“There's Not A Lot Of Sense From Government Right Now."

Posted on 25th April by JuniorDoctorBlog

Ben White, junior doctor, campaigner of NHS no. 1At Xmas and Justice for Health, quit his training job on national television this morning.

In his response something he said resonated with me- “there is not a lot of sense from government right now.” To my mind this phrase  encapsulated the whole dispute.
Ahead of the first full NHS junior doctor walk-out in history now seems a good time to document the completely insane handling of the process.
The ‘Weekend Effect’

Supposedly this all started with Hunt and colleagues ‘discovering’ that patients admitted at weekends had a slightly higher chance of death than weekdays. This whole concept has taken a rightful battering;

What we know about this now is:

– The study was commissioned by government

– The independence of key authors is questioned

– The study showed no link to junior doctor cover

– Pending studies of the same data may show no ‘weekend effect’ at all

– It’s likely sicker patients are not properly adjusted for

– It’s a phenomenon seen worldwide, which no health system has been able to understand or ‘fix’

– The study concludes its unlikely this ‘effect’ is actually avoidable
So, not a great start. From this starting point, we are told, the government began the drive for a ‘Seven Day NHS’
The Seven Day NHS 

A ‘back of the envelope’ idea from the last conservative manifesto.
– originally led by Sir Bruce Keogh

– The actual plan was originally to improve urgent and emergency care, then create elective work throughout the week

– All heads of the NHS said this would require additional funds, staff and years of planning, outside of additionally needed funds to keep NHS going at current service

– A ten-point survey of ‘Seven Day’ criteria found medical cover at 100%, while most other services were between 50-60%. The cut off for finding a service “7-day NHS” ready was 70%. So nearly there without any massive reorganisation required.

– The 7-day NHS criteria desperately fell down on social care and mental health- both areas savagely cut by this government

– Hospitals touted as already ‘7-day’ like Salford Royal, have neither routine elective weekend work or a new contract. They did however spend additional funds and recruit extra staff.

– After a year of ‘7-day’ NHS policy speeches, NHS strategy head Charlie Massey revealed they didn’t know how much it would cost, how many staff would be needed, or what it was. He was told he was ‘flying blind’ on the issue

– A leaked report from the DoH showed that it would need 4000 extra doctors, funding of£0.9 billion/yr or £3.6 billion by 2020, and likely would not change the ‘weekend effect’.
So, you are a government in power- you misidentify a problem, create a nonsensical plan to try to fix said likely unavoidable problem, don’t fund it, plan for it or cost it, and then try to improve upon the existing 7-day cover for doctors, already at 100%, while ignoring the huge 7-day service gaps in social care and mental health that are a genuine problem.
Make any sense so far? No? It gets worse.
The Junior Doctor Contract

Into this mess was ‘imposed’ this new contract.

What we now know about this:

– it will cut pay for junior doctors coming into the system from August, and all doctors by 2019.

– It removes all previous safeguards on overworking doctors, and removes ‘real-terms’ fines for hospitals who make illegal rotas, replacing the system with part-time guardians schedules to work just 4 hours/week.

– Cass Business school said the proposed rotas under the contract risked jet lag, and may ‘breach employer duty of care’

– Remember no study showed junior doctor cover at any time was lacking already

– The contract discriminates against women and parents, by the governments own admission

– The legal power to impose is being challenged in court

– Negotiations have been ongoing for three years- there is no pressing need for new contracts

– This contract is completely untested and unmodelled- trusts need more doctors to implement it safely as it is

– A ‘junior doctor’ is any qualified doctor up to consultant level, 10-12 years of working. There are ‘junior doctors’ who have been doctors longer than Jeremy Hunt has been an MP.

– The contract began as a cost cutting exercise amongst a group of NHS execs in the south west
This has to have been one of the most damaging instruments of government policy in NHS memory. So if this contract won’t fix the problem that may not be a problem and actually ignores the real issues in the NHS, then one has to ask, why bother? Does it make sense to any of you?

