Coffee House

The Tories messed up with junior doctors. Here’s what they should have done

12 January 2016

1:31 PM

12 January 2016

1:31 PM

It takes some skill to turn the BMA into the NUM – but Jeremy Hunt has done just that. It takes nearly as much skill to persuade the public that people on £53,000 a year are scions of the oppressed working classes – but the BMA, aided by Hunt, have done that too. How did we get to the point where there is any sympathy about pay levels of anyone who is in the top quintile of earnings? Obviously the strange quasi-religious role that the NHS plays in British life is partly to blame, but the government have played a strong hand appallingly badly.

First, they have told the wrong story. The government are making this about patient safety – they say that a move to a seven-day NHS is needed because too many people die at the weekends when they shouldn’t. This they attribute to the lower levels of staffing and assert that the solution is a change to junior doctors working patterns. There is a fundamental problem to this position. On the one hand, while there are what are known in medical jargon as ‘excess deaths’ related to weekend admissions, there is no evidence they are a consequence of staffing levels. And to complicate matters further, the ‘weekend’ for these purposes includes Fridays and Mondays. On the other, who do you suppose the public trust on matters of patient safety – doctors or politicians? Well, only one group of workers wears a white coat to work.

The better argument would have been the unassailable one that the world of work has changed. Mobile phones, tablets and laptops mean that for many white collar workers the boundaries between work and home life have blurred. Service industries offer seven-day access. And the millions of self-employed workers in the UK – a group now larger in size than all public sector workers – do not have traditional nine to five, five-day-a-week jobs. They work when the client wants or when the job comes through. The dividing line should have been modern life – that would have put junior doctors on the old-fashioned, protectionist, trade union side of the argument. They would have been portrayed as luddites, much like the rail unions who are trying to stop the 24-hour Tube.

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Second, the government have chosen the wrong fight with the wrong enemy. You don’t need to make junior doctors work at weekends; they do that already. The staff who are actually needed at weekends to provide the same cover on Saturdays and Sundays are all the others – the staff who run diagnostics, do the blood-work and, of course, the consultants. The last of these groups are the ones who will fight against a seven-day NHS to the very last – the very last junior doctor. Why are consultants so anxious to back their junior colleagues? Because, as cruel NHS leaders put it, consultants want to spend more time playing golf. The government should have picked the fight with them. A change in their working patterns is essential to seven-day working. There are fewer of them, and they would have very little public sympathy.

Third, the government have made this a dispute between themselves and the junior doctors. This is a schoolboy error. The NHS is an independent arms-length body. The Tories have an electoral mandate for a seven-day NHS but they should simply have passed that on as a condition for the extra cash the NHS has received. The outcome should have been prescribed but the means left open to NHS England Chief Executive Simon Stevens, who has already made great strides in modernising the health service by allowing a range of variation across the country. If you can’t win a big fight then make it a series of smaller fights. If this was a hospital-by-hospital dispute rather than a national one, it wouldn’t make the headlines. There would be local battles not national demonstrations. And local solutions too.

The government are losing, and losing badly, because they have picked the wrong fight on the wrong grounds with the wrong people. If they seriously want to win they need a wholesale change in strategy and tactics.

John McTernan was Tony Blair’s director of political operations from 2005 to 2007. He was also a former chief of staff to Jim Murphy.

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Show comments
  • Alan

    The author clearly has as much grasp of the situation as Hunt. Funny how when I was working a few weekends ago we had – in just one department within the larger medical directorate – 2 consultants, 2 specialist registrars, 3 core medical trainees and 4 foundation doctors – all were present, all patients reviewed Saturday and Sunday. What were the barriers to patients being discharged? Lack of social work, inability to restart services in the community at the weekend. More doctors would have done precisely nothing to get those patients home earlier. They did however have safe treatment at the weekend with consultants present on site both days. Sadly the Health Secretary and many other commentators have no idea how the NHS actually runs.

    • Jennifer Gillespie

      Could not agree more!
      Too many folks appear to feel the need to comment yet they are so misinformed regarding the NHS and blinkered in their misconceptions regarding public service workers……it’s infuriating & worrying just how ignorant these guys are.

  • http://theknifeandme.wordpress.com/ The Knife

    McTernan’s description of the consultants is laughably misinformed on many levels. Most of us DON’T like the current junior doctors’ contract, particularly the New Deal bit – it has to be renegotiated; most of us are agnostic at best re the current strike; most of us DO work weekends and have done so for yeras, entirely UNPAID until our contract was regotiated; we are not afraid of the government discussing our contractual status, far from it. in addition we are the group who have been royally screwed over in the austerity/pensions grab after the 2010 election. Today’s juniors grew up in a different NHS, and understandably don’t know any different. Wait till they replace us old hands and you will see what a good deal the over 45 consultants of today have been giving the NHS.

    The golf claim has to be one of the most tired cliches out there. McTernan should know better.

  • Alf Alpha

    The DoH response to their consultation on Health policy for 2016/7 published last month shows how misconceived and lacking in support all this is. Page 13:

    “Fewer than 3% of responses that mentioned seven-day services were supportive. The main
    concerns were that seven-day services are not necessary, that they are not affordable and
    that they will put too much strain on staff who already work very hard.”

    https://www.gov.uk/government/uploads/system/uploads/attachment_data/file/487491/Mandate_Cons_Response.pdf

    Mr Hunt could have saved himself a lot of trouble reading the DoH’s own research

    • Leon Wolfeson

      “reading the DoH’s own research”

      Very amusing.
      But where then would he get ideological ammunition for the sort of changes he wants?

  • A Theologian

    One issue is retraining. Under the present contract if a JD switches then they retain their existing salary e.g. as a CT4; under the new contract they would be paid as a CT1. Given that as a CT4 the JD may well have a family, mortgage etc. this would act as a disincentive to retrain. Now you could say that the existing contract is not cost effective but from a patient perspective the more cross discipline there is in the profession the better. Also with technical advances what once was dealt with e.g. surgically may now be dealt with using gene therapy making the surgical speciality redundant. The JDs and the BMA might say that this is just the Tories dumbing down the medical profession ready for privatisation which is the long term goal. The reality is a mystery.

    But the real mystery seems to be that both sides agree that the NHS must be free at the point of delivery which requires an infinite resource. Since there isn’t an infinite resource the service is rationed by queuing on the patient side and excessive free hours / goodwill on the doctor side.

    Since introducing even nominal fees would be electorally toxic for either party (although fees would reduce cancelled / failed appointments, for instance, if prepaid) the Tories realistically can only drive the NHS into a fee driven privatisation by collapsing it.

    • Leon Wolfeson

      Even “nominal” fees would likely raise the cost of the NHS considerably, as it has NHS dentistry, because people won’t go to the doctor until they’re really, really sick.

      • A Theologian

        …which is wholly irrational behaviour.

        However, where I live we do pay a £40 fee (with appropriate safeguards) to see a GP which doesn’t result in the behaviour you predict but I accept that your view would be used to argue against fees.

        The fact is that the junior doctors do believe that the new contract is a step on the road to privatisation. See http://www.theguardian.com/healthcare-network/views-from-the-nhs-frontline/2016/jan/11/nhs-junior-doctors-striking-wrong-reasons-privatisation

        As someone who has had free emergency surgery on the NHS and expensive, uninsured non-emergency but nevertheless vital to be able to lead a semi-normal life surgery privately I can’t see a problem in the mixing of public and private provision. Indeed I am having a private operation tomorrow which the NHS will only carry out when my condition has seriously deteriorated to the point where it is life threatening. Gee, thanks a lot!

        • Leon Wolfeson

          Well, go to the doctor or eat? That’s often the choice the poor would have to make.

          People WILL be discouraged – it happens with dentistry!

          And you can’t see the problem with higher costs, more bureaucracy…in good part, the NHS is having to dial back it’s offerings because of Tory policy!

  • Frank

    The key point in all this shambles is Hunt, whose fitness-for-role has always been very questionable. Now that it is a clear as mud that he is hopeless, will Cameron put some-one in charge who is even slightly competent?

  • Hamburger

    The problem of weekend deaths in hospitals is the same throughout Europe. To pretend that “there is no evidence they are a consequence of staffing levels.” is simply wrong. Staffing levels are reduced at weekends and senior doctors or consultants are at best on standby. Mistakes are therefore more often and operations are, if possible, postponed which sometimes leads to complications.

  • Leon Wolfeson

    So, in return for no extra cash (the pittances being offered, which are for shoring up services affected by the top-down disorganisation…), the NHS should have slashed it’s Monday-Friday service and done less work overall in return for hospitals doing routine operations at the weekend. Hmm!

