The controlled demolition of the NHS

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Re: UK junior doctors strike

Postby Ace » Sat Sep 03, 2016 12:28 pm

Whereas I have some sympathy with the debate and am not close enough to know the detail, I am always shocked at the tail wagging the dog syndrome in the public sector.

The people that run any organisation should be allowed to manage, to put forward and implement change after proper consultation. If that change doesn't work, it's their heads on the line. If masses of junior doctors leave the NHS, that will be failure. If everything goes pear shaped, that will be failure. We have to let those in control manage effectively.

In all my working life I've had change enforced on me and I myself have enforced change on others. On many occasions, those impacted by the change have been anti, including myself. However, in the majority of cases, the change has worked and we've moved on, a better organisation.

I find the lack of response to change in the public sector mind blowing. In healthcare, teaching, local government, everyone seems to think the only thing required is more money, not change. We've already pumped huge amounts of extra cash in the health service and it not enough. It's never enough.

We need to have a programme of massive change in the public sector, to meet the needs of the next generations. The sacred cows need to go. We need the leaders and thinkers to be able to attempt change and implement radical thinking without the tail constantly wagging the dog. It should not be a policy argument, it should be a time to try new ideas.

Many won't like those ideas. Many will lose, some will gain. But we must change. We will make mistakes but that's how we will learn. If the proposed changes are wrong, it's the leaders heads that will roll. If those impacted by the change don't like it, they have to move on, find something they do like. We do not offer public sector jobs tailored to the requirements of the employees, we offer the jobs that society requires. And it's a rapidly changing society. So jobs will rapidly change.

It's not a popular view, and I'm sure I will get much criticism but we must let our heads of public sector services introduce change. It's not just about junior doctors hours, it's about leadership being allowed to manage. Almost everyone has change enforced on them in today's work place, primarily because the world is changing. My own staff are being relocated to new jobs, 20 miles away. They will now have to work alternate Saterdays and work up to 8pm in the evening. They don't like it. Many will leave. But the organisation needs to do it. If we don't, we will fail and many more jobs will be lost.

What they haven't done is strike. Why? Because unlike public sector workers, they can't hold the general public to ransom. They don't have that power. The days of powerful public sector workers holding their customers to ransom must stop.
 
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Re: UK junior doctors strike

Postby Trashcat » Sat Sep 03, 2016 10:34 pm

The answer of course is simple. Kill everyone over 70.
 
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Re: UK junior doctors strike

Postby Innuendoes » Sat Sep 03, 2016 11:20 pm

Trashcat wrote:The answer of course is simple. Kill everyone over 70.


Right, then start working backwards!
 
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Re: UK junior doctors strike

Postby Elessar » Mon Sep 05, 2016 12:26 pm

Anecdotal consensus:

Around 60% of junior doctors against the strike
90% of consultants support the strike
Divisions emerging within the BMA (apologies for the source but the story is true: http://www.dailymail.co.uk/news/article ... armed.html )
 
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Re: UK junior doctors strike

Postby fairydandy » Mon Sep 05, 2016 12:59 pm

Elessar wrote:Anecdotal consensus:

Around 60% of junior doctors against the strike
90% of consultants support the strike
Divisions emerging within the BMA (apologies for the source but the story is true: http://www.dailymail.co.uk/news/article ... armed.html )


What will your friend do, I wonder?

Anyway, from the article:
The action they’re proposing is disproportionate to what they’re asking for,’ she said. It’s not just five days of action, it’s flanked by the weekends – patients would be going nine days without properly seeing anyone. The NHS is already under strain and pressure and it concerns me that we’d only be adding to that. I don’t think there’s any appetite now.’

'Patients would be going nine days'...now isn't that the point I have trying to make about all of this, there's no fucker there at weekends!!!? ;-)

I know, I know...but listen, as a patient, I want a true, seven day hospital operation, with no change at all because the label on a particular day says 'Saturday' or 'Sunday'....there is no such thing anymore, isn't that the point? [he said provocatively]
 
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Re: UK junior doctors strike

Postby Elessar » Mon Sep 05, 2016 3:55 pm

September strikes cancelled. More to follow when I get home...
 
