[Politics] When did this country become so cruel?

[Harry Wilson's tackle]

What is the definition of poverty?

Without reeling out the Four Yorkshiremen sketch, what does it actually mean?

A couple of years ago I went to see some people, I hasten to add good honest folk in part time work, who had the majority of their funeral bill paid for by the DWP, they had a nicely furnished flat, iPhones and ran a car, at no point did I see anyone without shoes, scruffy clothes, scabies etc.


Is there an actual poverty line in UK, that anyone below a certain level of income is classed as in the poverty trap?

Do some politicians use the word poverty as an emotive vote catcher?

I have seen it defined as being in the lower half or quarter (whatever) of disposable incomes or some measure of material wealth. I have always hated this definition because it is relative. Being in the bottom half of the population in England is clearly not as challenging as being in the bottom half in Bangladesh, for example. Or in England 30 years ago (when we were allegedly poor but happy)

The UN and the WHO have definitions that refer to specifics such as access to drinking water, ability to maintain a healthy level of nutrition, and things to do with accommodation. This of course will vary according to who is doing the oversight and what their responsibilities are. Clearly Kent council would have greater aspirations to inform their targets and threshold.

The relative wealth definitions are counterproductive because there are two ways to change a skew distribution - one is to increase the income of the majority when there is a minority of super rich. This can lead to people who a relatively comfortable targetted for 'help'. This is how labour and tories game elections, appealing to 'workers' wanting more income, or the 'upper middle class' who simply want to keep more of what they have (lower taxes, anyone).

This leads, for example, to people asking how someone who uses their smart phone to call Nicky Campbell to spend 10 minutes complaining how they can't make ends meet can be for real.

I suspect that with easy access to good information we may, over the next 20 years, move away from the extremes of the debate ("give me a 35% pay hike", versus "I don't want my income to be taxed to subsidise scroungers"). To a certain extent I will temper any criticism of the junior doctors by stating simply that the NHS is buggered mostly because we don't have enough NHS doctors because they are clearing off to where they will be paid double, and we either fix this by hiking the salaries, or give up - or try importing massive numbers of doctors trained in poorer countries such as India; which is not a solution favoured by a large element of the electorate for a range of reasons).

I would be interested in @Neville's Breakfast thinks of the general sweep of my comments (we can agree to differ on minutiae of the details).

 

[Neville's Breakfast]

I have seen it defined as being in the lower half or quarter (whatever) of disposable incomes or some measure of material wealth. I have always hated this definition because it is relative. Being in the bottom half of the population in England is clearly not as challenging as being in the bottom half in Bangladesh, for example. Or in England 30 years ago (when we were allegedly poor but happy)

The UN and the WHO have definitions that refer to specifics such as access to drinking water, ability to maintain a healthy level of nutrition, and things to do with accommodation. This of course will vary according to who is doing the oversight and what their responsibilities are. Clearly Kent council would have greater aspirations to inform their targets and threshold.

The relative wealth definitions are counterproductive because there are two ways to change a skew distribution - one is to increase the income of the majority when there is a minority of super rich. This can lead to people who a relatively comfortable targetted for 'help'. This is how labour and tories game elections, appealing to 'workers' wanting more income, or the 'upper middle class' who simply want to keep more of what they have (lower taxes, anyone).

This leads, for example, to people asking how someone who uses their smart phone to call Nicky Campbell to spend 10 minutes complaining how they can't make ends meet can be for real.

I suspect that with easy access to good information we may, over the next 20 years, move away from the extremes of the debate ("give me a 35% pay hike", versus "I don't want my income to be taxed to subsidise scroungers"). To a certain extent I will temper any criticism of the junior doctors by stating simply that the NHS is buggered mostly because we don't have enough NHS doctors because they are clearing off to where they will be paid double, and we either fix this by hiking the salaries, or give up - or try importing massive numbers of doctors trained in poorer countries such as India; which is not a solution favoured by a large element of the electorate for a range of reasons).

I would be interested in @Neville's Breakfast thinks of the general sweep of my comments (we can agree to differ on minutiae of the details).

Regarding the NHS, I agree with your diagnosis but not your cure ! If doctors really are leaving to double their money abroad then increasing junior doctor pay by 35 % just won’t be sufficient and they will be back for similar next year. If anybody should understand these market forces it is the Tories. Poaching the best from India to replace those that leave is unsustainable for us and them because they will simply stop spending their limited budget on training as it won’t be worth it..and so it goes on. We are in a different position. We could take a strategic view that we cannot compete on pay and we will lose doctors but we can expand training places and factor it into the model. It’s the Tony Bloom approach ! Leverage our world class training and simply accept doctors will leave and be replaced. I’m not sure this has anything to do with poverty though. Doctors, teachers and train drivers earn a lot more than the median and yet they are the ones we are hearing about. The debate on poverty is more relevant to TAs, cleaners and those that leave school without qualifications or a trade and yet it is middle class professionals that are going on strike.
The problem with this debate is that, as you say, it is conducted from the extremes. I’m sure a lot of people on here will read my post and put me on ignore, which is absolutely fine. They will dismiss me as ‘a Tory’ because my views (as always) ‘aren’t with us’ therefore I must be ‘against us.’ I’ve had it already on this thread from good old Rog. The reality is I believe in higher taxation but I wouldn’t spend it on wages but on improving the service. That view is popular with no-one !

