Ship of Fools: Junior doctors' strike

Thread: Junior doctors' strike Board: Oblivion / Ship of Fools.

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Posted by Sipech (# 16870) on :

With 98% of the vote, junior doctors have voted overwhelmingly in favour of strike action.

There are a couple of default positions that people tend to hold or lean heavily towards:
1. Object to all strikes, especially those in key public services such as health, policing and firefighting.
2. Support all strikes, as that's the only real form of protest we have left to support workers' rights.

Not all fall into one of these extremes. I prefer to weigh up the merits and drawbacks of what the strike is about.

In this case, I am very uneasy about doctors going on strike. It doesn't seem reasonable to suppose that industrial action will leave patient safety unaffected.

Yet it's equally clear that the Conservative proposals to simply get doctors to work more and more hours is a quixotic quest that is all about being able to boast about a 24/7 NHS (which we already have, but Jeremy Hunt is blind to). It also puts patient safety at risk, by working the doctors to the bone.

As a moral issue, then, is it justifiable to have a short, sharp jeopardy to patient safety as a form of inoculation against a longer term threat?

As a thought experiment, let's say we have a Sliding Doors scenario:

In one world, the doctors go on strike and a relative of yours suffers serious harm that could have been prevented had the doctors not gone on strike.

In the other world, the doctors didn't go on strike and further on in time, as a result of overworked doctors, mistakes were made that resulted in similar harm to the same patient.

Has one suffered a greater injustice than the other? Or have they suffered the same, and that the issue is the greater total harm in the long run?

Posted by Dafyd (# 5549) on :

quote:
Originally posted by Sipech:
With 98% of the vote, junior doctors have voted overwhelmingly in favour of strike action.

That's 'Do we love our Wise and Benevolent Leader?' levels of support. Expect to see Hunt questioning whether strike action with less than 100% support has any legitimacy.

quote:
In one world, the doctors go on strike and a relative of yours suffers serious harm that could have been prevented had the doctors not gone on strike.

In the other world, the doctors didn't go on strike and further on in time, as a result of overworked doctors, mistakes were made that resulted in similar harm to the same patient.

Has one suffered a greater injustice than the other? Or have they suffered the same, and that the issue is the greater total harm in the long run?

Well, one of them has the junior doctors being overworked, and even if the total harm to the patients in the same in both cases, one of them has overworked people, which is a bad thing and an injustice in its own right. It is not perhaps as unjust as overworked streetsweepers, or supermarket checkout staff, but still unjust and a Bad Thing.
Merely because you've entered a public service profession does not make it acceptable to take you for granted., or that you have a moral obligation to go along with attempts to hold the public to ransom.

Otherwise, I think by presenting this as a choice between strike and don't strike, you're perhaps inadvertently placing the onus of responsibility on the junior doctors, as opposed to phrasing the question as one between impose a contract with cavalier disregard for working hours and negotiate a contract that does regard working hours.

Posted by Penny S (# 14768) on :

Being presented with the idea of "negotiations" in which one side has to agree to all the terms presented by the other before starting the discussion was atrocious.

I've known for some time that "consultation" now means "we'll tell you what we are going to do and give you the opportunity to say something about it before we do it anyway". That "negotiation" now means something similar shows that we are well on our way to Newspeak.

Someone on the radio this morning was saying that his junior doctor son has worked out that his income will drop by 40% if he continues next year to work the same hours as he does now. Another, also doctor, son is going to Australia.

[ 19. November 2015, 12:34: Message edited by: Penny S ]

Posted by alienfromzog (# 5327) on :

I have posted this in Hell, but I'll share here for those who haven't seen that thread.

If you want detailed explanations and arguments, I am very happy to give them. However this is an accurate summary:

http://tinyurl.com/jeremyhunt

If you agree, please share widely. The arguments are complex and the government is being deeply disingenuous. I suspect that many in the public don't follow the details but if they can see how unreliable Mr Hunt's pronunciations are...

AFZ

Posted by Alan Cresswell (# 31) on :

A 98% vote in favour of strike action in any profession, especially a profession like medicine where the "it'll harm patients" is a very strong argument for people who devote their lives to caring for people, is unbelievable. It's a stunning vote. A vote like that should be a massive wake up call to the government that they need to come to the negotiating table and discuss any changes to junior doctors contracts rather than dictate what those changes will be.

Posted by Schroedinger's cat (# 64) on :

I think the dichotomy is subtly different to consider actually. It is more a) a patient is left for longer than should be necessary before they are attended to, and this results in extended recovery time, more long-term issues or b) a patient is treated by an overworked doctor and suffers the same complications.