The NHS

The NHS is in real peril. Here is a rundown.

– The government ‘promises’ ten billion pounds over 5 years. This would push NHS funding LOWER in the OECD %GDP tables than it is now- to 6.7% which is lower than nearly all of Europe. France and Germany spend 11.1%, the US nearly 18%.

– Prof Don Berwick, former NHS safety tsar, said ‘I know of no country attempting to fund modern healthcare on 8% GDP, let alone 6.7%.’

– This is because NHS costs rises every year – this is called health inflation.

– If you cut funding, you don’t treat patients promptly and properly, they get sicker, and it costs more

– This creates a vicious cycle- where we are now

– Waiting times in A&E are at an all time high

– Hospital Trusts this year will reach a record £2.8 billion in the red- this is because hospitals refused to cut staff to save money, and overspent the budget from The government to keep patients looked after.

– GPs received 12% funding of NHS budget in 2010- this fell to 8% this year. With the government new plan of £2.4 billion this will still be only 10% by 2020.

– Recruitment and retention for medical and nursing staff is in trouble with rising vacancies

– An A&E in Lancashire closed last week because of a lack of doctors

– Meanwhile private companies are buying up services. 500% increase last year alone.
So is the solution to this mess increasingly aggressive political posturing, imposing a contract that is destroying morale, in a bid to fix a problem that doesn’t exist through a programme that doesn’t have a budget or a plan?! Rearranging the deck chairs on the Titanic isn’t even half of it. This is insane.
So when Ben White says “the government isn’t making a lot of sense” that’s TV politeness for – this government has lost all sense of governing. Whether that’s incompetence or incomprehension of the massive danger the service and the patients are now in, it’s hard to tell.
You might think that the strike tomorrow is extreme, but when faced with such an extreme scenario, what else can we do? A sensible offer of proper research and a trial of the new contract was put on the table yesterday by a cross-party group of MPs. The first sensible thing government has done for the NHS in years.

And of course rejected out of hand by Messrs Hunt and Cameron.
This is madness, not from junior doctors, but from a government set to destroy the NHS.
I think it’s time to send in the people in white coats. We are outside your doors Messrs Hunt and Cameron, a quiet word please?

Juniordoctorblog.com

Meeting Jeremy Hunt

Posted on 20th April 2016 by Alex Murray on MurrayHealth

As assignations go, this one could have been like a date with the devil. An hour in a room with Jeremy Hunt? For many of my 53,000 junior doctor colleagues, this might be their worst nightmare.

Actually, the reality was rather different.

Last night I met Jeremy Hunt in the heart of the parliament buildings. I was one of the two doctors who were invited from outside the Department of Health to talk. Why were we outside the DoH you ask? A group of junior doctors launched the peaceful indefinite protest 8 days ago now to highlight Jeremy’s unwillingness to return to negotiations over the junior doctor contract. An empty chair with his name sits beckoning for resolution.
So on my day off I turned up at 9 am to wait for a chance to talk.  The support from the public, MPs, civil servants and the BMA has been overwhelming.

His advisor and secretary turned up at our protest around 17:30 and asked if we wanted to talk to Jeremy.  I did not feel rushed to go meet him but there was a definite – ‘now is the only good time’ feel. As we walked up the steps to his parliamentary office, I carried the weight of 53000 doctors hoping he’d change his mind about imposing his contract.

Was I nervous? No. I genuinely wasn’t. And the reason is this: I don’t care anymore how it started, the whole ‘he said/he said’ arguments between the BMA and Jeremy, which I can never verify because they occurred behind closed doors. Nor do I care about which point was the sticking point in negotiations. Do I want a pay cut? No. Do I want to do more night shifts? Definitely not. I know the NHS is a political bargaining chip but I even don’t care at this stage which government is tinkering with it. What matters is the patients. We need a solution, a repair and – to go one further – an improvement to the relationship between junior doctors and Jeremy Hunt. Because only in that way will we break this deadlock.

