Doctors should Strike

[Emmapuddle]

If 98% of junior doctors are going to strike there must be good reason!

I know it'll be inconvenient for 3days but worth it to save the NHS.

I trust the 50,000 doctors rather than the sneaky politicians who gave themselves a pay rise this year!

[prh47bridge]

Politicians did not give themselves a pay rise this year. They do not determine their own pay. That is set by an independent body - the IPSA.

Being picky, 98% of those who voted backed a strike. The actual proportion of junior doctors backing a strike was somewhat lower.

As ever the issues are complex and it is hard to get at the truth. However, the Conservative manifesto said they would introduce a 7 day NHS, prompted by campaigns pointing out that mortality rates are higher at weekends and linking this to lower staffing levels. They want to introduce a new contract to implement that pledge. The contract in dispute:

• guarantees an average 48 hour working week for junior doctors

• reduces the maximum working week from 91 hours to 72 hours

• gives an 11% rise in basic pay

• removes pay increases linked to time in job and instead links pay with progression through training

• redefines "unsocial hours" that qualify for higher payments

Currently junior doctors get higher pay for working between 7pm and 7am on weekdays plus all day Saturday and Sunday. The new contract reduces this to weekdays after 10pm, Saturday after 7pm and all day Sunday.

The BMA argues that linking pay increases to progression through training will adversely affect doctors taking time out to have a baby, for example. They are also concerned that some doctors will end up with less pay (although the government reckons that only 1% of junior doctors will be worse off and 75% will be better off - a view which seems to be supported by independent analysts) and that the restrictions on working hours are not strong enough.

The BMA broke off negotiations last year. The government has since improved the contract on offer and is threatening to impose it since the BMA refuses to negotiate. That is what has prompted the strike.

The Review Body on Doctors and Dentists Remuneration (which is independent) produced a report after taking evidence from both sides. Their conclusions broadly support the government's position. The government accepted the recommendations and apparently told the BMA that 22 of the 23 recommendations were non-negotiable.

This strike is not about "saving the NHS" although I am sure the junior doctors will say otherwise. It is clearly about money. However, I am not saying the government is right and the doctors are wrong. I am sure that the truth, as ever in such cases, lies somewhere between them.

[Arrowminta]

From what I've gathered and, I might not be correct, the proposed contract might won't affect the current junior doctors pay so much but it will the ones coming up. It's commendable that the current doctors are fighting for the future on conditions and pay.

It will affect current medical students, the ones who have already paid upwards of 20K more for their training, don't forget.

It's also about standing up for not only doctors but all healthcare workers as we can be sure it will the the nurses and other staff next. I caught the news last night that they are now talking about charging nursing students tuition fees.

I support the strike.

[Arrowminta]

Excuse typos.

[SerenityReynolds]

prh47 worth noting that a similar independent review body also made recommendations regarding pay increases for NHS workers (and at nothing like the 11% for MP's). Which the government chose to overrule because of austerity and the fact that "we're all in it together" apparently!

There was a 76% turnout on the doctors vote - significantly higher than the 20-30% turnout the last time the tube drivers balloted to strike! That seems to be quite representative of the profession as a whole.

My take on it is that doctors don't want more money for what they already do, but to prevent an actual drop in earnings which will be the net result of mucking about with the classification of unsociable hours (among other things). You're absolutely right though, it is hard to see the wood for the trees on both sides thanks to media spin!

[claig]

'It is clearly about money.'

Does anyone know how much money we are talking about? What are the figures involved? How much would it cost to provide better weekend cover and maintain same pay structure as now?

[meddie]

The doctors aren't striking for more money though, they are striking to protect them from being made to work excessive hours, because safeguards against it happening will be removed and also to stop them taking a drop in pay of up to 30%.
They have had 1% pay increase in the last 5 years.
The 11% rise is only on basic pay and 30% -11% still equates to a 19% drop in wages.
The BMA broke of negotiations because there were no negotiations, they were told there were 23 changes to their current contract and only one was up for discussion, that's not negotiation, that's imposition.