 

[chickens]

And nor does it the poster to whom I was responding, who showed the typical wokie feeling of moral superiority combined with arrogance to assume your view is superior to others. Would that also apply to you, I wonder?

Is it arrogance and superiority to ask people to question the information they’re being fed?

On this very thread I unquestioningly repeated something I’d been told which turned out to be an exaggeration, and was correctly pulled up on it by @pastafarian.

My take on what the original poster was asking for, was that we don’t just “join a tribe” accept information uncritically and ‘other’ people who disagree with us, but look into things with an open mind and a willingness to change our position if the facts aren’t as first thought.

I don’t say this from a “my facts are fine, you change yours” position, but the alternative to debate in good conscience is the polarisation that America is currently experiencing. It’s a cul de sac of hatred and wilful misunderstanding. I don’t want to see it here.

 

[The Antikythera Mechanism]

To a certain extent I will temper any criticism of the junior doctors by stating simply that the NHS is buggered mostly because we don't have enough NHS doctors because they are clearing off to where they will be paid double, and we either fix this by hiking the salaries, or give up - or try importing massive numbers of doctors trained in poorer countries such as India; which is not a solution favoured by a large element of the electorate for a range of reasons).

As an aside, the Senior Partner at my local GP Practice posted a letter on their website yesterday, an excerpt of which is this;

"At present at Bartlett Group, more than one third of our GP posts are now vacant. This represents hundreds of missing appointments each week. When I joined Bartlett Group Practice in 1993, an advert for a vacancy would attract 50 applicants. Our most recent adverts have attracted zero applicants. When a member of the clinical team leaves, it is almost impossible to recruit a replacement. Some GP practices are fortunate and are still fully manned. Many, like us, are struggling with falling staffing levels. Many practices across the UK have closed-down altogether. I can only assure you that we are working tirelessly to try and recruit. We do hope to have some new GPs join over the next 3-4 months."

It makes grim reading

 

[vegster]

beyond sickening. but also not a one off, a coffee shop for the homeless in liverpool has also had their windows put in three times in the past too weeks. why?



something deeply, deeply wrong with the psyche in this country. imagine this thread will rapidly end up in the bear pit but a serious debate needs to be had as to why the mentality of so many seems to be be built around the idea of ensuring nobody gets any sort of help for free. proper ‘suffering builds character’ stuff.

personally i think this ‘i’m alright jack, so screw everyone else’ attitude was really fostered in the 80s, but four decades worth of headlines about ‘benefit scroungers’ etc., since then have ensured it has stood the test of time. meanwhile the gluttony of the 1% is more boundless than ever.

Yes, it started a few decades ago. As we became poorer as a nation the media stoked up division and hatred in order to deflect from the chronic social mess the country is in. so much easier to make people believe that groups of people are somehow conning the rest of us out of a decent wage, housing and education. This is still going on to this day with the current " Stop The Boats " mantra and more recently with immigration from Europe when all immigrants were either given houses, cash and plasma tellys for sitting on the sofa all day, or, they were all out undercutting UK builders, plumbers etc. it can't be both but the print media would rather anyone got the blame apart from the government or the billionaires that cream off everything.

So, hate the unemployed, single mothers, immigrants, illegal immigrants, the EU, Judges, Lefty lawyers, pensioners and even those that chose to leave work in their 50's, oh, Unions, Junior Doctors, Meghan and Harry... anyone. It's easier to whip up hatred and division rather than tackle the real problems.

 

[cheshunt seagull]

Fortunately we have you to put all these thick people on the straight and marrow

Think it will take more than me to overhaul 100s of years of the British class system. My point here is that it is something which is unique to England and can lead to potentially dangerous levels of deference in which people are listened to for who they are and not what they say. Johnson's PG Wodehouse act is all about this. As for my powers of persuasion, they never even worked with some members of my family but the reality is that I am not someone who goes round lecturing people.

 

[Harry Wilson's tackle]

Regarding the NHS, I agree with your diagnosis but not your cure ! If doctors really are leaving to double their money abroad then increasing junior doctor pay by 35 % just won’t be sufficient and they will be back for similar next year. If anybody should understand these market forces it is the Tories. Poaching the best from India to replace those that leave is unsustainable for us and them because they will simply stop spending their limited budget on training as it won’t be worth it..and so it goes on. We are in a different position. We could take a strategic view that we cannot compete on pay and we will lose doctors but we can expand training places and factor it into the model. It’s the Tony Bloom approach ! Leverage our world class training and simply accept doctors will leave and be replaced. I’m not sure this has anything to do with poverty though. Doctors, teachers and train drivers earn a lot more than the median and yet they are the ones we are hearing about. The debate on poverty is more relevant to TAs, cleaners and those that leave school without qualifications or a trade and yet it is middle class professionals that are going on strike.

