[GCW]

Sorry, I've not had time to dig the other references out.
The increased availability of access to GP has been shown to increase referral number though, and thus increases elective care work.

access to junior doctors is protected by e.g. referrals by GPs.

It's not a major point.

Except for all inpatients, urgent admissions and A+E attendances which are usually dealt with by juniors.

Let's not forget that a "junior" is anyone from straight out of Uni to people in late 30s/ early 40s who will start a consultant post in August!!

[monkoffunk]

Isn't that about GPs and A&E - not "elective" junior doctor type stuff?

What does this mean? Quite a confusing statement!

GCW was talking about a paper showing that increased availability of A&E and GP meant increased load - i.e. more people.  I was contending that the paper wasn't obviously relevant to the junior doctor, elective stuff discussion - because you can't just rock up to get an elective procedure: access to junior doctors is protected by e.g. referrals by GPs.

It's not a major point.

I guess I was just confused as I wasn't sure if you were equating junior doctors with elective work, "elective junior doctor type stuff" doesn't make sense to me. Obviously junior doctors do elective work, but most complex elective work and clinics are still consultant lead. There are junior doctors who are GPs, and junior doctors in A+E. At night the most senior doctor in A+E will be a junior doctor.

Anyway we have an increasing workload, without more availability of GPs or A&E docs. Plenty of problems and people out there waiting to fill the gaps in any expanded services!

[GCW]

It just gets more ridiculous!!

Jeremy Hunt promises to push ahead with seven day, 8-8 GP opening.
Almost half of the Challenge Fund/GP Access pilots have already reduced opening hours, amid lacking patient demand and uncertainty over future funding.
NHSE state 7 day GP access plans should be ditched.

Jeremy Hunt states juniors contract should be imposed due to weekend effect.
Studies published in Journal of Health Services Research and Policy and two in the Lancet suggest weekend effect is a fallacy.

Jeremy Hunt continues to promise a true 7 day NHS.
The Public Accounts Committee criticizes government plans, stating they are "completely uncosted" and contain"serious flaws".

In a highly critical report on NHS staffing levels, the influential Public Accounts Committee found that pressure on hospitals to save money was already leading to shortfalls on wards, and called for an urgent review of the size of the clinical workforce in England.

The militant buggers at the BMA once again state their polarised views. 

The BMA is clear that patients should have access to the same high quality of care, seven days a week, but if the Government wants more seven-day services, then it must finally answer the question asked by doctors, senior NHS leaders, medical royal colleges and now the Public Accounts Committee: how will it staff and fund them?

Jeremy Hunt's NHS plans for increasing staffing are clearly working too.

There are 300 vacancies for F1 training posts in England this year after they were oversubscribed in 2014 and 2015, which doctors’ leaders have blamed on the ongoing dispute over the junior doctor contracts.

Health Education England is advertising 300 places for Foundation Year training beginning in July, which were unfilled by graduates from English medical schools.

It's all good 

[petejh]

It just gets more ridiculous!!

Jeremy Hunt states juniors contract should be imposed due to weekend effect.
Studies published in Journal of Health Services Research and Policy and two in the Lancet suggest weekend effect is a fallacy.

It doesn't matter how many bold typeface headlines you create GCW, the weekend effect studies authors are contradicting each other and that says to me that none of them should be taken at face value or used for headline-grabbing spinning for political ends.


It sounds grand and convincing to the layperson, when 'Prof xyz of medical institution abc' is reported in the media saying his study shows 'the weekend effect doesn't exist'....
Until his counterpart, 'professor efg of 'medical institution jkl', completely contradicts him and says the study is flawed, and that his study shows 'the weekend effect does exist'... Which is what happened yesterday on R4 with the latest weekend mortality studies you just mentioned.


It's about money and power on both sides of the argument as well as patient safety.

Fairly balanced editorial here

[slackline]

Fairly balanced editorial here

I wouldn't hold out for the weekend elective service you're keen on though...

There is a real argument for improving the weekend service, but at a cash-strapped time when beneficial treatments are rationed, there is also an obligation to ask whether this is the best use of scarce resources.

Healthcare costs, you can't do "more with less".

[petejh]

I'm not holding out for anything.

It's more the tone of the debate on here that riles me.

[tomtom]

It's more the tone of the debate on here that riles me.

I didn't think it had been that bad?

[petejh]

It's very lopsided.

[slackline]

Last Friday you wrote...

I'm interested in the 7 day elective care.

Slackers - you can get your car fixed on Saturday, stock up on the week's supplies on Sunday, watch a film, relax with a pint in the pub, catch a plane or a train, go and do all sorts of activities on a weekend. Why the fuck shouldn't you, in principle, be able to sort out non-emergency healthcare issues on a weekend?
Of all the things it's possible to do on a weekend this would be the one that gives the greatest increase in quality of life for the general population who pay for their health service. But you don't think this is something worth aspiring to?

Other professionals such as lawyers, architects, engineers generally don't offer weekend service (or if they do it prohibitively expensive) and that's fine, they aren't central to one of the most important parts of quality of life - health. We don't have a national lawyer service or a national architect service.

