[webbo]

I have staff in my Team currently cancelling appointments with patients so that they can do their Information Governance training. Apparently if the Trust doesn't achieve a 95% compliance by the end of the week, they will get a large fine/ reduction in funding.
It's all about improved patient care so they tell me.

[davej]

I have staff in my Team currently cancelling appointments with patients so that they can do their Information Governance training. Apparently if the Trust doesn't achieve a 95% compliance by the end of the week, they will get a large fine/ reduction in funding.
It's all about improved patient care so they tell me.

Same in my dept 40-60% understaffed most days yet we still have to find time to do Information Governance.

[davej]

I have staff in my Team currently cancelling appointments with patients so that they can do their Information Governance training. Apparently if the Trust doesn't achieve a 95% compliance by the end of the week, they will get a large fine/ reduction in funding.
It's all about improved patient care so they tell me.

Same in my dept 40-60% understaffed most days yet we still have to find time to do Information Governance  and other bollocks:wall:

[GCW]

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

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

That's why I find it so amusing that the latter-day saints of our business (1) attribute to me motives that just weren't there, and (2) accuse me of corrupting morality, which I wish I had the power to do.

[lagerstarfish]

I have staff in my Team currently cancelling appointments with patients so that they can do their Information Governance training. Apparently if the Trust doesn't achieve a 95% compliance by the end of the week, they will get a large fine/ reduction in funding.
It's all about improved patient care so they tell me.

Same in my dept 40-60% understaffed most days yet we still have to find time to do Information Governance.

at our place they just set the computers to lock you out unless you do the e-learning (info governance etc)

fortunately, at my level anyway, it's the kind of thing you can pass most efficiently by just redoing the test in rapid succession without doing the learning part

what's the point?

just make sure you get a screen shot of your pass mark - that's all that counts

[psychomansam]

I have staff in my Team currently cancelling appointments with patients so that they can do their Information Governance training. Apparently if the Trust doesn't achieve a 95% compliance by the end of the week, they will get a large fine/ reduction in funding.
It's all about improved patient care so they tell me.

It's about patient care, confidentiality and reputational damage among other things. They are all important issues. Making sure people understand and are regularly reminded of their responsibilities for IG is important. Pre-assessment can reduce the time taken to 10 mins if people already know what they need to. Not a big ask. And it's not bollocks.

As a student, I left things to the last minute. As a student. And for a trust to do that on this week, with major strikes planned, is ridiculous. Cancelling appointments with patients to achieve the compliance levels sounds like a clear a case of poor* planning, probably at numerous levels.

*I suspect the top level planning resulting in the staffing shortages to be intentionally destructive and thus effective rather than poor planning.

[monkoffunk]

“No trade union has the right to veto a manifesto promise voted for by the British people."

What a joke. The "British people" never voted for their butter to be spread so thin that it decided to walk off the plate.

[Offwidth]

Its not a manifesto promise that the Junior doctors are blocking, they are simply a non issue in 7 day working, the extra cost is lost in the noise in the funding gap to achieve genuine 7 day working and other contracts are far more of an issue. Hunt is a lying liar who has lied again. On the subject of porkies, even the £8 billion the government say they will put in to achieve this was exposed as smoke and mirrors by ex minister Laws: the money needed was £30 billion (including mostly efficiency savings that many experts doubt can happen in a huge organisation where inflationary costs routinely exceed standard inflation measures) of which Stevens wanted half up front:

http://www.huffingtonpost.co.uk/entry/nhs-leaned-on-8bn_uk_56ee8229e4b0fbd4fe080b93


One of the junior docs on the bbc news this morning asked the very pertinent question if the new contracts guarantee safer working, why do they need to remove financial penalties from trust breaches and replace this very successful expensive punishment with some vague guardian role.

Then we have the new new costs of GP changes

http://www.theguardian.com/society/2015/jul/24/jeremy-hunts-seven-day-plan-for-gp-surgeries-could-cost-nhs-3bn-a-year

Are all these uncertainties in estimating the real costs of 7 day working real, or are the potential tens of billions involved and almost impossible gap filling in recruitment of new consultants (where will they all come from ffs??) political game changers.

http://www.nhsconfed.org/resources/2014/01/what-are-the-financial-implications-of-seven-day-working


Even the £1-2 billion numbers quoted from the 'government' side would be better spent elsewhere according to researchers:

http://www.manchester.ac.uk/discover/news/resources-needed-for-the-seven-day-nhs-services-may-be-better-spent

https://aheblog.com/2015/06/04/the-economics-of-a-7-day-nhs/

and a conservative MP health expert

http://www.telegraph.co.uk/news/nhs/12015006/The-seven-day-NHS-is-a-dangerous-obsession-until-we-fix-social-care.html

... finally, does anyone else here smell a rat that this dispute looks so impossible to solve that the right wing desire of local contracts will become the 'only possible solution'??

