Hear Our Nurses Roar

Posted on November 26th 2015 by Gagan Bhatnagar on the clinioncdoc.

I would not be where I am today without the compassion, dedication, and guidance of countless nurses. I am not a patient, I am a junior doctor.

For every heart-wrenching story I have to tell about my own experiences in hospital, there was a nurse stood right beside me. There was a nurse running with me to a cardiac arrest, who despaired with me as we alternated chest compressions to time. There was a nurse next to me who ran to fetch blood products needed to keep someone alive as they bled out because the porters would not have made it in time. There was a nurse with me when I told a patient for the first time that she had lung cancer. It was the nurse that held the patient’s hand, that hugged her, that cried with her. Nurses are the first port of call, they are the personal touch of the NHS that doctors can never be.

I’ve been alerted to a multitude of elderly Mrs. Smiths by nurses who just knew something wasn’t right. It might have been because her vitals were deteriorating or it could have been that she just didn’t mention her late husband that morning as she normally would. Nurses epitomise the good will that the NHS is run on. They laugh and cry with their patients. They will empty bed pans with one hand while fluffing pillows and blankets with the other. They will make their patients a cup of tea with one hand while dispensing life-saving medication with the other.

I am in awe of nurses because I know that I, nor the vast majority of the public, could ever do their job. They do the dirty side of healthcare that we shove out of sight and out mind. The cleaning of bed pans, washing of incontinent patients, and changing clothes soaked with vomit are only a few of the things they do on a daily (if not hourly) basis. They do this through gruelling 12 hour night shifts with no time for breaks, often getting punched, kicked, or spat on by confused or aggressive patients.

How much is their inherent caring worth? By any means – nurses do not earn an astronomical salary. Starting at a £21,692, their salary can go up to £28,180 after many years of working. As a ward nurse, that’s it – that’s your salary. The majority of us would consider that to be a paltry sum for the emotional and physical turmoil which nurses endure. As a society we thanked and encouraged nurses by offering to pay their tuition fees and providing them with a small sum of money to help get through an intense 3 years, knowing full well that what we get in return far outstripped that value.

Removal of nursing student bursaries is the latest in the Government’s string of attacks on the NHS. Nurses are already in a recruitment crisis, most wards are understaffed and overworked. The Government’s proposals will further compound a recruitment crisis. With all the stress associated with the job – is it fair to add in a student debt that they will likely never be able to pay off? How will this encourage more young compassionate people to go into nursing? How does that make nursing an attractive career prospect? A recruitment crisis will only lead to further demise of the NHS.

Thankfully, the value of nurses is not measured in money, it is far more intangible. However, this does not give the Government license to force such savage cuts on the NHS. The Government has once again demonstrated that it does not value workers that do not generate profit. The Government continues to promote a false economy while battling against doctors and nurses, the very workforce that keeps the NHS running. For this reason we see the NHS underfunded, understaffed, and on its last legs.

Nurses are our lions, they are the pride of the NHS. Hear them roar.

I thank them whole-heartedly and am eternally grateful to them. They are the NHS. I will stand shoulder to shoulder with my colleagues, for the long-term safety of our patients, and the future of the NHS. Please consider signing this petition:

https://petition.parliament.uk/petitions/113491

I’m a Junior Doctor – On the Precipice of Strike Action

Posted on November 7th 2015 by Gagan Bhatnagar on the clinioncdoc.

Industrial action is not a step that a doctor takes lightly.

I am a junior doctor, having been qualified for 6 years, and am training to become a Cancer Specialist that delivers chemotherapy and radiotherapy. I am not an activist, nor an anarchist, nor an anti-government protester. The last 12 years of my life have been dedicated to a singular agenda – patient care. I will not drone on about the sacrifice of blood, sweat, and all too often tears that have accompanied my training, suffice to say that I am where I am through significant personal sacrifice.

I am not unique, nor am I alone. There are 50,000 junior doctors who have made the same sacrifice with a common goal in mind – patient care. It is precisely for this reason that I have voted for industrial action. As counter-intuitive as this may seem to the non-medic – doctors truly are striking for the safety of the public. 