What was most striking during our meeting was the disconnect, the mismatch. We both said we want to protect patients and improve services. He trusts and respects Bruce Keogh and David Dalton, yet we junior doctors on the frontline know they are outdated and no longer have their finger on the pulse of the NHS or the lives of junior doctors. He seems to genuinely believe his new contract will save lives at weekends, we know that – contract or no contract – we simply do not have enough doctors as it is.  We are papering over the cracks in the NHS with goodwill. There are so many rota gaps I get daily emails from multiple hospitals asking for locum cover. He says he will hire another 5000 doctors, we know these ‘extra’ doctors just don’t exist. And if they did, what on earth would make them want to come work in England, where a contract is being forced upon them?

We had a civilised conversation, not a slanging match, and I asked a lot of questions, about staffing levels, safety, funding, statistics interpretation and how we came to this impasse.  Nothing new was said but under-running this discussion was the feeling that he believes what he says, though we know some, if not most of it is flawed.

Jeremy Hunt may think he is doing the best thing for us, but myself and the 53,000 doctors in uproar over this know that contract imposition is far from the best thing for our patients, us, or the future of the NHS.

So I asked the ‘what if’ question. What if you could have anything in exchange for removing imposition? His reply? ‘Nothing’.

Is there really nothing he would ask for in exchange for removal of the imposition and to work with junior doctors?
And so, sadly, the peaceful protest outside the DoH goes on in the hopes of future negotiations.

I stand for my patients and for my colleagues but, if Jeremy genuinely stands for improving the NHS, surely we should be on the same page? What would it take, Jeremy? Call me naïve, but I stand by this: it is never too late for us to find a solution together if the imposition is removed. The olive branch is there to take up. Let us pick up a clean slate and move forward together: what would it take, Jeremy?

Alex Murray
Junior Surgeon

Do No Harm Does Not Mean Do Nothing

Posted on 18th April by JuniorDoctorBlog

It is a common misconception that the only principle of being a doctor is ‘Do No Harm’.

The four pillars of medical ethics, beat into us at every exam and interview, are thus;

“Beneficence, justice, autonomy and non-maleficence.”

Let me explain. Beneficence simply means ‘do the best for your patient’, or more simply ‘always act in the interests of your patient’.

Autonomy means ‘respect the individuals right to make their own decisions’, and this often comes into conflict with the first pillar. The best medicine for my patient might not be one they want, or their decisions might bring them to ill health e.g smoking, but that’s their right. Some patients may not have full autonomy- advanced dementia, confusion, even being drunk. Then we act in the best interests of the patient, and do what we can.

Justice means different things to different people, but essentially is ‘treat all patients fairly and equal’, but each decision must be right for the individual patient, and respect their wishes.

Finally, non-maleficence is the infamous ‘do no harm’, but already you see the complexity. ‘Do no harm’ does not mean do nothing.

Take for example an operation to replace a broken hip. Have you ever seen it? A vital, life-saving intervention for an older person who breaks their femur (the long leg bone that ends at the hip)- it starts with a long slash across the thigh, followed by wrenching and cutting through the thick muscles to the bone itself. The head is sawn away and ripped out, the cavity ground down and shaped with power tools, a metal head chiselled and rammed in, then hammered into the existing bone. Blood flies out, cement pours in. It’s one of the most brutal things I’ve ever seen done to a human being. It certainly would constitute ‘harm’, but it serves a higher purpose- the beneficence of the patient, ie a new hip, restored mobility, and a better chance of longer life. The same could be said of nearly everything medicine does- from the needle puncture for a blood test to the toxic side effects, and indeed intended effects, of chemotherapy for cancer. To simply say ‘do no harm’ means ‘take no action’ neglects the fundamental balance of risk and benefit that underlies all medicine.

