Do you support the junior doctors' strike?

[Amberley54]

Alright, here we go...

Over the last few years, I've had a few medical problems which has meant long times overnight. On a number of these occasions, I have overheard some of the junior Doctors saying they could not be bothered to order tests and to leave it for the day shift - terrible behavior I have drawn attention to twice.

The other thing that really ticks me off about this whole thing is that I was rushed in last week and, whilst waiting to be seen, I heard three junior Doctors gleefully talk about how they'd voted for the strike action but wouldn't turn out for the protests and would treat the strike as a holiday!

Sorry to say that, under those circumstances, I can't support them

Disappointing to read your experiences, but certainly not the norm here.
My wife has worked as a staff nurse on nights in an acute surgical unit for over 20 years and can give many, many examples of junior doctors being shat upon by more senior colleagues, yet going the extra mile to ensure patient care and dignity. Hunt's imposed changes are unnecessary, unethical and almost certainly discriminatory. But hey, he's a Tory, and that's what they do.

 

[NY Yankee]

People get sick and injured 24/7. They don't just go to the hospitals during the weekdays between 9 AM and 1700 (5 PM). And I've never heard of a doctor's union. I've heard of a nurse's union, but not a doctor's union. Aren't they private employees who work for a wage agreed upon by the hospital?

In addition, going on strike is just callous. Unlike the Tube, where there are alternate routes, sick and injured people need hospitals. This strike could potentially cause a person to die.

 

[GatwickDepress]

People get sick and injured 24/7. They don't just go to the hospitals during the weekdays between 9 AM and 1700 (5 PM). And I've never heard of a doctor's union. I've heard of a nurse's union, but not a doctor's union. Aren't they private employees who work for a wage agreed upon by the hospital?

In addition, going on strike is just callous. Unlike the Tube, where there are alternate routes, sick and injured people need hospitals. This strike could potentially cause a person to die.

The British Medical Association is the trade union for doctors throughout the UK, and are sole contract negotiators for doctors as recognised by the NHS.

I disagree that it's callous. I'm not a doctor or work in the medical profession, but from chatting to an A&E doctor while having a procedure done on my ears the other week, doctors do not generally leave A&E or the ICU to go on strike; it's the non-essential services that are left understaffed.

While I can agree that a strike could potentially put lives at risk; what the government proposes will put patient lives at a much greater risk in the long run.

 

[me123]

People get sick and injured 24/7. They don't just go to the hospitals during the weekdays between 9 AM and 1700 (5 PM).

Correct

And I've never heard of a doctor's union.

Visit the BMA's website. They're a union, and a "professional association", which in addition to providing the typical services of a union, also provides medical education to its members. I've been a member for almost a decade, and it's only in the last few years that the phrase "trade union" has been used. The AMA performs a similar role in your country.

Aren't they private employees who work for a wage agreed upon by the hospital?

In the UK, almost all junior doctors are employed by the National Health Service. Our wages are essentially dictated by the government. The hospitals and health boards/trusts do have some role, but on the whole they are only able to pay the what the government will provide for that level of doctor, which is a product of their seniority and out of hours commitments. Please refer to my initial post earlier in this thread, in which I explain how a doctor's pay is calculated.

In addition, going on strike is just callous. Unlike the Tube, where there are alternate routes, sick and injured people need hospitals. This strike could potentially cause a person to die.

Sick and injured people do need hospitals. For the majority of the walkouts, emergency care will be covered, so sick and injured people will be cared for as normal. It is elective work that is being reduced. In terms of the full junior doctor's walkout (which is unprecedented in the UK), emergency clinical commitments will undoubtedly be covered by senior colleagues (who are, on the whole, supportive of junior doctors).