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Re: UK junior doctors strike

Postby Elessar » Mon Sep 05, 2016 3:58 pm

Over the past few days junior doctors have been described as radical, they have been described as militant, they have been described as prioritising ourselves over their patient’s safety.

This is not true.

Patient safety remains doctors’ primary concern. For the first time in this dispute NHS England have told us that a service under such pressure cannot cope with the notice period for industrial action given. Our hospitals are chronically under staffed. Our NHS is desperately underfunded. We have to listen to our colleagues when they tell us that they need more time to keep patients safe.

We have also listened to the concerns of working doctors, patient groups and the public. Thousands of you have been in touch, your level of anger over the Secretary of State’s imposed contract remains high, but at the same time you want to keep your patients safe during industrial action.

The BMA is therefore suspending the industrial action planned for the week of 12 September. The remaining programme of industrial action stays in place.

This does not absolve the Secretary of State. He continues to ignore the BMA’s request to stop the imposition. He continues to force upon junior doctors a contract that discriminates against carers, parents, doctors with disabilities and women, a contract that devalues our time and a contract that disincentives careers in our most struggling specialties. He continues to strive towards an uncosted, unfunded, unstaffed extended seven day service. He continues to disregard the concerns junior doctors have about staffing shortages and patient safety.

Future action is, however, still avoidable. The BMA has repeatedly said that it will call off further action if the Secretary of State stops his imposition of the contract, listen to the concerns of junior doctors, and works with us to negotiate a contract, based upon fresh agreed principles, that has the confidence of junior doctors.

There are four weeks until October. The Secretary of State must use this time to listen and act.

 
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Re: UK junior doctors strike

Postby JLP » Mon Sep 05, 2016 7:34 pm

fairydandy wrote:
Elessar wrote:Anecdotal consensus:

Around 60% of junior doctors against the strike
90% of consultants support the strike
Divisions emerging within the BMA (apologies for the source but the story is true: http://www.dailymail.co.uk/news/article ... armed.html )


What will your friend do, I wonder?

Anyway, from the article:
The action they’re proposing is disproportionate to what they’re asking for,’ she said. It’s not just five days of action, it’s flanked by the weekends – patients would be going nine days without properly seeing anyone. The NHS is already under strain and pressure and it concerns me that we’d only be adding to that. I don’t think there’s any appetite now.’

'Patients would be going nine days'...now isn't that the point I have trying to make about all of this, there's no fucker there at weekends!!!? ;-)

I know, I know...but listen, as a patient, I want a true, seven day hospital operation, with no change at all because the label on a particular day says 'Saturday' or 'Sunday'....there is no such thing anymore, isn't that the point? [he said provocatively]


If you want to be safe on a weekend then you do not need more junior doctors, you need more consultant s. Trouble is, the surgeons are doing private work.
Come on you Tigers.
 
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Re: UK junior doctors strike

Postby fairydandy » Mon Sep 05, 2016 7:45 pm

JLP wrote:If you want to be safe on a weekend then you do not need more junior doctors, you need more consultant s. Trouble is, the surgeons are doing private work.


My idea of 7 day working is just that, 7 day working. Nothing should change from a Friday to a Saturday, exactly the same number of staff, doctor's, admin, consultants, everything. It's got to happen at some point in the future.
 
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Re: UK junior doctors strike

Postby Elessar » Mon Sep 05, 2016 8:17 pm

fairydandy wrote:
JLP wrote:If you want to be safe on a weekend then you do not need more junior doctors, you need more consultant s. Trouble is, the surgeons are doing private work.


My idea of 7 day working is just that, 7 day working. Nothing should change from a Friday to a Saturday, exactly the same number of staff, doctor's, admin, consultants, everything. It's got to happen at some point in the future.