  • startledcod

    Can’t disagree with any of this.

  • The Masked Marvel

    The better argument would have been the unassailable one that the world of work has changed. Mobile phones, tablets and laptops mean that for many white collar workers the boundaries between work and home life have blurred. Service industries offer seven-day access. And the millions of self-employed workers in the UK – a group now larger in size than all public sector workers – do not have traditional nine to five, five-day-a-week jobs.

    Yet if the author is correct that the NHS having a ‘quasi-religious role’ in British life, that won’t play very well in the media either.

  • Roland Haines

    When the “junior doctors”, become senior doctors EG rich, they will become Tories.

    • startledcod

      Ooh, virtue signalling. They get a bit of money and then join the party of bastards who sole raison d’etre is to grind down the poor; that’s the trouble with you lefties you just don’t understand your opponents whereas they do understand you. It is for that reason that you always lose the arguments that matter.

      The great sadness is that the inhabitants of this country are in such a huge collective trance that abolishing the NHS and forming a decent healthcare system like operates in France, Germany, Australia, New Zealand etc. isn’t even on the table. If the NHS really is the envy of the world and such a great system how come no other country is emulating it?

      • Roland Haines

        If you think I am a lefty, you are grievously wrong Mr Cod.

        • startledcod

          I stand corrected, actually I don’t, I flap around hopelessly.

      • Leon Wolfeson

        One, the option of that sort of healthcare system is not on the table. What we’re seeing is a “NHS” where private companies profit over patients, and that’s set to get worse.

        Two, the higher poverty and living cost issues here makes that sort of system very very high cost (as the fees will deter people until they’re very sick), etc.

        Very very few healthcare systems can be defended except as “it evolved that way”.

        • startledcod

          Why is profit from healthcare such an issue? Competition keeps prices down and standards up. ‘Healthcare is too important’ some say, I say food is more important than healthcare and yet we have no problem with private providers or the rich paying more for fancier food. I would love to see hospitals run by the likes of John Lewis or Tesco because they understand that they thrive by providing the right product at a competitive price.

          The argument that everyone should have the same access to the same standard of healthcare is ludicrous, extend it to food and everyone would expect the taxpayer to fund their Fortnum and Mason grocery bill.

          • Leon Wolfeson

            No, competition only does that in markets. Healthcare works really, really badly as a market.

            You can eat some other foods.
            You can’t replace your health.

            And you want hospitals, again, run on treating only those who can pay, and without properly considering clinical standards, only using standard non-critical-infrastructure ones? Hmm!

            (Tip – If Tescos screws up, someone gets a refund. If a Surgeon screws up…)

            As you argue for good healthcare only for the rich, right.

            • startledcod

              If a John Lewis surgeon screwed up he would lose his job and John Lewis would suffer. If an NHS surgeon screws up, as they do, he generally keeps working and the taxpayer pays compensation.

              You choose which supermarket to shop at, why shouldn’t you choose your healthcare provider? I am not saying the state shouldn’t pay but I am saying they shouldn’t be a monopoly or even possibly a supplier; I know, why don;t we privatise it. Also medical insurance should be tax deductible.

              As I said above, the great sadness is that the inhabitants of this country are in such a huge collective trance that abolishing the NHS and forming a decent healthcare system like operates in France, Germany, Australia, New Zealand etc. isn’t even on the table. If the NHS really is the envy of the world and such a great system how come no other country is emulating it?

              • Leon Wolfeson

                So you’re saying that any form of issue is instant dismissal in the private sector…hmm!

                As you want massive duplication in something not a market. As you want the state to pay far more for…well, it’d have to be less people. There is no real market there, just money siphoned off for profits due to the nature of healthcare.

                Then you want the rich to be able to tax-deduct private health insurance, and the poor get…no care.

                As you ignore you’re not arguing for any of those systems, but something worse than America’s. As you ignore the fact they spend more on healthcare, which is the key issue – the Tory cuts. As you ignore (again) that most health systems are not defensible except as “it evolved that way…”

      • Matt

        Unfortunately the government have no intention of following the lead of successful (albeit with their own flaws) healthcare systems like the ones mentioned above, instead, slowly pushing us towards the corporate monstrosity of the USA

        • startledcod

          It’s the old NHS as national religion trope. I don’t think we’re going the way of the US so much as Cuba.

          • Matt

            Then I suggest you familiarise yourself thoroughly with the health and social care act and the proposed TTIP.

    • Leon Wolfeson

      Except that senior doctors are backing the juniors over this.

  • paulus

    The trouble with this Country is we don’t train enough Doctors. The bar is set so high the intellectual caliber of the recruits is far in excess of what is essentially a learnt profession. Technology will soon develop a body scanner that will be able to diagnose to and better anything a human can.

    • Leon Wolfeson

      “The bar is set so high the intellectual caliber of the recruits is far in excess of what is essentially a learnt profession.”

      One, no, the limit is the number of training places the government allow.
      Two, there’s a good reason you’re not in the medical profession.
      Three, are those scanners powered by Free Energy?

      • paulus

        I’ll uptick you Leon, you made me laugh, you pugnacious old thing.

        No the BMA have control over numbers. We know you are a sage on everything Leon but predicating technological advances on free energy seems a bit conservative. And we could never accuse you of that can we. I saw the technology on Star trek Once something is conceived its possible.

        • Leon Wolfeson

          “No the BMA have control over numbers.”

          Yea, shame about the facts of the government controlling the places isn’t it.
          And apparently my sarcasm was correct. Hmm.

          (And as for Star Trek…you know the Federation are a bunch of commies, right?)

          • paulus

            The Federation are commies? that seems highly unlikely Leon. An American made production from the 1960’s only a decade on from the McCarthy era. Maybe your reading of it is as true of the Government controlling the medical professions numbers.

            I think you are missing the vital ingredient for sarcasm Leon.

            • Leon Wolfeson

              True, I’m actually using it for instance. But not in the following;

              So you’re completely wrong over something well-documented? Hmm!
              Roddenbury was an anti-capitalist, and StarTrek was known for pushing the boundaries (i.e. a black-white kiss on TV!)…and got away with it because it was science fiction (as SciFi often does, when it asks hard questions).

              So, you admit I’m right as the facts…

              • paulus

                I’m sorry Leon Star trek is science fiction, not fantasy, there is no way that a communist system could deliver that type of technological advances.

                • Leon Wolfeson

                  So you get confused and don’t read my post.
                  As you knows your future history, right.

                • paulus

                  I think the temazapan the nurse has given you, has now kicked in Leon. The last post completely lost me, so I will give you the last word.

                • Leon Wolfeson

                  So you don’t think, just scream that disagreement with you should be punishable by drugging.

                  (And you don’t know Asimov/Campbell/Heinlein’s “Future History” concept either…why, it’s almost like you know next to nothing about SciFi!)

  • paul

    A view from God’s Country – NHS WALES.
    There is a reason that Junior Doctors in Wales are not on strike and that is because the Welsh Labour Health Minister works with not against doctors. The fault for today’s strike lies with the Conservative Government for failing to engage with and respect the Junior Doctors in England.”
    Nia Griffith MP, Shadow Secretary of State for Wales.

    • startledcod

      I think I’ll stay with the outcomes in NHS England rather than NHS Wales.

  • victor67

    Typical Blairite backing the Tory agenda.

    The reality is to fund the 7 day a week NHS they have decided to change the current terms and conditions of frontline staff. Whatever way you spin this. It will result in a significant pay cut.

    The Tories should have put this in their manifesto when they made all their promises and let voters decide if they wanted a pay cut for Doctors and Nurses.

    • fred finger

      Labour DID NOT have it in their manifesto’s years ago that they were going to TREBLE the cost of the NHS.

      • victor67

        It was the likes of McTernan , Milburn and Blair who believed private sector reforms were the answer and they wasted Billions on PFI and a useless computer system.

        Apart from staffing the other big cost that the Tories don’t talk about is the monopoly the big drug companies have over the NHS and how much they rip it off.

        • Leon Wolfeson

          Funny, perhaps the NHS should be allowed to bargain as a unit for drugs, eh?

      • Leon Wolfeson

        Oh, bring NHS funding to something like the average for a developed country.

  • Bill Ellson

    The underlying problem is despite the Blairite hegemony about ‘markets’ few modern politicians understand the basics of supply and demand. The United Kingdom is a wealthy country that should be training far more doctors, but instead the number of medical courses offered by universities has been limited by successive governments to the number of junior doctor posts that will be available. When you allow for people dropping out, getting run over or leaving to have a baby you end up with a lack of supply in an area where demand is high. This plainly and simply puts the price of said labour up, and places the junior doctors and the BMA in a position where they are able to take on governments of whatever hue and win.