Why isn't there 7 day elective care? Because it's too expensive... (or there isn't enough money, slightly different). Why is it too expensive?

...which suggested very strongly to me that you would like to see seven day healthcare (emergency and elective), even if you already know why it doesn't currently exist (I suggested this could be addressed by either going private* as you do for all the other weekend activities you listed or increasing taxes to cover the increased cost to the NHS).

I don't understand why or how being able to undergo elective treatment at the weekend would improve quality of life?

Having the treatment, regardless of when, improves quality of life.  There are laws governing sick-pay and so forth such that should you need to undergo treatment during the week and have to take time off from work your employers can not financially penalise you (this may not be so straight-forward for those who are self-employed, but presumably they put money by for such rainy days?). 

[Footwork]

http://www.mirror.co.uk/news/uk-news/jeremy-hunt-says-britains-care-7932080

The video at the top of the page.

Lets make money out of old people!

[petejh]

Last Friday you wrote...

I'm interested in the 7 day elective care.

Slackers - you can get your car fixed on Saturday, stock up on the week's supplies on Sunday, watch a film, relax with a pint in the pub, catch a plane or a train, go and do all sorts of activities on a weekend. Why the fuck shouldn't you, in principle, be able to sort out non-emergency healthcare issues on a weekend?
Of all the things it's possible to do on a weekend this would be the one that gives the greatest increase in quality of life for the general population who pay for their health service. But you don't think this is something worth aspiring to?

Other professionals such as lawyers, architects, engineers generally don't offer weekend service (or if they do it prohibitively expensive) and that's fine, they aren't central to one of the most important parts of quality of life - health. We don't have a national lawyer service or a national architect service.

Why isn't there 7 day elective care? Because it's too expensive... (or there isn't enough money, slightly different). Why is it too expensive?

...which suggested very strongly to me that you would like to see seven day healthcare (emergency and elective), even if you already know why it doesn't currently exist (I suggested this could be addressed by either going private* as you do for all the other weekend activities you listed or increasing taxes to cover the increased cost to the NHS).

I don't understand why or how being able to undergo elective treatment at the weekend would improve quality of life?

Having the treatment, regardless of when, improves quality of life.  There are laws governing sick-pay and so forth such that should you need to undergo treatment during the week and have to take time off from work your employers can not financially penalise you (this may not be so straight-forward for those who are self-employed, but presumably they put money by for such rainy days?).

I'm self-employed, I have been since 2002. I think you'll find there are lots of self-employed people who aren't well equipped for long rainy periods. In 2013 I paid ten thousand pounds on my health, on credit cards. Anf then missed 6 weeks of work, unpaid. How I wish I'd paid a less significant (but still significant) annual premium on health care and sickness cover. It isn't cheap though - I was being tight by not wanting to pay £800 per year for good health and wages cover. Many just don't have the means.

People like you are focused (to the nth degree..) on the letter of the law and how things should be. The world isn't like that. A lot of people would benefit from 8-8 availability and weekend availability because taking time off work isn't as easy as it is for your public sector job.

[GCW]

I'm not holding out for anything.

It's more the tone of the debate on here that riles me.

Sorry, I've tried to be as balanced as an unbalanced situation allows.  I'll shut up now.

[dunnyg]

Footwork - Dont feed the mirror ffs....

[lagerstarfish]

A lot of people would benefit from 8-8 availability and weekend availability because taking time off work isn't as easy as it is for your public sector job.

at this point some smart arse usually points out that people have a choice about working in the public sector or being self employed and that it is up to self employed people to factor stuff like medical costs into how much they charge their clients.

I realise that the world isn't like this, so won't say any such thing

what this does flag up (as mentioned before, by someone, I think) is the fact that the way NHS services are set up means that some people have to go outside the NHS for treatment, which helps to make it appear less valuable - if the NHS did provide a suitable service, it would be valued more by those people

[Footwork]

Footwork - Dont feed the mirror ffs....

I couldn't find the video alone to imbed!

[galpinos]

I'm not holding out for anything.

It's more the tone of the debate on here that riles me.

What do you mean? People are passionate about it as a national institution, that people feel very strongly about, is falling apart and instead of fixing it, the government are pushing forward with an ill-defined manifesto promise (I still don't know what a 7 Day NHS is, the last comment I heard for the Health Secretary was that it wasn't about 7-day elective care so I'm at a loss as what the difference is to the service provided now).

There appears to be no clarity (or even debate) about the intended outcome of having junior doctors contract changed so that makes people worried.

[slackline]

I'm self-employed, I have been since 2002. I think you'll find there are lots of self-employed people who aren't well equipped for long rainy periods. In 2013 I paid ten thousand pounds on my health, on credit cards. Anf then missed 6 weeks of work, unpaid. How I wish I'd paid a less significant (but still significant) annual premium on health care and sickness cover. It isn't cheap though - I was being tight by not wanting to pay £800 per year for good health and wages cover. Many just don't have the means.

Personal choices and hindsight.  You and others presumably think about these things when choosing to go self-employed, to not do so might be considered careless.