The chances of a problem occurring because of the strike is small, but the chances of a problem caused because - longer-term - doctors are overworked and departments are understaffed is quite high.

I don't actually want either scenario, but the former is, I think, less likely (because deteriorating problems should get a priority) and the latter would result in all sorts of blame, guilt and disillusionment (on all sides). I think that is a worse outcome.

So yes, I support the strike, because I don't think the decision was taken lightly to strike, and I think the 98% support shows that this is not a minor issue among some trouble makers. I also think Jeremy Rhyming-Slang should get a big slap.

Posted by Baptist Trainfan (# 15128) on :

Especially on such a large turnout. This means 75% of all junior doctors voted for strike action, not just a majority of those who 'bothered to vote' (as is often the case in these things).

Posted by Pomona (# 17175) on :

I know a lot of doctors, mostly junior doctors (this, by the way, just means any non-consultant doctor - doesn't mean newly-qualified) and other medics/nurses. All of them support the strike, none of them take this decision likely. To them, patient safety is the biggest reason behind the strike.

Posted by Not (# 2166) on :

Any harm to patients as a result of the strike is likely to be in the nature of delays to outpatient appointments or planned surgery. Whilst that's inconvenient and upsetting, those treatments and appointments will still happen, just later.

Consultants and staff grade doctors will all be working in whatever areas are needed on the strike days to cover emergency admissions, inpatients and treatments like chemo that can't safely be delayed or rescheduled. The core work will all get done, and get done by senior and experienced doctors so no one should be scared to go into hospital on those days.

But the impact will be on all the cancelled clinics and lists that will have to be rescheduled and all the many admin tasks junior doctors complete which will have to be caught up later (most of which will probably be done by the junior doctors themselves in following days). Whether that impact will be enough to persuade Jeremy Hunt to listen is uncertain.

For avoidance of uncertainty, I completely support the juniors in their action as do the vast majority of my consultant colleagues. Many of us worked without effective hours safeguards as juniors and know how unsafe that was. My concern is that Drs and nurses are crap at striking - because they really can't cope with letting patients come to harm, and so the impact of industrial action tends to be much diluted by whoever is left working their backsides off to make it safe and ok.

Posted by no prophet's flag is set so... (# 15560) on :

The trend here is to off-load services provided by physicians on to others as a cost saving. As examples, we have nurse-practitioners prescribing a from a limited formulary of medications, requesting medical imaging and treating directly without physicians. We also have pharmacists giving injections and refilling medications on their own.

Thus, I wonder if a strike doesn't partly, eventually, promote the inevitable, the reduction in physician role in medical care. We have had for a number of years here that no physician referral is required any longer to see other non-physician practitioners, and a clear second tier of service provision for those who will pay privately for non-physician services. Are they doing this in the UK?

Posted by Eliab (# 9153) on :

quote:
Originally posted by alienfromzog:
If you want detailed explanations and arguments, I am very happy to give them. However this is an accurate summary:

http://tinyurl.com/jeremyhunt

If you agree, please share widely.

A gentle reminder (mostly because I'm in sympathy with your objective) that Commandment 9 prohibits advertising and spamming. Discussing the issue - as robustly as you like within the limits of the commandments - is fine. Posting links to material for distribution and action elsewhere is outside the purpose of the boards, which is discussion.

If you wish to publicise that particular image, you can link to it in your sig.

Eliab
Purgatory host

Posted by alienfromzog (# 5327) on :

quote:
Originally posted by Eliab:
A gentle reminder (mostly because I'm in sympathy with your objective) that Commandment 9 prohibits advertising and spamming.

Posted by ExclamationMark (# 14715) on :

quote:
Originally posted by Pomona:
I know a lot of doctors, mostly junior doctors (this, by the way, just means any non-consultant doctor - doesn't mean newly-qualified) and other medics/nurses. All of them support the strike, none of them take this decision likely. To them, patient safety is the biggest reason behind the strike.

Concerns have been aired about patient safety for several years. What doesn't look good is that the issue of a strike is now being raised - over that concern - at a time when it appears that Doctor's pay may be affected by (IME long overdue) changes to the NHS.