No, that part of my post (doctor pay) has nothing directly relevant to the wider issue of poverty, but it gets conflated in that general discourse and the narrative that 'they are already paid well' and 'whatabout me'. So I thought it worthy of elaboration. I think your argument that if you agree to pay demands this is fundamentally wrong because the strikers will come back next year with a similar demand is an archetypal Conservative view of industrial relations, and invites the taking of sides. So I will declare that I am with the workers here.

I will elaborate. I have tried to not wander off topic so I have added footnotes(*)

You probably know that among my various responsibilities I train doctors (in their intercalating BSc year, and later on when they take specialist subject modules). I have worked collaboratively in research with medics for 40 years, in London and in Canada. I have seen how training and recruitment have changed. I was, rather ludicrously, (subject) Division Clinical Academic Grouping Lead for Education and Training here for 10 years. I have been part of our (meagre three-person) medical interview panel since the late 90s*. I have supervised specialist training over the last fifteen years which combines supposedly half time in clinics and half time in labs**. And I have been a patient repeatedly over the years, with some access to the landscape from the other side because the people treating me talk to me when they realize what I do. I have also worked as external examiner in many UK medical schools, ostensibly for phase 1 (preclinical) but owing to administration problems I have reviewed OSCEs and other clinical bits and bobs***

So I speak with some authority. The medics I teach in the intercalating group tell me lots of things. Many have told me that a large cohort are 'in it' for the money and are gaming their training so they can climb the greasy pole quickly. That will certainly involve jumping ship if the occasion arises.

Solutions?

• We could try to recruit better and weed out those going into medicine for non-altruistic reasons. This won't happen for several reasons some explained elsewhere in this post. No interviews being one.
• We could try to recruit wider, especially down the A level grade list where socially disadvantaged students can be found. However we tried this 15 or so years ago. We don't do it now. We found that a hugely disproportionate number of students recruited could not cope with the training and dropped out or failed. We also had one disgruntled student who claimed that her failure to thrive was due to institutional racism. She fed the story to the Evening Standard. Nothing came of it. It was a brick throw. But my colleague eventually resigned, disheartened.
• We could try to train differently. Well, when it comes to clinical training, the programmes are nationally approved and supposedly standardized. In my role as external examiner I found that training seemed to be entirely correlated with the quality of staff. At one globally recognized uni (I won't say which) the academics ran all the preclinical training. They were brilliant. And the admin consisted of me writing one free form report a year. They respected the wherewithal of the external examiner. Lower down the pecking order of unis for whom I have external examined, I have found the staff to be largely untrained (in teaching) or over-trained via Teaching Training (some of which I have taken myself) which seems designed for teaching soft subjects to polytechnic level students, not medical students. There are also too many students so a rote learning model with SAQs and MCQs is inescapable****.
• So I think that wider recruitment into UK medical schools is not a solution. Frankly the new students will be less capable of getting through training. We could make the training different (i.e., easier to pass) but that is not appropriate.
• Recruiting overseas trained doctors is not a solution either. They are of course very happy to be here for a while but soon feel the pressures of inadequate money. You may be happy with turnover but I am not. Here is an example. I first started training a young medic from outside the EU (at the time, now not) nearly 20 years ago. He is now known as a world expert on a rather niche mediaca issue, but his wider specialization is mainstream. After 15 years or so of working in his home country and visiting my lab, at the age of around 40, he decided to get a hospital job in the UK. He brought his wife and 2 kids here. He soon had to add private work to his basic work to pay the bills. After a year of hardly seeing his family, they upped-sticks and went back home. His income is much reduced there but the cost of living so much lower, and the hours conducive to family life.
• So we need some infrastructure changes but the only solution right now is to throw money at the problem. Using foreign trained medics in a high turnover system means the pipeline of trainees who will become consultants will dry up. The footballers Brighton recruit have been well trained up to a point where we think we can do something with them and develop them. The medical training model can't map to this, where overseas recruits are ostensibly fully trained and qualified for the first team after certification (passing the equivalent of a British Cycling Proficiency test plus bronze swimming certificate). We will end up with loss of tacit expertise, more negligence and misconduct and longer waiting lists, if we replace the conveyor belt of British trainees-to-consultants with a massive increase in overseas trained doctors, underqualified students entering medical schools and an expectation of high drop out compensated only by an increase in turnover. And I have to say we are already at capacity for training. Staff repeating preclinical tutorials***** 40 times? I think not.

Footnotes:

*We don't interview any more, for a range of reasons, only some of which are in the public domain; my experience was that most senior medics (and I am talking 99%) are too 'busy' to engage with interviewing. When we interviewed it was clear within seconds whether an applicant would get an offer or not - gut instinct based on body language and the first few words of the verbal exchange. The imperative was 'would you trust this person with your health. Overall this is not systematic interviewing and is extremely trditional and subject to clear conscious and unconscious bias so we binned it.

**This is another failed initiative because consultants have too much power over the process. My trainees were constantly being told to come to clinic, and the trainees (these were prestigious programmes) did not do nearly enough research. One day a fortnight instead of 2.5 days a week, for example, Ad after completion the trainees simply cut and ran.

