Junior doctors to escalate industrial action to all-out strike next month

[Waynflete]

Probably the most well-informed and considered post ever on NSC.

I'm sure that's not true but thank you, you're too kind!

 

[glasfryn]

some usful insights, but couple of things dont ring true. the rotas dont show patterns as you describe, and i've heard and read BMA reps saying it is about pay, with the fundemental sticking point that they want unsocial hours recognised with higher pay. as i last recall, that was the last of a dozen items unresolved, except the principle of the contract being imposed and the mistrust. which as far as i can tell is whats its really about, if they tore up the pay changes i think they still wouldnt accept it.

TBH would you trust this lot with a bag of 2d chips, they have to be the most distrusted government I have ever known, even more so than Blairs lot

 

[Indurain's Lungs]

My wife is a junior doctor, so let me take a stab at explaining, as I understand it...

The objections to the current proposals are in large part because of a total (justified) lack of trust in the government on behalf of doctors.

As you know, this is all part of the government's plan to have a '7-day NHS' for non-emergency care. (We already have a 7-day NHS for emergency care). This idea is based on a misuse of statistics to assert wrongly that there are more deaths at weekends because of staffing.

To achieve a 7-day NHS for non-emergency care you have to do one of three things:

1. Pay for more doctors, nurses and other staff to increase care by two days per week - which would cost a lot more money (and the trained staff don't exist because there are already shortages in key areas).
2. Get existing staff to work for longer hours to cover the extra two days - which is unsafe and unfair on those existing staff.
3. Spread the working hours of existing staff more thinly over the week, to cover the extra two days - which will reduce the quality of care.

Now, the government is claiming that it can deliver a 7-day NHS with no significant increase in total budget, with no doctor being paid less, with no-one having to work longer hours and no reduction in quality of care. That so clearly doesn't add up, and doctors have been rightly suspicious of these proposals as a result.

Lo and behold, when NHS Employers released some sample rotas for junior doctors under the new contract, they were found to be full of things like claiming a day immediately after a night shift was a 'day off', despite the doctor having worked for probably about ten hours on that day, from midnight to 10am, and having to return to work that evening. Also, breaking promises on not working consecutive weekends. They are also very worried that, although current junior doctors are being offered this contract, there is no protection for doctors in a few years' time from an updated contract that would be even more unacceptable. In short, what the junior doctors are being asked to do is not fair or safe - and when the government says they won't be paid less or work more hours they simply don't believe it.

Fundamentally, this is about a government trying to push through an uncosted and ill-thought-out manifesto pledge, not listening when the experts expected to deliver it tell them it won't work, carrying on regardless, then spinning against doctors by claiming it's all about pay - which is absolute rubbish. It is also absolute nonsense that changing the junior doctor contract will deliver 7-day NHS, of course, because they will also have to change the contracts of everyone else working in the NHS, too.

The end result is likely to be fewer doctors recruited, more doctors leaving the NHS to work abroad or in private practice, worsening shortages in key specialist areas like paediatrics, an overall worse service - and ultimately a recourse to more private medicine to fill the inevitable gaps, which will be more expensive for all concerned, especially the taxpayer.

So, support our junior doctors! They genuinely don't want to strike. They have been backed into a corner, and have judged that this is worth doing in the short term in an attempt to stave off something that would be much worse for patients in the long term.

Well explained.

There are also a number of nuances to the offer that can really screw people once it's imposed.

- non-resident on call shifts (for the people who only come in if needed) are being paid at a few pounds an hour and not counted for max hours even if the person is on site, working for the whole time. Nothing to stop all shifts being designated as "on-call" then calling people in to work all of them to breach hours limits legally.

- the strange offer to pay for Saturday if worked more than 1 in 4 will lead to lower staffing at weekends as trusts move all 1 in 2 or 3 rotas to 1 in 4.1

- allowing strange shift patterns (midnight starts etc) that would not allow any proper handover and thus threatening patient safety.

- offering an 11% rise in basic that is more than offset by cuts elsewhere. The independent review board's minimum suggested rise in basic was 14.9% in order to allow out of hours calculations to be changed fairly.

- claiming no doctor will earn less by offering pay protection for a few years then removing this and cutting pay dramatically once the contract is in place.

- NHS employers and the bma agreed a deal. Hunt vetoed this. The fault, therefore, lies completely with him.