The contract being imposed by Jeremy Hunt truly puts patients at risk in the long run, however. Being from America, you will understandably have little exposure to the NHS (in a similar way, I have limited exposure to the US healthcare system). The reality is that, in spite of high numbers of applicants to medical school, we struggle to employ enough doctors. We generally manage to cover clinical services, but there's often not as much "padding" in the system as we would like, so things like high service demand and staff sickness can really strain the system. Mr Hunt wants to stretch us even thinner on the ground by providing more staffing at weekends. Whilst we would generally agree with the principles of a truly seven-day NHS, we simply lack the staff to be able to do this. The only way Mr Hunt is going to achieve his stated goal would be to either work us even harder, or reduce the staffing level during the week. Neither option is safe for patients.

Doctors do not want to strike. Mr Hunt, however, has demonstrated that he does not want to talk. He refuses to sit down with doctors and come to a solution. Should he continue to do this, I cannot see any other option but to withdraw labour. If Mr Hunt would sit down and negotiate, I expect that these strikes could be averted.

 

[furnessvale]

Mr Hunt wants to stretch us even thinner on the ground by providing more staffing at weekends. Whilst we would generally agree with the principles of a truly seven-day NHS, we simply lack the staff to be able to do this. The only way Mr Hunt is going to achieve his stated goal would be to either work us even harder, or reduce the staffing level during the week. Neither option is safe for patients.

This is the bit I don't understand.

If thinning out staff on 5 days of the week to put extra staff on the other 2 will make things unsafe for patients on those 5 days, just how unsafe is it NOW for those patients unlucky enough to fall ill on the 2 days which are currently very poorly staffed?

 

[me123]

This is the bit I don't understand.

If thinning out staff on 5 days of the week to put extra staff on the other 2 will make things unsafe for patients on those 5 days, just how unsafe is it NOW for those patients unlucky enough to fall ill on the 2 days which are currently very poorly staffed?

Good question, thank you.

Currently, we have two levels of service. During the week, there is a "full" service, in which emergency and elective care is performed. This currently exists Monday to Friday, excluding public holidays.

At weekends and public holidays, it operates to an "emergency" service level, in which there is little to no elective work (no elective surgery, no outpatient clinics, no outpatient investigations, no chemotherapy day patients, and so on). Patients presenting as an emergency are, of course, offered everything that is required for their care regardless of when they present. But non-urgent work is held until a full service is running.

With the elective workload, more doctors are required over the course of the week. On weekdays, in addition to covering emergency care, doctors are required to run outpatient clinics, perform elective surgery, and look after the more routine cases. This requires more doctors than is needed to cover the emergency care. There are currently fewer staff at the weekend, because there is no elective workload and we are only looking after our emergency patients. This obviously varies between specialties - orthopaedic surgery need only run a trauma service and not their elective workload, whereas A&E departments will be essentially unchanged at the weekend.

Hunt would have you believe that higher mortality at weekends is directly caused by staffing levels. This is not true, there is no evidence to support this claim. Higher mortality does exist for patients admitted over the weekend, but the studies have not identified causation. It is true that patients admitted over the weekend are generally much more unwell than those admitted during the week, which would also contribute to a higher mortality rate.

Hospitals are busy every day of the week, but the lack of routine work at the weekends does mean that we require fewer staff as there are fewer patients. Under Hunt's plans, we would either have to work longer hours or stretch our resources even thinner. As Hunt claims that the new contract will reduce the number of hours that we work, it must be the case that services will be diverted away from weekday care. And this is where people will suffer.

Let me be clear. I support the principle of seven day NHS. It would be brilliant if we could offer the same service on a Sunday as we do on a Wednesday. However, Jeremy Hunt's plan to deliver this is flawed. He needs to train more doctors in order to achieve this aim. He has no plans to do so. He wants to cover more hours without increasing the number of staff, which must mean that either our hours will increase, or the number of doctors on any one shift will decrease. Both of these outcomes will be poor for patient care - either by diverting resources away from the "full service" days, or by increasing fatigue.

 

[furnessvale]

Good question, thank you.
SNIPPED

Thanks for the comprehensive reply.

This raises a further question, which I am putting in probably very simplistic terms.