***I have resigned as external for two UK medical schools recently because of their administrative incompetence. I cannot begin to go into details or I'll be here all day. I raised an eyebrow when I read recently that one of the hospitals serviced by one of these schools I worked with has just been done for institutionalize bullying. This mapped well to the 'computer says no' and multiple different office silo culture I had experienced.

**** I hate SAQs (short answer questions) because students learn a five line poem containing ten facts and chant it back. I hate MCQs because with a modicum of revision students breeze through them. And educationalists have deemed it the case that marks distributions should not digress so a question with very low marks must be 'wrong' and is excluded. There there is standardization whereby it is presumed that the average quality of students year on year is the same. So the pass mark is adjusted so that a predetermined number of students will get firsts and fails. At the very best unis this seemed to work well. You need to have hundreds of students taking the exams each year to have a big enough sample size to be able to piss about with the marks though. At lesser unis I felt the staff were covering their arses somewhat. The worst experience in lesser unis was model answers not mapping to the question, ambiguity over what was needed and excessive leniency - inclusion of some correct and some irrelevant buzzwords in an answer is not conductive to 80% surely? And the worst bit was the weighting rubrics - many being mad: "7 marks are awarded if the student makes 3 out of a possible 5 correct points". What? That said, it is impossible to set essays for classes of 350 students. No time to mark being the major problem. Plus they are hard to standardize, and marking rubrics that are granular (as they increasingly are) can't be applied consistently. Think about reading this post. How would you grade it and how would you defend the grading system? Our grading systems have at least 40 points. Can you create a 40 point grading system for this post?

*****University teaching where I work is increasingly delivered by junior staff. They do an MSc in teaching as part of their probation. Many do preclinical medical school teaching. It is the worst type of sound bite high density stuff, increasingly so as numbers increase. Students soon learn that they need to Get Preclinical Training Done. Box ticking. I worry that as numbers increase and the type of staff teaching is degraded we are heading for trouble, not just an increase in waiting list but a decease in hospital doctor competence.

 

[rogersix]

Regarding the NHS, I agree with your diagnosis but not your cure ! If doctors really are leaving to double their money abroad then increasing junior doctor pay by 35 % just won’t be sufficient and they will be back for similar next year. If anybody should understand these market forces it is the Tories. Poaching the best from India to replace those that leave is unsustainable for us and them because they will simply stop spending their limited budget on training as it won’t be worth it..and so it goes on. We are in a different position. We could take a strategic view that we cannot compete on pay and we will lose doctors but we can expand training places and factor it into the model. It’s the Tony Bloom approach ! Leverage our world class training and simply accept doctors will leave and be replaced. I’m not sure this has anything to do with poverty though. Doctors, teachers and train drivers earn a lot more than the median and yet they are the ones we are hearing about. The debate on poverty is more relevant to TAs, cleaners and those that leave school without qualifications or a trade and yet it is middle class professionals that are going on strike.
The problem with this debate is that, as you say, it is conducted from the extremes. I’m sure a lot of people on here will read my post and put me on ignore, which is absolutely fine. They will dismiss me as ‘a Tory’ because my views (as always) ‘aren’t with us’ therefore I must be ‘against us.’ I’ve had it already on this thread from good old Rog. The reality is I believe in higher taxation but I wouldn’t spend it on wages but on improving the service. That view is popular with no-one !

you misunderstood my point

 

[Harry Wilson's tackle]

As an aside, the Senior Partner at my local GP Practice posted a letter on their website yesterday, an excerpt of which is this;

"At present at Bartlett Group, more than one third of our GP posts are now vacant. This represents hundreds of missing appointments each week. When I joined Bartlett Group Practice in 1993, an advert for a vacancy would attract 50 applicants. Our most recent adverts have attracted zero applicants. When a member of the clinical team leaves, it is almost impossible to recruit a replacement. Some GP practices are fortunate and are still fully manned. Many, like us, are struggling with falling staffing levels. Many practices across the UK have closed-down altogether. I can only assure you that we are working tirelessly to try and recruit. We do hope to have some new GPs join over the next 3-4 months."

It makes grim reading

Precisely. This is why dismissing the doctors' 35% pay demand because the doctors will just come back for more next year needs deconstructing, as it seems to be an argument against agreeing to any request for a pay rise, ever. In my very long reply to another poster I could have added a question: if one argues that agreeing to, say, only half a pay demand is preferable (for reasons of whatever, affordability and that), how will this mean that the doctors won't be back next year for the same again, and how does this underpin an argument (as it must) that therefore acceding to the 35% is wrong because it will encourage the doctors to come back next year for the same again?

It strikes me that trying to work out exactly how much of a pay rise to allow that will please the doctors sufficiently that they won't leave the profession and also that they won't ask for a pay rise next year, is an exercise in futility.

HMG seem to have take the stance that they will only come to the table if the 35% demand is withdrawn, and that the union is prepared to swap a pay rise for changes in terms and conditions and, doubtless, an agreement to nots strike again. Even if the union became sufficiently meek to agree to this, what will it do to resolve the present problem, that of recruitment?