[meddie]

Incidentally the research that showed a worse death rate on weekend admissions included mon and friday as weekend days, both days which arent affected by weekend rotas, so how does paying less for a saturday solve that issue?

[mamadoc]

The strike is not purely about money

The current Drs will not lose money due to pay protection. They are striking for the sake of future colleagues and because what is applied to Drs now will almost certainly be applied to all NHS workers in future.

The non money aspects are:

1. The mandatory hours monitoring and penalties for long hrs will be removed. The hours limits will therefore be on paper only and Drs will go back to working very long hours as they did in the 1980s and 90s before the limits came in. As a patient you should be worried about that.

1. The reduction in pay for antisocial hours will drive down recruitment to acute specialties. Currently there is some reward for working every weekend in future there won't be so why choose the hard life of A&E over an easy clinic based specialty like dermatology. There is already a recruitment crisis in A&E. Again as a patient you should care about this.

1. A money related one but to point out the inequity. It is a pay cut. Why would there be pay protection needed if it was a rise?

The out of hours banding supplement is about a third of a juniors pay. The modest increase in basic will not compensate. Those working the hardest jobs will get a 30% cut.

[mamadoc]

There already is a 7 day NHS.

The weekend service is an emergency service and it works just fine for emergencies.

There is no elective, routine weekend service. It is debatable whether there really needs to be a 24-7 routine service. If there does then it will be very, very expensive. You will need loads more Drs, nurses, radiographers, physics, porters etc. Just redefining Saturday's as a normal working day for junior Drs will not achieve it at all.

The higher mortality for patients admitted at the weekend does not mean it is due to a lack of staff at the weekend. It is more likely because the people admitted at the weekend are sicker. They only come to hospital at a weekend if they really are sick. The authors of the paper wrote to JH pointing this out and asking that their research not be misquoted.

If the public want a truly 24-7 NHS they need to be willing to pay more tax which clearly they are not going to do. It can't be done off the back of driving down NHS workers pay.

[claig]

'If the public want a truly 24-7 NHS they need to be willing to pay more tax'

How much more tax? What sort of money are we talking about?

[mamadoc]

The government can say that only 1% of current junior Drs will be worse off only because those already working will have their pay protected for 3 years.

Those coming into exactly the same job next year will be paid less for the same job.

The hours limits will be on paper only as there is no penalty for breaching them anymore.

I'm a consultant. I support my juniors in striking. Why should they pay for Tory tax cuts. I will be doing the ward cover on the strike days myself.

[mamadoc]

I am not an economist but you can probably google it.

Basically Britain pays a much lower proportion of GDP for healthcare than pretty much any developed country. If you want a better service you'll need to up the percentage. I think it's from about 9% to more like 15%. Either by raising tax or bringing in an insurance system.

The WHO has done a report comparing investment vs outcome and the NHS comes out very well. It is a very efficient system.

[mamadoc]

I found a Kings Fund report but can't figure out how to link.

I was right that UK spends about 9% and that is close to OECD avg

US spends twice as much 18% because their privatised system drives up costs

France, Denmark, Netherlands, Canada and many countries people hold up as being good spend more than us around 12% mark.

What that would mean for an individual's tax bill I can't say

[claig]

What I wouldlike to know is in order to provide the same quality coverage as during the week at exactly the same pay and conditions of anti-social hour payments and if necessary the additional hiring of more doctors, how much extra would it cost to extend just that over the weekend?

We have a different system to France and America so it iswould be comparing apples and oranges.

What saving in cost for the improved system is the government risking a strike over?

[mamadoc]

I don't know the answer to that apart from a lot.

It's asking 2 days extra work from all NHS employees. It stands to reason you'd have to employ substantially more people. If you want that to be cost neutral you'll have to pay them less. That's their game.

But it can't work if it's just junior Drs. They can't run the place on their own at weekends. They will have to do the same to all staff. They are just starting with the Drs because they have less public sympathy.

If Saturday at 9pm is within normal hours for a junior Dr than the same will have to apply to nurses too.

