Interesting to read Mike's article and the comments that people from various sides have posted here. Almost everyone is seeing this from the point of view of whether the government is making a mistake to take on the vested interests, and almost no-one is asking whether Hunt might actually be right in trying to do what he is doing. I think that is very revealing.
Of course, all governments get into battles with vested interests of one sort or another - remember Patricia Hewitt and the nurses? The political significance is usually less than it seems at the time.
How could anyone forget Patricia Hewitt's sneering tone ! Surely the medical profession is grateful for having Hunt in charge after Lansley & Hewitt (Not to mention Mr Mid Staffs...) ?
Did Alan Johnson do anything of note whilst in charge, forgot he was there tbh now I've looked it up.
On topic - this strike's popularity will depend on the media war. Keep the smears/facts about the BMA coming and add in a couple of deaths today and support will drain away.
BBC – top on-line story – "Patients hit by junior doctors’ strike.
Thousands of patients have treatment postponed as junior doctors in England go on strike"
In the media battle, I make that HMG 1 – BMA 0.
Morning all,
And so Bowie gives way to more prosaic news. The alternative headline would be far worse for junior doctors:
"No discernible difference as junior doctors strike"
The alternative headline, if Labour was writing it would be "Red Tories undermine Corbyn". Oh no, hang on - I got distracted. It'd be "government-induced feud put patients at risk", or some such.
The public would support NHS staff no matter what. The details don't matter.
Seems to have been a bit of a realisation at the top of the BMA (and change of leaders? certainly a more militant attitude) that they can do what they like and they will be supported.
The government is quite right to try and equalise the available quality of care across the week, and have in this age of austerity taken reasonable steps to compensate doctors for it.
But ask the public if more money should be spent on the NHS/doctors/nurses/whatever and the answer will be yes, always and every time, so the doctors know they can hold out for more cash.
Let's not pretend that at the end of the day this is anything other than a common or garden strike for better pay and conditions. Doctors hold all the aces though, trying to reform the NHS is a thankless task. sigh
No, the strike is about avoiding worse pay and conditions. Whether equalising care across the week is a good or bad thing is not clear -- who apart from Jeremy Hunt wants to make weekday care worse? -- and nor is whether Hunt's plan is the best way to proceed.
The government should postpone the changes while it works out what it actually wants.
The BMA has published a summary of the recent negotiations, according to which four significant areas of disagreement remain. Three concern pay, in particular the definition of antisocial hours. The other is about safeguarding measures to ensure adherence to the new hours policy. Is this latter really irresolvable? Or is it just there to anticipate the charge that this is all about money?
The Government has promised that there will be no pay cut for all but one per cent of junior doctors. Some will even see a pay rise. True, many will not get the rise they expected. But that is very different from a cut. And if that is what we are striking about, we need to be upfront about it with a public that has voted to accept austerity.
We have also been assured that the maximum hours we can be required to work will be reduced. Some of us may work longer hours but many will work fewer. And the longest shifts will go. They may not be such congenial hours – there will certainly be more weekends. But those are the same hours that plenty of other professions accept, including nurses.
That's a really good article about the dispute. It would be good to hear something equally eloquent from a doctor on the other side.
Also a good info pane at the bottom with details of career progression, salaries and bonuses.
Blimey.
20-30's, earning up to £40,000 to £65,000 including overtime.
31 upwards as a Consultant picking up a starting salary of £74K rising to an average of £130,000.
Training heavily subsidised by the taxpayer.
The public will see those figures and begin to ask questions.
I think only about 15% of hospital doctors manage to make the jump to consultant.
And those not good enough to do so, will still earn a multiple of the average wage.
Sure.
I'm just pointing out that assuming that all doctors will make it to consultants in adjudging incomes is not correct.
Surely it is very easy to see if we're paying the right amount for junior doctors: are we struggling to recruit people of the required quality? If we are, then we're paying too little.
Interesting to read Mike's article and the comments that people from various sides have posted here. Almost everyone is seeing this from the point of view of whether the government is making a mistake to take on the vested interests, and almost no-one is asking whether Hunt might actually be right in trying to do what he is doing. I think that is very revealing.
Of course, all governments get into battles with vested interests of one sort or another - remember Patricia Hewitt and the nurses? The political significance is usually less than it seems at the time.
Very worthwhile distinction. If taking on vested interests is an absolute negative in itself then reform will never be possible. We should consider whether the proposed reforms are the right or wrong idea.
Personally I think a truly 7 day NHS is an idea long come, as well as an idea voted for at the election.
Good morning all. NHS England employs 1.3 million people. If it were a city it would be Britain's fifth largest. It's not particularly amenable to reform; Health has replaced Northern Island as the poisoned chalice of cabinet roles.
Didn't one of Blair's appointees to the SoS role exclaim "Oh f..., not health!" When offered the job?
The BMA has published a summary of the recent negotiations, according to which four significant areas of disagreement remain. Three concern pay, in particular the definition of antisocial hours. The other is about safeguarding measures to ensure adherence to the new hours policy. Is this latter really irresolvable? Or is it just there to anticipate the charge that this is all about money?
The Government has promised that there will be no pay cut for all but one per cent of junior doctors. Some will even see a pay rise. True, many will not get the rise they expected. But that is very different from a cut. And if that is what we are striking about, we need to be upfront about it with a public that has voted to accept austerity.
We have also been assured that the maximum hours we can be required to work will be reduced. Some of us may work longer hours but many will work fewer. And the longest shifts will go. They may not be such congenial hours – there will certainly be more weekends. But those are the same hours that plenty of other professions accept, including nurses.
That's a really good article about the dispute. It would be good to hear something equally eloquent from a doctor on the other side.
Also a good info pane at the bottom with details of career progression, salaries and bonuses.
Blimey.
20-30's, earning up to £40,000 to £65,000 including overtime.
31 upwards as a Consultant picking up a starting salary of £74K rising to an average of £130,000.
Training heavily subsidised by the taxpayer.
The public will see those figures and begin to ask questions.
I think only about 15% of hospital doctors manage to make the jump to consultant.
And those not good enough to do so, will still earn a multiple of the average wage.
Sure.
I'm just pointing out that assuming that all doctors will make it to consultants in adjudging incomes is not correct.
Surely it is very easy to see if we're paying the right amount for junior doctors: are we struggling to recruit people of the required quality? If we are, then we're paying too little.
Or the training isn't good enough, or the quality of those being trained initially could be better.
Many education standards have been dumbed down in the last decade or so; perhaps this is one of the outcomes?
The public would support NHS staff no matter what. The details don't matter.
Seems to have been a bit of a realisation at the top of the BMA (and change of leaders? certainly a more militant attitude) that they can do what they like and they will be supported.
The government is quite right to try and equalise the available quality of care across the week, and have in this age of austerity taken reasonable steps to compensate doctors for it.
But ask the public if more money should be spent on the NHS/doctors/nurses/whatever and the answer will be yes, always and every time, so the doctors know they can hold out for more cash.
Let's not pretend that at the end of the day this is anything other than a common or garden strike for better pay and conditions. Doctors hold all the aces though, trying to reform the NHS is a thankless task. sigh
No, the strike is about avoiding worse pay and conditions. Whether equalising care across the week is a good or bad thing is not clear -- who apart from Jeremy Hunt wants to make weekday care worse? -- and nor is whether Hunt's plan is the best way to proceed.
The government should postpone the changes while it works out what it actually wants.
The government has worked out what it wants as has the electorate. Equal care across the week was voted for in May 2015 it was a manifesto commitment.
"The Government has already told us, for example, that it plans to reduce the number of breaks during shifts down to just 20 minutes every six hours. In practice, this could mean that a doctor working an eleven hour shift will only get a single 20 minute break. We don’t think this would be safe."
This seems to me to be the 'killer' fact - if it is true, rather than all the blather about money at weekends. This has got to be unsafe and very bad for doctor's sanity and health.
Useful comments about 7 day NHS. There already is one by the way. Cameron and Hunt made this pledge workout a clue about what they wanted. Say Hunt gets his way and there are more doctors at the weekend - which incidentally means a poorer service during the week because he's not employing any more of them - and said doctor decides her patient needs a scan or blood test. Are they going to wheel themselves to x-ray? Or analyse their own blood? It's pointless having more doctors of you don't have the porters, radiographers, pathologists etc. It's a smokescreen but after their ill consisted pledge they have to be seen to be doing something.
