Tag Archives: junior doctors

Newspeak and the NHS

NHSpace is fed up with the various catchphrases used by the government and the media to spin stories about the NHS. Here are our top five, handily debunked and translated.

1 – Excessive demand / high bed usage

The NHS has seen a steady reduction in the number of inpatient beds, whereas the population has steadily risen and social care needs upon discharge have increased.

The overall number of ‘finished admission episodes‘ has increased by 2-3% each year, in a reasonably predictable manner. The same goes for emergency admissions, and the recently reported ‘unprecedented increase’ in emergencies is again only a 3% rise.

When the government say that hospitals are under strain from unprecedented demand, they actually mean unprecedented bed reductions and a lack of social care. If social care was properly funded then many patients could be discharged from hospital in a more timely fashion. And rather than year-on-year cuts, bed numbers need to at least increase in line with the population (around 1% each year).

2 – Overspending / hospitals in debt

The NHS budget has fallen in recent years, in real terms. We also spend less per head of population on healthcare than many other westernised countries. It should be clear that hospitals aren’t overspending, but are actually spending less than they should on their patients, all thanks to significant underfunding.

But the story goes further than that. To whom are the hospitals in debt? “The government had to lend cash-strapped hospitals a record £2.825bn in the last financial year” the Guardian reported in July this year. So state-funded hospitals are in debt to the state. Regardless of the fact that hospitals are being turned into independent businesses, they are still really underfunded rather than being in debt.

3 – No money left

The UK government cannot actually run out of money per se. If they spend too much and don’t apply enough taxation, then inflation will rise, but an increase in NHS funding doesn’t have to mean an immediate ‘NHS tax’. (Government spending is a matter of macroeconomics, and isn’t like a household budget.) The government could choose to provide an additional investment in our NHS in order to bring NHS funding in line with our European neighbours.

Every additional £1 spent on the NHS would boost the economy by £3 by supporting jobs and keeping people healthy. That means a £30bn injection of funding, which would represent a 3.8% of GDP increase in state spending, could increase the UK’s GDP by 4.4%. And this is nothing compared to what the King’s Fund think we could support. Their analysis suggests that, in the next few decades, the NHS could be funded to a much greater extent and still be affordable.

So far from there being no money left, the government could invest in the NHS and reap the economic rewards. Instead there is a political choice not to spend.

4 – 7 day NHS / weekend effect

The NHS is already open on weekends, and most specialties have consultants on-call and doctors on-site 24/7.

Hunt’s 7-day NHS is actually part of a top-down reform, pushed upon doctors at a time when government-enforced cuts mean that the NHS is already stretched too far. Forcing staff to work longer hours whilst using STP hospital closure plans to close departments isn’t safe, so Hunt needed a stick to beat them with.

This is where the weekend effect came in. A study commissioned by Hunt’s department, interpreted wrongly by Hunt, and quoted in press releases before it was even published, was used to attack doctors for working safe hours. How dare they only work one-in-four weekends when Hunt had proof that patients were coming to harm? But, as academics have revealed, Hunt’s weekend effect was based on flawed data and a downright flawed interpretation.

With his weekend effect rubbished, Hunt is now trying to make the conversation about doctors’ salaries, when in fact it’s about overstretching an understaffed service.

5 – Sustainability and Transformation

The Sustainability and Transformation Plans are supposedly about creating a modernised NHS. In reality, sustainability actually means financial restrictions and transformation means enforced closures and outsourcing. Any NHS organisation failing to follow the STPs will be denied what little new funding there is to be had, and will face a ‘failure regime’.

The end game here is for the government to whittle the NHS down into an basics-only service with a few large hospitals offering emergency and major illness care only. A two tier system will emerge, where a significant amount of routine care will be available privately and not funded by the NHS.

Doctors’ Strikes: Time For One Final Push

An open letter from the NHSpace blog to all those doctors considering what action to take.

Dear doctors,

You’ve come a long way since the ballot on industrial action last year. You’ve forced the government to come back to the table at least twice, and got concessions out of them. You did this by maintaining a united front, and by being honest and measured whilst your opponents were being deceitful and excessive.

That’s why you still hold the cards. Hunt went all-in months ago with his ‘imposition’. He has no greater sanction left, and can only harm you in the court of public opinion. And so Hunt is trying to convince the public to turn against you.

