Doctor strikes - how can a resolution be reached

[mids2019]

https://www.theguardian.com/society/2024/jan/06/settle-nhs-dispute-or-thousands-with-cancer-could-die-early-say-health-chiefs

It appears that there a real tangible reductions in cancer care due to industrial action. If introspection is now critically affecting patients how do we remove the crisis. Are juniou r doctors pay demands realistic and if they can't be met do we accept that we will have future disrupted service.?

I feel of the juniou r doctors get a significant pay rise nurses will soon start striking again so this is a real headache for government with ultimately patients losing out.

Unsafe

Will the government settling provoke another set of public sector strikes particularly in nursing?

Their 'training costs' are pretty arbitrary though. So much is on the job and a lot is expected back from them from day one. They are not get anything like £250k of training. And when you have doctors as junior as F1s with responsibility for the bleep on night shifts, I think there is a quid pro quo. I am in a supposed high stress, high profile job and it is nothing like the life of a junior doctor.

It might be a good idea to read a few news articles rather than asking so many questions on the basics?

I don't quite see how increasing pay improves safety or reduces stress. You may get paid more but without additional staff or change of systems there are the same working conditions.

This is the point at which the Government can take control of future striking.

Agree a pay rise (which is needed) and put it into terms and conditions that in future, Doctors cannot strike and need to work for the NHS for a minimum amount of time before being able to move abroad with their skills.

I don't have any issue with Drs also working privately, but there needs to be an agreed minimum contract with the NHS.

If you read the news articles, it is clear that they want both.

@RareApricity

I am assuming the answer is yes given discussions with others. I think personally higher band AHPs are going to push this.

But is the UK ready to consider moving to a hybrid public/private healthcare model such as they have in these countries, and which help to enable the higher salaries and more forgiving working conditions?

@FlyingCherub

I think that is an option as strikes can only harm patients. If cancer mortality rates can be linked to industrial action I do think you need to look at the balance between right to strike and patient outcomes.

Personally I think we need to bring in assisted dying to cut the costs on social care that have been plugged by NHS for over a decade. Freeing up money that is being spent on elderly who have no quality of life to prolong it is bonkers. I'd rather my money paid those who want to help people to have quality of life for longer. I don't know why it's taken us so long to consider this or why the govt insists on distracting us with "boats" rather than doing what the majority of the population is behind; enabling those with terminal illnesses to end their own lives legally and with dignity.

pay is one part of the problem. the changes hunt introduced as health Secretary made the pay situation much much worse. the restructuring of what counts as out of hours, the reduction in the number of training posts, lack of basic things like appropriate rest areas and the general attitude towards junior doctors - all of this combined has led to the current crisis.

for the first time, places in medical schools are going empty. no one wants to work in the NHS. these are tough jobs, we need to make it attractive to people so that the brightest and best come and stay in the NHS. even though doctors should have a strong sense of vocation, its not humanly possible to have such a tough job AND no breaks AND worry about money. something has to give at one point or another

I think doctors will accept less than they asked but only if that is coupled with other tangible changes to the overall structure of their contracts, training etc.

@rubbishatballet

I think we are headed that way ultimately. The NHS may be treated as a sacred cow but market forces in pay will strain the model. Maybe we have to have some sort of insurance system?

Starmer has mooted golden handcuffs re writing off student debt if junior doctors stay in the NHS for a certain period. That carrot approach would work much better than a stick such as making them to pay back some arbitrary training figure if they leave the country. With the current level of trust in successive UK governments, no-one would put all their eggs in one basket like that. People seem to forget that the kids who win medical school are among the brightest and have plenty of choice of career. Why would they choose medicine with these ridiculous binds?

The NHS may be free but it's frequently shit.

Was good in 2008 before now being underfunded for years.

Twitter thread from a U.K. emergency doctor:

”Over at least the past 16 years, we have seen a relentless increase in demand, both in primary care and in hospital care. This has been absolutely predictable by social statisticians for decades and is based on the fact that our elderly are surviving much longer.

Our elderly use a very large percentage of NHS of resources, unsurprisingly because they are more prone to disease, frailty, and dementia. They need more social care and hospital care as they get older. And they are living longer.
(Immigrants, by the way, use much less care).

Over this period NHS funding has, broadly speaking, risen about 1-2% over inflation. If NHS funding increases with inflation yet demand increases, then clearly spend per person will drop. Demand has increased considerably above 2%, which is why the NHS is failing to manage it.

Secondly, the NHS is not responsible for social or community care. When elderly folk come into hospital they decondition very quickly and require physio and OT to get back on their feet. Often a care package is required, sometimes even a care home place.