  • DavidL

    I fear McTernan’s right on this one. Jeremy Hunt played a blinder in calming the NHS down after the Lansley “reforms”, but he’s making a right pig’s ear of what ought to be a perfectly reasonable goal – a health service that is open when people need it (ie 7 days per week), not just Monday to Friday luncthime.

    • fred finger

      McTernan, political advisor to both Bliar and Brown, shame he at the heart of the disaster that was Labour.

      • DavidL

        Agreed. But they knew how to make their case (ie spin). Or at least Blair did. McTernan’s article was about Jeremy Hunt’s mishandling of a good, but tricky issue.

    • Leon Wolfeson

      Except there isn’t the demand, when polling’s done.

      Moreover, the costs…at a time when safe Monday-Friday cover is under threat…

  • Mrs Crewe

    It wouldn’t matter what the govt did. The BMA is another Marxist infiltrated Union only interested in making political mileage, they don’t give a stuff about the Drs they represent other than thinking the NHS should be run for their convenience and not the patients. They don’t care about patients and rely on the endless media chant of the ministering angels and the refusal to justly criticise medical practice when it falls below standard, which it does far to readily. This strike has been completely manufactured by the BMA abetted by the loony left running the Labour Party.

    • mickey667

      The British Medical Association are marxists?

      Ok.

      • Mrs Crewe

        Try reading before reacting

        • Jennifer Gillespie

          You should try. …thinking. …
          Before spouting embarrassing 80s sound bites. …
          A good source of amusement though. …thanks

      • red2black

        With a 98% vote ‘in favour’, and not having been on strike for 40 years, it’s clear to anyone with an ounce of common sense that the Marxist-Leninist BMA has always been in favour of a Dictatorship of The Proletariat.

    • Leon Wolfeson

      Ah, the Marxists in your mind.

      Never mind the strike vote figures, as you blame Labour for everything, etc.

      • Mrs Crewe

        Nope, just what they are accountable for.

        • Leon Wolfeson

          As I said.

          • Mrs Crewe

            So we shouldn’t hold previous current and future govt accountable for their chronic mismanagement of the country. Sounds like the sort of communist state the loony left would love to inflict on us.

            • Leon Wolfeson

              Blaming Labour for Tory decisions…hmm!

              As you scream hate at the left, seeing communists in your mind. Your PC accusation against the left as “loony” shows your agenda of preventing debate.

              • Mrs Crewe

                It was the BMA who walked away from the table and have refused for the last two years to have real discussions on the issue of people dying at the weekends. But hey let’s not let facts get in the way of a good old fashion Union day out.

                • Leon Wolfeson

                  Ah yes, the workers, why are the workers not stopped.

                  As you try to play the “weekend” card, one which ignores a multitude of factors like routine operations, etc. – the issue you’re painting does not exist in the form you claim it.

                  They walked because the government have not negotiated in good faith. As you also show.

    • Jennifer Gillespie

      Oh Mrs Crewe…..how blissfully ignorant you rant. ….so amusingly unintelligent tosh!

      • Mrs Crewe

        Ah another Union stooge.

        • Jennifer Gillespie

          Oh Dear Mrs Crewe…..how predictably presumptuous of you….Try thinking outside the box of tory clap trap…Erm and try getting outside and mixing in the real world with real people….you might actually learn something. ..

          ..I’m guessing 100yrs ago you’d have been the type to object to ‘loony lefty’ Mrs Pankhurst in order to preserve the righteous status quo! .

          ..thankfully the majority of intelligent folks nowadays do not possess your bias outdated ignorant view.

          • Mrs Crewe

            I used to be a nurse now I work in local govt. That real enough you, you elitist snob

            • Jennifer Gillespie

              ……elitist snob. …from Mrs Crewe who suggests that the BMA is a Marxist infiltrated union!

              Your incredulous ideas are even more unfathomable considering your background. ….

              As you work in local government perhaps you should be aware that the lack of social care is at the heart of many problems which negatively impact our NHS. …bed blocking by fit elderly patients within medical and surgical units because there is no home support available.

              As a nurse you surely are aware that doctors work weekends. …it is radiology and cardiology departments and the like who only provide emergency weekend cover. ..so why target junior doctors unsocial hours payments. …? It is the thin end of the wedge. If unsocial hours payment for doctors are cut then it’s only a matter of time before nursing staff contracts are changed. ….as a nurse I’m sure you’ll be aware that a cut in unsocial hours payments could see pays cut by up to 33%.

              ..I wonder if you objected to your pay and working conditions achieved via nurses unions. ..?….and would you be happy now to have your monthly salary cut whilst working the same hours?

              Of course our NHS needs to modernise and should always have optimum patient care at its heart. …however this is achievable by increasing investment and improving staff morale – NOT demonising any segment of a workforce who by in large are committed, caring professionals. …

              It is disturbing & worrying that more & more of our citizens are more than willing to join the hatred band wagon. ….even Mrs Crewe who was once part of the caring profession she now readily slates rather than support.

  • fred finger

    Wrong, they are really showing their true colours/

  • Magnolia

    The Labour government changed doctor’s training, their contracts and got rid of the consultant led team system when they introduced the EU working time directive. The new doctor’s contract brought in under a Labour government paid the GPs more to give up night and weekend care and hospital consultants got about 20% extra pay for doing the same job. Add in all the new hospitals paid for on the never never and is it any wonder that the NHS has now hit the buffers on doctors pay and conditions? Oh yes and there is also the rise in population to consider from the quite massive increase in immigration because of EU rules. The government may have its own agenda but it would not be surprising if the tax payers who fund it all were to think the whole lot due for an overhaul in the name of sanity. Remember those same tax payers are paying for our ever increasing debt interest payments.

    • Matt

      Labour took 2 groups, junior doctors and GPs that were in absolute crisis and improved their pay and conditions. Not a bad thing except, as they did with the consultants too, they grossly underestimated the amount of work and quality of service (QOF for GPs) they were providing and it cost them more than they expected. Be under no illusion, after years of clawing back GP is back in crisis and morale is lower than ever.
      Labour’s over reliance on PFI was a scandal (that this government is in no hurry to rectify).

      The truth is that today we bring patients with dementia in ambulances 3 times a week for dialysis. We treat people with advanced cancer and weeks to live on intensive care when their chemotherapy causes infections. People in their 80s who have heart attacks routinely have angiograms, stents, bypass operations, expensive medications and live another 5 years drawing a pension and having the council provide a carer 3 times a day. I’m not passing judgements on the rights and the wrongs but this is the reality of what modern society demands. All this costs billions. The way to pay for it is not to penalise the staff who already in general, do their best in difficult conditions.

      • Magnolia

        I actually agree with a lot of what you have written. Labour literally
        stuffed the GPs mouths full of gold because they were the gatekeepers
        holding back the tide of insurmountable demand. My aged P is over 80yrs
        old and is scared of dying as are most people. They want to hang on as
        long as possible because in truth they enjoy life. But, the cost to the
        NHS is considerable and my aged pays no tax because their income is so
        low. The trouble is that to withhold this care would be to in effect
        kill them.
        That is not a great dilemma and I fight for the right of
        my aged P to access all of the services that I know are available. The
        doctors hate me because I fight for my parent’s right to live. I am not
        at all scared of questioning what they do and I am sure that I will
        often seem to be rude simply for doing that. Who is going to decide
        these things? No Christian would be able to do it.
        Would an NHS under such a killing system not be just like the vile pro-death choices made in n*z! Germany?

    • Leon Wolfeson

      Blame the Other, blame Labour, etc.

      All over Hunt’s actions.

    • Jennifer Gillespie

      So it was Labour who introduced ‘EU’ working time directive. ….not the ‘EU’

      And it’s EU who are to blame for ‘massive increase in immigration ‘…..not the civil war in Syria with resultant humanitarian disaster

      How clever are you. ….????

  • King Kibbutz

    It’s easy. Just put adverts in media all across Asia and Africa, to the effect that we need qualified doctors. Don’t check their qualifications – they’re from places whose standards are…a little lax? And anyway, loads will be forged. Who gives a.
    Shove contracts to them that are way cheaper to maintain than those of existing staff. Sign it or walk. Job done. Just like has been happening for years in the trades, why not medics too?

    I’m wasted here me.

  • paul

    Hunt is like Private Pike – Stupid Boy !!!