[Something needs to be done: "accessing" end of life care for my father has brought the lack of organisation and cover into sharp focus for the first time. In my local area there's no District Nursing cover between 4.30 pm to 5.30 pm as they are on changeover; I couldn't get my dad's medicines as he was leaving hospital once as I was told it's a Bank Holiday weekend tomorrow - this was Friday - and most pharmacy staff have left. This was 2.30 pm on a Friday afternoon! This week there was 1 District Nurse for 250,000 people at night: imagine you're my Dad at end of life care waiting for a pain relieving injcetion. Fortunately this time it took only 90 minutes to get a visit - on one occasion is was 6+ hours, on another no one came until I rang the Hospice and a Staff Nurse came out herself. Not everyone knows what buttons to push or how to stamp their feet to get their necessary treatment].

Why wasn't strike action considered and driven forward before, if it is only about patient safety?

Significantly in my view, when the same thing was happening to Nurse, Doctors not only failed to help and support, they told the Nurses to suck it up.

[ 20. November 2015, 06:23: Message edited by: ExclamationMark ]

Posted by Sioni Sais (# 5713) on :

quote:
Originally posted by ExclamationMark:

Why wasn't strike action considered and driven forward before, if it is only about patient safety?

Mostly because the supposed negotiations at this time are nothing of the kind. Jeremy Hunt, on behalf of the government, is engaged in brinkmanship that he might not be able to pull off.

In any event, it isn't "only" about patient safety. It is about the whole future of the NHS.

quote:

Significantly in my view, when the same thing was happening to Nurse, Doctors not only failed to help and support, they told the Nurses to suck it up.

As far as the nurses' dispute was concerned I doubt there was a similar degree of support for industrial action within the nursing profession itself.

Posted by Alan Cresswell (# 31) on :

I'm not sure any strike ballot has quite had such support. Certainly not in any of the caring professions.

Posted by Alwyn (# 4380) on :

"a group of 900 junior doctors have written to patient safety expert Sir Robert Francis, who led the landmark inquiry into patient care at Mid Staffordshire NHS Foundation Trust, to raise their concerns that the new contract would have “grave implications” for patient safety." (The Independent)

The government seems to want to take the NHS back to the mid-1990s, when junior doctors reportedly worked for absurd numbers of hours. Like the belief that cuts won't hurt front-line services, the belief that making doctors work excessive hours won't put patients at risk seems to be precious to the government.

Posted by Baptist Trainfan (# 15128) on :

"a group ... has written". Tsk, tsk, Indy!

Posted by ExclamationMark (# 14715) on :

quote:
Originally posted by Sioni Sais:

quote:
Originally posted by ExclamationMark:

Why wasn't strike action considered and driven forward before, if it is only about patient safety?
Mostly because the supposed negotiations at this time are nothing of the kind. Jeremy Hunt, on behalf of the government, is engaged in brinkmanship that he might not be able to pull off.

In any event, it isn't "only" about patient safety. It is about the whole future of the NHS.

quote:

Significantly in my view, when the same thing was happening to Nurse, Doctors not only failed to help and support, they told the Nurses to suck it up.
As far as the nurses' dispute was concerned I doubt there was a similar degree of support for industrial action within the nursing profession itself.

By allowing Doctors to call the shots - that is to do private work alongside their NHS commitments - I suspect the NHS was doomed from the start. It's probably the worst failing of the 45 to 51 Labour Government

Posted by Arethosemyfeet (# 17047) on :

For something "doomed from the start" the NHS has been remarkably successful over the last 68 years. Always room for improvement, sure, but on balance it's excellent.

Posted by Curiosity killed ... (# 11770) on :

Not every doctor has a lucrative private practice lining his pocket. GPs are unlikely to have a private practice, it's more likely to be radiologists and specialists can sell their services to Mammon.

Neither is the issue as clear cut as the sound bite cry of "ban doctors from having private practices" suggests. According to this blog, the NHS would be so overloaded without the private practices that it would grind to a halt. Even this article from the Guardian which argues that doctors should not be allowed to earn money from both NHS and private consultancies has this quotation:

quote:
“Dr Dean’s solution of ‘banning’ NHS consultants from working for other employers, which is how it would have to work in radiology, would leave the NHS with a major shortfall in radiology service provision until the current workforce shortage is addressed.”

Posted by Marvin the Martian (# 4360) on :

I'm very impressed with the 98% vote in favour, especially on such a large turnout. And I have to say, I am in full support of the reasons behind this strike.

For the avoidance of doubt, I'm still a Tory. But I one of those Tories for whom "don't fuck with the NHS" is a line in the sand.

Posted by Doublethink. (# 1984) on :

*Is knocked over by a passing feather*

Posted by Boogie (# 13538) on :

My son is an airline pilot. He is well paid and well rested. I want that for all pilots - I also want it for surgeons who will be fiddling about with my insides and doctors and nurses who will be taking decisions about my health care!