[webbo]

I have staff in my Team currently cancelling appointments with patients so that they can do their Information Governance training. Apparently if the Trust doesn't achieve a 95% compliance by the end of the week, they will get a large fine/ reduction in funding.
It's all about improved patient care so they tell me.

It's about patient care, confidentiality and reputational damage among other things. They are all important issues. Making sure people understand and are regularly reminded of their responsibilities for IG is important. Pre-assessment can reduce the time taken to 10 mins if people already know what they need to. Not a big ask. And it's not bollocks.

As a student, I left things to the last minute. As a student. And for a trust to do that on this week, with major strikes planned, is ridiculous. Cancelling appointments with patients to achieve the compliance levels sounds like a clear a case of poor* planning, probably at numerous levels.

*I suspect the top level planning resulting in the staffing shortages to be intentionally destructive and thus effective rather than poor planning.

As Lagers says you can usually pass it without doing the learning. So despite it being important in the way you describe above, it is set at level which has no value to anyone. So everyone forgets about it and gets on with seeing patients.

[Will Hunt]

I appreciate Sam's point and agree that a certain amount of corporate bollocks and training is useful and necessary in a large organisation - though not when it is poorly managed. I'm not sure if I've mentioned this on here before but Webbo's final point is actually quite illustrative of why I think the NHS actually works:

So everyone forgets about it and gets on with seeing patients.

All the people (the good ones anyway, there's plenty of shite people in the NHS) are completely focussed on the patient and get the job done in spite of the management, not because of it.

[lagerstarfish]

what we need is a 5 minute Victoria Wood and Julie Walters sketch explaining the Caldicott principles in an amusing way with hilarious examples

everyone would enjoy watching it and would remember it for years

[slackline]

Good speech

[monkoffunk]

Its not a manifesto promise that the Junior doctors are blocking, they are simply a non issue in 7 day working, the extra cost is lost in the noise in the funding gap to achieve genuine 7 day working and other contracts are far more of an issue. Hunt is a lying liar who has lied again.

I agree. And we aren't asking for anything extra, just the status quo, and that's bad enough! It's not surprising that doctors were targeted, the Tories are working their way through the whole public sector. And yes, other contracts will be next. It's got nothing to do with a 7 day NHS, it's the Tories economic policy.

[Offwidth]

what we need is a 5 minute Victoria Wood and Julie Walters sketch explaining the Caldicott principles in an amusing way with hilarious examples

everyone would enjoy watching it and would remember it for years

I'm sympathetic to the importance of such training but how does that square with such dull time consuming material often so badly scheduled and that a moron could pass. Such things eat away at the soul. Victoria Wood would have been a lovely touch, preferably with music from Prince and Bowie.

[Fultonius]

The way (c)unt and the rest of the "government" are behaving to me only means one thing - Hunt has been appointed to dismantle the NHS, come hell or high water he'll have full government backing. Why? Because he's probably been offered a peerage in the future with a few well paying exec roles on the board of healthcare providers.

"weather the storm Jeremy, and all will be repaid"

[rich d]

Jeremy Hunt was co author of this http://www.theguardian.com/politics/2009/aug/16/tory-mps-back-nhs-dismantling back in 2009. Seems the perfect person to then put in charge of the NHS 

[GCW]

If anyone is interested in history, I (re-)commend to you "NHS SOS" as a read.

[slackline]

[Lund]

Despite a feeling that I'll be going against the wind here, and apologies if I missed the answer, but I'm really struggling to understand what this is all about.  Pete JH keeps trying to wield Occam's razor, and not really getting anywhere, but I guess it's worth a go...  humour me, perhaps I'm stupid.

I want facts only - and as little politics as possible...

* The Tories want a 7-day NHS.  That is, they want non-emergency cover to be available on saturday and sunday too.

* They are starting with junior doctors.  They'll need to do it for the rest (technicians etc.) too, but have started with junior doctors.

* They want the new junior doctors contract to be cost neutral.  Justification for this is that the overall number of patients seen will not increase - people can take a sunday appt instead of taking time off on a friday, for example.

QUESTION 1: IS THIS WRONG?  IF IT IS WRONG, WHY?  WHY WILL THE OVERALL WORKLOAD INCREASE?

* In order to do this, it's very complicated, but essentially doctors will have to swap a shift during the week for one at the weekend.

* There were arguments about not working too many hours, and lots of other things.  During the talks over the winter, the BMA and the government agreed on all of these things.

* The one remaining piece of disagreement between the BMA and the government was saturday pay.  The BMA want it to go up; the government don't.