Allow me to explain – we are trained, nay, indoctrinated to analyse the risk versus benefit of every action we take as doctor. We use scientific evidence to help guide our decisions – this is aptly known as ‘evidence based medicine’. When I prescribe chemotherapy I have to analyse all the life-threatening side effects that could befall my patient, and weigh it up against the benefit my patient may receive from the toxic drug. I make a similar risk assessment when I prescribe Paracetamol (do they have liver failure? Are they on other medications?).

In a similar manner doctors up and down the country have weighed up the risk versus benefit of the new junior contract and the possibility of industrial action. Thankfully, we have scrutinised the details of the Department of Health’s offer and have not fallen victim to catchy headlines and government rhetoric. Sadly, the devil truly is in the details.

We are desperate not to strike, because the service will halt and there is a possibility that patients might come to harm (though we will do everything in our power to ensure necessary safeguards are in place). Having analysed the contract with the same keen eye with which we analyse our patients, many doctors are reluctantly voting for industrial action because the alternative is far worse. 

Doctors envisage a future where we are overworked due to lack of penalties on Trusts for overworking us (the Health Secretary has still offered no safeguards for this). We envisage a future where women, who make up a majority of junior doctors, cannot balance family life and career and have to choose between the two. We envisage a future where doctors are penalised for pursuing research for ground-breaking new therapies for cancer or dementia. We envisage a future where a doctor’s experience is not valued and rewarded. We envisage a future where the work-life balance of vital specialties such as Accident & Emergency is untenable and will suffer crippling losses to the work-force (which is already under-recruited). We envisage a future where children simply don’t want to be doctors because the gruelling training is not valued by the government. Some envisage a future of private health-care being pushed through by the government where patients may be asked to choose between cancer treatment and selling their homes.

This future would be a grim place to be a patient. Unfortunately, the risk versus benefit ratio is heavily in favour of a short term inconvenience to avoid a long-term catastrophe.

The Health Secretary, whatever his intentions, has little understanding of the front line and what doctors and nurses sacrifice to make the NHS work under increasing financial strain. For a decade we have continually been doing more with less, and the service is spread dangerously thin as it is. His words ring empty when he commends us for being the back-bone of the NHS but in the same breath tells us to ‘get real’. Or when he suggests doctors are not willing to negotiate when of the 23 key points he has stated 22 are non-negotiable (the single point he is willing to negotiate is travel expenses). 

His lack of understanding has been shown clearly with his repeated misuse of scientific data for which he was reprimanded by Fiona Godlee, the chief editor of the British Medical Journal. His promises of 11% payroll rises (while apparently remaining cost neutral) fall to pieces when the details are examined. Unfortunately Mr Hunt is playing a game of politics while the entire medical profession is whistleblowing at a contract that is unsafe for patients and may be the demise of the NHS.

Like any other person, or any other profession, we want to feel valued. Reducing our pay (in real terms) by up to 25% is just one of the issues at stake (Mr Hunt has offered a ‘temporary pay protection’, future junior doctors will be worse off). We are not asking for a pay rise. We are asking to be valued. We are asking for the right to a social and family life. We are asking to be treated as a bright and dedicated workforce that can think for ourselves. Give us autonomy. I am dismayed the Secretry of Health has not once asked for the advice or guidance from the doctors he is supposedly working with. Why not ask us how to improve service? Surely we have more insight than anyone else?

A doctor that is happy and feels valued will go much further for their patients – because that is the only thing we know. We channel our lives to be single minded – patient safety is our calling. 

If patient safety was truly the Health Secretary’s aim, he would heed our calls.

Drop the pre-conditions. Drop your threat of imposition. Adequately fund and staff your plans or appreciate what is actually feasible. Listen to our concerns and get us back round the table.

The strike is avoidable, and it is at Mr Hunt’s discretion.

The Locum Price Cap is Coming!

Posted on November 10th 2015 by What The Bleep

With the government's plan to cap rates on locum shifts for doctors from the 23rd November 2015, and reducing further the capped rate on two future dates (1st February 2016 and again on 1st April 2016) the prospect of doing locum shifts is becoming less appealing. With the junior doctor contract dominating our attention the government are implementing the locum agency price cap, keeping this under the radar and knowing we can't fight this publicly with the junior doctor contract as it will be hard to gain public support for our fight against this. So we thought it was important for us to make this page to keep you updated with advice on how to fight the locum price cap.
The first thing we all need to do is to register our views and response to the proposals using the government's response form here. Urgent this must be done by the closing date of 5pm 13th November.