Interesting to read Mike's article and the comments that people from various sides have posted here. Almost everyone is seeing this from the point of view of whether the government is making a mistake to take on the vested interests, and almost no-one is asking whether Hunt might actually be right in trying to do what he is doing. I think that is very revealing.
Of course, all governments get into battles with vested interests of one sort or another - remember Patricia Hewitt and the nurses? The political significance is usually less than it seems at the time.
Hunt is doing the right thing in the wrong way.
He is being disingenous to say there will be no losers when junior doctors will effectively lose money by the rebanding of antisocial hours.
He could have pointed this out, he could have said that they will have to suck it up with a pay and/or hours cut and that is the environment we are in, he could have said in his effort to restructure the NHS the practice of junior doctors working all hours for extra pay would have to cease and surely that is sensible.
But no.
He, and every other minister, has focused on the 11% pay rise and repeated that no one will lose out.
That is wrong and gives entirely the wrong impression, as though an 11% pay rise compensates for the change in working practices. It doesn't (even if it is right that it should) and it is this which is a failure of government both practically and morally IMO.
The public would support NHS staff no matter what. The details don't matter.
Seems to have been a bit of a realisation at the top of the BMA (and change of leaders? certainly a more militant attitude) that they can do what they like and they will be supported.
The government is quite right to try and equalise the available quality of care across the week, and have in this age of austerity taken reasonable steps to compensate doctors for it.
But ask the public if more money should be spent on the NHS/doctors/nurses/whatever and the answer will be yes, always and every time, so the doctors know they can hold out for more cash.
Let's not pretend that at the end of the day this is anything other than a common or garden strike for better pay and conditions. Doctors hold all the aces though, trying to reform the NHS is a thankless task. sigh
No, the strike is about avoiding worse pay and conditions. Whether equalising care across the week is a good or bad thing is not clear -- who apart from Jeremy Hunt wants to make weekday care worse? -- and nor is whether Hunt's plan is the best way to proceed.
The government should postpone the changes while it works out what it actually wants.
The government has worked out what it wants as has the electorate. Equal care across the week was voted for in May 2015 it was a manifesto commitment.
Maybe it has but I doubt those voting were clear that this would mean a poorer service during the week. Without more doctors it has to.
"Some advocates for leaving, going beyond the Norway option of belonging to the single market institutions without being a member of the EU, have suggested that the UK can simply maintain free trading relations with the bloc it has just left by signing a bilateral trade agreement. An FTA would give the UK access to the single market without formally having to be a member and hence without committing to implement all its rules. Models for this are apparently supplied by the deals given to eastern European countries like Moldova and Ukraine.
Along with most of the magic solutions peddled by the leave campaigners, this solution is both a political non-starter and of uncertain economic benefit."
Some good points and some dubious points mixed together in this editorial. The best point is probably this one:
"And even if the UK achieved full access to the single market without a formal pact, it would rapidly find itself having to adopt many of the regulations of that market if it wanted to survive. The UK is not a big exporter of manufactures that needs merely a traditional agreement on goods tariffs. Its comparative advantage is in sophisticated services, particularly in the financial sector, that are governed by complex regulation. To continue selling into the EU, the UK will find itself adopting large swaths of the single market’s rules without having any say over how they are created."
I'm just pointing out that assuming that all doctors will make it to consultants in adjudging incomes is not correct.
Surely it is very easy to see if we're paying the right amount for junior doctors: are we struggling to recruit people of the required quality? If we are, then we're paying too little.
Medicine was always the most oversubscribed university course at UCAS time in my day - to the extent that students weren't allowed to put down 6 medical degrees on the form - they had to have a back-up Biochem option. Is that still the case?
Interesting to read Mike's article and the comments that people from various sides have posted here. Almost everyone is seeing this from the point of view of whether the government is making a mistake to take on the vested interests, and almost no-one is asking whether Hunt might actually be right in trying to do what he is doing. I think that is very revealing.
Of course, all governments get into battles with vested interests of one sort or another - remember Patricia Hewitt and the nurses? The political significance is usually less than it seems at the time.
Hunt might be right to aim for a 7-day NHS but it is not clear that he is, and there is even more doubt that he is going about it in the right way. Hunt may have fallen into the New Labour trap of mistaking slogans for policy. What does a 7-day NHS even mean? Emergencies are already catered for, and the hospitals don't turf out patients on Friday evenings.
Do we need outpatients to run at the weekend? Maybe: it would be more convenient for people at work during the week, but is it worth paying receptionists, porters, drivers and nurses to come in, as well as doctors, to run a clinic 90 per cent of whose users would prefer to attend during the week?
Similarly, does Hunt want elective surgery moved from weekdays to weekends? It would even out death rates but are there benefits for numerate observers?
Most of the NHS, at least in hospitals, is already 24x7, which is why junior hospital doctors face pay cuts. They are already doing those hours as overtime. What value Hunt adds is unclear and it would be better to appoint some sort of commission to work out what we want from the NHS and how best to get it.
Imagine the outpouring of anger if Labour had won the GE, and their proposed changes to the NHS budget had been put into practice. No ring fencing, less money, the strikes would be continual. Wouldn't they?
The BMA has published a summary of the recent negotiations, according to which four significant areas of disagreement remain. Three concern pay, in particular the definition of antisocial hours. The other is about safeguarding measures to ensure adherence to the new hours policy. Is this latter really irresolvable? Or is it just there to anticipate the charge that this is all about money?
The Government has promised that there will be no pay cut for all but one per cent of junior doctors. Some will even see a pay rise. True, many will not get the rise they expected. But that is very different from a cut. And if that is what we are striking about, we need to be upfront about it with a public that has voted to accept austerity.
We have also been assured that the maximum hours we can be required to work will be reduced. Some of us may work longer hours but many will work fewer. And the longest shifts will go. They may not be such congenial hours – there will certainly be more weekends. But those are the same hours that plenty of other professions accept, including nurses.
That's a really good article about the dispute. It would be good to hear something equally eloquent from a doctor on the other side.
Also a good info pane at the bottom with details of career progression, salaries and bonuses.
Blimey.
20-30's, earning up to £40,000 to £65,000 including overtime.
31 upwards as a Consultant picking up a starting salary of £74K rising to an average of £130,000.
Training heavily subsidised by the taxpayer.
The public will see those figures and begin to ask questions.
I think only about 15% of hospital doctors manage to make the jump to consultant.
And those not good enough to do so, will still earn a multiple of the average wage.
Sure.
I'm just pointing out that assuming that all doctors will make it to consultants in adjudging incomes is not correct.
Surely it is very easy to see if we're paying the right amount for junior doctors: are we struggling to recruit people of the required quality? If we are, then we're paying too little.
The public would support NHS staff no matter what. The details don't matter.
Seems to have been a bit of a realisation at the top of the BMA (and change of leaders? certainly a more militant attitude) that they can do what they like and they will be supported.
The government is quite right to try and equalise the available quality of care across the week, and have in this age of austerity taken reasonable steps to compensate doctors for it.
But ask the public if more money should be spent on the NHS/doctors/nurses/whatever and the answer will be yes, always and every time, so the doctors know they can hold out for more cash.
Let's not pretend that at the end of the day this is anything other than a common or garden strike for better pay and conditions. Doctors hold all the aces though, trying to reform the NHS is a thankless task. sigh
No, the strike is about avoiding worse pay and conditions. Whether equalising care across the week is a good or bad thing is not clear -- who apart from Jeremy Hunt wants to make weekday care worse? -- and nor is whether Hunt's plan is the best way to proceed.
The government should postpone the changes while it works out what it actually wants.
The government has worked out what it wants as has the electorate. Equal care across the week was voted for in May 2015 it was a manifesto commitment.
Not a great argument I'm afraid. In 2005, the voters happily voted for a Chancellor who had abolished boom and bust. Just because the electorate has voted for a something it doesn't necessarily follow that it will get it.
Question for those with the details: a doctor who will be worse off under the new contract, is currently working how many hours per week?
My understanding is that the crossover is 80-90 hours, depending on when the overtime is worked currently - with those working more than those hours being worse off in future.
"Some advocates for leaving, going beyond the Norway option of belonging to the single market institutions without being a member of the EU, have suggested that the UK can simply maintain free trading relations with the bloc it has just left by signing a bilateral trade agreement. An FTA would give the UK access to the single market without formally having to be a member and hence without committing to implement all its rules. Models for this are apparently supplied by the deals given to eastern European countries like Moldova and Ukraine.