Assuming no increase in the amount of elective cases (there are only x number of hernia repairs etc per annum), spreading them over 7 days instead of 5 should mean less per day, and therefore a requirement for less medical staff on each of those 5 days.

What I also see is that facilities such as operating theatres, radiology etc, would be more intensively used over 7 days and there would be a requirement for less of them. Could this be an area where Hunt sees the potential for savings?

 

[Masboroughlad]

I support them 100%

Slowly but surely the Tory austerity plan is coming unstuck. They seem to be making a good job of upsetting many different sectors of society.

 

[DarloRich]

People get sick and injured 24/7. They don't just go to the hospitals during the weekdays between 9 AM and 1700 (5 PM). And I've never heard of a doctor's union. I've heard of a nurse's union, but not a doctor's union. Aren't they private employees who work for a wage agreed upon by the hospital?

In addition, going on strike is just callous. Unlike the Tube, where there are alternate routes, sick and injured people need hospitals. This strike could potentially cause a person to die.

May I suggest you research the National Health Service and how it operates. Try not to use those American websites that seem to think our wonderful NHS is, in fact, some kind of communist backed plot to do something awful to people.

 

[ComUtoR]

**snip*

Sorry to say that, under those circumstances, I can't support them

Well done for sharing your opinion. I agree that similar circumstances can cause people to side against the Jr Dr's and indeed any industry. It is a shame that a few people can put such a blight on their entire profession.

I have been in the "care" of the NHS for the past couple of years and my experience has been more in the negative than the positive. I also know people very close to me who work (not as Jr Dr's) but do work in the NHS.

I must admit I am in the camp who believe that the system is in dire need of change and I do want a "7 day service"

I still 100% support their right to strike.

 

[YorkshireBear]

What gets me about the whole thing now is that no matter what the outcome is, there will be a bitter taste left in the mouth of all staff. Morale will be destroyed frankly whoever gets there way (winning is not a word i use in these situations).

There is a very interesting article on the bbc today regarding junior doctors using this as the main justification for working abroad, especially Australia and the Middle East. http://www.bbc.co.uk/news/health-35771182

Link above
--- old post above --- --- new post below ---

May I suggest you research the National Health Service and how it operates. Try not to use those American websites that seem to think our wonderful NHS is, in fact, some kind of communist backed plot to do something awful to people.

That tickled me.....

The NHS always forms the backbone of the most interesting conversations i have with people from the USA.

 

[Tetchytyke]

The NHS is bursting because it has suffered year after year, cut after cut.

Absolutely spot on.

I obviously won't name it, but the trust where my clinical psychologist partner works has now closed their waiting list to new patients. The trust is in the process of restructuring and it has been made clear to the Consultant-grade staff that they will be made redundant or they will be downgraded, because the trust needs to make significant cost savings. My partner's job is not being replaced when she leaves.

As with anything in life, you get what you pay for. And this government have decided that they don't want to pay for the NHS. Whether this is a deliberate attempt to downgrade the service in order to champion privatisation as the solution remains to be seen, but I strongly suspect that it is. They will not confirm that NHS work will be provided by NHS trusts, instead making a mealy-mouthed promise that "NHS treatment will still be available". I'm sure it will: provided by the tax-dodging Richard Branson.

 

[furnessvale]

The NHS is bursting because it has suffered year after year, cut after cut.

Perhaps I am wrong but it appears that NHS funding has risen year after year.

What IS happening is that medical advancements are making ever increasing demands on the NHS budget, demands that are outstripping the budget increases.

The NHS, Government and people of this country have to make a decision.

Do they wish to further increase NHS spending to match these medical demands and therefore increase taxation to pay for it.

Do they wish to keep NHS spending as it is (maybe index linked) and therefore put some limit on the increasing medical demands.

Or do they wish to reduce NHS spending and put more reliance on private medical care, with all the implications for individuals.

I do not see any other options. If there are others I am sure someone will state them.