It is important to stay together against the cap from the start as otherwise it will gradually drain the NHS of good locums and cripple the NHS. Now some doctors may think that this doesn't concern them as they don't do external locum shifts, and you would be wrong. This will impact everyone, it will affect those who do external locum shifts, those who do locum shifts within your own hospital, and by draining the NHS of locums it will affect doctors on-call who are understaffed when Medical Staffing are unable to find a locum doctor willing to work for peanuts at short notice, and it will also affect doctors during the day when Medical Staffing personnel try rearranging and stretching their own doctors to cover shortages across the rota that they can't fill with locum doctors.

WHAT WILL HAPPEN?

Most trusts have an 'internal'/'bank' locum rate which they offer to their own doctors, and if they fail to fill the shift they will offer it out to locum agencies to fill with an 'external'/'agency' locum. Now unfortunately the difference in pay between internal and external locum can be massive and initially for the first capped rate on 23rd November will most likely affect the external locums worst, bridging the gap between external and internal locum rates, however the further reductions in the capped rate will then affect all doctors.

Below is the new proposed locum pay rate table published by the government's Trust Development Authority.

WHAT WE NEED TO DO

1. AGREE A RATE WITH YOUR HOSPITAL

From the 22nd November if Medical Staffing in your hospital try and alter your rates for internal locum shifts we advise discussing with your colleagues in your hospital and formally agree a rate with Medical Staffing that is reasonable (negotiations should be led by your year rep). For internal rates FY1s should not be getting less than £30-35 per hour, SHOs £35-40 per hour, and Registrars £45-50 per hour (more for A&E), so this may not affect those just doing internal locuming in November, but if you agree this rate in November then Medical Staffing will be the ones facing the problem when the government drops the rate again on the 1st February 2016. If Medical Staffing drop the rate in February then stick to your guns and don't take the shifts, you are stronger united.

Now with the new capped rates we are unsure how the Medical Staffing will react but at the end of the day if the internal doctors don't take the internal locum for less than their agreed rate then Medical Staffing will have to try and fill the gaps in the rotas with external doctors which will be harder for them to get.

2. DON'T GET BULLIED INTO DOING EXTRA SHIFTS

Please be warned with the government's plan it will become harder for Medical Staffing personnel to fill locum shifts and we expect that they may start to take advantage of doctors (especially FY1s) so don't be bullied into doing an extra shift you don't want to do, or into taking a shift for a rate that you don't want. You are not obliged to do additional hours. If you do feel bullied into covering extra shifts then please call BMA for advice. 0300 123 1233.

3. SUBMIT INCIDENT FORMS

If you are understaffed and a locum doctor is not supplied as a result of the locum price cap, submit an incident form as a risk for patient safety, and continually bring it up in junior doctor/departmental forums. For patient safety issues you must also inform the Clinical Director each time this happens. 

4. TAKE YOUR NAME OFF THE INTERNAL REGISTER

If Medical Staffing personnel are not negotiating on the rate then stand your ground and ask to them to take your name/details off their 'internal locum' register. This is a register of doctors in the hospital who have opted out of the European Working Directive and who get emailed about internal locum jobs. This leaves a clear message that you are not interested in the locum shifts for the rates they are offering.

5. JOIN A LOCUM AGENCY

If you do still want to do locum jobs at your hospital then ask to be taken of the hospital internal locum register and join a locum agency (pick one which supplies to your hospital). It is unclear how badly the price cap will impact locum agencies but we would advise joining one, because their interests align with ours they will be an additional defence against the capped rates. Though you may have to take care that some locum agencies don't just follow the government's cap giving you low rates. Let them know early on what set rate you are only willing to take jobs for, then the locum agencies will be forced to fight against the cap to find doctors jobs for these rates otherwise the agency will be out of business. They also have more money, personnel and resources to fight against the price cap.