Along with most of the magic solutions peddled by the leave campaigners, this solution is both a political non-starter and of uncertain economic benefit."
Some good points and some dubious points mixed together in this editorial. The best point is probably this one:
"And even if the UK achieved full access to the single market without a formal pact, it would rapidly find itself having to adopt many of the regulations of that market if it wanted to survive. The UK is not a big exporter of manufactures that needs merely a traditional agreement on goods tariffs. Its comparative advantage is in sophisticated services, particularly in the financial sector, that are governed by complex regulation. To continue selling into the EU, the UK will find itself adopting large swaths of the single market’s rules without having any say over how they are created."
I think the counter point is that we would only have to comply with EU rules for those products we sell to Europe, those we don't wouldn't have to. Though in reality companies would still make products globally compliant rather than do it nation by nation.
As for regulation and the City, I don't see how it is any different being inside or outside the EU, we don't have a veto and Dave isn't trying to negotiate for one.
The public would support NHS staff no matter what. The details don't matter.
Seems to have been a bit of a realisation at the top of the BMA (and change of leaders? certainly a more militant attitude) that they can do what they like and they will be supported.
The government is quite right to try and equalise the available quality of care across the week, and have in this age of austerity taken reasonable steps to compensate doctors for it.
But ask the public if more money should be spent on the NHS/doctors/nurses/whatever and the answer will be yes, always and every time, so the doctors know they can hold out for more cash.
Let's not pretend that at the end of the day this is anything other than a common or garden strike for better pay and conditions. Doctors hold all the aces though, trying to reform the NHS is a thankless task. sigh
No, the strike is about avoiding worse pay and conditions. Whether equalising care across the week is a good or bad thing is not clear -- who apart from Jeremy Hunt wants to make weekday care worse? -- and nor is whether Hunt's plan is the best way to proceed.
The government should postpone the changes while it works out what it actually wants.
The government has worked out what it wants as has the electorate. Equal care across the week was voted for in May 2015 it was a manifesto commitment.
Probably more thought they were voting for bringing weekends up to weekdays than for bringing weekdays down to weekends.
The manifesto said: we will continue to increase spending on the NHS, provide 7-day a week access to your GP and deliver a truly 7-day NHS – so you know you will always have access to a free and high quality health service when you need it most.
Interesting to read Mike's article and the comments that people from various sides have posted here. Almost everyone is seeing this from the point of view of whether the government is making a mistake to take on the vested interests, and almost no-one is asking whether Hunt might actually be right in trying to do what he is doing. I think that is very revealing.
Of course, all governments get into battles with vested interests of one sort or another - remember Patricia Hewitt and the nurses? The political significance is usually less than it seems at the time.
Very worthwhile distinction. If taking on vested interests is an absolute negative in itself then reform will never be possible. We should consider whether the proposed reforms are the right or wrong idea.
Personally I think a truly 7 day NHS is an idea long come, as well as an idea voted for at the election.
A truly 7 day a week NHS is surely going to cost us a lot more money, isn't it?
Imagine the outpouring of anger if Labour had won the GE, and their proposed changes to the NHS budget had been put into practice. No ring fencing, less money, the strikes would be continual. Wouldn't they?
Remember the Darzi reforms under Labour? The idea that the NHS has been frozen since 1948 until Jeremy Hunt's appointment is just spin.
Mr. Eagles, it's like asking someone who their favourite Diaodochos was - and they say Meleager.
Edited extra bit: this might be the most obnoxiously obscure thing I've posted this year.
For those shockingly unfamiliar with the events of the 4th century BC: after Alexander's death there was some prevarication over what to do (his half-brother had a child's mind, and one of his wives was pregnant).
Meleager stirred the foot soldiers to revolt. This was eventually quelled. A short time later the regent, Perdiccas, had Meleager's supporters trampled to death by elephants. Meleager did not survive much longer himself.
Interesting to read Mike's article and the comments that people from various sides have posted here. Almost everyone is seeing this from the point of view of whether the government is making a mistake to take on the vested interests, and almost no-one is asking whether Hunt might actually be right in trying to do what he is doing. I think that is very revealing.
Of course, all governments get into battles with vested interests of one sort or another - remember Patricia Hewitt and the nurses? The political significance is usually less than it seems at the time.
Very worthwhile distinction. If taking on vested interests is an absolute negative in itself then reform will never be possible. We should consider whether the proposed reforms are the right or wrong idea.
Personally I think a truly 7 day NHS is an idea long come, as well as an idea voted for at the election.
A truly 7 day a week NHS is surely going to cost us a lot more money, isn't it?
I would hazard a guess at 10-15% extra for staff costs to increase the number of available people for weekend shifts. At least. The only way to make the NHS work 7 days a week is to reduce the service provision on weekdays and use the spare capacity to improve weekend services. There is no way we can afford another 10-15% increase in NHS funding.
Interesting to read Mike's article and the comments that people from various sides have posted here. Almost everyone is seeing this from the point of view of whether the government is making a mistake to take on the vested interests, and almost no-one is asking whether Hunt might actually be right in trying to do what he is doing. I think that is very revealing.
Of course, all governments get into battles with vested interests of one sort or another - remember Patricia Hewitt and the nurses? The political significance is usually less than it seems at the time.
Very worthwhile distinction. If taking on vested interests is an absolute negative in itself then reform will never be possible. We should consider whether the proposed reforms are the right or wrong idea.
Personally I think a truly 7 day NHS is an idea long come, as well as an idea voted for at the election.
A truly 7 day a week NHS is surely going to cost us a lot more money, isn't it?
Given the Tories were the only party to offer to stump up the £8bn which we were all told was necessary just prior to the last elections, and that the economy has romped away under good Tory stewardship, I imagine both political understanding and budgetary allowance will be made.
That said, reforming the dreadful overtime-ridden current Docs contracts makes much sense.
And, to all those making the facile argument 'what about the porters, ancilliary staff etc' - flip the argument on its head and you'll see why the Doctor's contracts have to be the start. There would be no point reforming porter's pay/conditions unless the Docs were in place.
For those interested in understanding the Doctor' strike, rather than just spouting their own political views of what it is about, I heartily commend the post on the previous thread timed at 00:05 this morning from the good Dr. FoxInSox, consultant medicus of the County of Leicestershire.
For those interested in understanding the Doctor' strike, rather than just spouting their own political views of what it is about, I heartily commend the post on the previous thread timed at 00:05 this morning from the good Dr. FoxInSox, consultant medicus of the County of Leicestershire.
He's a vested interest on at least 2 counts - Dr and Corbynite.
I would hazard a guess at 10-15% extra for staff costs to increase the number of available people for weekend shifts. At least. The only way to make the NHS work 7 days a week is to reduce the service provision on weekdays and use the spare capacity to improve weekend services. There is no way we can afford another 10-15% increase in NHS funding.
If we are going to expand the number of patients treated and the number of inteventions of various sorts, surely it would reduce net costs to use the facilities more fully 7 days a week rather than 5 days a week. There are a hell of a lot of fixed costs in the NHS.
Off topic, the FT has editorialised about the EU referendum: " ...snip... The UK is not a big exporter of manufactures that needs merely a traditional agreement on goods tariffs. Its comparative advantage is in sophisticated services, particularly in the financial sector, that are governed by complex regulation. To continue selling into the EU, the UK will find itself adopting large swaths of the single market’s rules without having any say over how they are created."
But the UK is at least as big as the remaining EU in financial services, and negotiation about rules and terms is a two-way street.
Just shows her relative inability to grasp context and the passage of time, given her youth. By the time she's be in her 40s, Ed will be a mere footnote in history.
Miss Jones, youth is no excuse for that sort of misjudgement. She's not six.
Mr. Nabavi, you're assuming we won't have an incompetent of EU-phile government at some point which would permanently sign away negotiation/taxation/regulation rights. Cf Brown and throwing away veto after veto to be decided by QMV, where the eurozone has a critical mass.
For those interested in understanding the Doctor' strike, rather than just spouting their own political views of what it is about, I heartily commend the post on the previous thread timed at 00:05 this morning from the good Dr. FoxInSox, consultant medicus of the County of Leicestershire.
The Strike is more than about pay, but a whole bunch of issues are deliberately being mingled with the contract dispute by both sides.
