#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/

Can't some doctors be employed as 'teaching doctors' or at least have teaching as a set number of their hours?

There are lots of areas of the UK with no med school close by so there must be capacity for more schools and more teaching esp in rural areas.

Teaching doctors would still need to keep their skills up-to-date by working. Juniors need to be performing operations in order to learn. some of these operations are infrequent and need an experienced consultant to perform them, others which are more frequent can gradually be handed over to the registrar to perform.

My hospital is 50 miles away from the nearest med schools and we have loads of med students. Just because there isn't a med school nearby doesn't mean there aren't students. They send them everywhere.

Isit, a government that is selling itself as a cutting government could be continuing the work that Labour did on locally agreed rationing priorities - not that I'm aware Labour did much to implement them. They could also increase the NICE remit, or are they trying to avoid mentioning NICE as it's generally thought to be a true success of the Labour administration?

They could also have avoided re-creating NHS England, which was created back in the late 80s, then dismantled by Labour, and has been created again for the good reason that, erm, no idea. Oh yes, to stop the secretary of state being blamed for crap health policy. That's going really well.

There are only 5 med schools in the whole of Scotland. That means there are hospitals hundreds of miles from the nearest ones.

I'm 100 miles from the nearest medical school. We still get students. From entering medical school to becoming a consultant took me 19 years. Which is fairly average. That's quite a time lag.

I didn't post this weekend. But that's because I was at work. As were consultant colleagues in every department with whom I had contact (so that's A&E, O&G, surgery, anaesthetics...just as a starter). Since I started as a consultant I've worked from Saturday morning to Monday lunchtime as one block, approximately one weekend in four. And, of course, working the full week before, and the full week afterwards. If I'm up all night (not uncommon) I'm working a full day afterwards. I'm only paid for a fraction of the out of hours work I actually do. The work load is expanding. For all the staff. Staffing is shrinking. Recruitment is getting harder and harder. Because the students see what we work, and they do not want to work like that. So they look for less intense specialities, or leave the country, or leave medicine.

I do not know a single consultant who has opted out of weekend work. I have known two who did reduced weekend work - they split the weekends between them. But they were in their 60s, and this pace of work is a killer.

Athena, medical students and trainees are sent miles away, often the other side of the country, from their supporting medical school to ensure they are receiving their education. This is why medical students need cars. When DH did his registrar post, we bought a house in a fairly central position (also where I had my job). He spent a year in this city, 2 years in a city 1.5 hours commute north of our house and 2 years with a 2 hour commute south of our city. His training was topped up with training days at centres throughout the UK.

I'm a doctor and what bothers me most is that people don't seem to realise how awful our job can be. Yes, it can be brilliant and very rewarding, but we see a lot of traumatic stuff. We see people dying far too often. And these are not just 'expected' deaths where elderly people simply reach the end. No, it's young dads with cancer. It's lovely grannies who didn't want to bother us hence come in far too late. It's children. It's babies. It's absolutely awful to see someone die despite the amazing work put in by the team. And trust me, some deaths are horrible. No one ever talks about it. It's "part of the job" we're supposed to be able to deal with it. Just like that. I still cry when I see someone die. I cry at home when I've seen a child die. I get paid absolutely peanuts compared to tube drivers (just an example). I went to university for 5yrs. I had a student loan of £30000. Why should I not be paid properly for the amount of responsibility we have (for people's lives!) and emotional stuff we go through? Every day I come home and wonder whether I made a mistake today. What kind of a job is that? And why do I go through it every day? Because I care. And I will keep caring, but if my pay is cut by a third (ie, no extra money for out of hours) then I'm not sure whether it's worth it anymore. I could do something far less stressful and get paid far more.

At my local hospital, I needed an echocardiogram on a Sat night. The nurse said to me "We can't do that tonight because we need a cardiologist and they don't work weekends".

At the same hospital, I needed an emergency c-section over the Christmas period and was told "We only have one team on because it's Christmas. That team are in the theatre."

My c-section was supposed to be done by a consultant, for a few different reasons. The midwives were open about the fact that there was only one consultant working because the others had the night off. They were available on call apparently, but there wasn't time to get anyone in for me. Luckily, the young Dr who ended up doing it did a great job. But, if it had been a normal weekday then there would have been more than one consultant there and it would have been massively reassuring.

