#ImInWorkJeremy

[wonkylegs]

Doctors across the UK hit back at Jeremy Hunts attack on the professions weekend working with #ImInWorkJeremy Twitter campaign.

Hunt is trying to blame Doctors for a failing in providing a joined up and properly funded service rather than looking at the problem and coming up with
proper solutions he's looked
at consultants to be a scapegoat
Various news sources to appeal to all political bents
www.independent.co.uk/life-style/health-and-families/health-news/iminworkjeremy-doctors-send-jeremy-hunt-photos-of-themselves-working-over-the-weekend-10398504.html

www.dailymail.co.uk/news/article-3166330/ImInWorkJeremy-Doctors-Twitter-post-pictures-work-Jeremy-Hunt-claimed-medics-weren-t-doing-weekend-shifts.html

metro.co.uk/2015/07/18/iminworkjeremy-nhs-workers-inundate-jeremy-hunt-with-247-selfies-5301742/

[Mrsmorton]

I'm in fucking work, doing unpaid overtime. Where the fuck is Jeremy Hunt?

[cdtaylornats]

How many of those tweets were from consultants.

[easterlywinds]

My consultant husband went in this morning to give a second opinion and stayed to help with the operating for about 3 hours. This is on his day off and he won't be paid for it (and doesn't expect to be). He didn't tweet about it though.

[totallybewildered]

My consultant brother is also at work all weekend this weekend, and on call most weekends, and has never had a single Christmas day off ever in the last 25 years.

[IPityThePontipines]

Where are all these consultants who don't work weekends? I haven't met any.

Jeremy Hunt doesn't have a clue.

[puremuscle]

It would be interesting to see some statistics form Jeremy Hunt about what percentage of consultants have opted out of on call commitments including their ages.
I haven't heard of any Consultants doing this.

The media and the general public also seem to have the perception that 'junior' doctors have just been set lose from medical school. Many are extremely skilled and experienced doctors just as safe and competent as some Consultants.

cdtay- Consultants are older than the more junior doctors and therefore much less likely to be tweeting and sharing on FB.

[ethelb]

Easterly, wouldn't the proposals mean your DP would be paid for that work though? The fact he was needed that much but wasn't scheduled to be working illustrates the problem?

[easterlywinds]

Ethel, probably not. He wasn't the on call surgeon. The on call surgeon had benn in all weekend but had a complex case come in. In their speciality, they tend to need a second consult for these complex cases but they don't happen frequently enough to warrant having a second surgeon on call. A lot of these second opinions can be done over the phone. DH then stayed to help because (1) his colleague had been unusually busy and (2) he is going to be looking after this patient this week so it's an advantage to help right from the start. He thinks it will give the best outcome for the patient.

[easterlywinds]

Also, even if they decided to appoint a second consultant to help out, his rota and EWTD means that he is already on call one weekend in five. With the staff they have, they cannot do more weekends and still have enough sessions to function during the week. These patients need elective surgery and clinic follow-ups.
This is a speciality which other surgeons are not keen to work in. It took DH 5 years of medical school, 1 year house officer, 2 years SHO, about 1 year locum posts, 5 years registrar, a 1 year overseas fellowship and 1 year of locum consultant before he got this post. This is typical for his speciality. If anything, people tend to do more fellowships, DH has a very good reputation in the field so was head-hunted very early on in his career. So it's not as simple as saying employ more staff. It's also expensive to complete all this training, including the speciality exams, courses and fellowship.

[wonkylegs]

Interesting analysis of the paper that Hunt uses to justify his "it's all about the increased mortality rate" stance juniordoctorblog.wordpress.com/2015/07/18/weekend-mortality-and-the-7-day-nhs/

[wonkylegs]

I've never met a consultant that has opted out of weekend working (and I know an awful lot of consultants) but I know of many who have gone in or phoned in to see patients and their families on weekends they are not working just to make sure they are ok. I know many who work late or go in early to see patients - none of them have to do this as part of their jobs but they do because they care.
The problems of the NHS are nothing to do with the 'working ethics or culture' of its doctors and everything to do with underfunding of service, constant political tinkering and lack of joined up thinking by those in charge.

[Isitmebut]

The NHS is surely in the Sick People Business, no one has suggested that no one works at weekends, is anyone suggesting that in the sick people business where people can be just as ill on a Saturday and Sunday, that the service to those sick people are just as good at weekends when less Consultants and other services that help during the week, are not on duty.

Now I don't necessarily buy the fact that more people die in hospitals at weekends, is DUE to reduced weekend services.

But it appears to me that a lot of the doctors etc 'kicking back' (and indeed elsewhere in the Public Sector) are having trouble adapting that we are no longer in the 2000's, when the government could and was not only throwing money and PFI debt at our services, but actively asking senior staff to 'offer less, for more money'.