It is nearly 2 decades since I was last a Junior Doctor and much has changed. Like other bits of national life some of these changes are positive and some negative. Others will take different perspectives.
No one becomes a Doctor to work office hours, and never has. The question is how many hours and to what purpose?
25 years ago the hours were brutal. I once worked 132 out of 168 hours in a week on an acute medical specialist unit with a level 2 High Dependency Unit. Those hours were unsafe and paid at less than normal rates (38% of basic rate even on Christmas Day). There were no formal training programmes and Juniors had very unstable careers where they were applying for new jobs every 1-2 years, or even 6 monthly.
Those hours were tackled both by the EWTD and by the New Deal which was a UK initiative. This is how the Banding system came into being. By paying higher rates for overtime market forces brought down. In 2007 in the infamous MMC/MTAS fiasco all the training posts were amalgamated into regional training programmes, greatly reducing career instability.
So with reduced hours and stable programmes what are they complaining about?
Well the new complex shift patterns mean loss of contact time with other members of the team, and loss of continuity with multiple handovers of patients. This is bad for patients but also for the Trainees who become isolated and unsupported either by their trainers or by their peers.
Regional training programmes make for long commutes. Our Leicester Trainees can be working up to 90 minutes drive away from the base. Doctors very often marry each other, part of the feminisation of medicine, and are often older graduate students. Being on conflicting rotations and conflicting shift patterns can be as destabilising of family life as the old excessive hours without the camerarderie of the old system. Doctors are not alone in this sort of work pattern of course, my father was a salesman and I only saw him at weekends when I was a lad.
The intensity of the out of hours work has increased (technology and sicker patients) and the training to deal with it has got worse. This is particularly the case in some specialities, leading to a recruitment and retention crisis. This year only 59% of UK graduates from 2013 are in a UK training post. About 10-15% are probably overseas, some permenantly. Many of the rest have left for other careers.
I would hazard a guess at 10-15% extra for staff costs to increase the number of available people for weekend shifts. At least. The only way to make the NHS work 7 days a week is to reduce the service provision on weekdays and use the spare capacity to improve weekend services. There is no way we can afford another 10-15% increase in NHS funding.
If we are going to expand the number of patients treated and the number of inteventions of various sorts, surely it would reduce net costs to use the facilities more fully 7 days a week rather than 5 days a week. There are a hell of a lot of fixed costs in the NHS.
Oh, my last sentence should read "increase in staffing costs". Not funding outright.
I take the point though, the fixed asset capacity utilisation would be better with a 7-day system, though I'm not sure that it would make a massive amount of difference without the increased staffing. No point in having patients in for an MRI scan without the operator or without the doctor to makes heads or tail of the results.
For those interested in understanding the Doctor' strike, rather than just spouting their own political views of what it is about, I heartily commend the post on the previous thread timed at 00:05 this morning from the good Dr. FoxInSox, consultant medicus of the County of Leicestershire.
Part 2:
Hunts new contract cuts the pay, worsens the hours, penalises part time working and career breaks (remember this is a young largely female workforce), does not address training at all (and these are training posts) at the same time as graduates get higher tuition fees to pay back. No wonder the Juniors voted to overwhelmingly strike!
My solution:
1) Hunt needs to withdraw his threat of imposition in August. This gives a year to come up with a better contract that addresses the issues of Junior Doctors as well as a 7 day NHS that is sustainable not just a slogan. Removing this threat is the only way to stop the strike, as otherwise there is no time for negotiation.
2) Hunt needs to decide what a 7 day NHS means, and work through the implications of the supporting services required. This includes senior doctors supervising, but also pathology, phisio,OT, social workers, managers, secretaries, record clerks, patient transport etc to be decided, and funded. Improving the weekend mortality should not be at the expense of in-week mortality.
Just shows her relative inability to grasp context and the passage of time, given her youth. By the time she's be in her 40s, Ed will be a mere footnote in history.
The student has quite sturdy thighs. Maybe she's aiming to get every future Labour leader's head tattooed on them. She'd better hope that there isn't too heavy a turnover.
For those interested in understanding the Doctor' strike, rather than just spouting their own political views of what it is about, I heartily commend the post on the previous thread timed at 00:05 this morning from the good Dr. FoxInSox, consultant medicus of the County of Leicestershire.
He's a vested interest on at least 2 counts - Dr and Corbynite.
But the UK is at least as big as the remaining EU in financial services, and negotiation about rules and terms is a two-way street.
No, they want to grab financial services for themselves. That is the weakest point in the entire Leave argument.
They want to do that whether we are in or out though. Explain how we can repel their attacks better within the EU than outside of it, we don't have a veto and the ECJ is quite clearly politically motivated.
For those interested in understanding the Doctor' strike, rather than just spouting their own political views of what it is about, I heartily commend the post on the previous thread timed at 00:05 this morning from the good Dr. FoxInSox, consultant medicus of the County of Leicestershire.
He's a vested interest on at least 2 counts - Dr and Corbynite.
I thought he was a LibDem!
His post started off with a few reasonable points but "some Doctors get married and don't want to work unsociable hours" isn't a basis for the government to give them even more money.
For those interested in understanding the Doctor' strike, rather than just spouting their own political views of what it is about, I heartily commend the post on the previous thread timed at 00:05 this morning from the good Dr. FoxInSox, consultant medicus of the County of Leicestershire.
He's a vested interest on at least 2 counts - Dr and Corbynite.
I thought he was a LibDem!
His post started off with a few reasonable points "some Doctors get married and don't want to work unsociable hours" isn't a basis for the government to give them even more money.
As I've said repeatedly: it's very easy to tell whether the pay system is correct. It's called the market. If we're struggling to recruit and retain doctors, then we're probably paying too little. If we're oversubscribed, then we're probably paying too much.
I would hazard a guess at 10-15% extra for staff costs to increase the number of available people for weekend shifts. At least. The only way to make the NHS work 7 days a week is to reduce the service provision on weekdays and use the spare capacity to improve weekend services. There is no way we can afford another 10-15% increase in NHS funding.
If we are going to expand the number of patients treated and the number of inteventions of various sorts, surely it would reduce net costs to use the facilities more fully 7 days a week rather than 5 days a week. There are a hell of a lot of fixed costs in the NHS.
They want to do that whether we are in or out though. Explain how we can repel their attacks better within the EU than outside of it, we don't have a veto and the ECJ is quite clearly politically motivated.
We do have a veto on some aspects (not enough, I grant you - blame Blair and Brown for that). More importantly, we do have some institutional protection - which Cameron is trying to strengthen - in that the EU has to be careful not to disadvantage non-Eurozone members of the Single Market. If we leave, even if we then immediately sign straight back in to the EEA or something similar, we'd obviously lose all that protection; the Eurozone could do what it liked.
But the UK is at least as big as the remaining EU in financial services, and negotiation about rules and terms is a two-way street.
No, they want to grab financial services for themselves. That is the weakest point in the entire Leave argument.
I can't imagine the protectionist barriers they'd have to put up to achieve that which wouldn't be open to financial "innovation" a la Eurodollar market of yore and at the same time increase their own costs of doing things.
For those interested in understanding the Doctor' strike, rather than just spouting their own political views of what it is about, I heartily commend the post on the previous thread timed at 00:05 this morning from the good Dr. FoxInSox, consultant medicus of the County of Leicestershire.
He's a vested interest on at least 2 counts - Dr and Corbynite.
I thought he was a LibDem!
His post started off with a few reasonable points but "some Doctors get married and don't want to work unsociable hours" isn't a basis for the government to give them even more money.
It's not about giving them even more money, it is about not accepting a pretty big wage cut. Doctors are the one group of people who's services are in high demand globally and in the private sector over here so most could walk into a non-NHS job. They also vote Tory. Hunt is barking up the wrong tree here.
Off topic, the FT has editorialised about the EU referendum: http://www.ft.com/cms/s/0/48f88fe4-b85f-11e5-b151-8e15c9a029fb.html#axzz3wwukIKEw "Some advocates for leaving, going beyond the Norway option of belonging to the single market institutions without being a member of the EU, have suggested that the UK can simply maintain free trading relations with the bloc it has just left by signing a bilateral trade agreement. .... Along with most of the magic solutions peddled by the leave campaigners, this solution is both a political non-starter and of uncertain economic benefit."