QUESTION 2: ARE THE PREVIOUS TWO BULLETS CORRECT?  IF NOT, WHAT IS IT ACTUALLY ABOUT?  WHAT SPECIFIC POINTS ARE STILL REMAINING IN CONTENTION?

That's it.  I'm not interested in privatisation, Jeremy Hunt being a cunt, Tory vs. Labour, whether Labour started it in 2002, or whatever, just the things above...  Neither do I care if you are for or against doctors salaries going up, or whatever.... we can talk about that after if necessary...   Just some answers to a couple of questions... that's all...

Can someone please answer the above?

[36chambers]

Does this help in any way?

[monkoffunk]

* The Tories want a 7-day NHS.  That is, they want non-emergency cover to be available on saturday and sunday too.
* They are starting with junior doctors.  They'll need to do it for the rest (technicians etc.) too, but have started with junior doctors.
* They want the new junior doctors contract to be cost neutral.  Justification for this is that the overall number of patients seen will not increase - people can take a sunday appt instead of taking time off on a friday, for example.

The concept of full 7 day services are certainly laudable. To suggest this can be done in a cost neutral way is ridiculous. It will be hugely expensive to fully extend services. Patients seen will undoubtedly increase. Do you expect that clinics on a Wednesday will suddenly not be fully booked? That there will be empty operating theatres with nothing to do? Services are pushed to breaking as it is, and the population is getting older and more sick. Advances in medicine are hugely increasing the size of the population living with chronic illness. Pressures are increasing all the time. Increase the number of appointments/elective theatre slots and patients will rapidly fill them. Maybe waiting lists will reduce initially, but doctors taking it easy during the week to make up for Saturday clinics? No way. On that point, taking doctors away from the week day shifts to put them on the weekend will pressurise rotas further and already there are gaps in many specialties (particularly acute services such as A+E). Regardless of the debate over pay, I don't think it unreasonable to be unhappy with the idea of working more weekends for no pay increase, but it seems highly likely that pay will go down. This does not seem fair, but really its not what this is about. The sort of sample rotas we are seeing which spread doctors around to cover these extra shifts look like they have been written with someone with no clue what it means to work outside of 9am-5pm. It looks almost intended to induce a state of perpetual jet lag. The government clearly know this is an issue and that rotas will be disruptive to any form of work life balance. Their own equality assessment confirms this. They accept that the new contract will discriminate against women, but do not seem overly concerned by this. Its likely the situation will then worsen as doctors quit the profession and go abroad. This isn't idle speculation, I already know doctors who will be off to work for banks from August and others seriously looking into options in Canada and Australia, who never planned to leave the country.

Further background: http://www.bma.org.uk/working-for-change/doctors-in-the-nhs/seven-day-services

http://www.independent.co.uk/news/uk/politics/junior-doctors-outraged-over-new-contract-that-discriminates-against-single-women-a6963356.html

"Doctors have reacted furiously after the Government’s own impact assessment of the new junior doctor contract said any “adverse effect” impact on women’s pay was a “proportionate” means to an end.
The Department of Health’s Equality Impact Assessment of the controversial new contract, which was published in full this week, found that aspects of the new contract would “impact disproportionately on women”, with particular disadvantages for single mothers. "

http://www.theguardian.com/society/2016/apr/28/equality-watchdog-warns-junior-doctors-contract-potentially-illegal

* The one remaining piece of disagreement between the BMA and the government was saturday pay.  The BMA want it to go up; the government don't.

Give me a moment will get back on this one...

[Lund]

Does this help in any way?

No.  It's partisan.

[i.munro]

That's it.  I'm not interested in privatisation,
Can someone please answer the above?

Then nobody can answer as this is entirely driven by the desire for privatisation.

[duncan]

Despite a feeling that I'll be going against the wind here, and apologies if I missed the answer, but I'm really struggling to understand what this is all about.  Pete JH keeps trying to wield Occam's razor, and not really getting anywhere, but I guess it's worth a go...  humour me, perhaps I'm stupid.

I want facts only - and as little politics as possible...

* The Tories want a 7-day NHS.  That is, they want non-emergency cover to be available on saturday and sunday too.

* They are starting with junior doctors.  They'll need to do it for the rest (technicians etc.) too, but have started with junior doctors.

* They want the new junior doctors contract to be cost neutral.  Justification for this is that the overall number of patients seen will not increase - people can take a sunday appt instead of taking time off on a friday, for example.

QUESTION 1: IS THIS WRONG?  IF IT IS WRONG, WHY?  WHY WILL THE OVERALL WORKLOAD INCREASE?