[wonkylegs]

11% rise but only 1% worse off, 75% better off and the overall pay envelope to remain the same..... How does that work?
Reduces overall working hours, not employing more staff and now we end up with more staff working weekends - where do these drs come from? Oh yes we're pinching them from mon-fri
Mortality rates and 7 day NHS are a red herring. Mortality rate report actually said that they could not attribute a cause, the government also included mon & Friday in the 'wkend' despite these being normally staffed days.
7 day NHS is about elective services not emergency/acute services which are already 7days. It's about convienience not about saving lives - very different issues.
Although the strike is about Junior Drs Pay and conditions it does have a wider impact on the future of the NHS. There are already huge recruitment and retainment problems for staff with many crucial services being currently understaffed - arguably making pay and conditions worse will make this worse. In some areas such as A&E it won't take many drs leaving for the service to collapse - we can't even recruit from abroad at the moment, suitably qualified foreign drs don't want to do the jobs either.

Saying you are reducing hours and then removing safeguards to ensure that is the case (whilst creating a funding crisis that incentivises abuse) has been compared to lowering speed limits and the removing speed cameras and police.

If you re categorise unsociable hours for drs then these changes will need to filter to other staff too - nurses, radiographers, physios etc
So although it is about the junior Drs it is also about the wider health of the NHS.

[claig]

'They are just starting with the Drs because they have less public sympathy.'

I think they have got that wrong. My guess is that the public trusts the dctors more than the political class. I get that a better service over the weekend is needed, the public will go along with that, but I don't think they will agree that anti-social hour pay etc should be reduced in order to provide it. On the contrary, the public will start asking why haven't we got a better weekend cover and why aren't we prepared to pay for it.

Why was government money going to charidees like Kids Company etc instead of providing a decent weekend cover in hospitals?

[claig]

"Ministers drew up plans to change the contract in 2012, but talks broke down last year.

The government has indicated it will impose the new contract next year in England."

www.bbc.co.uk/news/health-34383677

Has this current row over contracts got anything to do with the last failed attempt at contract change? Was the last time about the same issues or over something else?

[claig]

In 2012, was it about weekend cover in hosptals or was it something else?

[claig]

As an ordinary member of the public, not paying too much attention to this and not understanding it, I get the impression that it is about weekend cover for us, the public. But is weekend cover a cover for something else, is it an attempt to get the public onside over something that is about much more than weekend cover?

[mamadoc]

Part of the proposal is to make Saturday's (and all weekdays) until 10pm normal working hours so attracting a basic rate of pay rather than a higher rate as they do now.

This means it will be cheaper to employ junior Drs at weekends and so employers can afford to put more of them on. Not good for Drs (work more weekends for less pay) but possibly good for the public to increase staffing at weekends.

The problem is that this on its own won't work.

If you still have enough same number of Drs and you put more on at the weekend then there will be less in the week so services Mon-Fri may be worse. OR you can make them work more hours for less pay. The government says it's not doing that but it has removed the penalties for breaching hours limits so Drs think In practice this will happen and could actually be unsafe if they are made to work very long hours.

Also junior Drs on their own can't run the hospital so they will need to change the terms for all staff if they want to push this through. Watch out for nurses and other hospital staff striking in future.

The other question is do we actually need a routine service at the weekend? The bank and the dentist aren't open at the weekend and we accept that.
When Tesco open 24 hrs they don't have every till open and the cafe and the fish counter at 3am just the main shop.
We do already have a perfectly good emergency service at weekends. A&E is staffed the same at weekends as in the week. You still get your broken leg fixed just the same or your baby delivered whatever time or day. You just don't have outpatient clinics or routine ward rounds of stable patients or non-emergency surgery every day.
If sat and sun were just like other days we would get through more work and be more productive but I don't think we would necessarily be safer.
If we do want a full service at weekends it stands to reason it will cost a lot of money to employ the extra staff to do it and work life balance will be worse for NHS workers.

[coffeetasteslikeshit]

I support the strike. It's not about money, it's about saving lives and saving the NHS.

[Emmapuddle]

If Dr's need to strike-I'll support our doctors. Too many services are being cut including police, fire service, paramedics. These services are important to my family and I wish to keep the fantastic NHS.