It won't. It will make things worse. Which makes me think that those in the tory party who want to flog off the NHS (after it has been run down till it becomes hated by the public) have taken over.

 

[Peteinblack]

If that's the case, then surely virtually every other era in this country would have been far more cruel and selfish? People had far less money and possessions in every era pre-Thatcher, at least.

Just one example.
In the 1970s, young workers could buy a property costing x 4 their salary. Today, they need x 8-10 their salary. Moreover, for many young people, over 50% of their monthly salary goes on rent to a buy-to-let landlord who has bought dozens of properties to rent, and thereby further reduced the number of homes available for ordinary people to buy, while creating a scarcity that pushes up prices even higher.

Then young people are patronisingly told that their inability to afford a house is because of the £10.99 pcm they spend subscribing to Netflix, rather than stagnant salaries, exorbitant property prices and rip-off landlords.

 

[Jackthelad]

When did this country become so cruel?

Since 1834 when The Tory Party were formed.

 

[Simster]

Regarding the NHS, I agree with your diagnosis but not your cure ! If doctors really are leaving to double their money abroad then increasing junior doctor pay by 35 % just won’t be sufficient and they will be back for similar next year. If anybody should understand these market forces it is the Tories. Poaching the best from India to replace those that leave is unsustainable for us and them because they will simply stop spending their limited budget on training as it won’t be worth it..and so it goes on. We are in a different position. We could take a strategic view that we cannot compete on pay and we will lose doctors but we can expand training places and factor it into the model. It’s the Tony Bloom approach ! Leverage our world class training and simply accept doctors will leave and be replaced. I’m not sure this has anything to do with poverty though. Doctors, teachers and train drivers earn a lot more than the median and yet they are the ones we are hearing about. The debate on poverty is more relevant to TAs, cleaners and those that leave school without qualifications or a trade and yet it is middle class professionals that are going on strike.
The problem with this debate is that, as you say, it is conducted from the extremes. I’m sure a lot of people on here will read my post and put me on ignore, which is absolutely fine. They will dismiss me as ‘a Tory’ because my views (as always) ‘aren’t with us’ therefore I must be ‘against us.’ I’ve had it already on this thread from good old Rog. The reality is I believe in higher taxation but I wouldn’t spend it on wages but on improving the service. That view is popular with no-one !

You're wrong about poaching from India. All the while we allow Indians to work here and they send money back home, the Indian government would be stupid to discourage such investment. You see exactly the same thing with the Philippines, where they train nurses with a view to allowing them to work oversees and send money home.

These countries don't train their medical staff to have them all working at home. Why would they when their own countries can't afford to pay them all? They are trained in order to export the labour.

 

[Peteinblack]

Fortunately we have you to put all these thick people on the straight and marrow

Sadly, such enlightenment and consciousness-raising would be lost on someone as arrogant, condescending and morally superior as you.

You exude the very character traits that you condemn in the “Wokies”.

 

[Neville's Breakfast]

No, that part of my post (doctor pay) has nothing directly relevant to the wider issue of poverty, but it gets conflated in that general discourse and the narrative that 'they are already paid well' and 'whatabout me'. So I thought it worthy of elaboration. I think your argument that if you agree to pay demands this is fundamentally wrong because the strikers will come back next year with a similar demand is an archetypal Conservative view if industrial relations, and invites the taking of sides. So I will declare that I am with the workers here.

I will elaborate. I have tried to nor wander off topic so I have added footnotes(*)

You probably know that among my various responsibilities I train doctors (in their intercalating BSc year, and later on when they take specialist subject modules). I have worked collaboratively in research with medics for 40 years, in London and in Canada. I have seen how training and recruitment have changed. I was, rather ludicrously, (subject) Division Clinical Academic Grouping Lead for Education and Training here for 10 years. I have been part of our (meagre three-person) medical interview panel since the late 90s*. I have supervised specialist training over the last fifteen years which combines supposedly half time in clinics and half time in labs**. And I have been a patient repeatedly over the years, with some access to the landscape from the other side because the people treating me talk to me when they realize what I do. I have also worked as external examiner in many UK medical schools, ostensibly for phase 1 (preclinical) but owing to administration problems I have reviewed OSCEs and other clinical bits and bobs***

So I speak with some authority. The medics I teach in the intercalating group tell me lots of things. Many have told me that a large cohort are 'in it' for the money and are gaming their training so they can climb the greasy pole quickly. That will certainly involve jumping ship if the occasion arises.

Solutions?