Registering requires an application form and a CRB, however once done you are sorted and you will get access to the same jobs at your hospital but potentially at a better rate!
It is also worth being aware that if you are in a training post, your contract says you should not take locum work for another employer. This doesn't stop you from working as an external locum through a locum agency in your own hospital.

Junior Doctor Contract - Longer Hours, Less Pay, Patients Suffer #NotSafeNotFair

Posted on November 1st 2015 by Taha Nasser on the The Utopia.

What are the DDRB recommendations in question?

Recommendations 3, 4, 5, 6, 7, 8, 17, 18 increase routine working hours from 7am – 7pm Mon – Fri to 7am – 10pm Mon – Sat. This increases ‘standard rate’ working hours from 60 – 90 hours per week, an increase of 30 hours.

What would be the effects of this?

It would mean that ‘standard rotas’ and standard days can be much longer. Currently, having to pay us more than basic rate for that extra 30 hours a week with a banding system means that there is a financial incentive for rota co-ordinators to not rota us on for even longer hours back to back and to make sure that our rotas aren’t purely shift work.

If we did move to a system that resembles shift work, for which there would now be no financial penalty, it would cause:

• Greater social strains on doctors since it’s likely they would be working evening, weekend and night shifts even more routinely.
• Greater fatigue and potential damage to patients due to mistakes
• Less interaction with our consultants and thus end up less well trained by the time we become consultants

How do we know that we will work hours for less pay?

(Dr Steven Bishop models effects of DDRB proposals on doctors’ pay)

Broadly speaking, the changes to the contract are likely to cause an overall pay cut in the vast majority of specialties. This was modelled by Dr Steven Bishop, an Academic Clinical Fellow in Anaesthesia and a Specialty Registrar from the Cambridge University Hospitals Trust. His model, based upon the pay scenarios proposed by the DDRB showed that the majority of specialties including general medicine, surgery, psychiatry, A&E, Obstetrics & Gynaecology and Anaesthetics suffered sizeable pay reductions throughout their training period, with Anaesthetic trainees being especially badly hit.  The exact pay cut varies depending on what the DDRB sets as their basic pay rate for non out of hours work, but at it’s most severe it may lead to a pay cut between 10 and 30% depending on the specialty. The changes in pay structure would also mean that doctors would end up in a higher bracket of pension contributions earlier but since their overall pay would be cut, they would actually get a lower pension return when they retire. The DDRB also recommends a cut down on current annual leave, which is tantamount to an even greater pay cut.

What has been the Department of Health’s Response?

It’s worth analysing Jeremy Hunt & the department of Health’s responses to the realities that I’ve outlined so far.

(The BMA explains why the new contract proposals are unacceptable)

In September, the BMA walked out of negotiations after the department of health had made 22 of the 23 points on the DDRB proposal ‘non negotiable’ before the negotiations had even concluded. The department of health then released a statement claiming that it was the BMA that was at fault and that the new contract ‘increases basic pay’ and ‘rewards those who work across all clinical specialties’. In reality whilst basic pay may increase marginally, for many overall take home pay will decrease significantly. By only mentioning part of the picture whilst not explaining what the overall effect would be, the department of health has purposefully tried to mislead us and the public on the issue. And as for the second part of the department of health response, that the new contract ‘rewards those who work across all clinical specialties’ – that simply isn’t true. Many general medical and surgical specialties as well as GPs will suffer pay cuts.

(Parliament debates the Junior Doctors’ Contracts from 16:15 onwards)

This past week Jeremy Hunt was involved in the commons debate where he attempted to claim that no junior doctor would suffer a pay cut. Unless the sample pay schemes that we have been shown are going to be totally revised, this simply cannot be true. As Dr Steven Bishop’s analysis shows, every pay scheme proposed by the department of health creates a pay cut to multiple specialties. Bearing in mind that that this is the same department of health that misrepresented research about deaths on the weekends then used those false conclusions to make an attack on consultants who already work weekends, and then purposefully attempted to mislead the public into believing that we were actually getting a pay rise by only mentioning our basic pay it’s little wonder that we’re forced to conclude that Jeremy Hunt is lying when he says that no doctor will suffer a pay cut, likely in a crude attempt to divide our ranks the week before we are set to vote on a strike. It is  therefore absolutely vital that we see through this tactic and continue onwards united behind the BMA.