There are three linked variables: cost, quality, and flexibility (“choice” is the government's buzz-word for the latter). Cost: the NHS is cheap by affluent western standards. Quality: health outcomes are middling-good. Consequently NHS cost-effectiveness is probably the best amongst affluent western countries. High cost-effectiveness is achieved through a relatively inflexible system: waiting times, no 24/7 access to non-emergency care. Greater flexibly means less efficiency: if you are offering a choice of appointment times there has to be some slack in the system. Making things a little awkward for people also has a filtering effect and reduces demand.

The NHS also has good staff buy-in to the idea of a fair system for all, even if it isn't. Extra voluntary hours helps efficiency.

If you increase the flexibility of a service demand will go up so it either has to cost more or quality goes down for the same cost. This is irrespective of political hue: French healthcare has more flexibility, slightly better quality but costs more and is less cost-effective. US private healthcare is slightly more flexible still and slightly higher quality at double the cost and is much less cost-effective. Hunt says he wants to increase flexibly with no increase in cost or deterioration in quality. This simply can't be done.

If you piss-off your staff, efficiency deteriorates.

[Lund]

* The Tories want a 7-day NHS.  That is, they want non-emergency cover to be available on saturday and sunday too.
* They are starting with junior doctors.  They'll need to do it for the rest (technicians etc.) too, but have started with junior doctors.
* They want the new junior doctors contract to be cost neutral.  Justification for this is that the overall number of patients seen will not increase - people can take a sunday appt instead of taking time off on a friday, for example.

The concept of full 7 day services are certainly laudable. To suggest this can be done in a cost neutral way is ridiculous. It will be hugely expensive to fully extend services. Patients seen will undoubtedly increase. Do you expect that clinics on a Wednesday will suddenly not be fully booked? That there will be empty operating theatres with nothing to do? Services are pushed to breaking as it is, and the population is getting older and more sick. Advances in medicine are hugely increasing the size of the population living with chronic illness. Pressures are increasing all the time. Increase the number of appointments/elective theatre slots and patients will rapidly fill them. Maybe waiting lists will reduce initially, but doctors taking it easy during the week to make up for Saturday clinics? No way. On that point, taking doctors away from the week day shifts to put them on the weekend will pressurise rotas further and already there are gaps in many specialties (particularly acute services such as A+E). Regardless of the debate over pay, I don't think it unreasonable to be unhappy with the idea of working more weekends for no pay increase, but it seems highly likely that pay will go down. This does not seem fair, but really its not what this is about. The sort of sample rotas we are seeing which spread doctors around to cover these extra shifts look like they have been written with someone with no clue what it means to work outside of 9am-5pm. It looks almost intended to induce a state of perpetual jet lag. The government clearly know this is an issue and that rotas will be disruptive to any form of work life balance. Their own equality assessment confirms this. They accept that the new contract will discriminate against women, but do not seem overly concerned by this. Its likely the situation will then worsen as doctors quit the profession and go abroad. This isn't idle speculation, I already know doctors who will be off to work for banks from August and others seriously looking into options in Canada and Australia, who never planned to leave the country.

This is the key bit really.  You can't have some of this as part of your argument directly as it doesn't make the razor: yes, it's relevant, but it's not ONLY relevant.  Increasing pressures on the NHS as a result of increasing demands on the increasing population will happen with or without a seven-day NHS - unless the seven day thing makes it worse... because all the doctors fuck off to Oz... don't get me started on that, Oz is not all that as many will discover... but that's a different topic too.

Now you could have an argument that said at present, patients cannot get an appointment.  At the moment they would go on a waiting list, and one that is eternally growing longer and longer as there are not enough appointments - i.e. supply is lower than demand and remains so overall.  I don't think waiting lists are getting longer and longer?  (Yes there are peaks and troughs?)  Or is this not the case?  But in any event: this too doesn't make the razor...

... the "same cost" thing works if and only if there are the same number of appointments overall.  Keeping the same number of hours worked per doctor the same (another thing I hear is agreed) = the same number of appointments overall?  This is why I don't understand the argument that changing to a model that has doctors available on a saturday and a sunday as well as M-F *increases costs* (unless you pay more for doctors to work saturday and sunday which is quite the point).

The fundamental thing I'm not getting though is really about the appointments and the hours and whether or not the move to seven days is in fact asking doctors to see more patients, or just to the same number of patients all week?

I get the rest.  There is loads of interesting stuff there.  The penalising women thing - at first glance I don't agree with that, sorry, because it's OK for Dad's to get fucked but not Mum's?  What about Mum being able to work weekends when Dad is about instead because she can choose saturday shifts?  But we should leave that for the time being and I may well be missing something.  Just like we should also leave the fact that A&E is surely stuffed at the moment because nobody chooses a speciality where you have to work regular, 12 hour, unsociable shifts... it's much easier to be a single body part doctor M-F....

I guess the summary is: in the sample rotas, compared to the rotas now, are there more hours worked, or the same?