FT, always wrong on the EC. “A happy 10th anniversary Emu – Europe’s currency union has been a remarkable success”, headline to a leading article in the Financial Times, 26 May 2008
"The new currency (Euro) is a triumph of political will over practical objections. Its physical launch is a testament to a generation of visionary leaders who pursued a dream, often against the grain of public opinion." Leading article, Financial Times, 2 January 2002.
“Britain will not take a leading role without joining the first circle [i.e. signing up to economic and monetary union],” wrote Lionel Barber on 4 July 1998. (now the FT Editor)
@tnewtondunn: But who is 'Labour' these days? Corbyn's office say they do support the strike, party HQ say not the official line https://t.co/3p1I2RYBy6
They want to do that whether we are in or out though. Explain how we can repel their attacks better within the EU than outside of it, we don't have a veto and the ECJ is quite clearly politically motivated.
We do have a veto on some aspects (not enough, I grant you - blame Blair and Brown for that). More importantly, we do have some institutional protection - which Cameron is trying to strengthen - in that the EU has to be careful not to disadvantage non-Eurozone members of the Single Market. If we leave, even if we then immediately sign straight back in to the EEA or something similar, we'd obviously lose all that protection; the Eurozone could do what it liked.
We are already outnumbered by QMV, the non-EMU nations don't really like the City either so it's not so much a Euro/non-Euro split rather than UK vs the rest when it comes to financial services. Sometimes we get fleeting support from Sweden and Denmark.
If you could enlighten me on what these institutional protections are I would be interested to know. As I see it we have none, we don't have a FinReg veto, we haven't been able to stop the extra-territorial nature of the FTT proposals (something we could probably do better outside via the WTO) and we couldn't stop the EUParl from voting in a bonus tax on a whim.
Our influence is zero and they are all out to get us wrt to the City. In or out makes little difference. I think people have begun to realise that as well.
For those interested in understanding the Doctor' strike, rather than just spouting their own political views of what it is about, I heartily commend the post on the previous thread timed at 00:05 this morning from the good Dr. FoxInSox, consultant medicus of the County of Leicestershire.
He's a vested interest on at least 2 counts - Dr and Corbynite.
I thought he was a LibDem!
His post started off with a few reasonable points "some Doctors get married and don't want to work unsociable hours" isn't a basis for the government to give them even more money.
As I've said repeatedly: it's very easy to tell whether the pay system is correct. It's called the market. If we're struggling to recruit and retain doctors, then we're probably paying too little. If we're oversubscribed, then we're probably paying too much.
If there's a retention problem it's in part due to the subsidised training for which there is no obligation to recompense the NHS should the recipient choose to pursue riches overseas upon qualification. This needs to be examined and reformed.
But the UK is at least as big as the remaining EU in financial services, and negotiation about rules and terms is a two-way street.
No, they want to grab financial services for themselves. That is the weakest point in the entire Leave argument.
I can't imagine the protectionist barriers they'd have to put up to achieve that which wouldn't be open to financial "innovation" a la Eurodollar market of yore and at the same time increase their own costs of doing things.
I incline towards this view too. Zurich and Geneva seem to do fine outside the EU as financial centres.
'Explain how we can repel their attacks better within the EU than outside of it, we don't have a veto and the ECJ is quite clearly politically motivated.'
Well Richard N recently said that issue around the City might sway his view. But I was puzzled by this as, with the PM no longer apparently demanding any meaningful safeguards for the City, this is an issue which is not going to develop as a result of 'renegotiation'. We can take a view on it now.
Perhaps we can comfort ourselves by blaming Brown and Blair and hoping all those nice people in other EU countries will be nice to us.
For those interested in understanding the Doctor' strike, rather than just spouting their own political views of what it is about, I heartily commend the post on the previous thread timed at 00:05 this morning from the good Dr. FoxInSox, consultant medicus of the County of Leicestershire.
He's a vested interest on at least 2 counts - Dr and Corbynite.
I thought he was a LibDem!
His post started off with a few reasonable points but "some Doctors get married and don't want to work unsociable hours" isn't a basis for the government to give them even more money.
It's not about giving them even more money, it is about not accepting a pretty big wage cut. Doctors are the one group of people who's services are in high demand globally and in the private sector over here so most could walk into a non-NHS job. They also vote Tory. Hunt is barking up the wrong tree here.
Who they vote for is irrelevant. Political allegiance should be no bar to reform.
I incline towards this view too. Zurich and Geneva seem to do fine outside the EU as financial centres.
Yes, but accepting EU rules on (inter alia), Freedom of Movement.
I'm not saying we can't negotiate something acceptable. What I'm challenging is the idea that we can have our cake and eat it, with zero input from the rest of the EU as to what the nature of the new deal would be.
That is why I keep banging on about the lack of any coherent plan from the Leave side. It's going to be a negotiation: we want as free a market in services as possible, what do the Leavers realistically think we'll have to give in return to get it?
For those interested in understanding the Doctor' strike, rather than just spouting their own political views of what it is about, I heartily commend the post on the previous thread timed at 00:05 this morning from the good Dr. FoxInSox, consultant medicus of the County of Leicestershire.
He's a vested interest on at least 2 counts - Dr and Corbynite.
I thought he was a LibDem!
His post started off with a few reasonable points "some Doctors get married and don't want to work unsociable hours" isn't a basis for the government to give them even more money.
As I've said repeatedly: it's very easy to tell whether the pay system is correct. It's called the market. If we're struggling to recruit and retain doctors, then we're probably paying too little. If we're oversubscribed, then we're probably paying too much.
If there's a retention problem it's in part due to the subsidised training for which there is no obligation to recompense the NHS should the recipient choose to pursue riches overseas upon qualification. This needs to be examined and reformed.
if it's a retention problem why don't they just get a new job instead of going on strike ?
For those interested in understanding the Doctor' strike, rather than just spouting their own political views of what it is about, I heartily commend the post on the previous thread timed at 00:05 this morning from the good Dr. FoxInSox, consultant medicus of the County of Leicestershire.
He's a vested interest on at least 2 counts - Dr and Corbynite.
I thought he was a LibDem!
His post started off with a few reasonable points but "some Doctors get married and don't want to work unsociable hours" isn't a basis for the government to give them even more money.
It's not about giving them even more money, it is about not accepting a pretty big wage cut. Doctors are the one group of people who's services are in high demand globally and in the private sector over here so most could walk into a non-NHS job. They also vote Tory. Hunt is barking up the wrong tree here.
Who they vote for is irrelevant. Political allegiance should be no bar to reform.
Well as a Tory member, I'm not sure the government should be in the business of pissing off supporters who work hard and buy into the idea of aspiration. Becoming a doctor isn't easy and once it's done requires a lifetime of education and training. People like you who think they should all bugger off because they are on strike don't seem to get how hard the job is.
My best friend is a doctor, for a couple of years he was basically socially absent either working or catching up on sleep. His choice and he gets paid well for his trouble, but that's the point, it's not an easy job. Your ire would be better directed at the tube drivers.
I agree, to a large extent we can take a view on the position of the City in the event of a Remain. What I'm trying to get the Leavers to turn their attention to (in vain, I think) is a view on what Leave would mean for the City.
The rebel stronghold of Salma in NE Latakia has been liberated by the SAA. Hard to exaggerate the strategic importance of this.
Looks like the war of attrition that the Syrian government and its allies have been waging might have reached the breaking point. Good chance the whole rebel front in Latakia might collapse whilst, one should note, the coalition continues to score tactical victory after tactical on every front.The beginning of the end of the Syrian Civil War, lets see what impact this has on the peace talks at the end of the month.
I incline towards this view too. Zurich and Geneva seem to do fine outside the EU as financial centres.
Yes, but accepting EU rules on (inter alia), Freedom of Movement.
I'm not saying we can't negotiate something acceptable. What I'm challenging is the idea that we can have our cake and eat it, with zero input from the rest of the EU as to what the nature of the new deal would be.
That is why I keep banging on about the lack of any coherent plan from the Leave side. It's going to be a negotiation: we want as free a market in services as possible, what do the Leavers realistically think we'll have to give in return to get it?
I absolutely agree we can't have our cake and eat it. The disingenuous idea that Leave supporters put around that through sprinkling pixie dust Britain will somehow have the best of both worlds is incredibly offputting. Equally, the Remain camp wildly overstates the dangers of leaving.
Neither side is doing itself any favours. The public expect it to have to weigh pros and cons. They won't believe anyone who suggests it's all one way.
