Junior Doctors Strike

[Lanchester]

Do the Junior Doctors seriously think that they are still
respected for always putting the interest of their individual patient first?

Doctors should be paid reasonably well and maybe about the same as an employed lawyer with the same seniority -
but doctors are not special beings -
and they are not deserving of adulation for doing the job they are trained and paid to do.
Many years ago a doctor would have been much better educated than the people in his (hardly ever her in those days) community.
Many people could not afford their fees, and many doctors varied their fees depending upon a particular patients ability to pay.
Doctors were close to their community. They could be a spokesman for their community.
There was a natural gratitude and deference to the doctor.
Doctors were regarded with respect for their dedication and their position in the community.

That was all long ago. The world has changed. People are educated and have complex and challenging jobs themselves.
BUT modern doctors seem to feel entitled to that same old special status - which they have not earned.
There seems in fact to have been an inflation of expectation amongst doctors.

Doctors now seem to want all the benefits of being a public sector employee with the rewards and risks of being a businessman.
Really the doctors need to decide what they want:
Public sector NHS job - great - but don't be too greedy.
Private sector job - great - but fund the WHOLE thing yourselves (no hidden subsidies)

the doctors never asked for a pay rise

The single biggest reason the BMA called a strike was because they won't accept a contract that does not give more overtime pay on Saturdays. More money is more money, so who is going to pay for it?

Nottsmove - so it may be bad for your self image to acknowledge it ...but you do realise that the BMA and the JDs are explicitly using their "withdrawal of emergency cover" as a bargaining lever in this industrial dispute ?

hibbleddible Thu 28-Apr-16 10:21:52

"I find it very sad that after 6 years in university, and coming up to 2 years training in the NHS, I may no longer be able to afford to work as a doctor."

Sounds like you are maybe aged mid / late 20s then.
After meeting the variety of people that you must have come across and their health issues and other circumstances in their lives that they are struggling to deal with,
how is it that you sound so immature and self pitying?

I don't support the JD's. I felt quite angry watching them all shouting and cheering - quite the party atmosphere - while responsible for cancellation of thousands of appointments and procedures.

The couple I know who are both junior doctors have 2 kids in private school. The mother has failed her professional (fellowship?) exams repeatedly but does not seem to suffer any adverse career effects. They have 2 houses and 3 cars.

OTOH my elderly friend was admitted to hospital on the first day of the strike, waited 6 hours in A&E to be seen (she is 90) and has since had her care package cancelled because any hospital admission requires "reassessment". So she is now stuck in hospital where she is worried she is a "bedblocker".

I know who I would give the money to and it's not the junior doctors.

*IF that is what the population want, fine. They will then have to get used to the fact that either waiting lists and queues in A&E get even longer, or they will have to pay and go privately.

But it is pretty clear that that is not what the population wants, and the government does not represent what the population wants. And the trouble is that it is not members of this government that will suffer, because they will certainly get private medical care.*

Why can't we have a European social insurance system?

Healthcare would still be "free" and the government would pay the premia of the poorest. There would also be more money sloshing around - top-ups, competition between hospitals forcing them to offer more hotel-type services and charge for the privilege. As I understand it - and I am happy to be corrected - the main reason the French etc spend more on healthcare per capita is because they "top-up" i.e. the total includes patient contributions. The insurance industry is closely regulated to ensure that nobody is excluded.

If we all agree that more money needs to come from somewhere - what's wrong with this option? Or do the junior doctors like the power that holding a monopoly employer (and by extension, their patients) to ransom brings?

urbanfox the doctors did not ask for their contract to be changed. The dispute could be solved by agreeing to reinstate the old contract. How is that "asking for a
payrise?"