Two things to do:

1. Make sure that you vote yes and yes to both types of strike in the forthcoming BMA ballot. The wording of these strikes may not be exactly what you want, but they are worded in accordance with legislation that means that the BMA then has the freedom to go forward with a complete strike if needed.

2. Make sure that you find out who your local MP is (Find your MP) and write to them, making it absolutely clear why you are opposed to the contract and if they’re conservative, make it clear that allowing these contracts to go through will cost them your vote.

See Taha Nasser's blog on the The Utopia.

The Fallacy of Hunt

Posted on October 29th 2015 by Gagan Bhatnagar on the clinioncdoc.

“Sorry, this is quite complex for early in the morning” – Jeremy Hunt

The time: 07.15 on the 29th of October 2015 on the BBC.

What Mr. Hunt was trying to explain was how junior doctors working “within the legal limit” will not see any reduction in their pay.

By comparison, thousands of junior doctors have been up all night caring for patients. They would be expected to make life-saving, high-pressure decisions at 07.15 after being awake for 10 hours without so much as a bathroom break. The kicker – this time is classed as ‘social hours’ or ‘plain time’.

Fallacy 01: If Mr. Hunt can not manage simple arithmetic at 07.15 because it is too early in the morning, should he be peddling ‘sociable’ working hours of 0700-2200 Monday to Saturday for doctors? – Where doctors receive no additional remuneration for working outside of the standard 9-5 time bracket.

Given that Mr. Hunt is not particularly strong in arithmetic, we may want to delve deeper into what he is promising for the hard-working junior doctor workforce. He proposes the following: 

• A reduction in maximum working hours from 91 hours/week to 72 hours/week
• A pay envelope that is cost neutral – that is to say, no money is being put in or taken out from the pot of money used to pay junior doctors.
• Extending services by 40% to  include Saturday and Sunday
• No additional doctors will magically appear to fill in for these extended services.

Let’s provide an example with some estimated rounded figures

• Let’s say, for any given week, a hospital requires 100,000 junior doctor man hours (JDMH).
• Let’s say there are 1000 doctors in the hospital each working 100 hours/week to achieve this.
• By extending services by an extra 2 days – the hospital now needs 140,000 JDMH.
• However, there are still only 1000 doctors (a deficit of 400 doctors).
• The hospital now requires 140 JDMH per week per junior doctor.
• However, there is no additional money being inserted into the system. So, that’s 40% extra for no additional cost.
• But now the maximum number of hours a doctor can legally work is reduced to 50 hours / week so the hospital needs 2800 doctors to cover the 140,000 JDMH.
• Again, there are no more doctors, there is no more money – the solution: to make doctors’ labour cheaper and make them work ‘off the books’.
• Alternatively, this could be done at the expense of closing services on, say, a Wednesday to reduce the number of JDMH required by the trust.

Fallacy 02: If there are no more doctors, and there is no more money, extending services by 40% will mean the same doctors are doing this from the same pay envelope. That is, more work for no extra cost. His intentions were made clear by increasing plain time from 60 hours/week to 90 hours/week.

Mr Hunt has reduced the maximum number of hours that a doctor can ‘legally’ work. Doctors already go far beyond their contracted hours and don’t ask for a penny more. Doctors DO NOT work 91 hour weeks because of perverse monetary gain. They work these hours because there are simply not enough doctors, because there is a NECESSITY to work these hours.

Fallacy 03: By reducing the maximum hours but not increasing the number of doctors in the pool, he is advocating an increase in unpaid ‘off the books’ labour of the current doctor workforce. This is confirmed by the removal of financial penalties to trusts for over working doctors and the removal of regular hours monitoring – both of which acted as safeguards to prevent a fatigued workforce.

Mr Hunt keeps mentioning patient safety on weekends. The rhetoric of 15% higher mortality at the weekend. The dreaded ‘weekend effect’.

Let us be clear, Mr Hunt keeps quoting a research paper by Freemantle et al (2015). Increased mortality associated with weekend hospital admission: a case for expanded seven day services?

