HSC Act 2012, 40% of CCG contracts (worth £3.54 billion) have been awarded to private healthcare companies (compared to 41% awarded to the NHS) (9). This figure is set to increase to £20 billion over the next few years. Note at this point that private healthcare must cherry pick profit making services (for example, elective hip replacements rather than emergency trauma surgery; they have a legal obligation to their shareholders to do so) while the NHS is left to provide less profitable services.

When TTIP (an EU US trade deal) goes ahead at the end of the year, many of the above changes may become irreversible (according to Michael Bowsher QC, a former chair of the Bar Council’s EU law committee) (10). US healthcare companies have already begun to invest heavily in UK facilities (11).

To make things worse, the PFI burden is only just about to kick in for many NHS trusts. Annual PFI repayments will peak at £2.7bn in 2029/30. 

According to Professor Keith McNeil, former CEO of Addenbrooke’s Hospital, the ‘only thing holding NHS together now is the dedication, passion, commitment of frontline workers’. This is precisely why the junior doctors’ contract is such an important battlefront and why we should resist attempts to break the backbone of acute and elective NHS care. If the government imposes the current contract, recruitment and retention of high quality junior doctors to provide 24/7 care will become even more of a challenge. It doesn't take a rocket scientist to work out that patient safety will be compromised by this contract.

In many ways, shifting the attack from consultants to junior doctors after July 2015 was an error of judgement by government in this fight, a single mistake in what has otherwise been a powerful ‘shock and awe’ onslaught. The government underestimated the courage and political will of 54,000 junior doctors, and the conflict has highlighted the looming threat to the entire NHS.   

Anyone who says that the junior doctors’ contract dispute has nothing to do with saving the NHS is at best missing the whole picture, at worst cheering for the wrong team. In the ongoing battle to save the NHS, we should all be supporting junior doctors and at the very least hope for a draw. A check mate would be a huge but unlikely bonus.
 
Vinod Achan is a Consultant Cardiologist at a well known NHS Foundation Trust

[Fultonius]

Does anyone else get the feeling this is all "hidden in plain sight"? It's as if we can:1) see what's happened, 2) easily predict what's going to happen and 3) do fuckall about it.

Powerless. Fucking referendum on the EU but we let those shower of self-serving, smug arrogant pricks decide things like this for us. 

[Footwork]

So details of the new Junior Dr Contract has emerged. Here's the section that has been causing a bit of controversy:

"Any indirect adverse effect on women is a proportionate means of achieving a legitimate aim. Whilst this may disadvantage lone parents (who are disproportionately female) due to the increased cost of paid childcare in the evenings and weekend, in some cases this may actually benefit other women, for example where individuals have partners, it may be easier to make informal, unpaid childcare arrangements in the evenings and weekends than it is during the week due to the increased availability of partners and wider family networks at weekends and in the evenings"

Are the DoH complete fuck nuggets.

What if your family live many hours away or don't even live in the country anymore? What about single Dads and actually seeing your kids? This coming after the DoH saying that 7-10pm and Saturdays are not classed as anti social working hours.

f&*@ing Tory w&@$ers 

[a dense loner]

Eh? I don't understand your rage? Nor do I understand why that section has caused any controversy? Why is it even in there? None of that has any relevance to anything?

[GCW]

The DoH have effectively said that the contract hits certain groups more, in a way that is "disproportionate" but justified. Women quite rightly realise that it will affect single parents more.

[petejh]

How could it hit single parents less?

Being a single parent hits work/income more, there's a non-headline.

[GCW]

It's the governments own assessment. If you aren't full time you have a disproportionately higher loss of income with the new contract, ie pro rata pay is less than full time.

Brief article.

[GCW]

More filtering out.

http://www.theguardian.com/society/2016/apr/01/female-doctors-new-contract-medical-royal-colleges?CMP=Share_iOSApp_Other

https://www.rcplondon.ac.uk/news/rcp-and-rcs-joint-statement-publication-junior-doctors-contract-and-equality-analysis

Any indirect adverse effect on women is a proportionate means of achieving a legitimate aim

[Oldmanmatt]

Is this not the most fucking desperate act of twatishness you've ever heard of?

I Know Che was a Doctor, but ffs.

Junior doctors' leaders 'trying to topple the government'
http://www.bbc.co.uk/news/health-36126740


Sent from my iPhone using Tapatalk