This is the responsibility of the local council to sort out. But council funding has been cut and social workers are dealing with huge case loads. So there are big delays. And we can't send the patients safely home until their care package is sorted out. So they wait. And wait.

And they sit on hospital wards waiting. Often bored and frustrated. About 33% of hospital beds are filled with 'fit for discharge' patients. UK hospitals can do nothing about this. We are effectively working on 66% capacity. Which is one of the key reasons why A&E is rammed.”

@rubbishatballet I don't think the public want to have a hybrid or private system. Talking to 3 families from Sydney over New Years and they also can't see their GP and have to pay over $100AUD to see them for 15mins! They also then have to pay for certain prescriptions on top. To me that just increases the problem the NHS currently has as it creates another issue of health for wealth meaning issues won't be treated and fester causing more and longer term health issues.

As NHS resources are disproportionately aimed towards the elderly then maybe the discussion has to revolve around geriatric care and the degree to which the possibly large costs towards end of life are funded.

We have actuaries to work out pensions based on life spans so could we do something similar for health care? A system like a pension but toward an old age health pot?

They are still liable for their student debt but it actually costs over £230,000 to train a doctor! Their student loans of £45,000 are a drop in the fucking ocean that tax payers essentially pay to train them. Over 50%/year group have absolutely no interest or intention in working in the uk. There are around 9,500 places/ year. I do think that there should be a minimum number of years that doctors should work in the uk to at least repay some of those literally billions of pounds we have provided to get them in to that career ladder. They should also be paid appropriately and have better conditions.

What that article doesn't show is that actually the numbers of appointments cancelled due to the strikes is virtually no different to the appointments cancelled when there aren't any strikes. Most cancer surgery has gone ahead, even though for many of those people their oncological outcomes would have been no different if they'd waited another few months. The people that are being negatively impacted are those with benign disease, but that doesn't make good headlines.

The government has already spent more money covering the strikes than it would have cost to give the pay restoration they are asking for. The govt has no incentive to resolve things.

To pick up an earlier point, there already is an agreed minimum NHS contract for those consultants who want to do private work. Increasing the number of sessions that they do for the NHS wouldn't make much difference unless they increase theatre space, increase nursing and medical staff to run more clinics etc.

@MrsElijahMikaelson1 once again that banded £200,000 plus is arbitrary. In any case it is a moot point as if they were paid properly and treated properly, I doubt they would want to go to the other side of the planet. They don't start out with that objective, they end up using it as an escape route.

They want ...and deserve ....both better pay and better conditions. Both are linked....

Could you imagine every 6 months potentially having to move around the county from Cornwall to Newcastle in order to achieve the next part of your job? No say in that, no real warning but you know you have to do it as there are no roles in your area. Whilst in that area you have worked many many hours a week across day/night/weekend with no real choice in how and when. Not being able to book a guaranteed week or two to get married and have a honeymoon. To have to be apart from your family when you next change jobs or to constantly uproot them. To have to keep finding somewhere To live. To work Christmas with no uplift to your pay so paid around £15 an hour working next to an HCA in around £18 yet you are directly responsible for the lives of many people. Oh amd whilst you are at it, to stomach all the extra costs of things you have to do like register and training running into hundreds and hundreds of pounds......

There aren't enough Dr's so at the moment a lot of the above can't be changed (although some could)...

Hence they are trying to tackle the pay as good enough pay can make up for poor conditions. Pay people enough and those that wish will start to apply to train and will stay with the NHS and bit by bit the conditions will change and everyone wins. I sincerely doubt they think they will get the full 35% but they do need a very decent increase and have already said it could be phased in over time. Patient numbers are only rising yet Dr's, Nurses and other HCPs are not able to respond in kind.....

Aren't higher salaries jobs in countries which private/hybrid models?

@RareApricity the £250k is pre graduation…..so it’s not ‘training on the job’ it’s training to get them to the point of being able to do the job. (I’m a dr btw).

Then there is the misuse by patients.

I see so many people queued g up because of a cough or cold. Pointless waste of time - if they had to pay they wouldn’t go.

8 week wait to see a GP here unless urgent! Who’s waiting 8 weeks?

Some medication should be over the counter - some should be prescribed by nurses -

Not all patient care needs to be via a doctor.

@mids2019 that's the general idea with paying taxes - you pay into your "health pot". It doesn't touch the sides now we are all living longer, not always with good quality of life. The govt has underfunded health services, social care services, education and allows tobacco companies, alcohol and food companies to create huge issues with cancer, dependency issues and obesity. It's almost as if they want to make us turn to private because they've cut anything they can and run it as a business model for decades...so maybe the question should be "what happened when we had a pandemic and let them choose who to pay for medical supplies?" - and we can see exactly where it leads.