All strength to their elbows.

Posted by alienfromzog (# 5327) on :

I've received email notification from the BMA today: The strike is on. First action next week.

AFZ

Posted by leo (# 1458) on :

Good luck to them - they deserve it.

Posted by Aravis (# 13824) on :

A representative said on the radio earlier that A&E, childbirth etc would not be affected by this strike - it was calculated to cause delays only.
If the strike didn't take place and a number of junior doctors left their posts in this country, it seems likely that would also result in delays in NHS services. So I'm not at all surprised by the massive support for this action.

Posted by alienfromzog (# 5327) on :

quote:
Originally posted by Aravis:
A representative said on the radio earlier that A&E, childbirth etc would not be affected by this strike - it was calculated to cause delays only.
If the strike didn't take place and a number of junior doctors left their posts in this country, it seems likely that would also result in delays in NHS services. So I'm not at all surprised by the massive support for this action.

First thing to say is that I note your location is South Wales and hence you won't be affected at all. The strike is England only.

The first two strikes involve junior doctors doing emergency work only. So there will be cancellations of elective procedures. Essentially you will see a weekend / bank holiday service on a Tuesday.

The third day of action involves a total removal of labour. To ensure a safe service the hospitals will cancel elective work (clinics, theatre, etc.) and arrange for say 3 consultants to work together to do the emergency work where normally only 1 would work with their team of juniors.

AFZ

Posted by cattyish (# 7829) on :

I worked as a junior doctor before the European Working Time Directive was enforced and during the changes brought about by sanctions applied to NHS employers who broke the rules. My marriage and my mental health suffered. It got better when employers were fined. These proposals to remove safeguards for junior doctors' working hours deeply worry me, even though I'm now a GP in Scotland. The money is a bit of an issue for lots of people, but working hours are more important.

Cattyish, concerned.

Posted by itsarumdo (# 18174) on :

There's someting about political ideas being touted without referring to people working in the field that will be affected. Clearly, Jeremy H unt and David Cameron would/should normally take notice of a 98% uniformity of opinion in any profesison regarding working arrangements - but since this now an issue of govermment "face", the answer has become the usual one - ignore it, issue misinformation, let it happen and then blame the offenders for everything that happened. If the press support the conservatives the way that they usually do, everyone will just grumble at overpaid doctors.

Posted by toadstrike (# 18244) on :

Just over 3 years ago I found myself in A&E after suddenly suffering a serious condition.

One of the nurses there, a lady called Sarah, absolutely stunned me with her dedication, in some cases to the most difficult of patients (which hopefully, for once, didn't include me).

My parting shot to her, one which I still feel and which I said in so many words to her face at the time, was "Whatever they pay you, it's not enough".

As for junior doctors, I don't want anyone fiddling with my carcass who isn't 100% happy with his or her life and concentrating on eliminating whatever is depriving me of 100% happiness in mine. If I've got to cough up more tax to get it, so be it.

Posted by alienfromzog (# 5327) on :

Just wanted to post a bit of public information. Wherever you stand on the strike, know this: If you need emergency medical care it will be available the same as any other day. 24 hours a day, 7 days a week.

How about this for a thought:

The Sun celebrates extra bank holiday for Royal Wedding in 2011
Apparently EXACTLY the same level of service is unsafe... From Today's Telegraph

I don't care what you think of the dispute, you will be cared for if you need it.

If you are having an elective operation or outpatient appointment cancelled today, I'm sorry.

AFZ

Posted by Baptist Trainfan (# 15128) on :

On a bit of a tangent: I wish that the medical profession wouldn't use the phrase "elective operation". It gives the impression that we choose to have operations when we could really decide not to, or just for fun so we get to pass a bit of time in hospital.

I don't think my wife would have said that about either her gall-bladder removal, nor her knee replacement. Why not just call them "less (or non-) urgent operations"?

Posted by alienfromzog (# 5327) on :

quote:
Originally posted by Baptist Trainfan:
On a bit of a tangent: I wish that the medical profession wouldn't use the phrase "elective operation". It gives the impression that we choose to have operations when we could really decide not to, or just for fun so we get to pass a bit of time in hospital.

I don't think my wife would have said that about either her gall-bladder removal, nor her knee replacement. Why not just call them "less (or non-) urgent operations"?

I understand your point. Sometimes you hear the phrase 'non-urgent' but 'elective' is actually an important concept.

If you have a perforated appendix and peritonitis then there really isn't much choice about whether to operate or not. If we don't operate then you will die. Of course you still have the right to say no to treatment but essentially the risks of the operation (up to an including death) and much less than the risk of not operating.