“Hunt’s contract is far more damaging than any strike. He’s stretched the NHS so thin that people are already falling through the cracks.”

But he hasn’t succeeded yet. A new poll shows 57% of the public still support the strikes, and 51% believe Hunt should not have been reappointed. You can still win the public relations battle. Just do the following:

1 – Be team players. If the public think that doctors are divided over the contract and the strikes, they’ll lose faith in you.

2 – Be constructive. If you don’t like the strikes, focus your energy on talking about the issues you want fixed, rather than attacking your colleagues.

3 – Keep the message simple. The government are still pursuing the ‘7-day NHS’ line, which is easy for the public to follow. So remember: Hunt’s contract is far more damaging than any strike. He’s stretched the NHS so thin that people are already falling through the cracks.

4 – Expect to win, and soon. The government may have put on their poker face, but underneath the pressure is showing. If you can keep the public on your side, the government will have to cave in soon.

Regardless of what you think of the strikes, you must work together to win this fight. The very future of the NHS depends on your actions in these coming days and weeks.

Best wishes,

NHAspace

Why Are Doctors Striking Again?

The BMA are planning a further series of walkouts, this time stretching to five consecutive walkouts each month (8am-5pm). But why are doctors still unhappy? NHSpace looks at some if the reasons.

1 – The contract still isn’t fair

There are some serious problems with the contract that Hunt is imposing, including poor treatment of pregnant women and parents who work part-time. The latest version of the contract pretends to fix these, but the fix is time-limited so that future doctors will suffer. Hunt is treating the contract like a broadband contract, offering a good deal initially but a bad one in the long run. Doctors care about their future colleagues and aren’t about to sell them out.

2 – The government is slashing the NHS

Groups such as the NHA have been aware of the STP hospital closure plans for several months. Now that these ‘secret plans’ are finally being reported in the media, you can be certain that every doctor is aware of the latest hatchet job being performed on the NHS. The idea that Hunt could achieve a ‘truly 7 day NHS’ with no additional funds was nonsensical; expecting it to happen in the midst of massive service cuts is utterly ridiculous.

3 – Whistleblowers are still being punished

The Chris Day case highlighted the fact that doctors in training posts has no whistleblowing protection and could lose their careers just for speaking up. The BMA has made some headway by asking Health Education England to acknowledge their duty as a de facto employer, but you can expect doctors to push for a cast iron commitment to whistleblower protection.

4 – The government are privatising the NHS 

The STP hospital closure plans will create huge gaps in England’s healthcare system; gaps which the private health companies will be happy to fill, for a fee. Healthcare is already being rationed (ask anyone applying for routine surgery that requires ‘funding approval’), but the STPs will take us to the point where co-payments and top-up health insurance become the norm. This isn’t what today’s doctors signed up for.

Read more about privatisation: 5 Forms Of NHS Privatisation You Should Know About.

5 – Jeremy Hunt was reinstated

By inviting Jeremy Hunt to continue as Health Secretary, Theresa May has shown a lack of respect for medical professionals. But in all honesty, Hunt is just a figurehead. The gradual sell-off of the NHS and mistreatment of its workforce is a core Conservative policy, both due to the party’s ideology and their ties with corporate party donors, many of whom own shares in private healthcare. Doctors will express their anger at Hunt, but of course the problem goes much deeper.

An All-Out Strike?

On Thursday 11th February, Jeremy Hunt announced that he would be unilaterally imposing a new contract on front-line doctors. In his infamous imposition letter, Hunt claimed he had the support of a whole raft of NHS CEOs. In fact, most of them had never seen the letter and did not agree with the imposition.

The BMA had proposed an alternative contract that was ‘cost-neutral’ (no more expensive than the existing deal) but kept Saturday as a weekend day with appropriate pay. Hunt couldn’t accept this because of his obsession with a ‘7-day NHS’, which we all know already exists. He therefore vetoed all such deals offered by the BMA, preventing any settlement that might scupper his plans to force doctors to work extra weekends for no extra pay. To add insult to injury, Hunt claimed that no doctor would work consecutive weekends, and then published ‘example rotas’ that had doctors working three weekends straight.