Absolute no brainer - I support the Junior Doctors but I think it is too late to save the NHS.Heathcare is already well on the way down the track of what happened to Dentistry provision in the UK. All of us need to be sure we have a plan to access healthcare in future, when the NHS no longer provides free care at the point of need.
Alternatively support the junior doctors, para-medics, nurses, GPs and every other member of NHS clinical staff who are screaming out about the underfunding and understaffing.
The fact that the contract attempts to justify disadvantaging women and those who work part time - suggesting female junior doctors just ask a relative to help with childcare for overnight and out of hours shifts ought to be setting alarm bells ringing (especially on this site) that all is not well with the mentality of those making decisions about the way the UK is run.

I was told yesterday that when the NHS was originally established, it was strongly opposed by the BMA. Not exactly relevant, but interesting.

Misti the government has a mandate for a 7 day NHS. It was one of the reasons I voted Conservative (and I am sure I was not alone).

The old contract does not allow for this.

Yes we can argue about other specialisms and more funding - but he is basically doing what his party was elected to do.

Weekend cover is dire - another "study" is scarcely necessary to prove what we already know.

Why can't we have a European social insurance system?

Personally I have nothing against social insurance systems (having used one for the last two decades) but it's important to point out that the European systems that provide comparable quality healthcare to the NHS (France, Germany, Netherlands) also typically spend a lot more per capita on health care.

Social insurance systems can give excellent care but they are more expensive than NHS style systems, because you have to pay for an insurance bureaucracy and related computer systems to chase payments through the system.

The advantage may be that people find it easier to relate their healthcare to the money they put it, and thus be prepared to pay a bit more. My healthcare cover costs about €12,000 a year (about €8000 in obligatory contributions and a further €4000 for top up cover) and I do not begrudge a single cent of that.

Where I live, all employees - whatever their income- pay 8% of salary to cover 70% of their healthcare costs. Is that what people in the UK want?

Yes it was aj and to persuade them, the SoS for Health promised to "stuff their mouths with gold".

And let's not forget that most of the increases funnelled into the NHS under Brown's government went straight on staff wages.

Personally I think Hunt should call their bluff and offer to accede to all their demands if they give up their pensions. That would save a few billion quid.

Personally misti yes, I would infinitely prefer that to a government-run system. I think it offers more choice for patients and better quality whilst ensuring that the poor and disabled are looked after.

Off-topic, but we are all mostly agreed that governments and politicans are useless toerags, but then paradocially, we expect them to deliver healthcare to 70-odd million people. Then we complain when it gets political. It's nuts (but then I also spend time under a social insurance system and know how much better the quality and delivery of care was).

Misti the government has a mandate for a 7 day NHS. It was one of the reasons I voted Conservative (and I am sure I was not alone).

Sure. But they could fulfil their election promises in a number of different ways - for eg, by employing more doctors (as well as other paramedicals - a true 7 day NHS will require more of everyone, including technicians and administrators).

Mandating a 7 day NHS is all very well, but you can't have a 7 day NHS (or indeed any NHS) without doctors. Doctors, like all employees, retain the right to withhold their labour, either through legal strikes or by voting with their feet and going to work elsewhere, as many are doing. You might disagree with them, as is your right, but you can't stop them short of imposing slave labour as a condition of medical training.

Ultimately, you can't argue with economics: if you wish to employ a resource that is in short supply, then you have to be prepared to pay the going rate, or to offer other inducements. What this contract does is to reduce effective pay for a significant minority of doctors (often those working in the most demanding areas) and, in most cases, to worsen their already difficult working conditions. They would be stupid to agree to it, and I think the one thing that we can all agree on is that doctors are not, on the whole, stupid.

the government has a mandate for a 7 day NHS. It was one of the reasons I voted Conservative (and I am sure I was not alone).

So you voted for something, but weren't planning to fund it?

What on earth did you think would happen?

Lanchester- I am not a JD.

Of course I realise the strike was a bargaining tool. It was designed I imagine to cause maximum impact on government whilst minimising risk to patients. That is not to say that there is no effect on patients and it is this that is regrettable and upsetting.

the main reason the French etc spend more on healthcare per capita

Is that we pay quite a lot more for a healthcare system that provides similar outcomes to the NHS in most areas.