• We could try to recruit better and weed out those going into medicine for non-altruistic reasons. This won't happen for several reasons some explained elsewhere in this post. No interviews being one.
• We could try to recruit wider, especially down the A level grade list where socially disadvantaged students can be found. However we tried this 15 or so years ago. We don't do it now. We found that a hugely disproportionate number of students recruited could not cope with the training and dropped out or failed. We also had one disgruntled student who claimed that her failure to thrive was due to institutional racism. She fed the story to the Evening Standard. Nothing came of it. It was a brick throw. But my colleague eventually resigned, disheartened.
• We could try to train differently. Well, when it comes to clinical training, the programmes are nationally approved and supposedly standardized. In my role as external examiner I found that training seemed to be entirely correlated with the quality of staff. At one globally recognized uni (I won't say which) the academics ran all the preclinical training. They were brilliant. And the admin consisted of me writing one free form report a year. They respected the wherewithal of the external examiner. Lower down the pecking order of unis for whom I have external examined, I have found the staff to be largely untrained (in teaching) or over-trained via Teaching Training (some of which I have taken myself) which seems designed for teaching soft subjects to polytechnic level students, not medical students. There are also too many students so a rote learning model with SAQs and MCQs is inescapable****.
• So I think that wider recruitment into UK medical schools is not a solution. Frankly the new students will be less capable of getting through training. We could make the training different (i.e., easier to pass) but that is not appropriate.
• Recruiting overseas trained doctors is not a solution either. They are of course very happy to be here for a while but soon feel the pressures of inadequate money. You may be happy with turnover but I am not. Here is an example. I first started training a young medic from outside the EU (at the time, now not) nearly 20 years ago. He is now known as a world expert on a rather niche mediaca issue, but his wider specialization is mainstream. After 15 years or so of working in his home country and visiting my lab, at the age of around 40, he decided to get a hospital job in the UK. He brought his wife and 2 kids here. He soon had to add private work to his basic work to pay the bills. After a year of hardly seeing his family, they upped-sticks and went back home. His income is much reduced there but the cost of living so much lower, and the hours conducive to family life.
• So we need some infrastructure changes but the only solution right now is to throw money at the problem. Using foreign trained medics in a high turnover system means the pipeline of trainees who will become consultants will dry up. The footballers Brighton recruit have been well trained up to a point where we think we can do something with them and develop them. The medical training model can't map to this, where overseas recruits are ostensibly fully trained and qualified for the first team after certification (passing the equivalent of a British Cycling Proficiency test plus bronze swimming certificate). We will end up with loss of tacit expertise, more negligence and misconduct and longer waiting lists, if we replace the conveyor belt of British trainees-to-consultants with a massive increase in overseas trained doctors, underqualified students entering medical schools and an expectation of high drop out compensated only by an increase in turnover. And I have to say we are already at capacity for training. Staff repeating preclinical tutorials***** 40 times? I think not.

Footnotes:

*We don't interview any more, for a range of reasons, only some of which are in the public domain; my experience was that most senior medics (and I am talking 99%) are too 'busy' to engage with interviewing. When we interviewed it was clear within seconds whether an applicant would get an offer or not - gut instinct based on body language and the first few words of the verbal exchange. The imperative was 'would you trust this person with your health. Overall this is not systematic interviewing and is extremely trditional and subject to clear conscious and unconscious bias so we binned it.

**This is another failed initiative because consultants have too much power over the process. My trainees were constantly being told to come to clinic, and the trainees (these were prestigious programmes) did not do nearly enough research. One day a fortnight instead of 2.5 days a week, for example, Ad after completion the trainees simply cut and ran.

***I have resigned as external for two UK medical schools recently because of their administrative incompetence. I cannot begin to go into details or I'll be here all day. I raised an eyebrow when I read recently that one of the hospitals serviced by one of these schools I worked with has just been done for institutionalize bullying. This mapped well to the 'computer says no' and multiple different office silo culture I had experienced.

**** I hate SAQs (short answer questions) because students learn a five line poem containing ten facts and chant it back. I hate MCQs because with a modicum of revision students breeze through them. And educationalists have deemed it the case that marks distributions should not digress so a question with very low marks must be 'wrong' and is excluded. There there is standardization whereby it is presumed that the average quality of students year on year is the same. So the pass mark is adjusted so that a predetermined number of students will get firsts and fails. At the very best unis this seemed to work well. You need to have hundreds of students taking the exams each year to have a big enough sample size to be able to piss about with the marks though. At lesser unis I felt the staff were covering their arses somewhat. The worst experience in lesser unis was model answers not mapping to the question, ambiguity over what was needed and excessive leniency - inclusion of some correct and some irrelevant buzzwords in an answer is not conductive to 80% surely? And the worst bit was the weighting rubrics - many being mad: "7 marks are awarded if the student makes 3 out of a possible 5 correct points". What? That said, it is impossible to set essays for classes of 350 students. No time to mark being the major problem. Plus they are hard to standardize, and marking rubrics that are granular (as they increasingly are) can't be applied consistently. Think about reading this post. How would you grade it and how would you defend the grading system? Our grading systems have at least 40 points. Can you create a 40 point grading system for this post?

*****University teaching where I work is increasingly delivered by junior staff. They do an MSc in teaching as part of their probation. Many do preclinical medical school teaching. It is the worst type of sound bite high density stuff, increasingly so as numbers increase. Students soon learn that they need to Get Preclinical Training Done. Box ticking. I worry that as numbers increase and the type of staff teaching is degraded we are heading for trouble, not just an increase in waiting list but a decease in hospital doctor competence.