  • Matt

    I doubt that many of the people (minority of the population) who voted conservative did so because they want non-emergency services on the weekend. Many did so out of the fear of the economic competence of the opposition.
    Companies that employ staff at weekends do so because it is more profitable to do so. Increasing the amount of activity at the weekend in the NHS will either need more work to be done (by the same number of people) or require cuts in services at other times. It is not a cost neutral proposal but the government is trying to force that.

  • In2minds

    “Obviously the strange quasi-religious role that the NHS plays in British life is partly to blame” –

    Indeed, and much as all governments get ‘the religion of peace wrong’ so do they fail to face up to the NHS. Those of us who live outside of the media/government bubble are looking for better leadership on both.

  • telemachus

    I rarely get exercised by issues but this is one
    1. The BMA for a group of intelligent people have failed to get across to me as Joe Public just why they have called a strike
    2. Hunt is so obviously lying when he says it is about reducing deaths at weekend by getting doctors to work then when we all know that it is the Junior Doctors who do deliver the care at weekends
    *
    What I do know is that they need to get around the table and sort it before more folks die

    • King Kibbutz

      What, even Jews?

      • fundamentallyflawed

        I think Telemachus has been hacked 😛

    • Matt

      Most junior doctors work 1 in 4 weekends at present. The government wants us to work more weekends. In order to do that in a cost neutral manner they want to restructure the remuneration system. It is patently clear to doctors and the BMA that this new structure will result in an actual pay cut despite a headline pay rise in basic pay.
      Added to this, at present there is a robust deterrent to hospitals systematically making doctors work beyond their rostered hours. The government want to change this effective system (which very rarely ever needs enforcing because the deterrent works) with a watered down system where hospitals that are fined effectively pay themselves. You couldn’t make it up!

      • telemachus

        Thank you Matt
        That still seems to me, as uninitiated, that your main concern is a pay cut
        The media perceive that and have a vague notion that you are concerned that they will make you work more hours
        Are you telling us it is not true that maximum hours will be cut from 91 to 72
        *
        It seems to us that the facts remain unclear. Or perhaps the BMA or Hunt are misrepresenting them

        • Matt

          The NHS currently runs on the goodwill of its staff. In most jobs I have worked I have averaged 1-2 hours per shift unpaid beyond my rostered hours. My wife has worked even busier jobs where 2-3 hours per day was routine and driven by an entirely altruistic wish to do her best for her patients. She is now on maternity leave and sees the demand for more weekends and a pay cut as a serious kick in the teeth such that she will simply change career if it is enforced. There is a strong sense of professionalism but the constant erosion of pay, conditions, respect etc is making the job increasingly stressful and unrewarding. Doctors have had enough. A retention and recruitment crisis is growing. If you knew how many doctors (especially those straight out of house jobs and also those over 50 ) are planning to imminently leave you would (should) be worried.

          The government is proposing a change in the maximum number of hours in one week and this is welcomed. However, the average number of hours per week is unchanged.
          Currently, Mon-Fri is really, genuinely stretched. You can’t safely cut week day work to roster more doctors the weekend. There are no extra doctors and no extra money so where are the extra hours going to be squeezed from? Very suspicious that they want to change the current (effective) system of monitoring excess hours.

          There is no trust left between the department of health and doctors. This genuinely has nothing to do with what the BMA does or does not say. The BMA is fighting for its own survival and being forced to vigorously defend the views of its grass roots members (not the other way around). Otherwise I will find something else to spend £36 a month on (like 3 hours of child care on a saturday). Jeremy Hunts words and actions throughout this dispute have been defamatory and inflammatory throughout. I would say Machiavellian but he would take that as a complement.

          • telemachus

            So
            Does it come down to Trust?
            *
            All of us understand your dedication and work over and above contract
            What we cannot fathom is why it is not possible for your representatives to come up with a formula to entrench the limiting of hours and protecting your pay
            We all accept that Hunt is styling the dispute to be over the seven day working issue, which, for you juniors it patently is not. We understand that each time he spouts this, as he did on the lunch time news that he further alienates you
            *
            Why oh why however do you not get the BMA to put forward something that enshrines the limiting of hours and pay protection in understandable words in a new contract
            Explain it simply to the media and Joe Public
            And then public opinion will force Hunt to accede

            • Matt

              A significant part of it is trust. I wouldn’t describe myself as particularly political but I do not trust the conservatives on the NHS initially based on their lie about no top-down re-organsation of the NHS followed by the biggest, most expensive re-organisation that specifically made competition and tendering (and therefore privatisation) an integral part of the functioning, but now on their handling of contracts.

              The difficulty for the BMA is that the dispute is very complex. Even the current pay system is hard to convey accurately. There are so many aspects of the dispute which aren’t even reported such as implications on maternity leave, research time, fees etc. Ultimately, the government has been fighting dirty since the start and have been on the back foot. They are scared of making this about pay and anti-social hours (which is probably 80%) of the issue and have been focusing on the 20% patient safety. This is a strategy forced on them by spin, lies and misinformation from the other side.
              Please do not forget that after the BskyB fiasco Murdoch owes Hunt big time. It is no co-incidence that the Sun and Times have been particularly hostile including some really nasty, unfounded personal attacks on BMA members. The BBC is under threat at the moment and has not (in my opinion) been very balanced in its reporting.
              The BMA does have some simple, clear information out their but getting it reported has been an uphill struggle outside the left wing media.
              This is why so many junior doctors have taken it upon themselves to organise their own ‘meet the doctors’ events in recent weeks to try and engage with the public. Generally Joe public is very supportive as I know from talking to them about it.

              • realfish

                ‘I do not trust the conservatives on the NHS initially based on their lie about no top-down re-organsation of the NHS…’

                So it was fit for purpose was it?

                • Roger

                  Yep. Some parts. Some in Stoke. Some depending on a Post Code Lottery.
                  Remember budgets increased and year on year productivity declined. We Taxpayers did not get anything that was commensurate with the extra put in, so where did it all go? A lot went into pay-packets, around 60% they computed.
                  I cannot speak for or against these Junior Doctors, I accept that they are dedicated and hard working, but organised in the sense of the Private Sector they are not. I think they need management and organisation training as part of their educations. I have had medical treatments in many countries in Europe and the one that was regularly uncoordinated and appeared amateur in it’s method was the NHS. The NHS scares me.

              • telemachus

                You need some better soundbites and better spokesmen if you are to keep the public on side
                But you also need to demonstrate some flexibility
                Remember the media are scouring the public for cancers delayed now and if you get as far as the full February strike, lives lost

                • fred finger

                  It was the BMA that left ACAS, the meeting with ACAS was something the BMA demanded. Crap from you as usual.

                • telemachus

                  Faced with continued “Cave in or we will impose anyway” what choice had they?
                  *
                  Sadly your post emphasises that the Juniors have failed to get across what may be a very legitimate case

              • Leon Wolfeson

                Also there’s the key element that junior doctors can’t get qualified anywhere else.

            • http://rantingoldgit.blogspot.co.uk/ Arthur Sparknottle

              I think the doctors have systematically failed to get across their case in this and other disputes. My partner is a GP. Everyone thinks they get £100K plus and they don’t. She is lucky to get 75% of that and then has to pay about £9K for indemnity insurance now that there are adds on day time TV inviting people to sue health professionals because they don’t feel as good as they think they should after treatment. So even at £61K its a good wage by comparison to many, but over the last decade her hours have increased to insupportable levels and she works from 8am to 7 or 8 at night without a single meal break, just grabbing biscuits between visits in the car, or snatching a swig of water between patients in the surgery. The money has declined and the hours and pressure have got much worse. People don’t know about and don’t understand the realities of the job. Hospitals have passed out much more work to GPs who are now earning much less money. We don’t know about these things because teh government are winning the propaganda battle and they are winning it because of really poor input from the Doctor’s leadership. We NEVER hear them except in reaction to Hunt’s statements. They need to take the initiative, and striking is THE WORST POSSIBLE way to get the public on their side. If some patient’s relative comes on TV in teh next few days saying, ‘My relative died because of the junior doctor’s strike’, or even ‘My mother missed her operation and is now worried and confused,’ the public will be deeply turned off the doctor’s case. They are shooting themselves in the foot here.

              • telemachus

                This is precisely the point
                You need to get your message across
                GP’s come over as being highly paid yet resisting evening and 7 day working
                They should try telling Joe Public that if they work every Sunday they have to cut out say Wednesday and then folks cannot get an appointment Wednesday
                The message is not getting out
                The BMA needs a better PR machine for GP’s and Junior Doctors

                • http://rantingoldgit.blogspot.co.uk/ Arthur Sparknottle

                  It would be impossible for her to work harder. It is an inner city, difficult practice. They can’t get the new QOF payments because they are ordered to get 97% compliance with flu vaccinations. How do you achieve that? Compulsion? Thousands of pounds of wages lost on that alone. It is an impossible target in an area with high ethnic make up and poor people who don’t respond to letters and invites. Nevertheless, she is there weekend after weekend vaccinating the old and vulnerable and there is no pay for the job. They fail on that one every time. It isn’t in their control.

