Tuesday 12 January 2016

NHS strike - why do this?

I find both sides stance on the NHS doctor's strike hard to fathom. For the Doctors' there is a big risk, that is that they get seen as greedy and get exposed for it.

This has happened in the past, generally nurses, paramedics and firefighters re all everyday heroes beyond reproach. Yet the firefighters managed to strike and lose against a Government in recent times, mainly because their actual hours and pay was exposed in the media; as a result they had to cave into the Government.

This perhaps it is different, although the leaders of the BMA, are hard lefties who think Corbyn is a moderate uncle. As such, their judgement on how far to go has to be questioned.

On the other side, the Government's base case is a 30% effective pay cut due to increased hours alongside a real 11% pay rise. Nobody is going to be happy when presented with that and young doctors are much put upon. Those I know work hard and are paid relatively little; of course in later years this dilemma is reversed.

Which makes me wonder what Jeremy Hunt is doing, the doctor's pay issue lies with another group and there are other ways to create a 7 Day NHS - which in itself should be a very popular policy. As always on health, any reform is met with fierce resistance and any Government has a tough time. Why this fight this fight though with such a weak case. I have seen hardly any justification in the media for the Government position, which generally means they don't have any decent facts to stand their case up and the civil service have left them swinging.

All in all a bugger's muddle, the result of which is if you are reading this try not to get run over by a bus today.


John in Cheshire said...

In brief, I don't want a health service that makes you feel as if they're doing you a favour and therefore you should be grateful for whatever you are given. Thus I've long wanted the NHS to be turned into an insurance based provision, just as with home and car insurance, where you can demand treatment and take your business elsewhere if you don't get it. One consequence would be that everyone, including people over 60 would have to be insured, which wouldn't be such a bad thing. As for the junior doctors, I have no sympathy so they'd best get back to work and stop whinging.

tolkein said...

We know a young doctor and his wife. He's not a Lefty - was in Army. He'd take a socking pay cut, and not see much change in hours. The tales of mismanagement he tells!
Why do so many junior doctors emigrate and get a great deal out in Sydney or Melbourne - nothing like the gruelling hours that those in England endure.
We do need more marketisation in NHS - within free at delivery - and much more competition, but I fear that the Govt doesn't really get the NHS and therefore comes across as hard faced. The Tories really shouldn't be alienating junior doctors. That they have done so is political incompetence. I'm afraid it looks as though the Govt wants hospital doctors to pay for the great deal that GPs enjoy. And that's an area that the Govt could tackle.

andrew said...

On a national basis:

(1) - yes, the NHS is woefully inefficient. Repeated experience tells me they could get 10% extra just by making sure the whole team turns up on time (it's always the b****** anaesthetist)
Never mind the managers (there really are too many) etc etc


(2)- yes, it is cheap, mostly by virtue of underpaying staff and being pretty much the monopoly buyer of doctor and nurse time

On balance many still think
cheapness + inefficient is better than profit-making + efficient

You probably don't think this if you can afford to pay

You probably will think this if you are very young or very old and have more than one thing wrong with you.
- or have a family member that falls into this class.

Care for people in this 'complex/difficult/long term' area runs 500-1000+ per day possibly for months.
Try getting insurance for that.

On weekend working:

Doctors generally dont mind working evenings / weekends, but do expect to be paid overtime. Time not at work with family (evenings / weekends) is more valuable than 'normal working hours'.
Under Hunt's proposals, the 'evening' starts at 10pm.

Doctors generally dont mind working evenings / weekends.
If you get ill, it means you have a slightly better chance of living if you fall ill over the weekend, but a slightly greater chance if you fall ill in the week.
Without extra resource (and there is none) the mortality rate over the entire week will not change.

Doctors generally dont mind working evenings / weekends.
But they do not work alone and need a corresponding increase in all support staff.
This includes social services - people outside the NHS - there is no funding for this.
Without all the support staff (who are there m-f), the existence of a doctor on sat/sun will not save that many more lives.

The new contract also reduces the scope for future pay rises.

So, basically you get to lose your family life, get a pay cut (hunt is not open or trustworthy on this), get a reduction in the chance of increasing earnings later in your career and this is all to achieve in global terms, at best - no improvement in patient care at all.