Every decision therefore is usually a conflicting mix of all of the four pillars of medical ethics, and we must synthesise every part of the law and of our own conscience to act in the best interests of the patient, fairly, safely and in line with their own wishes.

Now apply this view to the next junior doctors full strike, with emergency care juniors walking out as well.

We’ve heard plenty about the ‘do no harm’ argument – the government has lined up everyone on the payroll to give their two cents in the press. Darzi, Stephenson, Keogh, Davies. Some retired guy that resigned as chief medical officer 15 years ago.

But does it actually add up?

Let’s look at the situation on the ground. There are around 44,000 consultants in NHS hospitals, 54,000 juniors Doctors and 10,000 non training and dental staff. On any given emergency day, such as the Royal Wedding, the number of junior doctors that cover emergencies only is around 10-30% of the workforce. So in a full walk out, assuming everyone does walk out, you would need about 5000-18,000 doctors to replace them to provide emergency care. You have 54,000 non-junior doctors, consultants and other non-training doctors, on payroll, who also happen to be the most experienced doctors in the hospital. That’s without preparation. Hospitals are taking proper measures to ensure safety, led by our consultants and managerial colleagues. In fact, with the active movement of additional blood taking and clinical support staff to wards, the deployment of several consultants per striking junior, and proper bed management, some hospitals might even be the safest they have ever been. So the proposition of significant ‘harm’ is logically unlikely.

What about autonomy? The government spin machine would like you to believe we have none, we are ‘misled’ by our union, and we do not have the ability to make decisions ourselves. This movement has been led by the grassroots from the beginning- the hashtag #iminworkjeremy trended nationally in July 2015, from everyday doctors in response to the first shots from government over this contract in the press, not the BMA. Since then it has been the grassroots at the forefront, driving the BMA. Not the other way around. It is our jobs to take large volumes of information, synthesise that and make a complex decision, and then take responsibility for that judgement. To say we act without understanding is ludicrous.

What about beneficence? Much of the public don’t understand this issue, and for that we apologise. It’s about making a workforce cheaper, removing safeguards that cost hospitals money, and stretching lucrative elective weekday work into the weekend. It is, as it always has been, about money for the government, at the cost of safety. We recognise that, and we recognise that this contract will create dangerous conditions for patients, crippling retention and recruitment at a time when the NHS is already on the brink. An A&E in Lancashire closed last week due to lack of staff- we have a long term duty to patients to make sure that doctors have safe working hours and staffing levels.

Lastly- justice. I take this pillar of medical ethics to mean that every member of society should have the same healthcare, should be treated fairly based on need alone. The NHS is one of the most just and equitable healthcare systems in the world, and it is being summarily destroyed. We cannot stand by and watch this happen.

We are trying all we can to avert the next strike- we don’t want it, but it is the only treatment option we have left.

We want to talk- for the past six days doctors have been camped outside the DoH waiting for Jeremy Hunt to open his door and begin negotiations again.

In the fight for justice and beneficence Justice For Health are taking Mr Hunt to court today, issuing proceedings officially at 4pm. Their aim is to have the High Court review the government’s actions on the contract and the NHS and decide if this is safe and rational. A win in the court could avert this whole mess, a step in a new direction to save the NHS.

But they can’t do it without your help- Jeremy Hunt is trying to bully these crowd funded doctors with threats of huge costs, demanding £33,000 up front to even get the case to a judge. He is trying to use the deep pockets of the government to put down a safe, effective and reasonable intervention against a dangerous contract.

Will you help us?

http://www.crowdjustice.co.uk/case/NHS

Do no harm does not mean do nothing. If you want justice, for the long term benefit of all of us, do this.

Juniordoctorblog.com

 

How To Solve The Health Crisis. Leave Us Alone.

Posted on 12th April by JuniorDoctorBlog

Dear Messrs Cameron, Osbourne and Hunt,

You may have noticed the NHS is doing pretty badly lately; funding is at a record low,waiting times are at a record high, and morale across the service is at rock bottom.