                  In my opinion they need much better spokesmen. They don’t have them or those they have are not proactive. This strike of the junior doctor part of the profession smacks of railwaymen’s union or the NUM. I’ve nothing against miners or rail workers but it is a PR disaster to go down that route. I drove past my local hospital this morning to be waved at by a squad of not very pre-possessing people waving at me and brandishing placards. I shook my head at them. They are selling their profession down the river acting like that.

                • telemachus

                  Yes
                  There is no doubt that the Department of Health are conspiring with whatever Health Secretary they have to belittle and devalue the doctors
                  And the doctors play into their hands
                  I some ways your post does aswell
                  Joe Public has no clue as to the importance of QOF to both the patients and Practice Income
                  Yet the term is thrown out with gay abandon by the GP’s
                  The BMA needs to distill simple messages and get in some first class PR people

                • http://rantingoldgit.blogspot.co.uk/ Arthur Sparknottle

                  I keep saying that last point you made to her. She is 55 now, but is intending to leave the profession in the next year or two. I’m glad if she does. Her workload is life shortening as it is now. She can work part time in the private sector easily until retirement. Fixed hours, fixed pay, no nasty surprises when practice income is worked out. Since the 9 doctors at her practice are all working like dogs for a net income in the sixty K bracket, how the place an be open at week ends I have no idea. More doctors will have to be taken on and this would reduce the income further by significant amounts. These people are highly qualified, extremely experienced diagnosticians. people arrive in front of them for a ten minute slot with a garbled account of how they are feeling (in her case in broken or non existent English often) and they get a good service. Pity to lose that, but in this case, lose it they will.

                • telemachus

                  Sadly
                  That is the consequence of a Secretary of State and Department of Health that fails to value its workforce
                  GP’s are retiring early and Junior Doctors are emigrating
                  And we, poor Joe Public, are soon to be up a creek
                  *
                  The BMA could be trumpeting these simple messages

              • Leon Wolfeson

                Your right wanted cuts, you got cuts. Whining about your personal situation…

                • http://rantingoldgit.blogspot.co.uk/ Arthur Sparknottle

                  Nothing to say to you troll boy. You’ll be calling me an anti-Semite any time now. Utter contempt is all I have for you pal.

                • Leon Wolfeson

                  Yes, of course, just as you have concept for your former partner.

                  As you whine about my commenting on your expressed views – again, you wanted cutd and got cuts, your whining now is hypocritical.

                • http://rantingoldgit.blogspot.co.uk/ Arthur Sparknottle

                  Zzzzzzzz……

                • Leon Wolfeson

                  Yea, the boring truths I know.

                • http://rantingoldgit.blogspot.co.uk/ Arthur Sparknottle

                  Zzzzzzzz….. Snort…… Zzzzzzzzzz.

                • Leon Wolfeson

                  Quite, you keep on being unable to disagree with those boring truths…

                • http://rantingoldgit.blogspot.co.uk/ Arthur Sparknottle

                  Craving my attention? I don’t communicate with trolls and the terminally dishonest.

                • Leon Wolfeson

                  So you don’t communicate with yourself, you say, as you try and hype yourself up, when you’ve not actually argued with any of the points I’ve made, instead choosing to whine and talk about your censorship preferences.

                • http://rantingoldgit.blogspot.co.uk/ Arthur Sparknottle

                  Still craving my attention? Why not go away?

                • Leon Wolfeson

                  Why can’t you censor me, why won’t those evil facts go away, as you spin fantasies about cravings…

                • http://rantingoldgit.blogspot.co.uk/ Arthur Sparknottle

                  Stalking is a crime. I’m phoning the police. I’ve made it clear I want no contact with you, yet you insist on following me about the Internet and accusing me of things I have not done, said or advocated. You also habitually have my posts deleted – the only time it ever happens. Then you deny having done so. I googled your screen name the otehr day and find I am not your only target. You have accused numerous people of being anti-Semites without any reason when they happen to disagree with your opinion or advocate causes of the Conservative Party. NEVER CONTACT ME OR ATTEMPT TO ADDRESS ME AGAIN.

                • Leon Wolfeson

                  Ah, legal threats. What a surprise.

              • Roger

                Shot themselves in the foot.
                It is all about the slow grind down to what is affordable and we cannot afford the constant increases in demand.
                If you looked coldly and disspationately where the bulk of the money goes, well it goes on us oldies. The Lion’s share is spent on the over 65 years of age. Does anyone know how many extra weeks of life that money is buying? So many situations where we would be, maybe should be, allowed to die in our homes, but no a fortune is wasted to no avail. I remember, years ago, the last six weeks of my MIL life, in hospital, under NHS care. The last miserable six weeks of her life. They discharged her on a Friday after six weeks of nothing, she died on the Monday. She was going to die, she was 87 years of age and the fools only a month before were talking about a hip replacement. Time we were allowed to die at home and with some dignity. If the NHS would allow those who were obviously going to die to die instead of pretending to be Gods and defy nature, then much pressure would be removed. Not just the NHS fault our expectations have become out of kilter with reality.

                • http://rantingoldgit.blogspot.co.uk/ Arthur Sparknottle

                  For every one who thinks like you do, there are probably ten who will sue the hospital and the doctor for not resuscitating the dying, ninety-five year old cancer patient who is compassionately let go. A lot of people will just not let go of their relatives as you recommend. By the way as someone who is sixty five and who has paid tax through the nose for forty some years of full time work, but never had so much as a day in hospital and haven’t even seen the GP in two years, I’ll be damned if I will see someone refuse me treatment if I need it in the future. On the other hand, when it is time to die, it is time to die, BUT…. That isn’t a matter of age alone. It is a matter of whether there is a realistic prospect of significant improvement in a condition. If there is; I want it. If not, there is no point.

          • quotes

            many very fair points but i have to wonder why it is that public sector workers think that working beyond your “rostered hours” is so exceptional for high-skilled, full-time roles? in the private sector that is hardly unheard of. do you think that ftse workers down tools at 5pm?

            the nhs doesn’t run on goodwill. it runs on huge amounts of taxpayer money. if you want to use your incredibly valuable skills elsewhere feel free. but i don’t think you have the right to volunteer your own time out of “goodwill” and then complain that it’s being exploited. it’s not “goodwill” in that case, is it?

            • telemachus

              I think you may misunderstand
              *
              I think Matt might point you to the mistakes that have been documented to occur when these highly skilled doctors are overtired
              And the voluntary goodwill is necessary in the interests of keeping individual patients alive

            • Mynydd

              In the well managed companies in the car and oil industries to name but two, workers down tools at the end of their shift, so do supermarket workers. Any company who relies on unplanned overtime should sack its managers because its inefficient

              • Peter Harrison

                Low paid staff on shifts down tools at the end of their shift. White collar staff don’t, particularly not if they are higher paid. Most people in the private sector on the kind of pay junior doctors get would have a contract setting standard hours of work but expecting them to work the hours required to get the job done. So, although my job in theory is 9-5, 5 days a week, in practice I rarely leave the office before 6 and I sometimes end up working evenings and weekends, particularly if there is an urgent problem that needs to be resolved. It doesn’t mean my company is inefficient. It just means I am paid a lot of money as a senior manager and am expected to act professionally.

                • Leon Wolfeson

                  And your productivity is far lower than if you worked 40 hours a week.
                  This is well known – since the 1909 study Hours of Labour ( Sidney J. Chapman), in fact.

                  Your behavior is unprofessional.

                • fundamentallyflawed

                  Yet companies employ people on 48 hour and above contracts.. so many unprofessional (yet wildly successful) companies

                • Leon Wolfeson

                  Mostly wildly inefficient and struggling companies who turn to things like regulatory capture, but details!

                • Roger

                  Rubbish. For many senior Managers it is unforeseen events that demand increased hours and claiming that such should be planned for is naive. In 1992 I worked most of 7 days per week for a straight 40 weeks and if I had not a lot of jobs, standard working week, tools down at 5:00 PM jobs would have been lost.

                • Jaria1

                  Try and run a hotel on set hours or take a day off especially at weekends. The Union tried to impose set hours and coincidentally owned a hotel of their own and they found it impossible to keep to their own rules.

                • Leon Wolfeson

                  Oh, a badly understaffed hotel. Hmm.