For those interested in understanding the Doctor' strike, rather than just spouting their own political views of what it is about, I heartily commend the post on the previous thread timed at 00:05 this morning from the good Dr. FoxInSox, consultant medicus of the County of Leicestershire.
He's a vested interest on at least 2 counts - Dr and Corbynite.
I thought he was a LibDem!
His post started off with a few reasonable points "some Doctors get married and don't want to work unsociable hours" isn't a basis for the government to give them even more money.
As I've said repeatedly: it's very easy to tell whether the pay system is correct. It's called the market. If we're struggling to recruit and retain doctors, then we're probably paying too little. If we're oversubscribed, then we're probably paying too much.
If there's a retention problem it's in part due to the subsidised training for which there is no obligation to recompense the NHS should the recipient choose to pursue riches overseas upon qualification. This needs to be examined and reformed.
if it's a retention problem why don't they just get a new job instead of going on strike ?
Its a political stunt.
My cousin turned down a job with a private health trust to work for the NHS, should he go back and accept that job? There are countless NHS workers who have turned down private work to "do their duty" for the nation, they just didn't expect to be told unilaterally that their wages would be going down.
For those interested in understanding the Doctor' strike, rather than just spouting their own political views of what it is about, I heartily commend the post on the previous thread timed at 00:05 this morning from the good Dr. FoxInSox, consultant medicus of the County of Leicestershire.
He's a vested interest on at least 2 counts - Dr and Corbynite.
I thought he was a LibDem!
His post started off with a few reasonable points but "some Doctors get married and don't want to work unsociable hours" isn't a basis for the government to give them even more money.
It's not about giving them even more money, it is about not accepting a pretty big wage cut. Doctors are the one group of people who's services are in high demand globally and in the private sector over here so most could walk into a non-NHS job. They also vote Tory. Hunt is barking up the wrong tree here.
Who they vote for is irrelevant. Political allegiance should be no bar to reform.
Well as a Tory member, I'm not sure the government should be in the business of pissing off supporters who work hard and buy into the idea of aspiration. Becoming a doctor isn't easy and once it's done requires a lifetime of education and training. People like you who think they should all bugger off because they are on strike don't seem to get how hard the job is.
My best friend is a doctor, for a couple of years he was basically socially absent either working or catching up on sleep. His choice and he gets paid well for his trouble, but that's the point, it's not an easy job. Your ire would be better directed at the tube drivers.
I know plenty of doctors too, and know how hard they work. They seem to do very nicely financially, and no, I don't think they should all bugger off. But quite a few would do well to look around and appreciate just how much better off they are relative to the majority of those paying their taxes to finance and educate them, and dial down the 'Me, Me, Me' rhetoric.
I incline towards this view too. Zurich and Geneva seem to do fine outside the EU as financial centres.
Yes, but accepting EU rules on (inter alia), Freedom of Movement.
I'm not saying we can't negotiate something acceptable. What I'm challenging is the idea that we can have our cake and eat it, with zero input from the rest of the EU as to what the nature of the new deal would be.
That is why I keep banging on about the lack of any coherent plan from the Leave side. It's going to be a negotiation: we want as free a market in services as possible, what do the Leavers realistically think we'll have to give in return to get it?
I absolutely agree we can't have our cake and eat it. The disingenuous idea that Leave supporters put around that through sprinkling pixie dust Britain will somehow have the best of both worlds is incredibly offputting. Equally, the Remain camp wildly overstates the dangers of leaving.
Neither side is doing itself any favours. The public expect it to have to weigh pros and cons. They won't believe anyone who suggests it's all one way.
It will be better in some aspects and worse in others. Overall it will make no difference. I think European banks will face a lot of internal and political pressure to move jobs back to Frankfurt and Paris should we leave, the Americans will probably stay put, some might make noises, but our tax regime is more friendly than Germany or France, they may open up branch offices in Dublin for certain transactions but beyond that I don't see anything happening. A friend who works for SocGen told me they are staying put come what may, the quality of labour available in Paris is why they came to London in the first place and leaving the EU doesn't suddenly make the French education system produce graduates who think like British ones.
For those interested in understanding the Doctor' strike, rather than just spouting their own political views of what it is about, I heartily commend the post on the previous thread timed at 00:05 this morning from the good Dr. FoxInSox, consultant medicus of the County of Leicestershire.
He's a vested interest on at least 2 counts - Dr and Corbynite.
I thought he was a LibDem!
His post started off with a few reasonable points "some Doctors get married and don't want to work unsociable hours" isn't a basis for the government to give them even more money.
As I've said repeatedly: it's very easy to tell whether the pay system is correct. It's called the market. If we're struggling to recruit and retain doctors, then we're probably paying too little. If we're oversubscribed, then we're probably paying too much.
If there's a retention problem it's in part due to the subsidised training for which there is no obligation to recompense the NHS should the recipient choose to pursue riches overseas upon qualification. This needs to be examined and reformed.
if it's a retention problem why don't they just get a new job instead of going on strike ?
Its a political stunt.
My cousin turned down a job with a private health trust to work for the NHS, should he go back and accept that job? There are countless NHS workers who have turned down private work to "do their duty" for the nation, they just didn't expect to be told unilaterally that their wages would be going down.
Wondered how long it would be until that panacea was rolled out.
As long as doctors don't have to change their behavior or the interests of patients are put first just give the good old magic money tree another shake
Oh stop waffling Richard and try answering the question.
You have said City issues could sway your decision. How, exactly, when the PM is not negotiating on this topic?
He is. The institutional protections against Eurozone hegemony are an absolutely key point for me.
On the other side, which you ignored, who knows? I don't see the slightest smidgen of a grown-up discussion from the Leave camp on this.
But when it comes to the City it isn't EMU vs non-EMU it is UK vs the rest. Without a veto on FinReg we have no protection from whatever the EMU nations come up with. The bail-in rules are a great example, it is an EMU solution that is being implemented EU-wide. Without a veto (or at least the threat of using it) we were unable to get an opt-out from it.
Explain specifically how Dave would prevent that situation with whatever protections he is trying to get but not a veto on FinReg.
I incline towards this view too. Zurich and Geneva seem to do fine outside the EU as financial centres.
Yes, but accepting EU rules on (inter alia), Freedom of Movement.
I'm not saying we can't negotiate something acceptable. What I'm challenging is the idea that we can have our cake and eat it, with zero input from the rest of the EU as to what the nature of the new deal would be.
That is why I keep banging on about the lack of any coherent plan from the Leave side. It's going to be a negotiation: we want as free a market in services as possible, what do the Leavers realistically think we'll have to give in return to get it?
I absolutely agree we can't have our cake and eat it. The disingenuous idea that Leave supporters put around that through sprinkling pixie dust Britain will somehow have the best of both worlds is incredibly offputting. Equally, the Remain camp wildly overstates the dangers of leaving.
Neither side is doing itself any favours. The public expect it to have to weigh pros and cons. They won't believe anyone who suggests it's all one way.
It will be better in some aspects and worse in others. Overall it will make no difference. I think European banks will face a lot of internal and political pressure to move jobs back to Frankfurt and Paris should we leave, the Americans will probably stay put, some might make noises, but our tax regime is more friendly than Germany or France, they may open up branch offices in Dublin for certain transactions but beyond that I don't see anything happening. A friend who works for SocGen told me they are staying put come what may, the quality of labour available in Paris is why they came to London in the first place and leaving the EU doesn't suddenly make the French education system produce graduates who think like British ones.
I'd be more worried about Paris than Frankfurt. Attracting enough high-flying staff to live and work in a city whose cultural attractions comprise a Palm House and an oompa oompa band rather than London looks like a non-starter to me.
For those interested in understanding the Doctor' strike, rather than just spouting their own political views of what it is about, I heartily commend the post on the previous thread timed at 00:05 this morning from the good Dr. FoxInSox, consultant medicus of the County of Leicestershire.
He's a vested interest on at least 2 counts - Dr and Corbynite.
I thought he was a LibDem!
His post started off with a few reasonable points "some Doctors get married and don't want to work unsociable hours" isn't a basis for the government to give them even more money.
As I've said repeatedly: it's very easy to tell whether the pay system is correct. It's called the market. If we're struggling to recruit and retain doctors, then we're probably paying too little. If we're oversubscribed, then we're probably paying too much.