When the government offered GP's more money and said that they could 'opt out' from out of hours services, they were INFORMED by the BMA 90% of GPs would and did - meaning we were flying in doctors from Scandinavia, Europe an elsewhere at great expense, to COVER those out of hours services.

”House of Commons Health Committee;" "GP Out-of-Hours Services”
www.publications.parliament.uk/pa/cm200304/cmselect/cmhealth/697/697.pdf
^”11. According to the BMA, as many as 90% of GPs are expected to opt out of providing out-of-hours cover.10 As PCTs take over responsibility for providing GP out-of-hours

At the same time, NHS Dentist thought that they were being knobbed, and an available high street NHS Dentist opened for new business, became as rare as hen's teeth.

Now I remember BBC documentary soon after that where a really nice and constructive businessman (I apologise I forget his name), known for turning around businesses, went into the NHS for his report - and (amongst other things) he found that many operating theatres either worked short time on Friday, or there were no major operations going on at all.

Apparently from the 'money is no object' 2000's, half of all NHS Consultants get an annual 'clinical excellence award' bonus of £75,000 on top of their salary, and others get lesser bonuses of 20,000, so no wonder many are kicking back as judged 'excellent' - so maybe the answer is get those NOT getting the £75k 'Brucie Bonus', who I guess are indirectly being told that 'they must try harder' - take the weekend shifts and aspire to week day excellence.

The OBJECT of this policy, from a government putting in more extra money into the NHS than they promised just months ago, is to try ensure our health is not put in any more danger at weekends than would be during weekdays, which SURELY is not unreasonable?

It must be a historical thing, as it seems to me the ONLY public service that DOES realise that they have to now adapt to the unsustainable excesses of the 2000's, is the 'can do' Army, as everyone else whines before thinking about what is trying to be acheived.

[Isitmebut]

P.S. It is about time that the 'non elite' NHS staff received somewhere near the financial and work conditions luv those at the top received under Labour e.g. sooner than later, give similar % pay rises to the lesser paid NHS staff like nurses (as the Private Sector is finally enjoying) who work just as hard, if not harder, than those at the top.

The Public Sector average salaries and pensions did appear to outperform the Private Sector, especially after the crash, but if Ministers are reforming 'the tops' working conditions, remuneration and hours - few UK citizens would argue if you looked at the lesser paid public sector workers again, in a favourable light. IMO.

[Isitmebut]

The businessman focusing on the NHS via the BBC 3-part series with a follow up, was Gerry Robinson, and well worth a repeat look for anyone who thought that the NHS didn't need serious reforms - as I suspect a few of his observations on what could be improved, still could be.

en.wikipedia.org/wiki/Can_Gerry_Robinson_Fix_the_NHS%3F

[honeysucklejasmine]

I read a Facebook post earlier that suggested getting in more doctors is pointless if you don't also bring in radiographers, pharmacists, phlebotomists etc to provide diagnostic support.

My DM worked as a hospital pharmacist when I was a kid. She did work weekends etc on an on call basis, and was always home late on Friday as they needed to dispense everything before the pharmacy closed for the weekend. I think it frustrated her that it was closed. With three young kids, it would be better to work shifts over the seven days rather than having to change plans last minute.

I've never met a HCP who didn't want the best for their patients, but some of them are limited by the regulations/"opening hours" of their profession.

[Milkyway1304]

I'm quite a senior registrar (eligible for consultancy in the immediate future). I've just arrived home after my 830pm-930am night shift that ran over. I can assure everyone that there were a lot of consultants in over the weekend! I also resent the perception that junior doctors are essentially students. I have 10years of experience, and have managed thousands of patients. Even the most junior registrar will have 5 years post graduate experience.

[Isitmebut]

"I read a Facebook post earlier that suggested getting in more doctors is pointless if you don't also bring in radiographers, pharmacists, phlebotomists etc to provide diagnostic support."

THE OBJECT of the policy is it not, whether more doctors, "phlebotomists", whatever, is to ensure a continuous 7-days Hospital/NHS - before going into exactly how that will be achieved, how many more might need to he hired - is anyone saying that our levels of sickness and need for medical care is higher Monday to Friday, or that a hospital offers the same level of service/services on a Saturday and Sunday, as they do Mon-Fri?

[VivaLeBeaver]

At my hospital the Only reason there are less Drs in at the weekend is because the routine outpatient clinics don't run. The wards still have doctors, a&e still have drs. There's no routine operations but there's enough staff to cover emergencies. Pharmacy now opens at the weekend.

[easterlywinds]

Viva, I do wonder if the general public realise the difference between elective and emergency work. I do genuinely believe that some people think all hospitals close down on Friday evening and reopen Monday morning.
Isitme, it is actually very hard to get a clinical excellence award. My DH applies for one every year - he does extra research work, acting as a clinical research lead (unpaid) and has been surgical lead for the last 3 years which effectively means managing the surgical team in terms of making sure the service is always staffed, ensuring work is always done to highest standards etc (another unpaid role). Yet he is still deemed unworthy of an award. Only 2 very senior people in his dept have an award and they don't earn an extra £75000.