The BMA has now asserted that, by failing to provide “appropriate funding for the required level of workforce needed to deliver safe services and adequate training”, the government has broken the original ‘heads of terms‘ agreed during the initial negotiations in 2013. There will be no more talks based on ‘cost neutrality’ – that horse has now bolted, and the BMA will settle for nothing less than a fully-funded workforce. As Dr Johann Malawana of the BMA puts it, “We also know – and the public understand this – that if the Government wants junior doctors to take the brunt of delivering more services across seven days, they need to put their money where their mouth is.”

So will we be seeing an all-out strike in the coming weeks and months? The BMA have made it clear that they do not take such action lightly, and have done all they can to avoid harming patient care. But with the Conservative government working to impose an unacceptable contract that is based upon flawed ideology rather than evidence-based medicine, full strike action may be the only option left.

Analysis: BMA Suspends Strike Action

Junior doctor Alex Ashman updates us on junior doctors’ contracts.

This afternoon, the British Medical Association (BMA) announced that they were suspending the 48 hour strike, which was due next week. Hospital management across the country are sure to have cheered at that news. But why would the BMA want to avoid industrial action? What are they asking for? And what are the government doing?

Why Did The BMA Suspend The Strike?

The threat of industrial action before Christmas was enough to force Health Secretary Jeremy Hunt into talks at the eleventh hour. Hunt had previously refused to negotiate, so this ceasefire was a small victory for the BMA.

Last week’s strike action was triggered by a lack of progress, and the need for the BMA to retain the mandate provided by the 97% of members who voted for action. The strike revealed a great deal of public support for junior doctors, and was said to have ‘landed a hit’ on Hunt.

Conciliatory talks at ACAS have now resumed, with Hunt sidelined. The BMA are obviously keen to aid the talks by suspending strike action, whilst keeping the ace in their hand – the 10th February walkout – as an incentive for the government to make a deal. Avoiding excessive strike action keeps the public on the doctors’ side, and thus keeps pressure up on the government.

Why Are The BMA Still Threatening Action?

There are several aspects of the new contract that the BMA find unfair, including:

  • Removal of safeguards that prevent unpaid overtime.
  • Classification of late evenings and Saturdays as ‘normal hours’.
  • Removal of pay for unsocial hours.
  • Removal of annual pay rises.
  • Removal of pay protection for academics and pregnant women.

Last week, the BMA stated that they still disagreed with the government on around 20 out of the 44  points being discussed.

What Are The Government Doing?

Outside of the talks, the government continue to bully junior doctors. Jeremy Hunt and David Cameron openly blame junior doctors for an imagined lack of 7-day NHS cover. Despite Hunt being criticised for misrepresenting stroke mortality figures, Cameron still repeated his misleading figures on national radio. Both the Health Secretary and the PM have gone on the record threatening the ‘nuclear option’ of forcing the contract upon junior doctors. Whispers in Whitehall are that the government are certain they will win the dispute through sheer brute force. Perhaps they have forgotten that, as with any nuclear option, they are courting mutually assured destruction.

 

Junior Doctors’ Pay – The Facts

Junior doctor Alex Ashman has the inside story on what junior doctors are actually paid.

A new ‘investigation’ by the Daily Mail has apparently revealed that fifty thousand NHS staff earn more than £100k. The timing of this announcement is somewhat suspicious, coming as it does during a dispute over junior doctors’ pay. But how much do junior doctors actually earn?

Basic Pay

A first year doctor (F1), having completed five/six years in medical school, receives a basic salary of £22,636. Thanks to below-inflation pay rises under the coalition government, today’s F1s are as much as £6,300 worse off compared to F1s in 2010.1

F1s are paid poorly because they traditionally received free onsite hospital accommodation. This was taken away in 2010, but there was no compensatory pay increase.

After one year, F1s become F2s, and their basic pay rises to £28,076. Further progression is rewarded with smaller increases thus:

Year of Service Typical Title Basic Pay Minimum Age
 First House Officer / F1  £22,636  23
 Second Senior House Officer / F2  £28,076  24
 Third Senior House Officer / CT1  £30,002  25
 Fourth Senior House Officer / CT2  £31,838  26
 Fifth Registrar / ST3  £34,402  27
 Sixth  Registrar / ST4  £35,952  28
 Seventh  Registrar / ST5  £37,822  29
 Eighth  Registrar / ST6  £39,693  30
 Ninth  Registrar / ST7  £41,564  31
 Tenth  Registrar / ST8  £43,434  32
 Eleventh  Registrar / ST9  £45,304  33

Banding Supplements

For many junior doctors, basic pay is funded by their regional deanery. The hospital they work for then pays a banding supplement based on the unsocial nature of the hours they work (nights/weekends/long shifts).