You all made some silly promises about money- that’s okay, we all say things we don’t mean sometimes. You perhaps got a little confused and said that you were committing “half a trillion” pounds to the NHS over this parliament- which is simply the current flat yearly budget (~£100 billion) x 5 years. You said this was ‘the most amount of money ever given to the NHS’, but you might remember every successive government since 1948 could have said the same- it’s called health inflation.

You may have forgotten about that when you said you were ‘committing 10 billion‘ pounds ‘extra’ to the NHS, to fund the NHS ‘own’ plan. Except it wasn’t the NHS own plan– it was yours, and it’s not nearly enough even to keep the lights on.

Everyone’s a critic eh? It’s not nice when people say you’ve done a bad job, so I can fully appreciate why you asked hospital accountants to hide the debts under their carpets, and told hospital managers to pay for less nurses and doctors last year. I can feel your annoyance when hospitals decided that wasn’t safe, and had to hire lots more agency staff to fill the gaps. You said some silly things blaming this on agency fees, but that’s okay, 80% of the cost of this was the gaps themselves, and you won’t make that mistake again next time will you? Will you?!

You’ve said some funny things about the health service. You’ve said you want it to be the ‘safest health care system in the world‘, but I think you also want it to be the cheapest in the industrialized world? I picked up a few bits for you to read- might help. This one shows increased funding improved outcomes in healthcare. This one shows big reorganizations in healthcare don’t work at all.

You’ve said some things which, I think, aren’t true. I do hope I’m wrong. You said you were committed to keeping the NHS public – but Virgin just bought huge swathes of services, and private company contracts increased 500% this year. You have neglected to mention this, but that’s okay – government is busy work, and not everything can be in every speech. Some people might not mind NHS privatisation, but I do think you should let them know.

You’ve handled the junior doctor contract rather badly. I don’t think it’s unfair to say so. 98% of ballotted doctors voting for strike action, the first doctors strike since 1970, the first ever emergency walk out in NHS history, record levels of dispersal, record low morale. Can I make some suggestions? Have you thought about just leaving them alone?

Since 2006 they have had a £6000 one off pay cut, then a further cumulative 25% pay loss while working in the busiest and least funded decade in NHS history. But no one really complained, bar a half-hearted effort in 2012. I don’t think this is about money, but understand the context.

Doctors conditions are already poor and retention is already a problem. Record levels of doctors leave training after two years, vacancies and rota gaps have increased 60% in two years, and 1/3 GP training posts and  50% of year 3/4 A&E registrars resigning.

So what’s the hurry? Do correct me if I’m wrong, but if contract changes are cost neutral, but could threaten recruitment and retention of staff at a time when the NHS is under incredible pressure, and doctors say is categorically less safe than current conditions, one has to ask, why bother? Why not talk for another year, rather than strikes and strikes, and resignations. Not to mention the reversal of all equality workplace gains in the last decade. Mr Hunt wanted ‘certainty’ in the health service- but I cannot imagine a more uncertain time.

Why not just leave us alone? It’s not too wild an idea. You might say the BMA asked for contract negotiations and therefore the contract must change. This is like inviting your friend for tea, punching them in the face repeatedly and then wondering why they wanted to leave. You can’t force them to keep having tea at your house, and if tea isn’t essential, then why would you?

It might hurt your feelings a little bit, but that’s okay. We all have little tiffs, we all make mistakes. No need to be too proud about it. After all, why would you want to wreck a whole health service just to save face?

It must be a tricky job, being in charge of everything. Why don’t we just sit and talk for a bit, about how we might all make the NHS better?

Unless of course that’s not what you want at all. Unless you have decided that with four years of government, a weak opposition, and deep pockets controlling >50% media and the BBC, you might decide to ram through as much toxic and undemocratic policy as you possibly can. Kamikaze politics, with a hope some strong PR spin at the end will still save the next election? So why not ram through massive NHS-reorganisation and sell off, privatise the schools and the land registry, cut disability benefits and cut corporate tax, cut funding to the opposing party and turn the BBC into state-run television. Why not in fact trample the entire fabric of democracy, safe in the knowledge that the public are too apathetic to offer any significant opposition?