Thank you for that detailed reply. Something I like about NSC is the range of skills and experience people bring to discussions. That’s when you have waded through the no marks who enjoy dishing out anonymous abuse.
One thing you have misunderstood is when I said we should not accede to the 35 % pay rise because they will come back next year and ask for more and your conclusion that it is an archetypal Conservative view. That is a misinterpretation. I wrote that simply because the Maths does not add up in response to you saying that doctors are resigning for double pay elsewhere. This means that 35 % does not touch the sides. If it did then I would give it, as the market demands. As you are not advocating doubling pay I am simply suggesting that we increase the number of medical school places and accept turnover because it is inevitable. It is happening anyway. Medicine is still, I think, a course that is difficult to get on to, which is ridiculous when the consequence is filling gaps with expensive agency staff and cheaper people trained abroad. This is replicated across the medical profession, with a shortage of places on eg postgraduate/doctorate psychology courses ie the ones that lead to actual jobs. There is also a nationwide shortage of speech therapists. It does make sense to widen the talent pool as at the moment lack of funding seems to be creating skill shortages.
I know the dynamics of teaching are different but some of the same factors apply and there are also important differences. I have very rarely met any young teachers who intend to still be doing the job in 5 years time. Money is sometimes a factor, in part because their uni mates go straight in to jobs that 2 years later are paying salaries the young teachers will take 20 years to achieve. The gulf is huge. When I was a trader most of the youngsters I interviewed were science, maths and engineering graduates who would rather use their talents to make money than to build bridges, take part in research or teach. I worked with an oil trader who started out designing and installing oil rigs. These alternatives cannot be competed with but just as significant are workload and training. Modern teacher training puts people off the profession because of endemic bullying, workload and formulaic learning. I got nothing of any importance from it. The system creates artificial barriers to entry and it is basically an endurance test rather than an environment suited to help people work with learners. It kind of sounds similar to what you describe in your last paragraph.I was told by many teachers not involved with teacher training that I will never teach like this at the end of it, apart from during inspections. They were right. The demands of teaching are not just in the training though. Teachers are expected to be social workers, behavioural and SEN specialists etc etc. Apologies for replying a little randomly to your points but you also raised the cost of living. With national pay rates in both the NHS and education, people (including the chap in your example) really should consider relocating. We have world class teaching hospitals on Merseyside (that saved my life !) and house prices a fraction of the equivalent down South.

 

[Neville's Breakfast]

You're wrong about poaching from India. All the while we allow Indians to work here and they send money back home, the Indian government would be stupid to discourage such investment. You see exactly the same thing with the Philippines, where they train nurses with a view to allowing them to work oversees and send money home.

These countries don't train their medical staff to have them all working at home. Why would they when their own countries can't afford to pay them all? They are trained in order to export the labour.

Yes, good point. @Harry Wilson's tackle will know I guess but presumably it means that the UK has to validate the training in India. Does that come with any unintended consequences and is it better than offering more training places here in the UK ?

 

[dsr-burnley]

Just one example.
In the 1970s, young workers could buy a property costing x 4 their salary. Today, they need x 8-10 their salary. Moreover, for many young people, over 50% of their monthly salary goes on rent to a buy-to-let landlord who has bought dozens of properties to rent, and thereby further reduced the number of homes available for ordinary people to buy, while creating a scarcity that pushes up prices even higher.

Then young people are patronisingly told that their inability to afford a house is because of the £10.99 pcm they spend subscribing to Netflix, rather than stagnant salaries, exorbitant property prices and rip-off landlords.

I think the seventies is a poor example, partly because the high interest rates meant that (even to buy a cheaper house) the inflation adjusted cost per month was higher than it is now, and partly because the percentage of owner-occupiers was lower than it is now. Low interest rates area major contributor to the house price boom.

 

[Hastings gull]

Sadly, such enlightenment and consciousness-raising would be lost on someone as arrogant, condescending and morally superior as you.

You exude the very character traits that you condemn in the “Wokies”.

There you go again! Your view should be interpreted as enlightenment and consciousness- raising, when in reality it is simply your view and nothing else. My mention of wokies is simply that this happens so often with our wokies on here - presumably such as yourself - who assume that their view is morally superior, and that others of a different persuasion need your version of "enlightenment". You can criticise me when I ever post that what I think must be superior to others' opinions. NSC is a forum for various views -you take it to mean that your view must be consciousness-raising.

 

[chickens]

If that's the case, then surely virtually every other era in this country would have been far more cruel and selfish? People had far less money and possessions in every era pre-Thatcher, at least.