[VivaLeBeaver]

I don't think Jeremy Hunt understands the difference between elective and emergency work.

[puremuscle]

isitme- I think you are entirely misunderstanding the sentiments of the doctors posting on social media. I don't think I have seen or heard anyone arguing against the provision of high quality of care 7 days per week. Most HCP actually feel very strongly about providing a high level of care. That is why the majority enter Medicine in the first place; it certainly isn't for the money.

Jeremy Hunt is totally mis-using statistics to form the conclusions to suit his agenda (which is probably privatisation in the longer term) and to encourage further headlines about lazy, highly paid doctors. He is suggesting that a lot of Consultants are opting out of out of hours care and therelitefore that people are dying as a result. This is nonsense. As a doctor married to a doctor with lots of medical friends, I haven't come across any Consultants 'opting out'.

Doctors are angry with the incorrect information being broadcast and splashed across the newspapers on on a weekly basis. It's usually GPs, now it's hospital Consultants. GPs are constantly being slated for being lazy and opting out of out of hours care. The labour government offered them the option to not cover their own patients for all out of hours work and most of them, after years of doing this, breathed a sigh of relief and accepted. Of course many GPs do continue to do out of hours work, just less than before. The labour government were arrogant and ill informed enough to think that it could be provided more cheaply in other ways. They were wrong but ever since there has been a backlash against GPs carefully orchestrated by the labour and now the Conservative government.
I can tell you as someone who actually works in the profession and therefore knows what is going on that the reality is that GPs are getting more and more over worked, more and more stressed and more and more of them are choosing to retire early or not to go into this branch of Medicine. Obviously, if it was such a marvellous option, that would not be the case.

I think you are mis-informed on 'less elite' HCP pay e.g. nurses (nurses have mostly escaped the media backlash are portrayed as poorly paid angles).
If you actually look at the figures:
www.rcn.org.uk/support/pay_and_conditions/pay_rates_2014-15

Nurses start on around 21,500 and can progress to nearly 100,000.

A junior doctor starts on around 28,000 after 2-3 years longer at University with a large amount of debt and having excelled academically in order to enter Medical School in the first instance.
You are wrong to say that nurses work harder than doctors. I know many good and some excellent nurses but I don't think any of them would suggest that they work harder than doctors. They work less hours and have a lot less responsibility than doctors.

I don't think anyone is objecting to a high quality service 7 days per week but how it is achieved is what is relevant. Yes, absolutely, NHS reform is necessary but this needs, imo, to be more on the managerial side than the medical one. However, it is much easier and suits the government much better to just antagonise doctors and quote inaccurate statistics.

[puremuscle]

Yes viva, I don't think JH understands the difference between emergency work and routine work nor do a lot of the public.

[honeysucklejasmine]

itismebut I don't really understand your post tbh. Obviously everyone knows there are less staff on in the weekend, but the way this is being played out in political sound bites is all wrong.

Are you arguing that routine stuff (e.g. outpatients) should also happen on Saturday-Sunday?

[wonkylegs]

Hunt has directly attributed increased patient deaths to lack of consultant cover on weekends by picking a line out a report, not referring to the whole study and the context that was given and referring to an option for consultants to opt out of weekend working as if this is the norm rather than an exception. Very few consultants do opt out and that is usually for very valid reasons which would mean you wouldn't want them to be working at that time anyway.
He's not been talking about GPs or other services only consultants as if this is where the flaw lies.
The NHS generally gets very good value out of its medical staff, my husband would earn a far better salary in most first world countries than he does here but he like many of his colleagues believe in the values of the NHS rather than just monetary return. The UK still has a very low % of GDP spent on healthcare compared with equivalent countries despite the political protestations on the subject.
A full 7-day service will require a significant investment as otherwise you are just spending thin resources even more thinly and not providing the joined up thinking of the support services which is setting the system up to fail.
I'm on holiday at the moment (without my DH, he's working) and was speaking to a US Dr who does almost the exact same specialism as DH, he was quite shocked how low the pay scales were in the UK. We have never considered leaving due to various factors but we do know many colleagues who have gone to countries that do appreciate them not only with decent pay but also respect and appreciation for the difficult job that they do.

[IPityThePontipines]

Pure muscle - a nurse on £100,000 is rarer than rocking horse poo. The vast majority of working nurses are on Band 5 pay.

It is also utter nonsense to say we have escaped media criticism, the nursing profession was held almost entirely responsible for Mid Staffs, midwives shouldered the media blame for Morecambe Bay (despite both situations occurring due to widespread failures at all levels) and we've frequently been attacked for going for all-graduate status and apparently being "too posh to wash".

I also think the "who works the hardest" argument is a non-starter, everyone's work is valuable, we are a team.