If there's a retention problem it's in part due to the subsidised training for which there is no obligation to recompense the NHS should the recipient choose to pursue riches overseas upon qualification. This needs to be examined and reformed.
if it's a retention problem why don't they just get a new job instead of going on strike ?
Its a political stunt.
My cousin turned down a job with a private health trust to work for the NHS, should he go back and accept that job? There are countless NHS workers who have turned down private work to "do their duty" for the nation, they just didn't expect to be told unilaterally that their wages would be going down.
Hardly a situation unique to doctors is it ?
Of course, but we don't really have a shortage of people who want to go into public administration and they aren't exactly critical to the health (literally) of the nation.
Wondered how long it would be until that panacea was rolled out.
As long as doctors don't have to change their behavior or the interests of patients are put first just give the good old magic money tree another shake
Perhaps Chris A can tell us how much extra tax he currently overpays to HMRC by choice ?
'Explain how we can repel their attacks better within the EU than outside of it, we don't have a veto and the ECJ is quite clearly politically motivated.' Well Richard N recently said that issue around the City might sway his view. But I was puzzled by this as, with the PM no longer apparently demanding any meaningful safeguards for the City, this is an issue which is not going to develop as a result of 'renegotiation'. We can take a view on it now. Perhaps we can comfort ourselves by blaming Brown and Blair and hoping all those nice people in other EU countries will be nice to us.
Just as we watch as the countries in Schengen wonder why they can no longer rely on the nice folk in Shengen countries to follow EC law as they manage the borders.....
I incline towards this view too. Zurich and Geneva seem to do fine outside the EU as financial centres.
Yes, but accepting EU rules on (inter alia), Freedom of Movement.
I'm not saying we can't negotiate something acceptable. What I'm challenging is the idea that we can have our cake and eat it, with zero input from the rest of the EU as to what the nature of the new deal would be.
That is why I keep banging on about the lack of any coherent plan from the Leave side. It's going to be a negotiation: we want as free a market in services as possible, what do the Leavers realistically think we'll have to give in return to get it?
I absolutely agree we can't have our cake and eat it. The disingenuous idea that Leave supporters put around that through sprinkling pixie dust Britain will somehow have the best of both worlds is incredibly offputting. Equally, the Remain camp wildly overstates the dangers of leaving.
Neither side is doing itself any favours. The public expect it to have to weigh pros and cons. They won't believe anyone who suggests it's all one way.
It will be better in some aspects and worse in others. Overall it will make no difference. I think European banks will face a lot of internal and political pressure to move jobs back to Frankfurt and Paris should we leave, the Americans will probably stay put, some might make noises, but our tax regime is more friendly than Germany or France, they may open up branch offices in Dublin for certain transactions but beyond that I don't see anything happening. A friend who works for SocGen told me they are staying put come what may, the quality of labour available in Paris is why they came to London in the first place and leaving the EU doesn't suddenly make the French education system produce graduates who think like British ones.
I'd be more worried about Paris than Frankfurt. Attracting enough high-flying staff to live and work in a city whose cultural attractions comprise a Palm House and an oompa oompa band rather than London looks like a non-starter to me.
Surely Dublin, Goldman Sachs are already there as well as a few other Americans.
I incline towards this view too. Zurich and Geneva seem to do fine outside the EU as financial centres.
Yes, but accepting EU rules on (inter alia), Freedom of Movement.
I'm not saying we can't negotiate something acceptable. What I'm challenging is the idea that we can have our cake and eat it, with zero input from the rest of the EU as to what the nature of the new deal would be.
That is why I keep banging on about the lack of any coherent plan from the Leave side. It's going to be a negotiation: we want as free a market in services as possible, what do the Leavers realistically think we'll have to give in return to get it?
I absolutely agree we can't have our cake and eat it. The disingenuous idea that Leave supporters put around that through sprinkling pixie dust Britain will somehow have the best of both worlds is incredibly offputting. Equally, the Remain camp wildly overstates the dangers of leaving.
Neither side is doing itself any favours. The public expect it to have to weigh pros and cons. They won't believe anyone who suggests it's all one way.
From the article you quoted it seems the FT has been rather dishonest in the way they are putting the argument. They have framed the piece entirely in terms of an arrangement outside of EEA membership. If we were part of the EEA then all their arguments fall apart. Indeed in the EEA we have more influence than we do now as members of the EU. This is just the FT trying to muddy the water.
Comments
Did Alan Johnson do anything of note whilst in charge, forgot he was there tbh now I've looked it up.
The doctor's strike is the first Labour has ever officially supported.
The government should postpone the changes while it works out what it actually wants.
Sure.
I'm just pointing out that assuming that all doctors will make it to consultants in adjudging incomes is not correct.
Surely it is very easy to see if we're paying the right amount for junior doctors: are we struggling to recruit people of the required quality? If we are, then we're paying too little.
Personally I think a truly 7 day NHS is an idea long come, as well as an idea voted for at the election.
Presumably, Jezza imagines a bottomless pit of extra tax that he can tap into. Tax evasion of £75tn a year or such like.
I'm just pointing out that assuming that all doctors will make it to consultants in adjudging incomes is not correct.
Surely it is very easy to see if we're paying the right amount for junior doctors: are we struggling to recruit people of the required quality? If we are, then we're paying too little.
Or the training isn't good enough, or the quality of those being trained initially could be better.
Many education standards have been dumbed down in the last decade or so; perhaps this is one of the outcomes?
"The Government has already told us, for example, that it plans to reduce the number of breaks during shifts down to just 20 minutes every six hours. In practice, this could mean that a doctor working an eleven hour shift will only get a single 20 minute break. We don’t think this would be safe."
This seems to me to be the 'killer' fact - if it is true, rather than all the blather about money at weekends. This has got to be unsafe and very bad for doctor's sanity and health.
He is being disingenous to say there will be no losers when junior doctors will effectively lose money by the rebanding of antisocial hours.
He could have pointed this out, he could have said that they will have to suck it up with a pay and/or hours cut and that is the environment we are in, he could have said in his effort to restructure the NHS the practice of junior doctors working all hours for extra pay would have to cease and surely that is sensible.
But no.
He, and every other minister, has focused on the 11% pay rise and repeated that no one will lose out.
That is wrong and gives entirely the wrong impression, as though an 11% pay rise compensates for the change in working practices. It doesn't (even if it is right that it should) and it is this which is a failure of government both practically and morally IMO.
Maybe it has but I doubt those voting were clear that this would mean a poorer service during the week. Without more doctors it has to.
http://www.ft.com/cms/s/0/48f88fe4-b85f-11e5-b151-8e15c9a029fb.html#axzz3wwukIKEw
"Some advocates for leaving, going beyond the Norway option of belonging to the single market institutions without being a member of the EU, have suggested that the UK can simply maintain free trading relations with the bloc it has just left by signing a bilateral trade agreement. An FTA would give the UK access to the single market without formally having to be a member and hence without committing to implement all its rules. Models for this are apparently supplied by the deals given to eastern European countries like Moldova and Ukraine.
Along with most of the magic solutions peddled by the leave campaigners, this solution is both a political non-starter and of uncertain economic benefit."
Some good points and some dubious points mixed together in this editorial. The best point is probably this one:
"And even if the UK achieved full access to the single market without a formal pact, it would rapidly find itself having to adopt many of the regulations of that market if it wanted to survive. The UK is not a big exporter of manufactures that needs merely a traditional agreement on goods tariffs. Its comparative advantage is in sophisticated services, particularly in the financial sector, that are governed by complex regulation. To continue selling into the EU, the UK will find itself adopting large swaths of the single market’s rules without having any say over how they are created."
Do we need outpatients to run at the weekend? Maybe: it would be more convenient for people at work during the week, but is it worth paying receptionists, porters, drivers and nurses to come in, as well as doctors, to run a clinic 90 per cent of whose users would prefer to attend during the week?
Similarly, does Hunt want elective surgery moved from weekdays to weekends? It would even out death rates but are there benefits for numerate observers?
Most of the NHS, at least in hospitals, is already 24x7, which is why junior hospital doctors face pay cuts. They are already doing those hours as overtime. What value Hunt adds is unclear and it would be better to appoint some sort of commission to work out what we want from the NHS and how best to get it.
I'm just pointing out that assuming that all doctors will make it to consultants in adjudging incomes is not correct.