With so-called 'elective surgery' it's more complicated than that. There is a long list of risks from a gall-bladder operation. These have to be weighed against the benefits of the operation. I.e. to deal with the horrendous pain than gall-bladders can cause. For some people the risks are much higher than for others. Hence for elective operations we may not advise proceeding to surgery as the risks outweigh the benefits. This is a really important concept in medicine. All treatments carry risks which much be balanced against the benefits.

Thus with an 'elective procedure' we (doctor and patient together) may elect not to proceed; hence the term. For the most part, for obvious reasons, the same does not apply to emergency work.

AFZ

Posted by alienfromzog (# 5327) on :

Have just been notified by the BMA that the forthcoming strikes are on hold whilst talks continue.

Details to follow, I expect.

My own take on this is that I am not surprised. The main reason for the strike last week was that legally the BMA had to take it then or lose the right to strike without re-balloting. (Our Strike laws really are ridiculous in many ways). However given that the Threat of Strikes is the only thing that got the government to ACAS, and that whilst talks on-going the BMA is willing to suspend strikes, this is what I was expecting. If deal not reached in 6 weeks, expect further strike at that point...

AFZ

Posted by Alan Cresswell (# 31) on :

quote:
Originally posted by alienfromzog:
(Our Strike laws really are ridiculous in many ways).

That's because consecutive Tory and Tory-lite (aka Labour) governments have systematically removed most of the abilities of employees to affect their working conditions.

Posted by Anglican't (# 15292) on :

quote:
Originally posted by alienfromzog:
My own take on this is that I am not surprised. The main reason for the strike last week was that legally the BMA had to take it then or lose the right to strike without re-balloting. (Our Strike laws really are ridiculous in many ways). However given that the Threat of Strikes is the only thing that got the government to ACAS, and that whilst talks on-going the BMA is willing to suspend strikes, this is what I was expecting. If deal not reached in 6 weeks, expect further strike at that point...

I'm confused as to why the BMA went on strike. The ballot had been held and they had a mandate for it, but as far as I could see the strike (or the threat of a strike) was intended to get the government back to the negotiating table. The threat of a strike succeeded in doing that and talks resumed. As far as I'm aware, those talks are on-going. Although the mandate was about to expire why go on strike if the threat had achieved the (short-term) aim? I stand to be corrected but there doesn't seem to be a better answer than 'because we could'.

Generally speaking there's a lot of sympathy for medical staff but I think the BMA are in danger of over-playing their hand.

Posted by Doc Tor (# 9748) on :

Because as soon as the threat of the strike disappears, Jeremy 'Rhyming Slang' Hunt goes on the Today program and repeats all his usual lies about there being just one sticking point in the negotiations.

Some people just don't respond to anything but the nuclear option. The BMA have correctly identified Hunt as one of those people.

Posted by Sioni Sais (# 5713) on :

quote:
Originally posted by Anglican't:

quote:
Originally posted by alienfromzog:
My own take on this is that I am not surprised. The main reason for the strike last week was that legally the BMA had to take it then or lose the right to strike without re-balloting. (Our Strike laws really are ridiculous in many ways). However given that the Threat of Strikes is the only thing that got the government to ACAS, and that whilst talks on-going the BMA is willing to suspend strikes, this is what I was expecting. If deal not reached in 6 weeks, expect further strike at that point...
I'm confused as to why the BMA went on strike. The ballot had been held and they had a mandate for it, but as far as I could see the strike (or the threat of a strike) was intended to get the government back to the negotiating table. The threat of a strike succeeded in doing that and talks resumed. As far as I'm aware, those talks are on-going. Although the mandate was about to expire why go on strike if the threat had achieved the (short-term) aim? I stand to be corrected but there doesn't seem to be a better answer than 'because we could'.

My reading of AFZ's post is that having voted for action and declared the day the BMA had to go ahead.

quote:

Generally speaking there's a lot of sympathy for medical staff but I think the BMA are in danger of over-playing their hand.

Unlikely. For once it looks like a dispute between the government and a group of its employees has wider support. I'm surprised the unions haven't made more noise about other settlements they have got out of this government.

Posted by Anglican't (# 15292) on :

quote:
Originally posted by Sioni Sais:
My reading of AFZ's post is that having voted for action and declared the day the BMA had to go ahead.

Why would that be? Having named other days, the BMA called them off today.