 

[Raleigh Chopper]

Just wait until you have to deal with an unattended clopper that resembles Terry Waite's allotment though.

Disappear for a tea break and wait for a mouses ear to turn up.

 

[Waynflete]

some usful insights, but couple of things dont ring true. the rotas dont show patterns as you describe, and i've heard and read BMA reps saying it is about pay, with the fundemental sticking point that they want unsocial hours recognised with higher pay. as i last recall, that was the last of a dozen items unresolved, except the principle of the contract being imposed and the mistrust. which as far as i can tell is whats its really about, if they tore up the pay changes i think they still wouldnt accept it.

The rotas as released did show the patterns as I described, as per here: http://www.independent.co.uk/news/u...working-three-weekends-in-a-row-a6882541.html

Pay is still the major sticking point in terms of negotiations, but I think you're right that it's the wider issue and trust that this is really about. Unfortunately, the doctors have been schooled in how to run political spinning process and now find themselves having to justify arguments about pay, when their wider argument is much more powerful and important.

But if Jeremy Hunt genuinely cared about the wellbeing of patients he'd simply call a timeout on the whole 7 day NHS thing, not impose the new contract, and start again.

 

[The Rivet]

Are you sure they are closing just because staff are on holiday or could it be that the scanner has to undergo some maintenance and the Easter week with two bank holidays is the best time? Furthermore, are both depts closing or is it just the Brighton site?

I was told that is was one day maintenance.

 

[Brian Fantana]

I just cannot support junior doctors walking out and not providing emergency care. I totally respect their right to strike, and not provide non-essential care, but to walk out totally and put lives at risk is a step too far.

 

[Waynflete]

I just cannot support junior doctors walking out and not providing emergency care. I totally respect their right to strike, and not provide non-essential care, but to walk out totally and put lives at risk is a step too far.

I know what you mean. I'd just say to remember that these are people who dedicate their lives to saving lives and helping people. Imagine how bad things must be for them to justify doing this.

The government, meanwhile, will be hoping for chaos so that the tide of opinion swings against the doctors.

 

[Brian Fantana]

I know what you mean. I'd just say to remember that these are people who dedicate their lives to saving lives and helping people. Imagine how bad things must be for them to justify doing this.

The government, meanwhile, will be hoping for chaos so that the tide of opinion swings against the doctors.

It's a very tricky situation, granted. However, I think it's a very dangerous tactic by the JDs. They've had an awful lot of support and goodwill from the public up until this point but I really don't think people will take kindly to the next planned total strike.

I really hope the two parties get together again before the strike happens.

 

[beorhthelm]

The rotas as released did show the patterns as I described, as per here: http://www.independent.co.uk/news/u...working-three-weekends-in-a-row-a6882541.html

and this is the published source which doesnt show this pattern. which are guidance only, neither the government nor NHS Employers set the rotas, thats down to the local hopitals and trusts.

i agree if there was any sense they'd drop it and start again. its not even the area that needs most attention for 7 day service, but Reid screwed us all with the GP contracts who aren't going to accept another change either.

 

[Waynflete]

and this is the published source which doesnt show this pattern. which are guidance only, neither the government nor NHS Employers set the rotas, thats down to the local hopitals and trusts.

i agree if there was any sense they'd drop it and start again. its not even the area that needs most attention for 7 day service, but Reid screwed us all with the GP contracts who aren't going to accept another change either.

Those rotas (eg no.7) do show a 'day off' repeatedly marked as a day post nights... Which is not a 'day off' by any normal measure.

But anyway, I think we broadly agree it's bigger than these minutiae.

 

[clapham_gull]

Bloody murderers these doctors if you ask me, and Jeremy Hunt, who has PROOFED that more people die at weekends. AND they get loads of nurses too.

There's 1.8 million people unemployed in this country, just sack the lefties and replace them with people happy to do the job.

Bit lame to simply cut and paste from their manifesto.

 

[Technohead]

My wife is a junior doctor, so let me take a stab at explaining, as I understand it...

The objections to the current proposals are in large part because of a total (justified) lack of trust in the government on behalf of doctors.

As you know, this is all part of the government's plan to have a '7-day NHS' for non-emergency care. (We already have a 7-day NHS for emergency care). This idea is based on a misuse of statistics to assert wrongly that there are more deaths at weekends because of staffing.