There aren't enough doctors for a 5 day NHS. They can spread the 5 day service out over 7 if they really wish (it's not necessary, but whatevs), but all that will achieve is it will make weekdays (when all the routine stuff happens) less safe without particularly improving weekends.

The only way they can deliver a true 7 day NHS (even though they don't need to) is by doubling the number of doctors.

I disagree with what JLP says about needing more consultants though. Most of the staffing problems are at a junior level. Those gaps could be plugged by consultants but that would be poor value for money.

In any case, I don't know where new doctors are going to come from. There aren't enough kids wanting to study it any more (there were places available in clearing for the first time ever this year), and we've decided in a referendum we don't want any more foreigners.
 
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Re: UK junior doctors strike

Postby Elessar » Mon Sep 05, 2016 8:21 pm

Another problem with a 7 day NHS is it will destroy continuity of care, which is very important to patients and is already being eroded.

At the moment, if you're unlucky enough to be on a medical ward, you have the same team of doctors looking after you all week, on-call emergency cover over the weekend, and then back to your day team on Monday morning. If you want staffing levels on Saturday to be identical to Friday, you either need all doctors to work 365 days a week, thus maintaining continuity of care, or move to a shift system, which means doctors don't really know their patients and the hospital turns into a factory of machines treating numbers instead of people caring for people.
 
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Re: UK junior doctors strike

Postby fairydandy » Mon Sep 05, 2016 9:01 pm

Elessar wrote:Another problem with a 7 day NHS is it will destroy continuity of care, which is very important to patients and is already being eroded.

At the moment, if you're unlucky enough to be on a medical ward, you have the same team of doctors looking after you all week, on-call emergency cover over the weekend, and then back to your day team on Monday morning. If you want staffing levels on Saturday to be identical to Friday, you either need all doctors to work 365 days a week, thus maintaining continuity of care, or move to a shift system, which means doctors don't really know their patients and the hospital turns into a factory of machines treating numbers instead of people caring for people.


I'm not suggesting that it will be easy, but it is inevitable. If not now, in 20, 50 years. We can't go on shutting down hospitals at 17:00 on a Friday, it just simply can't work in a 24/7/365 society, it's not possible or sustainable!

Yes, we need more doctors and we should have them, but ultimately what are we to do with the NHS? I love it as much as you do, as much as we all do. We need an op, we have an accident, it's world class and it's free (apart from the tax burden on those who work)...but if it was a business, it would have failed long ago. Can we keep on pouring money into it? Yes, we can, but I'm not sure that money is the only answer, some serious modernisation is also required.

I went to the eye ward the other week...how many receptionists were there...three, yes bloody three, doing the job of one and god knows how many nurses and auxiliaries standing around in little groups chatting. It's harsh, I'm being harsh, but maybe things have to change in the NHS (heaven knows what my dad a life-long socialist would think of me for saying this...). :?
 
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Re: UK junior doctors strike

Postby Elessar » Mon Sep 05, 2016 9:15 pm

We see the inefficiency in the NHS because we feel we're paying for it, but I promise you, private healthcare systems are A LOT less efficient.

Because we don't have unlimited resources, we use evidence to control what treatment people get. In America, if you have the money, you get a CT scan as soon as you're ill. Yeah, it may well give the answer, but it's dreadful medicine and the radiation exposure is often completely unnecessary. The person I know worked in Australia last year and only managed to get one patient with appendicitis to theatre without them having a CT first. In the UK, getting a CT for appendicitis is an admission that you have crap clinical skills and can't identify a simple appendicitis (sometimes it's genuinely a difficult diagnosis in which case fair enough). He saw a hybrid private/public system in Australia and while the speed and quality of treatment was better there than in the UK, he saw a lot of unnecessary treatment that is simply a cash cow for the private operators.
 
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Re: UK junior doctors strike

Postby Elessar » Tue Sep 06, 2016 6:31 am

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Re: UK junior doctors strike

Postby Elessar » Tue Sep 13, 2016 9:33 pm

Worth reading:

Spoiler! :
A day in the life of a junior doctor in the NHS:

Start 07:50, ready for board round and teaching at 08:00.