Posted by alienfromzog (# 5327) on :

quote:
Originally posted by Anglican't:

quote:
Originally posted by Sioni Sais:
My reading of AFZ's post is that having voted for action and declared the day the BMA had to go ahead.

Why would that be? Having named other days, the BMA called them off today.

Not quite. I was referring to one of the strange bits of UK employment relations law: i.e.:
If members vote in favour of industrial action, the action must begin within four weeks of the date of the ballot. The quote is from gov.uk. I'm not sure which bit of legislation is stems from but I am guessing it's one of the many brought in in the 80's. I'll have a look (unless a floating legal expert can just tell us...)

So, if the industrial action last week had not gone ahead then no action would have been possible without a further ballot.

One could argue that as the government had come to the table, the BMA should have held off completely. That's a big risk to take as it then makes it much more difficult to take any action.

We can argue about the paradoxical nature of this particular piece of legislation later...

AFZ

Posted by alienfromzog (# 5327) on :

Found it!

It's Trade Union and Labour Relations (Consolidation) Act 1992 (“TULRCA”).

Maybe I should think about becoming a lawyer... [Biased]

AFZ

Posted by Anglican't (# 15292) on :

quote:
Originally posted by alienfromzog:
One could argue that as the government had come to the table, the BMA should have held off completely. That's a big risk to take as it then makes it much more difficult to take any action.

But I don't understand what was achieved by going on strike. The government wasn't talking so a strike ballot was held. The threat of a strike then brought the government back to the table. Where's the risk? If the talks come to nothing then the BMA would've had to re-ballot anyway because the mandate expired.

Posted by chris stiles (# 12641) on :

I'll leave the mechanics of the situation to AFZ. However, lets reverse the agency a little here:

quote:
Originally posted by Anglican't:
But I don't understand what was achieved by going on strike.

If the government genuinely wanted to talk, I do not know what was achieved by delaying offering talks till after the BMA had been balloted (the result was already a forgone conclusion).

But we all know why this was so - it was a cynical PR move, along the lines of spreading falsehoods in the press, 'sexing' up possible consequences and so on.

Posted by Sioni Sais (# 5713) on :

quote:
Originally posted by Anglican't:

quote:
Originally posted by alienfromzog:
One could argue that as the government had come to the table, the BMA should have held off completely. That's a big risk to take as it then makes it much more difficult to take any action.
But I don't understand what was achieved by going on strike. The government wasn't talking so a strike ballot was held. The threat of a strike then brought the government back to the table. Where's the risk? If the talks come to nothing then the BMA would've had to re-ballot anyway because the mandate expired.

I'd suggest that as the BMA had cancelled strikes in the past the government could have got the impression that the doctors would never go on strike at all. In coming out, the junior doctors showed how serious they were and are.

Posted by alienfromzog (# 5327) on :

Right, this is Purgatory so I plan to keep my anger down in Hell. Here, on the serious board I want to ask a question.

I have not changed my mind. The contract as written will make doctors do more for less and do more antisocial hours. This is unfair to doctors and unsafe for patients. (see above for details).

As such, professional responsibility demands a response, so here's my question:

What should I do?

Here's what I have done/will do:

1) I have written to my MP
2) The BMA have not said what they are going to do yet but I will continue to participate in industrial action.
3) On here, and other forums I will continue to write and argue about the issues, to hopefully inform as many people as possible.

But what else?

What is the right response? I genuinely fear for our health service. I genuinely think this is really bad for patients and the future of healthcare. What should I do? What should we all do?

AFZ

Posted by Pottage (# 9529) on :

I'm sure the Government hopes this will drift out of the news, overtaken by the EU, Trident and whatever other tragedies and emergencies the world can be relied upon to throw into the mix between now and August. The BMA and individual doctors such as you can address that with a steady stream of information.

I would suggest that the BMA needs to keep pushing the issues, and in doing that to continue speaking with a reasonable and responsible voice. The BMA and doctors generally start from a strong position in terms of public trust and sympathy (especially when compared with politicians).

The Government has made an error I think in imposing the contract. Even with the explanation that the negotiations have dragged on for years and can't be expected to last forever, that's a difficult thing for them to ask voters to stomach. The very fact that those negotiations have dragged on so long suggests that there can't be a sudden deadline that requires the Government, right now, to stop talking and say "that's it, have these terms."

But the BMA does need to reinforce the narrative (assuming this is the case) that there remain important aspects of the imposed terms that have safety implications. One message the Government did push out which carried some credibility was their argument that these updated terms meet all of those objections, and that therefore the only thing doctors are still arguing about is how much cash they will get.