To achieve a 7-day NHS for non-emergency care you have to do one of three things:

1. Pay for more doctors, nurses and other staff to increase care by two days per week - which would cost a lot more money (and the trained staff don't exist because there are already shortages in key areas).
2. Get existing staff to work for longer hours to cover the extra two days - which is unsafe and unfair on those existing staff.
3. Spread the working hours of existing staff more thinly over the week, to cover the extra two days - which will reduce the quality of care.

Now, the government is claiming that it can deliver a 7-day NHS with no significant increase in total budget, with no doctor being paid less, with no-one having to work longer hours and no reduction in quality of care. That so clearly doesn't add up, and doctors have been rightly suspicious of these proposals as a result.

Lo and behold, when NHS Employers released some sample rotas for junior doctors under the new contract, they were found to be full of things like claiming a day immediately after a night shift was a 'day off', despite the doctor having worked for probably about ten hours on that day, from midnight to 10am, and having to return to work that evening. Also, breaking promises on not working consecutive weekends. They are also very worried that, although current junior doctors are being offered this contract, there is no protection for doctors in a few years' time from an updated contract that would be even more unacceptable. In short, what the junior doctors are being asked to do is not fair or safe - and when the government says they won't be paid less or work more hours they simply don't believe it.

Fundamentally, this is about a government trying to push through an uncosted and ill-thought-out manifesto pledge, not listening when the experts expected to deliver it tell them it won't work, carrying on regardless, then spinning against doctors by claiming it's all about pay - which is absolute rubbish. It is also absolute nonsense that changing the junior doctor contract will deliver 7-day NHS, of course, because they will also have to change the contracts of everyone else working in the NHS, too.

The end result is likely to be fewer doctors recruited, more doctors leaving the NHS to work abroad or in private practice, worsening shortages in key specialist areas like paediatrics, an overall worse service - and ultimately a recourse to more private medicine to fill the inevitable gaps, which will be more expensive for all concerned, especially the taxpayer.

So, support our junior doctors! They genuinely don't want to strike. They have been backed into a corner, and have judged that this is worth doing in the short term in an attempt to stave off something that would be much worse for patients in the long term.

Spot on this .... but there's more. In practical terms, achieving the same care quality throughout the week will mean more NHS staff, especially senior doctors, on site at hospitals at weekends and evenings. There are also implications for access to general practice. It also requires other services being available to enable clinicians to provide high quality care as usual. This includes diagnostic and clinical support, social care, transfer services and administrative support. The government has been asked to clarify plans to introduce more seven-day NHS services, including how they will be funded, how they will be staffed and what assurances there will be that mid-week services are not affected. So far they have only confirmed that their plans focus on the delivery of urgent and emergency care but as yet there appears to have been no robust modelling of what the impact of seven-day services would be more generally on staff numbers or working patterns, the financial implications, or clinical outcomes for individual specialties.

It is clear the government wants to achieve a "full" 7 day a week healthcare service without any increase in funding, but they believe the biggest obstacle to that is unsocial hours payments that most NHS staff receive for working evenings, weekend and bank holidays. Rather bizarrely the government have chosen to target in the first instance the junior docs in this respect, even though they are a group of staff that arguably more than any other already provide 24 hours a day, 7 day a week, 365 days per year services, and are the backbone of existing services that extend beyond traditional 9-5 Monday to Friday operations, ironically particularly in the areas the government says it wants to focus on. The carrot for all this which the government PR machine focuses on is the hike in basic pay, but as the proposal is cost neutral (at present) its actually robbing Peter to pay Paul, with the robbing coming from the areas which do the most unsocial hours .... which also happen to be the most stressful, understaffed, critical areas where most harm can occur to patients. So a vicious cycle is entered into .... same number of doctors working more hours for less pro rata pay in these critical areas, decreased recruitment and retention follows so less doctors working even more hours for less pro rata pay, and so on and so on.

More PR from the government .... they are reducing the maximum number of hours allowed to be worked by a doctor, from 91 hours per week down to 71 hours a week. Who would like to be treated by the doctor entering the 68th hour they have worked? Maximum number of consecutive night shifts being reduced from 7 down to 4. But any shift that finishes before 2am is not classed as a night shift. And as you point out, the promise that no doctor will be rostered on consecutive weekends has already been broken, with it being redefined as a ratio of no more than 1:2 weekends worked over the 15-week period.