You dont have to have a political pov to see that that these proposals are a bit thick
- or badly communicated as hunt has not said it 'not just doctors, it is nurses, radiographers, social services, physiotherapists - the whole of the NHS and all linked services who need to work 7 day weeks'

BE said...

I agree with CU and Tolkien.

What a sorry situation. The NHS needs sorting out for sure, but the junior doctors seem to be the ones grafting while GPs and senior hospital doctors give a very good impression of being overpaid and underworked.

The government seems to be doing its best to irritate everyone simultaneously. You would have hoped the Tories would have learned their lesson from the previous parliament...

Elby the Beserk said...

Such a tough life for doctors these days they mostly retire in their early 50s it seems. Really tough...

CityUnslicker said...

Andrew - in my world long gone are the days of overtime, sign away your 48hrs and deal with it. If you get home at 10pm so be it. Doctors are people so get this.

What unions dont get is if you are a PA who cannot ever get a real pay rise then fixed working hours matter.

If you are a doctor who every hour and learning experience counts toawrds you becoming a millioniare in your mid-late 30's, then you can lump it; see accounting firm, lawyers, bankers, indeed all the other professions.

the only sympathy I have is junior doctors are low paid, then again they did get lots of free training.

On all your other points however, there is little to disagree with. I think with no numbers as to what 7 day vs 5 day offers is a very weak position for the Govt to defend.

Anonymous said...


I don't know about Doctors conditions, though in the inner London teaching institutions and in most other big city Hospitals I'm pretty sure it is fucking awful.

But lets be honest here, though he is a total jerk, Hunt ain't asking for the earth all he does is pursue what the Tories promised and rightfully so - a NHS which is FULLY open all hours and at weekends.

The monster.

Unionization is a big lumpen diseased body which prevents reform within the health service and across all NHS institutions - those contracts of employment sacrosanct. Contracts, of which the unions and legal teams help draw up and again most of these sorts of water tight agreements are non negotiable, so you get what other workers get; which is basically Nine to Five working and five days a week - weekend work is supposed to be a bonus - where the doctors deign to promise some of their valuable 'me time' - that had to change, they way to go about it should have been more subtly done.

The scum party for 13 years was complicit and the likes of Patricia Hewitt's bonkers reforms and they totally rolled over for the medical professions. All the time Browns client state sector was burgeoning, boosting an already top heavy bureaucracy with more civil servants, with the senior ranks being paid stupid money "to enable HR to offer remuneration equal to and for to compete with the private sector".
I know of some kid, who went into the NHS, he knew fuck all about computers [coding, hardware or software]. He, prior to his elevation was a junior manager barman, he went off to Manchester as some sort of administrator on £22K and about two years later when I saw him again, he told me he was pulling £70K as some sort of IT manager, he admitted with a smile that, he "still knew fuck all about IT systems but was getting better at typing".

Anonymous said...


Next, throw in the monumental waste that is NHS tendering and purchasing and therein the marvellous possibilities for widespread fraud - outsourcing and the merry go round of the revolving door of private-to public and back to private again, they must get bleeding dizzy with it all and just think, leave and cop a pay off and then come back for some more, AND another pension pot! Fucking staggering waste and all paid for out of the taxpayers pocket.
MacMentals ruinous PFI initiative, where Hospitals were built by outside corporate construction companies and then for the next thirty years the taxpayer is milked for the burdensome excesses.

Truly, it is a monster of a Gordian knot.

Hunt, is labouring under a mountain, the BMA were spoiling for a fight and yes the NHS is snowed under with work by that other thing which nobody ever mentions, millions of extra patients to care and treat - MASS IMMIGRATION is also driving the health service and doctors into the ground.

Hunt was doing his job, Dave has hung him out to dry and what will happen next is anyone's guess.

I know what needs to happen, the NHS needs to be privatized and PDQ but finding a politician with the nuts to first promise it, get voted in and then to face down the Health establishment and the UNIONS - is mission impossible.

Thus, we carry on on the road to nowhere and a vast and growing mountain of NHS debt. Something has got to give, will it be the doctors or will the government cave in, I have to say the latter is the only possibility.