 

[JamesT]

Perhaps I am wrong but it appears that NHS funding has risen year after year.

What IS happening is that medical advancements are making ever increasing demands on the NHS budget, demands that are outstripping the budget increases.

The NHS, Government and people of this country have to make a decision.

Do they wish to further increase NHS spending to match these medical demands and therefore increase taxation to pay for it.

Do they wish to keep NHS spending as it is (maybe index linked) and therefore put some limit on the increasing medical demands.

Or do they wish to reduce NHS spending and put more reliance on private medical care, with all the implications for individuals.

I do not see any other options. If there are others I am sure someone will state them.

In some ways it's a variation of your last option, but move to an insurance-based system with co-payments.

This usually brings horrified comparisons with the US system, but ignores that most of Europe runs such a system. Would there be that many issues running our system like the French or Germans? People with insufficient income get their premiums paid by the state, so they remain covered.

However, giving individuals control over the healthcare may result in different choices, especially compared to a system where it all appears to be 'free'. It also blurs the public/private line. Whereas you would have to go private currently if you wanted treatment the NHS was unwilling to provide, whereas it may become just a top-up you pay for the bit that is covered publicly.

 

[BestWestern]

I do wonder what the long term fate of the NHS is. We all know that no politician will ever openly do anything but support, praise and pledge the secure future of the service, but equally it is unavoidably clear that, frankly, it's knackered. The population continues to rise, swelled by EU visitors who understandably are drawn to the prospect of good quality, free of charge healthcare, modern lifestyles continue to pose avoidable health issues like diabetes and obesity, whilst at the same time the elderly continue to live longer and life-ending conditions like cancer edge ever closer to oblivion. The staff are too few, the hospitals too small, the money too short. Where does it go, ultimately?

There are surely only two possible outcomes in the long term; either a massive and sustained investment on a scale barely comprehendible to most, or the end of the NHS as we know it. It wouldn't surprise me in the slightest to think that in perhaps 50 or 100 yesrs time, anything other than emergency care might be chargeable. Routine treatments, GP appointments and anything else not involving an ambulance or A&E department, could all come with an invoice.

I support the strike, but doubt the long term sustainability of the system as a whole.

 

[backontrack]

I remain optimistic. If other countries can manage it, then so can we.

 

[Steveman]

I remain optimistic. If other countries can manage it, then so can we.

Manage what ?

 

[backontrack]

To run a healthcare service financed by the taxpayer as part of the welfare system.
--- old post above --- --- new post below ---
This is a brilliant story, but I can't take credit from it as it comes from a letter to the Private Eye. It reads as follows:

An inspiring short story

Sir,
I thought you may be interested in this incident that occurred on Saturday 12 March in the pedestrianised shopping street in Wilmslow, part of George Osborne's constituency., where the BMA was organising one of three events, with a petition about the junior doctors' contract and getting the NHS properly funded.
In Wilmslow I was politely asking passers-by: "Will you support the Junior Doctors?" An older man with a dog said: "No!" and continued walking, then tripped on an uneven pavement, and fell flat on his face. So, who came to look after him? The Junior Docs!
As campaigners were later coming together to go to the Village Hall to hear the speakers, one of the junior doctors said:
"The ambulance hasn't arrived for that chap yet."
I asked how long he'd been waiting. He said: "Over an hour; they've said they are particularly busy right now".
I wonder how Osborne's going to talk his way round that!
Cheers,
BARBARA DRESNER,
Tameside Keep Our NHS Public.

 

[BestWestern]

I remain optimistic. If other countries can manage it, then so can we.

What is the set-up in those other countries, though? Is the service as comprehensive? Same levels of access to non-residents and 'health tourists'? Same levels of national debt and economic issues? Much of the US system of power fought bitterly to oppose the potentially crippling costs of Obamacare.