You are leaving them few choices Messrs Cameron, Osbourne and Hunt. Strike or resign. Perhaps it’s #timetolisten? Or better yet, just leave them alone.
Juniordoctorblog.com

Dear Other Normal Human Beings

Posted on 6th April by JuniorDoctorBlog

As relevant today as it was 9 months ago…

Dear Other Normal Human Beings,

I am writing to you, because, like myself, you are a normal human being.

You, like me, wake up in the morning and sleep at night, eat meals, sometimes with loved ones, sometimes alone. We are alike in our requirement for other people, for happiness, for security, for food, for warmth, for shelter.

You may have children, you may have brothers or sisters. You have, or had, parents, and perhaps were lucky enough to know your grandparents.

You may have noticed that many health professionals are becoming uncharacteristically vocal. You may have thought them self-serving, morally bankrupt individuals, upset over their own pay packets.

I would like to explain to you, from one normal human being to another, what is going on.

I am a doctor. I decided to be a doctor before I really knew what decisions were, and can never remember wanting to do anything else. Once I knew how, I found the path, and worked my arse off. Six years, in secondary school, studying. Two years, in college, studying. I took four A-levels, I had 25% less free time than my friends, and when they were out, doing whatever they wanted, I was not. I was studying. Another six years at medical school, studying, and sometimes working to pay for the studying. The last three years of medical school I worked harder than I ever had, and the same hours as a full-time professional, sometimes way more. It even made me sick- in my final year I developed acute gastrointestinal bleeding. But, becoming a doctor was all that meant anything to me. So, I took my top grades and turned them in, in return I got fourteen years hard graft, and £50,000 worth of debt. [2]

Why is this important? Because, from the very beginning, I knew about sacrifices. As thousands of my colleagues have, as millions before me have, and millions will. I knew about sacrifice when I worked for a year before university, so I could afford the rent, when I missed my first family Christmas to work as a warden in student halls, so I could afford to stay at medical school. I knew about sacrifice when I missed nearly every other Christmas since, working, or sometimes studying. I knew about sacrifice when I’ve missed my friends weddings, my nieces and nephews birthdays, when everyone I knew was travelling, and I was studying, or working. Being a doctor, and it’s inherent position in society and in the hearts of the public, is irrevocably tied to sacrifice- it’s the dedication it takes to become, and to stay, a doctor, that by definition requires sacrifices to time, to personal satisfaction. All over the country right now, doctors and nurses, physiotherapists and occupational therapists, radiographers and ward clerks and all the other medical professionals are sacrificing their lives, minute by minute, to try to give you or your loved ones minutes, hours, days or years more. So, when, as a normal person, someone tells you doctors don’t understand ‘vocation’, you know now- it is beat into us before we even get through the door.

But, as a normal person, of course you understand why doctors would defend the NHS, would fight to protect it, and so vociferously attack it’s detractors. They have a vested interest, they want to keep their cushy salaries and great jobs, and the NHS is great for that.

Let me tell you straight: if I didn’t care about you, or my patients, I would be out there campaigning to close the NHS right now. I would make more money in the private sector in a day than I would in two weeks of NHS work. I could also take my UK Medical degree, one of the most respected qualifications anywhere in the world, and go and earn 50-200% more in the US, Australia, New Zealand [3]. In the private sector, if I stayed after 5pm to look after you, the next thing you see after my smiling face as you exit the hospital, will be the bill on the doormat; ‘overtime’, ‘time in lieu’, ‘additional hours rates’ aplenty.