James Higham said...

Y-e-e-e-s-s-s-s, think it's just called bloodymindedness.

Electro-Kevin said...

Tolkein - It isn't just doctors who can get a better deal in Sydney and Melbourne.

There is a TV show called Wanted Down Under where just about every trade can enjoy better pay, less pressure, better weather and more leisure time - as well as infrastructure that works, no litter and low crime.

Just how does Australia do it ? How do we get it so wrong ?

Electro-Kevin said...
This comment has been removed by the author.
Timbo614 said...

I just know we DO NOT want anything like the U.S. System!
From what I read (OK on NC) there, everyone has become aware that the health"care" system is only there to make a profit, NOT help people get better or care for them. It is extortionately expensive and even then the insurance companies use every get out clause they can muster.
We need some hybrid, maybe like France where it is a shared/partial insurance system. Where it is not free for every Tom Dick and Mohammed that turns up on the doorstep.

BE said...

There are plenty of excellent examples in Europe. Why in the UK is it always presented as state communism vs American Capitalism?

Anyway, EK, there is also a hilarious show I saw where they take Brits who want to emigrate and show them that it is not all milk and honey in Aus. Think it was on the Beeb ;-)

Why is Australia apparently more wealthy? Well, for similar reasons to Norway and Saudia Arabia, presumably.

If *only* the idiots who run this country would build some rich coal/oil/gold seams underground!

hovis said...

The problems go back to the inception of the NHS, when asked how Bevin got the doctors on side, he said " I stuffed their mouths with gold".

From this point onwards with a trade union such as the BMA, which (should have but) never has been broken, because it is middle class and full of "people like us"; the NHS was doomed to suffer. This - even before we get onto command and control structures. Add to this the nature of a profession which by it's nature will attract both those who wish to benefit others, but also psychopaths/sociopaths who crave the power of life and death and social status then reform is ever more difficult.

Agreed with others posts the US system is one where profit and outcomes are poor, the NHS has poor outcomes but at least has coverage - good points above on long term care/chronic/pre existing conditions that insurance simply does not cover. That said the NHS has been captured by producer interests whether that is doctors nurses etc or suppliers such as pharma. Many interestng FOIs on drug policy on the latter.

A French system is good as power resides with the patient, also doctors and hospitals are private so no monlithic blocs there.

Sebastian Weetabix said...

I think it was the great Dave Allen who once said doctors are a bunch of drunken necrophiliacs who get too much respect. Going on strike my cause that view to spread.

Sebastian Weetabix said...

My? I meant of course 'may'

Anonymous said...

"there are other ways to create a 7 Day NHS - which in itself should be a very popular policy"

Exactly who wants to see a GP on a Sunday? They already do Saturday morning appointments.

"if you are reading this try not to get run over by a bus today"

I would have thought it's not a bad day at all - the hospitals will be staffed by consultants and senior doctors. OK, you could have a dermatologist looking at your broken leg ...

Anonymous said...

"I know what needs to happen, the NHS needs to be privatized and PDQ"

Is that you, BE ?

AndrewZ said...

They are threatening to withdraw emergency care on February 10th. Even if enough staff can be found to provide some minimal level of service during that time the strike will almost certainly cause avoidable deaths. That will immediately turn the public against the strikers and do enormous damage to the reputation of the medical profession.

The worst-case scenario is that terrorist groups try to carry out as many attacks on that day as possible in the hope that the strike will increase the number of people who die from their injuries.

Electro-Kevin said...

BE @ 5.09 - 'Australians are better off because of minerals underground'

Then perhaps we can refrain from the old cannard that the average Brit is unsuccessful because he is too lazy - and then go undercutting what he DOES do with...

(I'd love to see that show on Australia)

Electro-Kevin said...

On the subject of doctors a consultant friend of ours reports that the biggest problem with the junior doctor strike is that none of the older doctors know how to use the computers !

Electro-Kevin said...

John Cheshire (first comment)

"Insurance wouldn't be a bad idea, particularly for those over 60"

Have you ever tried insuring an aged pet ? It becomes prohibitive.