The consultant haemotologist would also have been there. He came to see me a few weeks later and was apologetic about the fact that my labour happened over the holiday period...

From the posts on this thread, it appears that lots of consultants DO work weekends. It just doesn't seem to happen at the hospital I go to! There are always lots of hardworking nurses though, even if it is Christmas Day or Bank holiday.

I've also just remembered that when staying in that hospital as a patient, or when your child is a patient, most of the time if you don't get discharged by Friday, you will have to stay in until Monday. Why? Because the consultant who needs to come and do the ward round doesn't work Sat and Sun, so you/your child cannot be discharged if the consultant needs to see you first. That is also something that staff are quite open about.

I think you needed a cardiographer rather than a cardiologist to do the echo though yes they might well have needed the cardiologist to see it afterwards.

A consultant writes to Jeremy Hunt to explain his weekend cover rate works out to £2.61/hr.

After spending 26 yrs in the NHS I have now moved to the private sector. I was fed up of changing rules changing mangers restructure and box ticking shite
My NHS colleagues and I did do a good job we do care , unpaid ot etc was the norm for me . And guess what we did and do offer a 24/7 service.
The weekend service will be paid for by losing staff enhancements for unsocial hrs adding to th expressive for staff without a real,pay rise for years being forced to work longer . Also trained staff but unregistered staff will more than ever be expected to do more. Think aps instead of radiographers hcps instead of nurses .

Northernluker you need an echo physiologist for an echocardiogram , whilst they do the scan and the report you often need a cardiologist to ok any treatment plan

I am not sure that they will push this policy through ultimately. There seems to be a backlash from all quarters and I think Hunt has entirely underestimated the public reaction.

"The Public" are around 64 million, and I would suggest that the majority of people seriously question why if urgently needing hospital treatment at weekends they can not get the 'full' service offered in the weekdays before their personal crisis - and the current service gets jammed up over those 5-days, with nearly every NHS professional body saying they can only just cope as is - many professionals don't even want to see detailed plans (and funding) HOW this can be achieved.

The FACT is the population is likely to grow towards 70 million over the next decade, there has to be a near term and long term plan to cope,so if for some unknown reason THE PUBLIC don't want a 7-day service now, they will in the future.

I'd suggest that if anything, Mr Hunt might have underestimated those with a political 'bent' kicking back, even after the objections to EVERY Conservative led public sector reform since May 2010, and who is to say that ALL of those complaining actually WORK for the NHS. Just saying.

The issue is not that us doctors don't WANT a 7 day NHS. It's the way Jeremy Hunt goes about it. It sounds perfectly logical. But in order for that to happen EVERY service needs to be working at the weekend. For example: we often have people that are medically fit to be discharged from our point of view on a Friday morning, but they can't go home because their carers don't accept them back over the weekend...... (This happens ALL the time). People don't get certain scans over the weekend because there are less radiographers (again, not doctors). There are doctors around to order the scan and doctors to report the scan, but no one in to actually DO the scan. Sometimes, we can't send people home because pharmacy shuts at 1pm so they can't have their medication to go home with. There are also very few pharmacists on over the weekend. They're not in the news. Again, not doctors that are the problem here. Sometimes people need a review by a specialist nurse. They don't work weekends (not where I work anyway). Sometimes in order send someone home, specialist equipment needs to be ordered from a company. They're not open during weekends either. My job stays the same. I do exactly the same things on the weekend as I do during the week but with less resources. It's all the services around us that are unavailable which prevent us from doing our job properly.

However, yes, there should definitely be more doctors on over the weekend because we work our asses off trying to get everything done. And I do agree that consultant cover should be better, (ie people should not be put in harms way due to lack of services) but all the other services need to then be extended as well otherwise it's pointless. Healthcare provision is done by a TEAM. Not just doctors.

I suspect Mr Hunt knows that he will need to fund/train a full team for a 7-day roll out.