                • Jaria1

                  Do you enjoy making a fool of yourself. You know nothing about the Hospitality industry. Sometimes it’s good advice to say nothing rather than open your mouth and prove your ignorance

                • Leon Wolfeson

                  No, I don’t make your posts.

                • Leon Wolfeson

                  You then allow for that in scheduling. You have managers on-call, etc.
                  You’re defending bad management practices.

                  So you’re saying that bad descisions (and they will be) made by a tired man “saves” jobs.
                  One of the nasty things about cognitive decay is you don’t realize how impaired you are.

                  Would you turn up for work drunk? Because you were that and worse for much of that time, in decision-making terms (Assuming 8 hours a day).

                • Roger

                  No I was just saying you were talking rubbish. In an ideal World I would not want a Dr attending anyone unless mentally fresh and I would want him/her also to have some inkling of what might be wrong with a patient that has for some reason been admitted. My beef is not about medical skills or tiredness or overwork, but rank administrative incompetence. Yes I watch them closely and in recent years unfortunately have had time to do such. My impression is one of nearly controlled chaos with the blind leading the blind. Utter shambles with the back office functions hit and miss.
                  The other week I found to her horror a Ward Sister or whatever her title was intending to give me the same medicine orally and by iv. She was chatting with a Nurse at the next station and it is good that I check everything that they do.
                  One tip for anyone being treated by the NHS you manage them and don’t even try to let them manage you. Check everything twice and ask attending Doctors why they have no notes, no case files. The NHS needs a private sector organising bomb lit under it.

                • Leon Wolfeson

                  Ah, you’re ignoring the studies on working weeks. Okay.

                  As you wonder why badly understaffed admin…why records are so chaotic…
                  As you want them to refuse care to most people as not cost-efficient, right, and for much higher managerial pay, and…

                • Roger

                  No not ignoring anything. The problem is poor management and bad organisation exacerbated by the fact that patients are really not anyone’s first priority. People are not focussed, they do not check and serial mistakes remain uncorrected. Doctors arrive on wards with little or no idea why they are there, no case files, no prep, little contact with Nurses who when the Doctor has gone just shrug. The number of times I have been asked by a Doctor what my diagnosis is is frightening, they mostly arrive unprepared and disorganised. I sometimes wonder if we would be better off with a Blunket cardboard replica. Chaos rules in the NHS and none more chaotic that the Doctors. Think they get better further up with Consultants? Then think again.
                  For the money they get we deserve a lot better, but who is ever going to discipline these legions of rank amateurs? Medicine they may understand, but organisation has gone out of the window. Some are not fit to be let loose without a Handler.

                • Leon Wolfeson

                  Yes, the problem with overwork is management. In this case, the impossible demands put on management by the government. Overtired workers then make mistakes. The admin is done poorly, without the small numbers of dedicated staff who used to keep it straight (rather than wasting the time of better-paid nurses, who not as good at admin…)

                  The Tories disorganisation of the NHS rolls on.
                  (Plenty of admin staff to handle paying outsourcing to the private sector, of course, though!)

                • Roger

                  Not convinced. I do not understand that Doctors fresh on duty have absolutely no idea of the history of the patient they are attending. It is similar to attending meetings totally unbriefed. Me thinks you are full of excuses. As for admin staff in reception they appear to be totally disorganised. Around 15% of all appointments are wrong. Twice last year I received letters with appointments to see a Consultant only to find on arrival, after a three hour journey, that I was not on his list.
                  Look forward to the day of robot nurses, software initial diagnosis and I own and control my own data storage.
                  More money will not solve these problems but disciplined management will, unfortunately such types are not bred in the NHS.

                • Leon Wolfeson

                  That? That’s the central booking forced on hospitals by the government which is crap.

                  So you look forward to poor care for the rich. Hmm.
                  (Not to mention the issue of your USB stick getting corrupted, etc.)

                  As you hate on nurses and doctors, right, as you clearly want the “discipline” of refusing much care – only way your plan can work, with it’s fancy expensive toys after all.

                • Roger

                  No not a central booking system, but one for that specialist ward. You are just full of excuses. I do not hate anyone and just want to see improvements which benefit patients. I really do not understand why you cannot accept that the NHS does, in part, need to look closely at why it performs in such an amateur manner. Why do you excuse obvious failures which would, in the main, not be allowed in the private sector.
                  Me thinks you may be a little cog in that great machine and as a consequence do not see what us patients see and have to put up with. The NHS certainly is not the envy of the World and others are not out to copy our mistakes. It is not all universally bad, but like the Curates egg only good in parts.

                • Leon Wolfeson

                  Ah, you’re ignoring the central booking system. As you want the NHS to cut “amature” practices like working on clinical priority and not cost … not allowed in the private sector, after all. Not to mention some of those pesky rights for workers (never mind the fact junior doctors can’t legally work for anyone else, etc.)…

                  And you want to stereotype me like that, right.
                  The disorganized mess the Tories have caused…

                • Roger

                  Really in my experience the NHS has been a very amateurish organisation for a very long time now and I do not see doubling it’s budget was much for the benefit of patients. As for abuse of patients in NHS care then no doubt you’ll u will find some obscure way of pinning this on to the Tories? What is your problem? Why defend the indefensible as it is in all our interests that the NHS improves.

                • Leon Wolfeson

                  So you’re basing it off your dislike of the NHS, right. And I don’t defend the results of your cuts, as you admit your position of wanting the worst…

                • Roger

                  No basing it on personal experience plus that which is in the public domain such as the reports on Stoke etc.
                  Unlike you I want to see reforms that benefit patients. You like most in the Public Sector are only interested in that which benefits the NHS employees. I really would like to see the NHS deliver.

                • Leon Wolfeson

                  Ah, so you’re basing it on dislike plus stuff left over from the Tories,

                  As you want only your rich to be patients, right, as you hate on nurses and teachers, as you want it to deliver great services only to your class, I hear you.

                  (Oh and tip, I work in the private sector)

                • Roger

                  I do not understand why you think you know my thoughts other than those expressed here. Do you have a crystal ball?
                  You sound like one of those demented lefties who will not allow any critics my of the NHS even when facts show they have abused patients. Surely patients are the priority, the reason and the very essence of why the NHS exists?

                • Leon Wolfeson

                  Funny, I am reading your posts.

                  As you express your PC bigotry against the left, and try and suppress debate with your far right, totalitatian and social dareinist whining that disagreement with you is “demented”.

                  I understand, again, that you only consider the rich the real patients. How dare the poor be “abused” by having any access to healthcare, etc. – and hence you oppose the NHS, right.

                • Roger

                  Rubbish you have turned this into politics, I just want the NHS to improve for the sake of patients. I do not understand why all would not wish to see improvements?
                  Any critics my of the NHS, when justified, should not be confused with an attack on Labour who in turn illogically assumes if it is attacked then so are the Poor under attack. You are one very confused Labour Tribalists.

                • Leon Wolfeson

                  So you want to treat the rich only, I hear, you, to “improve” via not treating most.
                  You’re the one trying to make this political, as I use basic facts here.

                • Roger

                  Even the most twisted of minds could not distort my points into the meaning you have arrived at. You really are a saddo with a big chip on his shoulder. You want to twist every genuine complaint about poor or bad performance into a rich v poor or us and them scenario. You are a roadblock to improvement and not part of any future solution.

                • Leon Wolfeson

                  Ah, so you admit I’m not twisted, and that I read things accurately.

                  As you go on “UR SAD”, and boast you think you’ve wounded in in the shoulder with an axe, as you talk about other people’s posts without listing them, rich man, as you say that you’ll exclude people who want the 99% to have medical care from your “solutions”.

                • Roger

                  My class? What is your problem, not another one with a big failure chip on his shoulder?

                • Leon Wolfeson

                  Oh, so you think you have failed me and attacked me with an axe, leaving me with a bleeding wound on my shoulder.

                  Rich leech, pay tax.

                • Roger

                  How did you decide that I am rich? Truth is you cannot know such, but could suspect that in relative terms that could be true if you are in fact a Pauper.
                  Yep you display all of the traits and they are extremely ugly.

                • Leon Wolfeson

                  I can see your posts. As you demand I fit your PC stereotyping, of course.

                  As you once more state you’re very, very rich. And hate on the poor.

                • Roger

                  Rubbish. Why should I stoop to such base emotions, spite and envy is the preserve of the Leftards, mine is generosity to the deserved and I decide who I believe they are.

                • Roger

                  I do and even now as an OAP. In my working life I have probably paid in large multiples of the national average, so I believe I have paid in my share. As for my kids they have no debt to this society as The State provided little that I have not covered by my taxes or moreover paid for privately. They owe you lot nothing so go pull up your own socks.