So, are the government likely to backdown on implementation of this? Unlikely .... the junior doctors contract is just a stepping stone, with the bigger prize being the alteration of other NHS staffs contracts. So they have to persist or they lose the leverage for all the rest of the NHS staff out there. Others may disagree, but I think I know which of the two parties in this dispute is focused more on the financial aspect and which is focused on the patient care.

 

[Technohead]

They subsequently adjusted the pay calculator that they originally published so that it didn't show consecutive weekends, but have confirmed that consecutive weekends can happen - see http://www.nhsemployers.org/your-wo...contract/faqs/working-hours-and-patterns-faqs particularly point 3

 

[Technohead]

And for those concerned about emergency care for patients it is worth considering what Dr Rob Galloway has stated:-

"Mr Hunt

Today it was announced that there would be the first ever full strike by junior doctors in the NHS. This is a disgraceful thing to happen on your watch as health secretary.

No one wants this strike but it must be remembered it is just for 2 days and only from 9-5. All non urgent treatments will be postponed and consultants will cover the emergency work. So no patient should come to any harm because of this strike. As a consultant I will be one of those covering our junior colleges that we support.

On the other hand, if you get your way and you impose your unfair and unsafe contract, then many many patients will suffer when our junior doctors leave the NHS.

Your belligerence, arrogance and attitude is destroying the moral and good will of our junior doctors and is a significant threat to patient safety. You need to start putting the needs of our patients above the needs of your political career and political ideology.

It is time you apologise, removed the threat of imposition, resign and let others restart a fair negotiation. Anything less and our patients will suffer".

 

[darkwolf666]

I feel like I instinctively want to support the junior doctors, but I'm a bit confused as to what the problem is. Basic pay is going up, the only people who will lose financially are those that specifically choose to work more antisocial than social hours. Trainees all to be paid the same depending on where they are in training rather than how long they've spent getting there. Maximum hours down from 91 to 72 hours in a 7 day period.

What have a missed? I see BMA references to removal of safeguards but without any details.

Don't jump on me for being anti JD cause I'm certainly not. Had an op on Monday and full of praise for the staff. I'd just like to understand a bit more.

Does anyone seriously think this is right, should anyone, let alone someone who has to make life and death decisions, work so many hours? Only 71 hours in a 7 day period, that's ok then!

 

[darkwolf666]

And for those concerned about emergency care for patients it is worth considering what Dr Rob Galloway has stated:-

"Mr Hunt

Today it was announced that there would be the first ever full strike by junior doctors in the NHS. This is a disgraceful thing to happen on your watch as health secretary.

No one wants this strike but it must be remembered it is just for 2 days and only from 9-5. All non urgent treatments will be postponed and consultants will cover the emergency work. So no patient should come to any harm because of this strike. As a consultant I will be one of those covering our junior colleges that we support.

On the other hand, if you get your way and you impose your unfair and unsafe contract, then many many patients will suffer when our junior doctors leave the NHS.

Your belligerence, arrogance and attitude is destroying the moral and good will of our junior doctors and is a significant threat to patient safety. You need to start putting the needs of our patients above the needs of your political career and political ideology.

It is time you apologise, removed the threat of imposition, resign and let others restart a fair negotiation. Anything less and our patients will suffer".

This. This perfectly sums up the great majority of career politicians.

I have worked in an profession for the last 15 years where officers come up with the next great idea, which those on the ground can see is totally unworkable. The designer of the idea gets pats on the back from those above him (who are equally clueless), as big idea saves money (or appears to) or saves time, or looks more efficient. Designer then gets promotion on back of great idea and those on the coal face are left to cope with the mess left behind.

Sound familiar?

 

[Deleted member 22389]

If we all paid a bit more money for our NHS, stopped giving it away we wouldn't be in this mess.

 

[BLOCK F]

There is no offer from the Government, it is being imposed.

What elements of the revised conditions that the Government is imposing do you believe are fair?

I think the whole deal is fair. Look into it and tell me what is so unfair that it warrants this kind of action.
Are the BMA escalating this because the 'offer is to be 'imposed' or because the offer itself is so unjust that it warrants a total withdrawal from emergency care?

 

[BLOCK F]

The bottom line is its up the Hunt and the doctors to sort out. Its their dispute and up to them to decide if it's warranted or not.

It is up to them to sort it out, but doesn't prevent us from holding a view.