But, I, like you, have a family. I went to state school, and worked and grafted to pay for my six years at University. Without the NHS my grandmother would have gone blind, my father would have had several heart attacks, my mother would have died. I might have died. A private system would’ve bankrupted them, ended their hopes for a better future in order to pay to survive. I, like you, would do anything for the ones I love, and that is why I campaign to protect and improve the NHS. And that is why, when 5pm comes and goes, as does 6pm, 7pm and all the other hours in between, I, and every colleague I have ever worked with, stays for their sick patient. Because, one day, somewhere, for someone else, that patient will be their mum, or dad, wife or husband, son or daughter.

We have had, and always have had, the extraordinary privilege of one of the greatest healthcare systems, pound-for-pound, in the world. The reasons for it’s great outcomes and low cost are debatable. But there are some reasons we never mention. This country has a medical school system of international renown, whose doctors, for the most part, qualify and stay exclusively working within the NHS. The staff of the NHS gives untold free hours to the profession; when I was a first-year junior doctor, I calculated I worked one day at work for £4.10 an hour. I used to get paid more at Tescos. But a very sick patient needed a lot of complex care, and so I stayed, and helped, and he survived: as millions of patients have since 1948. [4]

The moves of the current government against the medical profession are calculated: to deride working conditions, salaries, hours and deplete hospital resources, until a normal person, like myself, buckles under the social, financial and emotional cost. At that point, a sea-change of new, private hospitals will open, and we will go and work there. And our lives will be pretty much the same- different bosses, the same bureaucracy and probably better pay. But our lives, as normal people, will not. You will still pay taxes, a stripped-down NHS will persist, for no frills, emergency care only, but not for all the other healthcare needs of a 21st century population: you will need private healthcare. And that healthcare insurance will cost you hundreds of pounds a year, if not a month. And if you don’t have insurance, you will spend thousands of pounds on the simplest, quickest procedure [5]. And the NHS won’t be there for my family, or the families of normal people across the country.

So, I want this to reach as many normal people as it can. If you don’t act now, it will be too late. It might already be too late.

We care deeply because we can see the great good the NHS does, every single day. And I care because, like you, I care about the ones I love.

Where can you start?

Here might be a good place:

Www.crowdjustice.co.uk/case/NHS

We are taking the government to court, to show us they aren’t gambling the future of the health service away on an unmodelled and unsafe contract.

If you want an NHS at all it’s time to help.

Yours sincerely,
juniordoctorblog.com

[PART 2: A Factual Appendix]
-What normal people appreciate, are hard, solid, unflinching, facts. So here they are.

[2] Medical students studying now can now expect to pay £9000 pay a year as of 2015 for six years for most courses: that is £54,000. Most will require a student loan to pay living expenses for a full time course, at a further £5000 a year that totals £79,000 for six years study. Maintenance grants for the poorest students have been scrapped, adding an additional £10,000 debt as a minimum.

[3] Starting pay for any consultant in the UK : £75, 249. In the US: £111,799.80 for internal medicine, £183,152.91 for a radiologist. ($/GBP rate correct at time of writing). In Australia: a basic salary of £78,000 for internal medicine consultants, BUT this is for a 38 hour working week. Average overtime and up-scale pay between £92,526.97- £244,366.10. Same with New Zealand for a 40-hour week, after average overtime and up-scale up to £128,039.69.
UK data: http://bma.org.uk/practical-support-at-work/pay-fees-allowances/pay-scales/consultants-england

US data:http://www.payscale.com/research/US/People_with_Jobs_as_Physicians_%2F_Doctors/Salary.

Australian data: http://www.imrmedical.com/australia-salaries-tax

New Zealand data: http://www.imrmedical.com/new-zealand-salaries-tax

[4] The NHS opened it’s doors, metaphorically, July 5th 1948. It’s first patient was a 12-year old girl with a liver condition. http://www.legislation.gov.uk/ukpga/Geo6/11-12/29

[5] This is incredibly interesting reading, although it is for claims, it is still very reflective of the actual cost. https://www.freedomhealthinsurance.co.uk/downloads/your-choice-procedure-payment-guide