                • MrChuck

                  That would be fine if junior doctors had a standard 9 to 5, 5 days a week work pattern, but they don’t. Typically standard hours are way beyond 40 per week and nights and weekends are part of the standard package, not something required occasionally to get the job done, as you put it. And the money doesn’t compare favourably with other professions, particularly in the light of the level of responsibility and the time taken to become a consultant.

              • fundamentallyflawed

                Industries which have made plenty of provision for shift working according to the needs of the business not the whims of the workforce?
                Those car and oil industries?

                *EDIT – On the Second point plenty of companies “steal” employees time.. Have to stay until the job is done/Sitting at your desk ready to work 15 mins early etc etc . I believe somebody was recently sued for this (and a well known truck company is definitely in hot water over its practices).

                I actually agree with your second point though

            • Matt

              I don’t doubt how hard other people work, or fail to recognise that the NHS is not free but paid for through taxation (including my own). Junior doctors were pretty tolerant of their lot before talk of a new contract arose. We never asked for more money. We never asked for less hours. Goodwill work has its own rewards. It is the step change in pay, conditions and protection threatened which makes us feel unvalued, exploited and demoralised.

            • Alan

              Those FTSE workers will of course be paid for more for a similar level of education and receive bonuses every year – doctors already work many hours over their contracted hours for no additional pay most of the time. Also remember that people working long hours made mistakes – with doctors that could cost you a life, not just some cash…

          • AndyTheScientist

            Don’t most careers require extra work today? Isn’t that just the way our work has gone? The difference is i guess hospital doctors work is at the place of work. Other professions tend to end up doing this extra work at home. I personally for many years did extra (unpaid) lab work at night and at weekends etc. Accountants, solicitors, barristers, marketers, scientists, teachers etc all do work at home. Many people will have constant access to their work e-mails, I personally still do international skype meetings at all hours of the day and night. We travel for work all unpaid usually.

            I agree there is a lot of this guilting people into unpaid extra work that goes on in many industries today. For some it’s always been that way, for others it’s relatively new due to the rise of the digital workplace.

            Whether it’s a good or bad thing people will have different views, however it would be fairer for the doctors to just admit that is what this dispute is really about rather than hide behind patient health. If the union wants to defend its workers current working conditions and pay fine, but just come out and say that is what they are doing.

            PS threats of doctors leaving in their droves is fine, ultimately if people don’t want to do the job people will leave, then the government will be forced to change the offer, it will all come out in the wash. Rather than striking perhaps doctors should leave in protest? You would think applications to medical school would be down by now, but i see no evidence that this is the case.

            • Leon Wolfeson

              Britain has a problem with presenteeism, yes.

              And no, what happens is the NHS fails and the poor get shafted.

              PS, “i see no evidence that this is the case.”

              The limiting factor on medical training places is government funding.

            • Matt

              “Other professions tend to end up doing this extra work at home.” We also have plenty of work to do when we get home too unfortunately. Exam prep, presentations, audits, research etc take up a huge amount of time.

              “it would be fairer for the doctors to just admit that is what this dispute is really about rather than hide behind patient health.”- It would also be fairer if the government admitted that they want to cut the pay bill instead of hiding behind patient safety. And that they ultimately have a privatisation agenda.

              “Rather than striking perhaps doctors should leave in protest? ” – UK doctors believe in the NHS. They don’t want to abandon it if it can be avoided. Many of the doctors striking (including myself), will not be massively affected be the new contract as we are close enough to the end of our training that we are being offered pay protection. This is a fight for the future and most junior doctors.

              “You would think applications to medical school would be down by now, but i see no evidence that this is the case.” Have you looked? 2015 applications are down 13.5% vs. 2013. May be many reasons for this including the 70k+ debts that most new medical students will now accumulate. It’s unlikely that spaces will go unfilled any time soon, but we we still be selecting the same calibre?

              • Paul

                What I would like to know is what Doctors and others mean when they refer to privatisation of the NHS. Below, I set out what I think you mean:

                The basic principle of the NHS is that it is free at the point of use (single payer system) not that the state owns it (single provider), and whilst we do charge for some areas (primarily social care, dentistry & prescriptions) the idea that charges will come in for hospital provided care is scaremongering. Especially to decry the government for it when it is not uncommon to hear doctors call for more charges in the NHS (eg drunken injuries, missed outpatients appointments, GP appointments). The area we really need to worry about “privatisation” is dentistry, where many practices refuse new NHS patients and write to existing NHS patients asking them to sign up for DenPlan or similar.

                So I can only presume when you refer to privatisation, you actually mean private for-profit operators providing NHS services (which is something we have always had in General Practice, Dentistry & Pharmacy). I further presume that the reason it is objected to (assuming they operate on the same tariff as NHS trusts)

      • fundamentallyflawed

        “It is patently clear to doctors and the BMA that this new structure will result in an actual pay cut despite a headline pay rise in basic pay.”
        For Drs who work more anti-social hours than their colleagues probably true.
        For Drs now being asked to work more anti-social hours their additional remuneration may indeed be less than they would get now however money not earned is not a pay cut.
        I think Dr’s need to face up to the fact that simply because they are Dr’s does not make them immune to the requirements to offer a 7 day service or to demand extensive additional payments.
        As for the deterrent you talk about – much of the public dialogue has been how the Drs are ALREADY overworked and do more hours than rostered

        • Matt

          You are right. A dermatology junior doctor working 9-5 mon-fri will potentially be rewarded with a pay rise.
          Doctors that work in emergency specialities such as A+E, intensive care, acute medicine, general surgery etc who already work extremely hard, make sacrifices in their family life and routinely work beyond their hours for altruistic reasons and for their own educational/training benefit are likely to be punished with a pay cut. I don’t think this is fair.
          The current system of hours monitoring is not perfect. Doctors do regularly work beyond their hours. However, it does have teeth, and doctors can call upon it to cause change when required. Why the government would seek to water this down only they can say.
          It does worry me that they are currently trying to secure an EWTD opt-out as part of the referendum negotiations. If they have their way we will lose the protection of the EWTD if we stay and lose it if we leave. Add to that the prospect of a new contract that cheapens the cost of anti-social hours…

          • telemachus

            The trainers, particularly the Surgeons want an EWTD opt out
            *
            We accept what you say in response to fundamentally flawed, but it should not be difficult for the BMA to get a simple form of words that enshrines workload/hours limitation in contract to remove Hunts suspicion that overworking may be welcomed by some juniors for their personal economic gain

            • Matt

              It is an inherent problem that what works for psychiatry may not work for surgery etc. To be honest, my working life was better before the strict implementaion of the EWTD- there were more of us at work (because we were rostered for more hours/had less compensatory time off after nights or weekends etc) and the intensity was less. We were even paid more. I earned more money as a house officer in 2004 than they do in 2015. Lets not forget that most european countries do not enforce the EWTD on doctors. Again it comes down to trust. Do we believe that in the current climate we will be safe from dangerous working conditions without the EWTD? I have sympathy for the surgeons. A lot of important training occurs in the middle of the night when emergencies come in.

              I honestly don’t believe that JH is concerned that doctors will attempt to overwork themselves in order to exploit the NHS. This is just another angle. If I want to work more hours than I do because of a motivation for money there is an abundance of locum work available.

              • telemachus

                You could write a training exception to the EWTD into the contract (ie certified by the relevant Royal College or Academy of Medical Royal Colleges)
                But you need to get the Public on side and pressurising Hunt
                This needs a simple message, well articulated and delivered repeatedly
                If you want to win, you need to keep the initiative

              • Leon Wolfeson

                That’s down to technicalities in the treatment of on-call hours, mostly, right?

                Something Cameron has miserably failed to try for, instead trying to destroy the EWTD here.

      • Jaria1

        Sorry striking by those who’s duty it is to look after the sick is not acceptable under any circumstances.

      • right1_left1

        ‘Most junior doctors work 1 in 4 weekends at present;
        Where ?
        Weekend visits by me for tests found the hospital almost empty !

        My guess is you dont want to be required to work weekends.
        ie you wish to maintain a privileged status.

        What’s good enough for the working classes, assuming their job hasnt been ‘globalised’ is certainly not suitable for the middle and upper middle classes.
        Perish the thought !

        • Matt

          “My guess is you dont want to be required to work weekends.”- with respect, my 11 years as a junior doctor working these roots and working 1 in 4 weekends (2 out of 3 when I worked in A+E) is more accurate than your guess based on a visit to a hospital for some tests.
          Hospitals are more quiet at the weekend. There are less patients coming for routine/elective tests, appointments and interventions and less staff as a result- across all departments and levels.
          “What’s good enough for the working classes, assuming their job hasnt been ‘globalised’ is certainly not suitable for the middle and upper middle classes.”- doctors represent a broad socio-economic background. In my experience there is absolutely no correlation between ‘class’ and dedication/professionalism in medicine.