I don't object in principle to a system whereby urgent, emergency care is free at the point of delivery, but everything else carries a cost. The concept of medical insurance also works successfully in other countries, after all. And it is perhaps the only way of encouraging a solid link between people's lifestyle choices and the consequences they bring. I would expect to pay significantly less than somebody who wants to smoke 40 a day, for example. A medical every year with an assessment of your 'health risk costs' might focus the minds of those who currently are content to eat, smoke and drink themselves into oblivion, safe in the knowledge that when illness catches up with them the good old NHS will be there to sort it out. Good health requires some level of effort, self preservation and respect, both for oneself and for the system charged with caring for us throughout our lives. That is something that we in the UK currently have a major problem with.

The welfare state would, of course, need to provide a base level cover of some sort for those unable to pay for their own insurance; nobody would be outrightly denied care, but again there would be a link between wilful neglect of one's health and the material healthcare costs of such a lifestyle.

 

[DarloRich]

Do you honestly think the Tories would ever allow such a system to develop? Their thresholds for "free" care and the standards offered would be so low as to make few people want/able to use the service AND leave many without access to health care.

I may be guilty of poor lifestyle choices but I don't work shifts (which has been suggested to have a detrimental effect on longevity and mental health). I might eat too many pies and cakes but I don't smoke. I drink now and again but don't take drugs. Who should pay more? Could I afford to pay for health insurance on top of my housing costs? I doubt it. Many would be in this position, especially those like me struggling to pay a mortgage on a vastly over priced house. It is even worse for the renters!

We can afford the NHS IF we are prepared to share the cost AND make all pay the tax they should. That doesn't mean that changes aren't needed but that we don't have to give in to an insurance based system just yet.

 

[BestWestern]

I don't think either political party would introduce it; as you say the Tories - particularly the current crop - would have people dying in the streets before it offered them anything, and of course dear old Labour would be dishing out the socialist utopia sweets to all and sundry. But then we could say the same about the NHS! I don't know where a solution lies, and I don't think anybody else does either. We shall instead resort to meddling, incompetence and short term-ism and hope it all crumbles slowly enough that noone will notice.

 

[DarloRich]

I don't think either political party would introduce it; as you say the Tories - particularly the current crop - would have people dying in the streets before it offered them anything, and of course dear old Labour would be dishing out the socialist utopia sweets to all and sundry. But then we could say the same about the NHS! I don't know where a solution lies, and I don't think anybody else does either. We shall instead resort to meddling, incompetence and short term-ism and hope it all crumbles slowly enough that noone will notice.

agreed. There needs to be a proper independent review/commission to decide what can be done with the NHS and how we pay for it. The review should take non political information from all sides and come to a transparent conclusion binding on all.

Obviously that wont happen so we will just keep muddling on till it falls apart and we all suffer.

 

[backontrack]

Not necessarily. We could be lucky.

 

[BestWestern]

Not necessarily. We could be lucky.

As in??

 

[WelshBluebird]

What is the set-up in those other countries, though? Is the service as comprehensive? Same levels of access to non-residents and 'health tourists'? Same levels of national debt and economic issues? Much of the US system of power fought bitterly to oppose the potentially crippling costs of Obamacare.

I don't object in principle to a system whereby urgent, emergency care is free at the point of delivery, but everything else carries a cost. The concept of medical insurance also works successfully in other countries, after all. And it is perhaps the only way of encouraging a solid link between people's lifestyle choices and the consequences they bring. I would expect to pay significantly less than somebody who wants to smoke 40 a day, for example. A medical every year with an assessment of your 'health risk costs' might focus the minds of those who currently are content to eat, smoke and drink themselves into oblivion, safe in the knowledge that when illness catches up with them the good old NHS will be there to sort it out. Good health requires some level of effort, self preservation and respect, both for oneself and for the system charged with caring for us throughout our lives. That is something that we in the UK currently have a major problem with.

The welfare state would, of course, need to provide a base level cover of some sort for those unable to pay for their own insurance; nobody would be outrightly denied care, but again there would be a link between wilful neglect of one's health and the material healthcare costs of such a lifestyle.