Doctors have a huge amount of public affection, support and trust because of the self-evident value of what they do, but they do already have some advantages people in other professions have never had and don't expect. In England at least, people studying for other careers very rarely have their fees paid for them by the state. And people employed in other professions wouldn't normally be paid at all for the time they are required to work late or at weekends, let alone at an enhanced rate. Whilst I don't think that people do begrudge doctors those advantages, it's something to bear in mind when trying to strike the right "tone" in keeping the debate alive and in the news.

Posted by Doc Tor (# 9748) on :

quote:
Originally posted by alienfromzog:

What should I do?

I would suggest this (and as the BMA are generally quite smart, I won't be the first to do so):

En masse, refuse to sign a new contract. AIUI, they'll be imposed from the next turnover date (1st August). No one signs up. No one. Hospitals stare into the abyss of having zero junior doctors in August.

You'll be back at work on the 2nd on the terms of the old contracts, and Jeremy 'rhyming slang' Hunt will be consigned to the dustbin of history.

Posted by Sioni Sais (# 5713) on :

quote:
Originally posted by alienfromzog:
Right, this is Purgatory so I plan to keep my anger down in Hell. Here, on the serious board I want to ask a question.

I have not changed my mind. The contract as written will make doctors do more for less and do more antisocial hours. This is unfair to doctors and unsafe for patients. (see above for details).

As such, professional responsibility demands a response, so here's my question:

What should I do?

Here's what I have done/will do:

1) I have written to my MP
2) The BMA have not said what they are going to do yet but I will continue to participate in industrial action.
3) On here, and other forums I will continue to write and argue about the issues, to hopefully inform as many people as possible.

But what else?

What is the right response? I genuinely fear for our health service. I genuinely think this is really bad for patients and the future of healthcare. What should I do? What should we all do?

AFZ

I agree, it is harmful to patient care, but I believe a majority of people agree that the government's policy regarding the health service in general and this issue in particular is far more harmful than the action being taken by the junior doctors. Amongst other things the government is aware that if they lose this argument, they will lose a lot more.

Posted by leo (# 1458) on :

I don't think people physically 'sign' new contracts.

Posted by Penny S (# 14768) on :

We never signed anything after ours was changed way back under Thatcher and Baker.

Posted by Leorning Cniht (# 17564) on :

Isn't the usual form to announce that the new contract takes effect on day X, and anyone who shows up for work has agreed to the new terms?

Posted by Oscar the Grouch (# 1916) on :

quote:
Originally posted by Pottage:
I'm sure the Government hopes this will drift out of the news, overtaken by the EU, Trident and whatever other tragedies and emergencies the world can be relied upon to throw into the mix between now and August. The BMA and individual doctors such as you can address that with a steady stream of information.

Keeping this in the public eye is vital - but will be hard. It is noticeable that the right wing press have consistently under-reported this dispute. For example, on the day that the likes of the Guardian and the Independent were reporting that Hunt was going to impose the new contract, and that the majority of doctors were still adamantly opposed, the Daily Mail website hardly had anything about this. If all you read was the Mail website, you would never know that Hunt had imposed a contract, or that he had lied about the support for this from NHS Trust chiefs.

The right wing bias in the UK press consists not just in what they report (and the slant that they give) - it is also about what they DON'T report. Hence the need for junior doctors and their supporters to do all that they can to keep the facts about this dispute in the public eye.

Posted by Doublethink. (# 1984) on :

We've recently had two CT1's filling a post as a job share - which is most unusual. But it does mean that even if their hours are stretched, they'd never be doing a hundred hour week. If you can afford it (and I realise that's a big if) it might be worth pairing up with someone to apply for posts in a job share set up. It doesn't solve the skullduggery of the government, but it ought to mean that you shouldn't end working so many hours that you lack confidence in the safety of your practice. Also, it means HR have to plan your shifts properly as they have to factor in the job share.

(Income wise, you could seek a second less pressured part time job with the other half of your week.)

ETA We've currently got a part time CT1 because the job share partner moved on afterr 6mths. What it does mean is that the CT1 does 12 months instead of six, which is nice from a continuity of care perspective. The job share worked well whilst it was ongoing - though I think it was accepted largely because there were few other options and previously our ward had to run without a CT1. Our experience with locum junior doctors was not good.

[ 14. February 2016, 08:25: Message edited by: Doublethink. ]

Posted by alienfromzog (# 5327) on :

I am getting married later this year. [Smile]

I think my fiancee (non medical) is a little worried that she'll never see me...