There are no doubt things that could be improved across society to the benefit of those who are employed and self-employed.  Personally I wouldn't mind paying more income tax if it were ring-fenced for health care.  I'm sure yourself and many others wouldn't object either (seems to be a slight undertone to what you write above).

People like you are focused (to the nth degree..) on the letter of the law and how things should be. The world isn't like that.

There is something wrong with having ideals/morals/ethics and seeking to achieve those?  Or should that be limited to the esoteric morals/ethics involved with climbing?

A lot of people would benefit from 8-8 availability and weekend availability because taking time off work isn't as easy

It would be convenient for everyone, but it costs money.  That is the bottom line with all of the discussion around 7-day services etc. and is unavoidable.

your public sector job.

No idea where you think I work but its not in the public sector.

[galpinos]

A lot of people would benefit from 8-8 availability and weekend availability

Is this what is being proposed? I honestly don't know, the manifesto promise was vague and there had been no clarification from the Department of Health.

If that is being proposed, should the public purse fund it? The NHS is underfunded at the moment but depsite this, has very good outcomes due to the efficiencies of the system. If we want to increase the availability of care, we need to fund it. Do you think this is where our taxes should go?

[Lund]

I don't think the discussion is totally lopsided - I think there's a lot of rational argument on both sides, some good and educational discussion - and clearly some people with different views.  Mostly it's OK, although it is a bit lopsided I think it's actually fine and a decent debate.  Hence I'm still here. 

P.S. GCW although you clearly have a clear opinion, I don't think that means you should stop posting.  It's never personal is it?

There are exceptions of course.  Slackline is foaming at the mouth, which is a bit annoying and I would much prefer it Slackers if you'd take your simplistic link-ridden posting off to a different topic as it's doing my head in.  I don't know what planet you're on, but it's not one of empathy, understanding, and compromise.  Stop slagging off other people's life choices for fuck's sake.  It's hardly immoral to want a public-funded seven-day healthcare service.

[GCW]

P.S. GCW although you clearly have a clear opinion, I don't think that means you should stop posting.  It's never personal is it?

I don't see much point in carrying on when resolution is impossible.

The sad thing is, I've had enough of all of this stuff and no longer really care. I half want it all to fall apart so people may appreciate what they used to have and abuse.

The only thing I don't get is who is going to do the work once it all falls apart shortly.

[petejh]

I'm not holding out for anything.

It's more the tone of the debate on here that riles me.

What do you mean? People are passionate about it as a national institution, that people feel very strongly about, is falling apart and instead of fixing it, the government are pushing forward with an ill-defined manifesto promise (I still don't know what a 7 Day NHS is, the last comment I heard for the Health Secretary was that it wasn't about 7-day elective care so I'm at a loss as what the difference is to the service provided now).

There appears to be no clarity (or even debate) about the intended outcome of having junior doctors contract changed so that makes people worried.

I agree there's a lack of clarity.

However my gut feeling is there's lack of clarity on both sides. For instance I can't help but find hypocritical the stance of some doctors who keep stating the NHS is underfunded (true) when I hear about the sky-high sums of money wasted every quarter paying doctors working for agencies that charge the NHS the earth. It took the government to impose caps on agency fees; on the face of it (to a layman like me) the BMA, doctors and the people arguing about the NHS being underfunded didn't seem that proactive in reducing huge agency costs for their services. Underfunding? What about overspending?

Presumably there is some personal choice involved in working for agencies that charge the NHS the earth Slackers? Not to mention ethics morals and ideals?

The doctors contract debate can be viewed through different shades of optimism to pessimism, cynicism etc. In less cynical moments I can see how it could be attempting to impose some much needed cost control on a powerful group of expensive people. Quite naturally they don't like this. I don't fully buy the govs argument nor the BMA's. Clearly there's a power struggle, it doesn't strike me as all about patient safety.

[slackline]

Slackline is foaming at the mouth,

Far from it, but it bothers me that the need for funding is being completely ignored in these discussions where people are saying they want 7-day a week services.

I would much prefer it Slackers if you'd take your simplistic link-ridden posting off to a different topic as it's doing my head in.

You should probably employ the forums functionality to "Ignore" specific users as then you wouldn't have to read them.

[petejh]

I don't know what planet you're on, but it's not one of empathy, understanding, and compromise.  Stop slagging off other people's life choices for fuck's sake.  It's hardly immoral to want a public-funded seven-day healthcare service.

This.

[lagerstarfish]

The only thing I don't get is who is going to do the work once it all falls apart shortly.

G4S

and when it turns out that they don't have the staff, the military will step in

[Johnny Brown]

For instance I can't help but find hypocritical the stance of some doctors who keep stating the NHS is underfunded (true) when I hear about the sky-high sums of money wasted every quarter paying doctors working for agencies that charge the NHS the earth

Presumably a 'properly-funded' NHS would be able to fill these positions from it's own resources and not require agencies. There is obviously a long history of the private sector profiteering from NHS contracts, so the answer would seem to be reduce their involvement? Cost overall would be higher but the standard of service should be better value.