The ‘weekend effect’ describes Friday to Monday (4 days) where a patient is up to 15% more likely to have died 30 days after admission. That’s right…1 month after admission to hospital.

Courtesy of Freemantle et al 2015 – 30 day mortality, relative risk by day compared to wednesday

To simplify this image – if an unwell patient is admitted on a Friday you have a 2% increased chance of not being alive 1 month later compared to a wednesday. Saturday 10%, Sunday 15% and Monday 5%.

The same study showed that an inpatient had a 1% LOWER chance of dying if they were in hospital on a Sunday compared to a Wednesday (although this value was not statistically significant) and a 2% LOWER chance of dying as an inpatient on a Saturday compared to a Wednesday (this was statistically significant).

Courtesy of Freemantle et al 2015 – In hospital mortality in comparison to wednesday

In fact, your risk of dying IN HOSPITAL is LESS on Saturday and Sunday than a Wednesday as Freemantle demonstrated in 2012. Weekend hospitalization and additional risk of death: An analysis of inpatient data.

Courtesy of Freemantle et al 2012 – mortality divided by day

Fallacy 04: Doctors do not deny a ‘weekend effect’. However, the cause of this effect is unknown. It has been observed that globally, more acute / unwell patients are admitted on the weekends and it is speculated that this is a major contributing factor to increased 30-day mortality. It is unlikely to be related to junior doctor staffing on Saturday and Sunday as indeed, mortality on those days actually DECREASES compared to when the hospital is more fully staffed.

The authors of the paper Mr Hunt so readily quotes have stated quite clearly:

“It is not possible to ascertain the extent to which these excess deaths may be preventable; to assume that they are avoidable would be rash and misleading.”

Fallacy 05: So why is Hunt being “rash and misleading”? His motivations are unclear. If this were truly about patient safety, Mr Hunt would promote more research into the actual cause of the weekend effect. Is it that patients are genuinely more unwell towards the latter half of week? Why is this? Is it the lack of social care facilities available at the weekend? Is it our weekend habits of excess alcohol, smoking and generally unhealthy lifestyles? Is it truly the lack of junior doctors or nursing staff? Is the lack of access to community GPs on the weekend? Is there a decrease in compliance when taking medications at the weekend?

There are no answers yet, only questions.

To steamroll through changes to try to fix an unknown is haphazard and foolhardy. Or perhaps he has an ulterior political agenda? Why else would the health secretary ignore the pleas and calls from the ENTIRE health workforce (including all the Royal Colleges) who have unparalleled insight into the workings of the NHS?

I am no politician.

Mr Hunt’s weakness with numbers is apparent. I, however, am trained to interpret scientific research. To analyse and critique data for the sole purpose of improving outcomes for my patients.

Patient safety is my calling. Is it truly yours Mr Hunt?

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See Gagan Bhatnagar's blog on the clinioncdoc.

An Apolitical Creature

Posted on October 27th 2015 by Gagan Bhatnagar on the clinioncdoc.

I am not a political creature.

I’m a doctor. I’ve spent the last 12 years of my life rigorously training to be able to look after the public. My training continues even now, as a clinical oncology specialist registrar (cancer specialist), and I look forward to many more years as a junior doctor. Up until now I did not worry myself with politics, perhaps naively assuming the UK government had the peoples’ best interests at heart. 

Why is this important? Why is this relevant? Because today I am no longer that person. Today I am angry, I am frustrated, I am genuinely worried. 

20,000 doctors turned up in London to protest contract imposition

The NHS is under attack and it WILL NOT survive without public support.

The Health Secretary,Jeremy Hunt, and the government are in the process of undermining and attacking doctors throughout the nation with the imposition of an unsafe and unfair contract. The details of this contract have been covered extensively in the media but, put simply, will lead to:

1. The removal of safeguards protecting junior doctors from overworking by removing financial penalties on hospitals for scheduling work-heavy rotas.
2. Removal of pay progression if doctors go into clinical research (yes…including cancer research) or decide to work part time to have a family – essentially penalising doctors for doing research or having a family.
3. Extending ‘plain time’ by 50% from 60 hours/week to 90 hours/week. (By comparison the average 9-5 job has plain time of only 40 hours) 
4. This will lead to a pay cut of up to 30% which will hit the acute specialties who do the most antisocial hours (Accident & Emergency, Intesive Care, Obstetrics, Acute medicine) that are already struggling to recruit doctors.
5. Recommended 20 minute break every 6 hours. That’s right…if I do an 11 hour shift, I am afforded only 20 minutes (including my time for lunch)