For my info, having been waiting with family to be discharged for hours awaiting a doctors signature; as there are clearly doctors at a different level of training/experience, at weekends, for every 20 doctors, what percentage would have the authority to sign discharge papers to release every patient on the wards, or A&E rooms to loved ones?

As I may have been unlucky, but maybe care workers don't accept patients at weekends as they are both paid by the hour and have their own 'case load' - and would have trouble 'dove tailing' their own patient services with hospital doctors discharging theirs?

Furthermore, I think that I read somewhere else that around 70% of A&E patients over the weekend are drink/drugs related, is that about right, and could the stresses of selfish piss heads on doctors and the system, be handled differently e.g. a high fine/bill deterrent, or state drying out tanks, manned by unsympathetic and less attractive hard arses?

With ever increasing demand, THIS is what I mean about trying to be NHS SMARTER in delivering services to help take pressure off of the health service - and the first reaction is professional associations and/or trade unions kicking back - almost hoping that Conservative government initiatives fail.

”New 999 System Cuts Wasted Ambulance Journeys”

”A pilot scheme that allows 999 call handlers to take an extra two minutes to judge patients will be expanded, Sky News learns.”
news.sky.com/story/1524285/new-999-system-cuts-wasted-ambulance-journeys

”Under the Dispatch on Disposition scheme, call handlers are given an extra two minutes to triage patients with serious but not life-threatening problems - and assess whether they need a blue-light response.”

”Health unions warned in January, when the pilot was announced, that it could lead to dangerous delays in responding to emergencies.”

”But figures seen by Sky News suggest the system reduces blue-light responses by almost a quarter without added risk to patients.”

”Since starting the system in February, South Western Ambulance Service (SWAS) has been dispatching 4,000 fewer emergency vehicles every week.”

”Neil Le Chevalier, director of operations, said: "It allows us to prioritise. It releases emergency ambulances to patients who actually need one."

”Under the scheme, life-threatening calls still get an immediate response, with the aim of reaching the scene within eight minutes.”

And no doubt they will pounce when the first patient falls through the triage crack, without even comparing the difference to the lives saved at the hospital, due to a lot less pressure on the system.

Funnily enough we called an ambulance in the south west about 2 months ago for my child who was fitting. He stopped breathing and became cyanotic. After 30 minutes we had a call back from the call handler to say the ambulance was delayed. After a further hour and another call back, we woke up our other child and took him to hospital ourselves with 1 driver and 1 person holding his head out of a sick bowl. I expect that counts as one less ambulance needed!

"During this (23-week) trial we have had no adverse incidents, no safety issues".

I expect they don't count those that use their own cars and/or you didn't throw a wobbler at the hospital when you got there.

It wouldn't have done any good to throw a wobbler at the hospital. The doctor and nurses (who were working at 2am) couldn't do anything about it, although it is written in the notes. I did ask the call handler to fill in an incident form but have no proof this was done.

I love how Gove is hobbling around on crutches and his wife has said the lack of weekend services is to blame because 'he couldn't have an X-ray as radiologists don't work weekends'

If it's a serious injury, you go to A&E. There will be radiology available. Going to minor injuries won't get you an x-ray unless they deem it suitable to send you to A&E for one. Obviously this wasn't the case.

People have such little understanding into how the NHS runs so the general public can quite easily get led astray by Hunt's claims.

And Hunt does realise he needs more staff, he's not commenting directly on it because he'll be waiting until unsocial hours is taken away - freeing up the money for more staff.

Or it will come out of the extra £10 billion a year by 2020 the Conservatives have promised and/or the on-going efficiency drives (unknown for 13-years) as he gets his front line priorities priorities right.

March 2010; ”Rise in NHS managers outstrips doctors and nurses”

“The number of managers in the NHS has risen at double the rate of doctors and nurses under Labour, official figures have disclosed.”
www.telegraph.co.uk/health/healthnews/7520408/Rise-in-NHS-managers-outstrips-doctors-and-nurses.html

And even with those manager numbers, it appears that like everything else, the government tended to go for quantity over quality.

Furthermore the May 2015 alternative was the HOPE of a few £billion more as they chased the Non Dom rich out of the country with their tax collection box waving in the wind.

(And you get a Gove dig in as well. Priceless.)