    • Roland Haines

      Don’t worry about people dying, your party is breathing its last.

      • Leon Wolfeson

        Ah, the evils of multi-party democracy, even here….

    • Jaria1

      We all know that there are more deaths at the weekend so do try and stop politicising this matter . You can see the Labour leadership are milking it already as much as they can.
      Have ACAS been involved?

      • telemachus

        Yes there are more deaths at weekend
        But the Junior Doctors deliver the weekend care
        He has picked a fight with the wrong group
        He should engage with the Consultants on that

        • Jaria1

          He is of course dealing with the BMA who are of course well aware of their strength. Blame who ever you wish but those that chose to tend to the sick should never think of going on strike.

          • Leon Wolfeson

            So no basic rights for anyone who dares help others.
            Then you’ll wonder why recruitment becomes even more of an issue.

      • Leon Wolfeson

        Your personalities all know…a different topic related to i.e. less routine operations at the weekend. Hmm!

  • mightymark

    “The NHS is an independent arms-length body. The Tories have an electoral mandate for a seven-day NHS but they should simply have passed that on as a condition for the extra cash the NHS has received. ”

    No very strong views on the dispute itself but I do wonder how credible the above quote is. How far would the public not blame the government because it had an “arms length” arrangement. If we are top have a welfare state (and I agree we should) I doubt that government’s can in reality offload responsibility in that kind of way.

  • http://www.facebook.com/profile.php?id=1245680941 Robin Tudge

    I kind of get the feeling the writer of this piece would have us believe all junior doctors are on £53k a year, which would be something of a lie.

    • alabenn

      You are right, some get £73000, the poor dears, lets strip the NHS cleaners of a couple of thousand to put them all on £73000, Attlee had to stuff their mouths with gold to get the NHS of the ground, it is the entitlement culture writ large.

      • quotes

        bevan, rather than attlee, but yes. i’m not sure there was any other option though. there would have been no nhs without any doctors staffing it. and there was cross-party consensus on the nhs and other welfare programmes so it’s probably fair to guess that a tory government would have been just generous and perhaps even more so.

        • Bill Ellson

          No, see my comment below.

      • Bill Ellson

        You are more than a bit muddled. “I stuffed their mouths with gold” was Aneurin Bevan’s response when in 1957 somebody asked him how he got the consultants to agree to the formation of the NHS. The majority of hospitals in England and Wales pre-NHS were local government owned and run, the remainder voluntary. Consultants were usually self employed and the deal with the hospitals was basically that they charged the patients who could afford to pay, but treated for free those who could not afford to pay. Bevan was very fond of fine dining and the high life in general. Lord Moran, President of the Royal College of Physicians, had the sense to wine and dine Bevan in Mayfair’s finest restaurants and in return Bevan agreed to pay consultants for the work they had always done for free, but allowed them to keep being paid privately for the work they had charged for. The BMA simply opposed Bevan over the NHS as they had opposed his Conservative predecessor Henry Willink and in 1948 GPs got given the simple choice of signing up to the NHS or losing their patients to other doctors who did. As Bevan never had an NHS GP, preferring to retain his personal physician, he was not really bothered what the BMA thought.

        • alabenn

          It was the Attlee government that set this monster up, Bevan was a legend in his own mind, the Welsh because of the chips on their shoulder about the English, took to propagating this nonsense.

          • Bill Ellson

            Perhaps you should have read my comment before replying.

            • alabenn

              I did, they still had to bribe them to set the bloody thing up, regardless of all the myths surrounding its inception.

      • Shorne

        Trainee doctors currently have a starting salary of £22,636 – at Foundation Year 1 – rising with experience to reach £30,000 within four years. Doctors in specialist training receive a salary of between £30,002 and £47,175, while those who make the grade can earn up to £69,325. You don’t just walk off the street to start as a trainee doctor either, as they are expected to have a medical degree, which can take between five to six years to get and will leave the student with about £40,000 of debt.

        • alabenn

          The junior doctors who have appeared on TV, being mostly foreign born or ethnic certainly look like they have just walked in of the street, judging by the standards of their discourse, it is as a money dispute now tainted by political machinations of a few Trots.

          • Leon Wolfeson

            Ah, blame them for not looking perfect and for not being White enough…

            As you blame those “few Trots” in your mind…never mind the overwhelming strike vote…

          • Shorne

            No doubt if you have to be rushed to an A&E Dept. You will insist on a white doctor?

        • Bill Ellson

          “You don’t just walk off the street to start as a trainee doctor”
          True, but as the number of medical degree courses is limited to the number of junior doctor posts available then anybody who scrapes through a medical degree is guaranteed a job in the NHS.

          • Leon Wolfeson

            “anybody who scrapes through a medical degree is guaranteed a job in the NHS.”

            Nope. The Tories have managed to mis-handle that as well and leave a significant percentage of graduates without a training position.

          • Shorne

            You haven’ t the faintest idea of the selection process have you.

            • Bill Ellson

              In that you fail to give any details, we can safely presume that neither do you.

              • Shorne

                Well show us your superior knowledge then.

              • Shorne

                Show us your in-depth knowledge then.

        • Leon Wolfeson

          You’re well behind the times, Shorne. Try £80-100 debt.

          • fundamentallyflawed

            Lovely massaged figures to account for all student debt (for things such as accommodation etc) Not the direct effect of tuition fees

            • Leon Wolfeson

              Er… that’s the debt the individual carries from student loans.

              Nothing’s “massaged”, people need money to live. The effect is direct.

          • Shorne

            I sure you are right.

        • fundamentallyflawed

          Even the BBC daren’t report the salaries as £22k – though I get the impression they would love to.
          The BBC reports with additional payments salary is around £30k at the start going upwards with experience and specialisation.

    • quotes

      my understanding – i’ve not followed this all that closely – was that the very few who will be losing out as a result of these changes (at least in outright income terms) must necessarily be on that much, as part of the reforms involve restrictions on overtime.

      so while not every junior doctor is on that much – and i agree mcternan gave that impression – those who are actually going to suffer detriment from the changes must be. as the govt so often say, those who work legal hours will (supposedly) get pay rises.

  • mickey667

    Machievelli wrote “The Prince” as a kind of broad job application.CV to get himself employed by one of Italy’s powerful families.

    Who is John McTernan touting for work with with this grubby little piece?

    • Vukefalus

      Machiavelli, correct in so many things, wrote: “It must be considered that there is nothing more difficult to carry out nor more doubtful of success nor more dangerous to handle than to initiate a new order of things; for the reformer has enemies in all those who profit by the old order, and only lukewarm defenders in all those who would profit by the new order; this lukewarmness arising partly from the incredulity of mankind who does not truly believe in anything new until they actually have experience of it.” The BMA and the Labtard party are the old order and Hunt, like IDS and Gove are the reformers.

      • mickey667

        “and only lukewarm defenders in all those who would profit by the new order; this lukewarmness arising partly from the incredulity of mankind who does not truly believe in anything new until they actually have experience of it.”

        Yes, but they certainly see how they profit from the new order now don’t they. Great British corruption at its best – http://www.mirror.co.uk/news/uk-news/david-camerons-gravy-train-scandal-7153710

        • http://owsblog.blogspot.com Span Ows

          Daily Mirror, LOL, on a par with the Star, far worse than the Sun and totalt toilet paper compared to The Daily Mail but I bet you crow when somebody links to them.

          • mickey667

            But the facts of your corrupt government with their greedy snouts in the trough of public money are verifiable.

            Facts eh? Awkward things.

      • Leon Wolfeson

        Ah, the people trying to slash services and who have alrerady done a lot of damage are “reformers”, as you spew PC bigotry at the left.

        The Unions, those evil workers…as you project from your Dear Leader syndrome, as you talk about the “nightmares” of other views being allowed…

        Machiavelli was correct about you. He was warning about poorly conceived change leading to dangerous outcomes. The Tory voters complaining to MP’s about cuts, for instance, are a prime example…

  • mickey667

    People are not luddites for wanting a work life balance.

    Technology ought to be used to the benefit of workers as well as people and customers, not to tie them to work so every waking (and sleeping) hour is linked in to work.

    This is what people oppose. Not technology but the use of it to enslave us to our mundane jobs, rather than liberate time for ourselves by using technology.

    You just don;t get.

    Nor do you get why the public are massively in the side of the doctors.

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