Ok great. But where do you draw the line?

Someone smokes 40 a day, ok fairly clear cut.
Someone drinks a bottle of wine every day, again pretty clear cut.

What about someone who has too much to drink one night and needs medical help? Their own fault maybe, but hardly a "lifestyle" if its one night.

What about if that person hadn't drunk much but had their drink spiked?
Not really their fault, but they were out drinking (doing damage to their bodies) and how can you tell the difference between someone who has had their drink spiked and someone who has knowingly taken something?

What about if someone gets attacked while walking home drunk, not really paying attention their surroundings? Kind of their fault in that if they had been more alert they wouldn't have got targeted.

What if someone injures themselves playing a sport? Again their "lifestyle" choice. But shouldn't we all exersize and keep fit?

Etc etc etc.

And even ignoring all that, if you go down the route of charging some people and not others for the same treatment then you'll need a fairly large administration system that will be a fairly large overhead (needing staff, resources etc) that could well take up any savings that you may make.

 

[Xenophon PCDGS]

What if someone injures themselves playing a sport? Again their "lifestyle" choice. But shouldn't we all exersize and keep fit?

Indeed so. But being inebriated, using recreational drugs or smoking to excess are not ways of keeping fit.

 

[DarloRich]

Indeed so. But being inebriated, using recreational drugs or smoking to excess are not ways of keeping fit.

they are ways of having a good night out!

I am sure everyone has had one to many or smoked the odd fag now and again. I am sure some of our members have taken recreational drugs. That doesn't make you (despite what the revolutionary puritanical wing of rail uk would have you believe) a bad person.

Nor, should it be said, are people who are alcoholics or drug addicts necessarily bad people. They are often weak, often recovering from substantial mental trauma or abuse and certainly ill ( for many different reasons) and need help.

For instance a friend of mine from school was a soldier, he served in several conflict zones and was badly affected. He fell out of circulation and took to drink (and I bet other things) to try and deal with his issues. How much should he pay for his treatment? How much should the tramp outside the station pay.

Is any one in a position to pass judgement on others in these cases?

 

[WelshBluebird]

Indeed so. But being inebriated, using recreational drugs or smoking to excess are not ways of keeping fit.

And yet in that example the person would still be needing medical treatment because a of a "lifestyle choice". That was my point more than anything else. That I just don't see how you can start charging people for treatment because their lifestyle contributed to their issues but not start charging other people despite the fact their lifestyle also contributed to their issues.

 

[Bevan Price]

I have sympathy with their cause - the Tories wanting to get extra work without paying for it. However, most strikes turn out to be futile, and workers often lose more money than they might get from any improvement in pay & conditions.

 

[BestWestern]

Ok great. But where do you draw the line?

Someone smokes 40 a day, ok fairly clear cut.
Someone drinks a bottle of wine every day, again pretty clear cut.

What about someone who has too much to drink one night and needs medical help? Their own fault maybe, but hardly a "lifestyle" if its one night.

What about if that person hadn't drunk much but had their drink spiked?
Not really their fault, but they were out drinking (doing damage to their bodies) and how can you tell the difference between someone who has had their drink spiked and someone who has knowingly taken something?

What about if someone gets attacked while walking home drunk, not really paying attention their surroundings? Kind of their fault in that if they had been more alert they wouldn't have got targeted.

What if someone injures themselves playing a sport? Again their "lifestyle" choice. But shouldn't we all exersize and keep fit?

Etc etc etc.

And even ignoring all that, if you go down the route of charging some people and not others for the same treatment then you'll need a fairly large administration system that will be a fairly large overhead (needing staff, resources etc) that could well take up any savings that you may make.

Hence people would undergo a medical. Long term, poor lifestyle choices are easily detected in that way. Emergency situations requiring ambulances, A&E departments and immediate treatment would continue to be provided by the state. There is little practical or fair way of charging for such incidents.