Ward round begins approx 09:00 - 09:15, where every patient under my team's care is reviewed and a list of jobs for the day generated.

During ward round a medical emergency is called for one of our patients and, after full assessment and initial management, it is decided they need an urgent CT Head. Quickly call radiologist and agrees for the scan to be performed. Phone CT: '...ah. Well, you're at the wrong hospital for an urgent CT today. One of our scanners is broken, you see and we need the engineers to come (private company). But we could do it now if you could get him here, although there aren't any daytime porters available (different private company). Sooo...'

'Ok, I'll bring him down myself - no worries.' Recruit another doctor, take patient to scan. During scan I'm reprimanded for not having completed manual handling at this trust despite having done the same ridiculous course at every other hospital I've worked and as a medical student.'

Scan done, thankfully looks ok. 'Sorry, also no porters to take the patient back.' Take patient back despite above mentioned reprimand.

Rejoin ward round and try to catch up on what's been missed.

Start cracking on with jobs. Lose one doctor to theatre and one to pre-assessment. Also worth noting that majority of staff are locums (thankfully in my case excellent locums, but I've been in many a situation where this is not the case.). This is due to chronic understaffing and leads to poor continuity of care (but the government have fixed the staffing problem, that's what they're saying; right?)

So you crack on with a busy day and get stuff done, often eating at a computer rather than taking any actual break. The day finishes about an hour late for the staff on normal days, which is excellent going (many of my colleagues will finish much later, daily.) and the overtime isn't paid, which we all accept is part and parcel of the job anyway.

I'm on call so am still on shift (minus break) and there are three patients to clerk in and admit, take bloods etc. One patient becomes very sick and urgent bloods are taken. As the only doctor on the ward of 40 odd patients, I can't leave so call porters to request the urgent bloods I've taken arrive safely to the lab (pod system not working and no private engineers to fix it). It's a different (private) company out of hours and I'm on hold to Vivaldi's Four Seasons for seemingly an eternity before someone picks up. Sure, porter comes up and sits next to me and starts chatting. Politely remind of the urgency of the bloods and he leaves, bloods en-route to lab. 2h later and no results. Phone lab...'sorry, they're not here.' Bloods never made it. Rebleed and run to the lab and back, thankfully leaving an excellent nursing colleague with my patient.

Later decide a different patient needs an urgent CT head again. Phone radiology (outsourced out of hours to a private company in order to get the scan. It's agreed and a reference is provided). Phone CT '...sorry the scanner is broken still. There weren't any engineers available today. And anyway, there aren't enough porters...'

I despair at this absolute mess around me, for which doctors, nurses, HCA's, radiographers, physio's, pharmacists and all the other members of staff that keep this sinking ship afloat out of good will are blamed for bringing it down, the media suggesting we are greedy and overpaid.

I hope the government wake up and realise that they are the ones destroying something that so many people are so passionate about. I hope that they realise that it's the progressive privatisation of services to companies accountable to nobody is killing it. I hope they realise that we, and the public, can see through the lies around staffing (rather hard to maintain when the patients that use our amazing organisation can actually SEE the problems).

But, you know, making doctors do NON-EMERGENCY work over weekends will solve this. The government is delusional or manipulative to the extreme and I can't actually decide which is worse. I, like many of my colleagues, want to leave because none of us want to work in a service where we can't provide the best care for patients anymore, and that responsibility is entirely out of our control. We're miserable because we care. It's very simple. But I'll stick around for now, as it really is worth fighting for.

Also, one more thing; once all of the above is done for the day, then junior doctors far and wide stay in work to go to theatre, to do mandatory training, to carry out work based assessments and the endless paperwork required for OUR OWN training. For free. And we always have, without complaint. But the media will still carry on with this 'lazy and overpaid' mantra of theirs.

Rant over


From http://www.facebook.com/oscar.maccormac ... nref=story
 
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