Surely it is very easy to see if we're paying the right amount for junior doctors: are we struggling to recruit people of the required quality? If we are, then we're paying too little.
CSE market forces.
An 18-year-old student has had [an] enormous tattoo of Ed Miliband’s head tattooed onto her thigh as a show of respect for her “hero”.
http://www.buzzfeed.com/jamieross/hell-yes-im-tat-enough
This Teenager Got A Massive Ed Miliband Tattoo And Her Mum Stopped Speaking To Her
“It hurt so much – I think it was the shading of his hair.”
http://www.buzzfeed.com/jamieross/hell-yes-im-tat-enough#.wvaZ5AWOp
My understanding is that the crossover is 80-90 hours, depending on when the overtime is worked currently - with those working more than those hours being worse off in future.
As for regulation and the City, I don't see how it is any different being inside or outside the EU, we don't have a veto and Dave isn't trying to negotiate for one.
The manifesto said: we will continue to increase spending on the NHS, provide 7-day a week access to your GP and deliver a truly 7-day NHS – so you know you will always have access to a free and high quality health service when you need it most.
Nothing about making weekday care worse.
Edited extra bit: this might be the most obnoxiously obscure thing I've posted this year.
For those shockingly unfamiliar with the events of the 4th century BC:
after Alexander's death there was some prevarication over what to do (his half-brother had a child's mind, and one of his wives was pregnant).
Meleager stirred the foot soldiers to revolt. This was eventually quelled. A short time later the regent, Perdiccas, had Meleager's supporters trampled to death by elephants. Meleager did not survive much longer himself.
That said, reforming the dreadful overtime-ridden current Docs contracts makes much sense.
And, to all those making the facile argument 'what about the porters, ancilliary staff etc' - flip the argument on its head and you'll see why the Doctor's contracts have to be the start. There would be no point reforming porter's pay/conditions unless the Docs were in place.
Mr. Nabavi, you're assuming we won't have an incompetent of EU-phile government at some point which would permanently sign away negotiation/taxation/regulation rights. Cf Brown and throwing away veto after veto to be decided by QMV, where the eurozone has a critical mass.
It is nearly 2 decades since I was last a Junior Doctor and much has changed. Like other bits of national life some of these changes are positive and some negative. Others will take different perspectives.
No one becomes a Doctor to work office hours, and never has. The question is how many hours and to what purpose?
25 years ago the hours were brutal. I once worked 132 out of 168 hours in a week on an acute medical specialist unit with a level 2 High Dependency Unit. Those hours were unsafe and paid at less than normal rates (38% of basic rate even on Christmas Day). There were no formal training programmes and Juniors had very unstable careers where they were applying for new jobs every 1-2 years, or even 6 monthly.
Those hours were tackled both by the EWTD and by the New Deal which was a UK initiative. This is how the Banding system came into being. By paying higher rates for overtime market forces brought down. In 2007 in the infamous MMC/MTAS fiasco all the training posts were amalgamated into regional training programmes, greatly reducing career instability.
So with reduced hours and stable programmes what are they complaining about?
Well the new complex shift patterns mean loss of contact time with other members of the team, and loss of continuity with multiple handovers of patients. This is bad for patients but also for the Trainees who become isolated and unsupported either by their trainers or by their peers.
Regional training programmes make for long commutes. Our Leicester Trainees can be working up to 90 minutes drive away from the base. Doctors very often marry each other, part of the feminisation of medicine, and are often older graduate students. Being on conflicting rotations and conflicting shift patterns can be as destabilising of family life as the old excessive hours without the camerarderie of the old system. Doctors are not alone in this sort of work pattern of course, my father was a salesman and I only saw him at weekends when I was a lad.
The intensity of the out of hours work has increased (technology and sicker patients) and the training to deal with it has got worse. This is particularly the case in some specialities, leading to a recruitment and retention crisis. This year only 59% of UK graduates from 2013 are in a UK training post. About 10-15% are probably overseas, some permenantly. Many of the rest have left for other careers.
Part 2 to follow.
I take the point though, the fixed asset capacity utilisation would be better with a 7-day system, though I'm not sure that it would make a massive amount of difference without the increased staffing. No point in having patients in for an MRI scan without the operator or without the doctor to makes heads or tail of the results.
Hunts new contract cuts the pay, worsens the hours, penalises part time working and career breaks (remember this is a young largely female workforce), does not address training at all (and these are training posts) at the same time as graduates get higher tuition fees to pay back. No wonder the Juniors voted to overwhelmingly strike!
My solution:
1) Hunt needs to withdraw his threat of imposition in August. This gives a year to come up with a better contract that addresses the issues of Junior Doctors as well as a 7 day NHS that is sustainable not just a slogan. Removing this threat is the only way to stop the strike, as otherwise there is no time for negotiation.
2) Hunt needs to decide what a 7 day NHS means, and work through the implications of the supporting services required. This includes senior doctors supervising, but also pathology, phisio,OT, social workers, managers, secretaries, record clerks, patient transport etc to be decided, and funded. Improving the weekend mortality should not be at the expense of in-week mortality.
It is not a short or simple answer.
Next Conservative Leader: Lay George Osborne, fast!
https://betting.betfair.com/politics/uk-politics/next-conservative-leader-betting-george-osborne-january-2016-110116-171.html
“A happy 10th anniversary Emu – Europe’s currency union has been a remarkable success”, headline to a leading article in the Financial Times, 26 May 2008
"The new currency (Euro) is a triumph of political will over practical objections. Its physical launch is a testament to a generation of visionary leaders who pursued a dream, often against the grain of public opinion." Leading article, Financial Times, 2 January 2002.
“Britain will not take a leading role without joining the first circle [i.e. signing up
to economic and monetary union],” wrote Lionel Barber on 4 July 1998. (now the FT Editor)
Look out for our new omnibus advert in @CIPR_UK's Influence magazine out on 29th Jan #Omnibus #publicrelations https://t.co/xPyV8u82IQ
https://t.co/3p1I2RYBy6
If you could enlighten me on what these institutional protections are I would be interested to know. As I see it we have none, we don't have a FinReg veto, we haven't been able to stop the extra-territorial nature of the FTT proposals (something we could probably do better outside via the WTO) and we couldn't stop the EUParl from voting in a bonus tax on a whim.
Our influence is zero and they are all out to get us wrt to the City. In or out makes little difference. I think people have begun to realise that as well.
Well Richard N recently said that issue around the City might sway his view. But I was puzzled by this as, with the PM no longer apparently demanding any meaningful safeguards for the City, this is an issue which is not going to develop as a result of 'renegotiation'. We can take a view on it now.
Perhaps we can comfort ourselves by blaming Brown and Blair and hoping all those nice people in other EU countries will be nice to us.
I'm not saying we can't negotiate something acceptable. What I'm challenging is the idea that we can have our cake and eat it, with zero input from the rest of the EU as to what the nature of the new deal would be.
That is why I keep banging on about the lack of any coherent plan from the Leave side. It's going to be a negotiation: we want as free a market in services as possible, what do the Leavers realistically think we'll have to give in return to get it?
Its a political stunt.
My best friend is a doctor, for a couple of years he was basically socially absent either working or catching up on sleep. His choice and he gets paid well for his trouble, but that's the point, it's not an easy job. Your ire would be better directed at the tube drivers.
Looks like the war of attrition that the Syrian government and its allies have been waging might have reached the breaking point. Good chance the whole rebel front in Latakia might collapse whilst, one should note, the coalition continues to score tactical victory after tactical on every front.The beginning of the end of the Syrian Civil War, lets see what impact this has on the peace talks at the end of the month.
Neither side is doing itself any favours. The public expect it to have to weigh pros and cons. They won't believe anyone who suggests it's all one way.
You have said City issues could sway your decision. How, exactly, when the PM is not negotiating on this topic?
Thanks for that interesting/insightful post.
Mr. Meeks, some Leave supporters suppose that.
There will be downsides to leaving. But I think that's better than shackling ourself to a runaway train heading over the cliff of ever closer union.
On the other side, which you ignored, who knows? I don't see the slightest smidgen of a grown-up discussion from the Leave camp on this.
'Yes there is. We could pay more tax.'
Wondered how long it would be until that panacea was rolled out.
As long as doctors don't have to change their behavior or the interests of patients are put first just give the good old magic money tree another shake
Explain specifically how Dave would prevent that situation with whatever protections he is trying to get but not a veto on FinReg.