We get more choice, and shorter waiting lists in most cases (though not all), but we pay a lot more for the privilege - and a lot of poor and disabled people fall through the gaps.

You really can't have something for nothing, however much your government would like you to believe.

It depends who you ask though - for me, patient choice is the most important thing. It would have meant that I would not have been stuck with an insufferable moron of a consultant who couldn't diagnose his way out of a paper bag the one time I had a serious health issue, for example. It would also mean that I could avoid my local "special measures" hospital - which would allow me to avoid the overwhelming smell of shit, if nothing else.

The NHS performs averagely well on some international models and well on those measuring efficiency - but I think that's because of all the rationing that goes on, both above and below the line. (No treatment for two of my relatives' macular degeneration, for example, or another who has to wait over a year for cataract surgery (at the age of 87).) Do the JD's really want to fight to preserve that level of care? If so, why??

My main "beef" with the current healthcare debate is that it just preserves the lie that healthcare can be funded 100% by taxation - irrespective of the rights and wrongs of the contract, I think it can't. And I also think that we should be grown up and deal with this now rather than when the whole system eventually collapses (as it must). No politician has the cojones for that, unfortunately.

And pausing - as higher rate taxpayers who also pay through the nose for private healthcare, DH and I think we pay more than enough already, especially given our dire local facilities (see above).

I would happily pay more - but not to the NHS. And definitely not to further inflate the wallets of JD's.

I think there needs to be removal of health from the political arena with an honest discussion about funding and what the NHS can afford. What seems wrong to me is to promise an unfunded/ uncosted 7 day NHS when what we have already is struggling and severely understaffed and underfunded.

Nottsmove16 Thu 28-Apr-16 10:40:31
"I fully support the junior doctors and I amazed at the misinformation that some people believe. It is difficult to know where to start. .....
3) junior doctors are not leaving emergency care patients at risk!....."
"
Lanchester Thu 28-Apr-16 11:10:38
"Nottsmove - so it may be bad for your self image to
acknowledge it ...but you do realise that the BMA and the JDs
are explicitly using their "withdrawal of emergency cover" as a
bargaining lever in this industrial dispute ?"

Nottsmove16 Thu 28-Apr-16 11:59:06
"Of course I realise the strike was a bargaining tool. It was designed I imagine to cause maximum impact on government whilst minimising risk to patients. That is not to say that there is no effect on patients and it is this that is regrettable and upsetting."

Make your mind up Nottsmove ! -
either the JDs are using their withdrawal of emergency care as a bargaining lever or they are not !

?? I think you misunderstood me- isn't that the purpose of a strike? A bargaining tool?

If you decided you didn't want the NHS doing routine procedures 7-days-a week (as opposed to the current 7-day NHS), because you feel it wasn't worth you paying for, then fair enough.

But I come back to: you voted for the NHS to offer an extra service, but object to it being paid for.

What did you expect would happen?

Pausing I voted to stop the NHS from harming and killing people at weekends due to neglect and understaffing. Because I have seen that happen with more than one family member.

If I need a MRI scan or discharge or whatever it should happen just as smoothly on Saturday as Tuesday. It makes no sense for expensive equipment to sit idle for huge periods of time. That is a hallmark of inefficiency.

And as for "paying" - you could fling the national debt at the NHS and some of the staff would still complain! How much will ever be enough when demand is infinite? As I said - let's see if the JD's want to give up their (unfunded) pensions and use that money to "save the NHS". I think they may just decline.

It was designed I imagine to cause maximum impact on government whilst minimising risk to patients. That is not to say that there is no effect on patients and it is this that is regrettable and upsetting

You imagine that the strike was designed to minimise risk to patients? What was the point then?

Some of the medics on here are being very mealy mouthed (at best) and dishnonet (at worst).