There’s an excellent article on this in the FT:

Millennials are not as badly off as they think
https://ftedit.onelink.me/Ju3k/j5vms9li

 

[Harry Wilson's tackle]

Thank you for that detailed reply. Something I like about NSC is the range of skills and experience people bring to discussions. That’s when you have waded through the no marks who enjoy dishing out anonymous abuse.
One thing you have misunderstood is when I said we should not accede to the 35 % pay rise because they will come back next year and ask for more and your conclusion that it is an archetypal Conservative view. That is a misinterpretation. I wrote that simply because the Maths does not add up in response to you saying that doctors are resigning for double pay elsewhere. This means that 35 % does not touch the sides. If it did then I would give it, as the market demands. As you are not advocating doubling pay I am simply suggesting that we increase the number of medical school places and accept turnover because it is inevitable. It is happening anyway. Medicine is still, I think, a course that is difficult to get on to, which is ridiculous when the consequence is filling gaps with expensive agency staff and cheaper people trained abroad. This is replicated across the medical profession, with a shortage of places on eg postgraduate/doctorate psychology courses ie the ones that lead to actual jobs. There is also a nationwide shortage of speech therapists. It does make sense to widen the talent pool as at the moment lack of funding seems to be creating skill shortages.
I know the dynamics of teaching are different but some of the same factors apply and there are also important differences. I have very rarely met any young teachers who intend to still be doing the job in 5 years time. Money is sometimes a factor, in part because their uni mates go straight in to jobs that 2 years later are paying salaries the young teachers will take 20 years to achieve. The gulf is huge. When I was a trader most of the youngsters I interviewed were science, maths and engineering graduates who would rather use their talents to make money than to build bridges, take part in research or teach. I worked with an oil trader who started out designing and installing oil rigs. These alternatives cannot be competed with but just as significant are workload and training. Modern teacher training puts people off the profession because of endemic bullying, workload and formulaic learning. I got nothing of any importance from it. The system creates artificial barriers to entry and it is basically an endurance test rather than an environment suited to help people work with learners. It kind of sounds similar to what you describe in your last paragraph.I was told by many teachers not involved with teacher training that I will never teach like this at the end of it, apart from during inspections. They were right. The demands of teaching are not just in the training though. Teachers are expected to be social workers, behavioural and SEN specialists etc etc. Apologies for replying a little randomly to your points but you also raised the cost of living. With national pay rates in both the NHS and education, people (including the chap in your example) really should consider relocating. We have world class teaching hospitals on Merseyside (that saved my life !) and house prices a fraction of the equivalent down South.

Many thanks for that.

I was discussing our conversation with a pal this afternoon, and he suggested to me that surely you weren't suggesting never giving in to pay demands because another one will be along next year. I now see (I think ) that what you meant was agreeing to 35% would be wrong because it would embolden the union.

I agree with that. No employer agrees to the union's opening gambit. The problem is that HMG simply refused to have discussions that acknowledge the opening gambit. They seem to want to make 'take it or leave it offers', or 'we will talk but only under certain conditions' gambits. Hence the militant stance of the union (which as been a long time coming - this has been rumbling on for years, with the BMA being restrained owing to circumstances - i.e., covid).

One way or another the two sides must come to the table. Given that the medical profession's union is not like my (former) union, focused on pursuing a political agenda (the BMA is socially conservative), then the side pursuing an agenda must by HMG. Well, it clearly is.

And I can understand the agenda - it is to not do what is necessary to reduce staff losses and waiting lists, and instead feed a long term plan to see the NHS run down, sold and replaced by an American system. As I have said before, if I were a market conservative that would be my agenda - based around the idea that socialist institutions are wrong by definition. And I wouldn't have much time for 'free collective bargaining' either. The employer should state the wage or salary and if you are prepared to work for that amount you take the job. Simple. I don't need to explain that this is not my political position.

As for the supply and demand equation....we are apparently training more doctors, and yet vacancies go unfilled (see post by @The Antikythera Mechanism). I know we are training more doctors because where I work we don't have the physical space (or staff) to take on more students. And applicants exceed places ten fold. Always have. Incidentally accepting more applicants has reached a ceiling in my view because student quality and achievement decline if students let in have lower grades. No, the problem is entirely one of retention of qualified doctors, not numbers of trainees. The tap is on full, but the bucket has massive holes in the bottom. And because positions aren't being filled it means we have not been able to take up the slack with Indian, Sri Lankan and Singaporean medics. It may be that it is harder for them to come here because of Brexit, but I doubt that is the case. Perhaps we have reached saturation here too.

So my hypothesis (which is not original) is that retention is poor because of salaries, and the only solution to the global problem is to fix this. HMG playing politics with the issue is a very poor look, albeit is astonishingly still going down well in some quarters.

Oh well. All the best

 

[Weststander]

I think the seventies is a poor example, partly because the high interest rates meant that (even to buy a cheaper house) the inflation adjusted cost per month was higher than it is now, and partly because the percentage of owner-occupiers was lower than it is now. Low interest rates area major contributor to the house price boom.

Getting a mortgage up until and including the 70’s was incredibly difficult, due to credit controls. My Dad was in a good financial position, but even he faced a very long grilling at the Alliance & Leicester BS in Duke Street, Brighton when applying for a remortgage …. it took an entire Saturday morning. The all powerful manager sitting in a huge executive chair, my hopeful Dad in the small customer chair .

3x was the typical income to lending multiple, but even that wasn’t enough, you required the lender to tick all their subjective tests too.