If we are going to be so ruthless (to save money) then perhaps we should start fining drunks in A&E and not treat ... first.

What have most of the over 60s done except put a lot of money in the pot ?

Anonymous said...

"If we are going to be so ruthless (to save money) then perhaps we should start fining drunks in A&E and not treat ... first."

Now there's an idea!

How about?

The thousands of health tourists.

It is reckoned conservatively that, the NHS spends £1.2 billion p/a on aids treatments for patients other than, those who've ever paid in. All you need to do is, pop over and get on the therapy course - no questions asked.

Thanks to, the ECHR and 'rights to a family life', what is never mentioned but is an onerous burden on the NHS and you can see this in hospital waiting areas up and down the country but especially England, where hundreds of thousands of elderly relatives of a Southern Asian ethnicity and most of these will never nor have they, ever paid in.

British taxpayers, are stiffed not only by a bad system but by EU-ECHR installed statute. How long can we, run an infinity limit NHS credit card?

Have you ever wondered why they (health tourists) - flock here?

Yes, as has been noted, the French system is far superior and have you ever had a unfortunate injury and thus had to visit a French hospital (they are very good btw) - you sit in the outside waiting room, until you have been assessed ie ability to pay - when this has been ascertained - then they allow you to enter the Hospital.
Or how about, in Spain where no interpreters are present (unlike the NHS who will provide translation services on the taxpayer card for over 50 languages!) - Spain make you pay up front and so do just about every other country on earth.

We are being taken for mugs, no wonder the work of our junior doctors [and all frontline staff in the NHS) resembles slave conditions.

Yes to 24/7 HOSPITALS but not GP surgeries (Saturday morning would do) and pay them a fair wage for it but lets get real elsewhere - cutting costs, there is so much the Executive could do, not least in cutting back on paperwork and bureaucracy.

Ed said...

I know three junior doctors through my brother (who also is one). They are all keen for the NHS to be more efficient and all support it becoming a 7 day, 24 hour service. They were all for the government's proposals to do this when they were first aired at a high level, comforted by the fact that the government stated that the vast majority of doctors would not experience a pay cut because of the rearrangement (1 or 5 % I think they claimed). All four of them are now allegedly facing a 25-35% pay cut if the new arrangements go through.

I don't know about the others but my brother has last year broken through into the higher tax band with the overtime he does. He's 30 now so had he done any other job he would have 9 years post university experience. How many other high quality professions do you know where 9 years experence routinely gets you £45k per year?

Anonymous said...

"I don't know about the others but my brother has last year broken through into the higher tax band with the overtime he does. He's 30 now so had he done any other job he would have 9 years post university experience. How many other high quality professions do you know where 9 years experence routinely gets you £45k per year? "

They sound like very dedicated lads and may God bless them all and then it is humbling. On the £45 K thing, again words fail me - honest opinion, for the lives they can save and people they can help = how much is actually quantifiable? But imho, lets put a figure on it:- a after 5years as an Intern/Houseman and suitably qualified should be ~ £150K basic.

I mean, a paperclip counter CEO are paid > £200K.

Jer said...

We often hear that the NHS is "cheap" or that we don't spend much on health.

Actually the truth is somewhat different, or so it seems.

Is a comparrison. We spend less than France or Germany, more than Spain and about the same as Italy.

In gerneral terms is it fair to say that we spend about the same as our European peers, but get a shittier service?

Steven_L said...

What have most of the over 60s done except put a lot of money in the pot ? (EK)

The over-60's haven't put any money in the pot. There is no pot, there is just a trillion and a half quid of debt. And they are the ones that ran it up.

Electro-Kevin said...

Steven L - Anyone who was economically active since 1997 ran the debt up.

I blame those who voted Labour (which I never did.) There is no need to single out the over 60s.

Most young doctors don't earn a lot, carry an awful amount of student debt and work long, unsocial hours. Their earnings have to be put in the context of rent and house prices. £45k in London and the SE does not mean a lavish lifestyle.

I cannot believe that we have a Tory party that has alienated the police, the doctors* and (soon) the military too. I expect the recent funding to sue soldiers will cause much dissent.

*Doctors are bright. They are not being led by the nose by militants or easily manipulated.