Banding supplements were introduced to punish hospitals for overworking their junior doctors. Doctors working traditional 80-hour weeks were given up to 100% extra pay, ending the 80-hour week pretty damned quickly!

Today’s junior doctors seldom receive the higher banding rates. A few receive a 0% rate and are ‘unbanded’, meaning they work 36 hour weeks. Most junior doctors work up to 48 or 56 hours a week, meaning they work 30-55% additional hours. For this they receive 20, 40 or 50% more pay, depending on just how many long shifts, nights, weekends and bank holidays they work.

How Many Junior Doctors Earn 100k?

None of them. Not unless they have a side job that pays more than their work as a doctor! As demonstrated above, doctors can easily reach their mid-thirties without ever getting anywhere near such a salary. Even a junior doctor in their tenth year earns less than an newly-elected MP.2

Footnotes

1 – In 2010 an F1 earned £22,412 basic pay, which would be £26,840 in today’s money. Assuming they work in a post with 50% banding pay, today’s F1s are £6,300 worse off compared with their 2010 colleagues.

2 – MPs currently receive an annual salary of £74,000 plus expenses. Compare this with an ST8 on 50% banding, who will earn £65,151 but have to pay their own professional expenses.

7 Reasons Why The Junior Doctor Contract Is Unfair

Junior doctor Alex Ashman explains why you shouldn’t listen to the Daily Mail.

Doctors aren’t in it for the money. Remember that they chose this career over many other options. If money was a big deal, they’d have skipped medical school and gone to work for Deloitte. Instead, they chose to work weekends and nights, getting shouted at and getting covered in other peoples’ bodily fluids. So please let’s do away with the Daily Mail conspiracy theory that doctors are scheming to bring down the NHS, like a bunch of crackpot Bond villains. They are in fact real people with children to feed and mortgages to pay.

Here are the real reasons why junior doctors are fighting against the new contract:

It Removes All The Safeguards

The new contract does away with ‘banding’, whereby hospitals have to pay junior doctors a higher rate if they are forced to work unsafe 80-hour weeks. Banding was a great innovation and successfully brought in a 48 hour week as required by the European Working Time Directive. Under the new contract, doctors will be left with no protection from dangerous long hours, thus putting patients at risk.

It Extends Normal Working Hours

The new contract extends so-called ‘normal’ hours to include late evenings and Saturdays, treating 9pm on a Saturday evening as being the same as 9am on a Tuesday morning. This can only be an attempt to have doctors work more hours, which is bad for patient safety.

It Punishes The Busiest Specialties

Junior doctors already working long hours in A&E, in GP surgeries, and in paediatrics will all suffer as a result of the new contract. These busy specialties are already struggling to recruit new doctors and will likely see an exodus of staff under the new contract. If this happens, the NHS will genuinely tip over the edge and experience a real ‘crisis’.

It Punishes Women and Academics

The new contract removes annual pay progression, which is awarded based on level of experience. This is the only annual pay increase doctors get, as their baseline salaries usually get 0% increases each year. Thanks to the removal of annual pay progression pregnant women, academics, and doctors who work less-than-full-time (e.g. parents who also work) will receive less pay.

It’s Being Forced Through By The Government

The contract negotiations between the government and the BMA doctors’ union were essentially a sham. The government came to the table with a list of demands, unwilling to haggle. Naturally, the BMA walked out.

Hunt Lied About Weekend Deaths

Jeremy Hunt’s line, about increased weekend deaths being due to doctors not working weekends, is a lie in more than one way. Firstly, junior doctors already provide a 24/7 service for the NHS. Secondly, the authors of the scientific paper used by Hunt have stated that any attempt to link weekend deaths with junior doctors’ working patterns would be ‘rash and misleading’.

Hunt Lied About The 11% Pay Rise

With the removal of ‘banding’ payments, junior doctors stand to lose around 30% of their pay package. Jeremy Hunt has offered an 11% increase in basic pay to compensate for this. Not only is this not a ‘pay rise’, but the 11% figure doesn’t relate to anything in the actual contract details, and thus seems to be a ‘sound bite’ used by Hunt in an attempt to discredit doctors.