These are amongst the few of the recommendations from the Doctors’ and Dentists’ Review Body (DDRB) which, suspiciously, lacks either a doctor or dentist on the panel. In fact, not a single front line health worker was on the panel to provide insight into what happens on the shop floor.

The government are suggesting these proposals are to provide a 7 day NHS while maintaining cost-neutrality. Let’s be very clear about this:

The NHS is a 24 hours/day, 7 days/week, 365 days/year service

 

Proof of a 7 day NHS. Thousands of placards held for doctors unable to attend as working on a saturday.

Distinctions between emergencies and routine care is something our Health Secretary has been unable to do. 

Emergency care is always covered, round the clock. 

However, if you would like that routine operation to remove a bunion, it may not be available on a Saturday or Sunday. The simple reason for this is that there just aren’t enough doctors, nurses, radiographers, healthcare assistants, porters, pharmacists, secretaries, cleaners on the weekend to achieve this. 

Herein lies the problem. The NHS is cash-strapped. Long term underfunding from the government has left the NHS on the brink of collapse. At present it is struggling to hold together a 5 day service and indeed may only be being held up by the good will of the staff who work an insurmountable number of unpaid hours for the benefit of the patient. 

The government are imposing an increase in productivity of 40% (2 extra days) without providing any more money or more staff. It has been suggested that for there to be such an increase, the NHS would need to recruit over 30000 more doctors(currently there are 53000 junior doctors). It does not take an economist to tell you this is fool hardy and short sighted. 

The proposals suggest same number of doctors will cover an additional 40% of the service. This will stretch the regular 5 days in the working week even thinner. At a time when staff are at breaking point, this will be the anvil that breaks the camel’s back.

Surveys have shown, if these contracts are unilaterally imposed by the government, up to 70% of junior doctors would move abroad or give up medicine entirely. Even if only a small fraction of this number leave the workforce due to unreasonable working conditions, this would have catastrophic implications for a stretched service.

So why? Why go against the advice of 53000 junior doctors and all the Royal Colleges who have unparalleled insight into how the NHS functions?

To paraphrase Noam Chomsky: Underfund,  Villify, Demoralise, Privatise.

In the long run, doctors would benefit from a privatised healthcare system (case in point The United States Of America). It will be the patients that suffer. So it should be ringing alarm bells when as a workforce we are fighting desperately to avoid it. The reason is simple…patients will suffer.

From day one, we are indoctrinated with one mantra – Do No Harm. As a workforce we go above and beyond for patients, we dedicate our lives to serve the public.We are not perfect and we make mistakes – we are after all human, but our goal remains singular.

Our previous health secretary, Mr Andrew Lansley, now sits on the board for a firm promoting privatisation of the NHS. There is no reason the current health secretary will not follow suit.

The imposition of these contracts would only be the beginning of the downfall. Nurses would be next, then pharmacists, then radiographers.  Then the reality of paying thousands of pounds for surgery for your burst appendix or for your grandmother’s hip operation, or hundreds of thousands of pounds for your cancer treatment may become a reality. Once the system is broken, there will be no going back. But those that have made the decisions on your behalf will already have lined their pockets.

So what can you do? Write to your MP. Voice your concerns. Join the debate. Support your junior doctors should they reluctantly ballot to strike. Start telling people. If you don’t stick up for the NHS when it needs you, it won’t be here much longer to stick up for you.

While it may not seem it now…this is everyone’s fight. 

I am not a political creature.

 I am a doctor.

#juniorcontract #notsafenotfair #saveourNHS 

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See Gagan Bhatnagar's blog on the clinioncdoc.

Avoidable Hospital Deaths - Who is Really to Blame?

Posted on October 22nd 2015 by Steve Smith on Big Up The NHS.

So Fiona Godlee, editor of the British Medical Journal, has at last written to Jeremy Hunt accusing him of “publicly misrepresent(ing) an academic article printed in the BMJ”.  She referred to theFreemantle paper which clearly demonstrated a statistical excess of deaths in patients admitted to hospitals over the weekends but which did not conclusively identify the cause.  She said that “Despite the authors’ very clear statements (that the data did not indicate a the cause) in the paper and elsewhere, you (Jeremy Hunt) have repeatedly told MPs and the public via media interviews that these deaths were due to poor staffing at weekends, with particular emphasis on medical staffing. This clearly implies that you believe that these excess deaths are avoidable”.Godlee is not the first to point out his overegging of the evidence. There are dozens of rapid responses printed alongside the paper in the BMJ (including my own) which say pretty much the same thing. Causality cannot be determined from this study and to imply that it can for political purposed is dishonest and potentially harmful.

Earlier this week two academic doctors wrote to the cabinet office asking it to investigate Hunt’s claim that the 11,000 deaths were due to too few doctors being on duty. They alleged that that he had breached the ministerial code of conduct by misrepresenting official statistics. The letter was signed by thousands of fellow doctors.

I know from personal contacts in the Department of Health and elsewhere that Mr Hunt has been briefed, is well aware of these concerns and understands the issues completely, yet he has continued to make the same unfounded claims.

So it appears highly likely that Mr Hunt has indeed deliberately attempted to mislead the public about weekend death rates, which begs a crucial question. Why has he felt it necessary to do this?

The wider context

This question should be considered with reference the wider context of what has happened to the NHS in recent months.

The NHS is under considerable pressure at the moment. Staff morale is low, finances are stretched to breaking point and demand for services is increasing. Disgruntled doctors have taken to the streets. More than 30 acute trusts have not been able to recruit a permanent CEO. Many have predicted a very difficult winter ahead with the potential for significant service failures.

In these circumstances one might expect a responsible government to take a lead on emergency contingency planning, identifying and plugging funding gaps and taking actions to encourage recruitment and retention of staff.

This has not happened. There is no central winter emergency plan – that has been delegated to the regions. (I know about the Cold Weather Plan which is about wearing a thicker pullover and is different). There is no attempt to help or financially bail out “failing” trusts, despite the fact thatmoney is available. Putting trusts into special measures and walking away is unlikely to help the situation.

Picking public fights with junior and senior medical staff by threatening to unilaterally impose Draconian changes in terms and conditions is deeply unhelpful. Promising the public an elective 7 day service when there is clearly insufficient money to operate the current system, threatening todeport overseas nurses,  capping spend on agency nurses regardless of whether they are essential for safety, going back on safe ward staffing level recommendations, the list goes on.

So why has Jeremy Hunt found it necessary to try to deceive parliament and the public about weekend mortality?

When taken in the wider context one can only speculate on his motives for doing these things.

• It could be that he is just ham fisted and does not understand how the NHS works
• It could be that he deliberately wants to break the NHS in order to facilitate a change toward a more commercial model
• It could be that he has become so focused on his spat with hospital doctors that he prepared to generate fear in the general public as a political device to get his own way regardless of the consequences
• It could be that he does not have the insight to realise that these scare stories cause real distress for real patients and staff and does not appreciate the harm he is doing.

Only he can say why he has done what he has done and perhaps he should be asked formally. In a sense the reason for his actions is unimportant – it is the consequences of his actions that matter.

When there is a major disaster such as a train crash and people are killed the investigation quite rightly looks at the senior management in charge of the service and if they are found lacking they may be vulnerable to prosecution on charges of corporate manslaughter.

If acute front door services in a major trust fail completely this winter it will be just as serious and potentially just as deadly as a major train crash. I don’t know if the law on corporate manslaughter applies in the NHS or indeed even if such a catastrophe would trigger an independent investigation. We all accept that it is so likely to happen that it will probably not even make the news headlines.

When emergency services are starved of funds and staff, stretched to the limit, abused and abandoned then mistakes are likely to occur and patients are likely to come to harm. Perhaps now is the right time to have a grown up, rational debate on avoidable deaths, their root causes, and the potential effective solutions – and to identify who is really to blame.

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