In principal, if there were little people (aliens) around I would love to work part-time. In my training program (paediatric surgery) that is almost impossible to do. There is a gender bias in that the women who take maternity leave can come back part-time if they pair up with someone. But the chances of the people in charge of my training approving such a move are tiny-to-none.

My plan is to step out of my training for 3 years to do a PhD. Not because of this nonsense but because it's what I want to do. I should be able to maintain some clinical work alongside.

To be honest, in my specialty, I'm not acutely concerned about the contract. I think I may be royally screwed money-wise but the way our departments work I'm not too worried about the hours being a problem. Not in the next few years (until I finish). However over in the acute medical specialties and A&E and general paediatrics and intensive care (to name the ones that come to mind instantly) I think patient safety is in grave danger.

I do want to find an effective way to fight back though.

I have written to my MP, I have signed the petition calling for meaningful negotiations and the no-confidence vote in Hunt. All of which is important. I guess what I am saying is, we need the public. The only thing that will stop this is a proper public response. The tame press will not report this well for us but Cameron is a complete coward when faced with any meaningful opposition.

We just need to find a way to make sure the opposition is meaningful.

AFZ

Posted by Frankenstein (# 16198) on :

quote:
Originally posted by Leorning Cniht:
Isn't the usual form to announce that the new contract takes effect on day X, and anyone who shows up for work has agreed to the new terms?

If you do not agree with the new contract, you without your Labour.

Posted by Frankenstein (# 16198) on :

quote:
Originally posted by Frankenstein:

quote:
Originally posted by Leorning Cniht:
Isn't the usual form to announce that the new contract takes effect on day X, and anyone who shows up for work has agreed to the new terms?
If you do not agree with the new contract, you without your Labour.

My contribution should have read:
If you do not agree with the new contract, you withdraw your Labour.

Posted by alienfromzog (# 5327) on :

Continuing my attempts at public service announcements:

The BMA has today announced the following industrial action:

8am on Wednesday 9 March to 8am on Friday 11 March

8am on Wednesday 6 April to 8am on Friday 8 April

8am on Tuesday 26 April to 8am on Thursday 28 April

Over each of these 48-hour periods, junior doctors will offer emergency care only.

So normal weekend emergency services on those days but expect lots of elective cancellations.

AFZ

Posted by alienfromzog (# 5327) on :

My apologies for bouncing this thread back to the top but there is a sense of despair in the NHS that we are being run by a government determined to destroy us.

I don't say that to make a party-political point here. (My politics are well known on The Ship). I say it because that is the mood in the NHS. We really are at breaking point.

This is a very good summary of the situation:

quote:
Philip Hammond in Private Eye:
Doctors have a professional duty to protect patients and to speak up if they believe care is not safe. Most doctors believe the new contract for junior doctors could make the NHS less safe for patients, which is why so many consultants and GPs are supporting their junior colleagues. Because the government has announced it will be imposed, most junior doctors believe that the only option is to take industrial action. This has to be balanced against a doctor’s professional duty not to harm patients. It’s an extremely difficult decision to make, and many doctors have been reduced to tears having to make it.

We fight for our health service.
We fight for our patients.
But we cannot do it alone.
Only a massive public response will stop this arrogant and obstinate government.

AFZ

Posted by Doublethink. (# 1984) on :

I second that, our morale is subterranean.

Posted by Ricardus (# 8757) on :

One thing I don't understand is - if you are pushing for:

- equal levels of service every day of the week;
- trusts to have a financial disincentive against overworking doctors;
- not spending any more money than at present,

Wouldn't the simplest solution be for all days to attract the same rate of pay, but overtime rates to start from the point where a doctor has worked more than a minimum number of hours?

So if you worked Saturday but had Tuesday off, you'd get the same rate as if you worked Monday to Friday.

And if you worked Monday to Friday but worked four hours late on Wednesday and Thursday, you'd get the same rate as if you worked normal hours plus eight hours on Saturday.

But neither side seems to be pushing for this, unless I've missed something.

Posted by Alan Cresswell (# 31) on :

It still misses the fact that Saturday and Sunday are unsocial work days.

Also that the contract that has not been put on the negotiating table is only with junior doctors. If you're going to have a genuine 7d a week health service you'll need to put the same contract terms on everyone else that you'll need to work on the same schedule - the consultants, nurses, radiologists, anaesthetists, porters, pharmacists ... the government addressing the issue of 7d NHS piecemeal and enforcing a non-negotiated contract on just one part of the system fails on all counts.

Posted by Ricardus (# 8757) on :

But the BMA are saying it's about not overworking doctors, rather than antisocial hours. (And I've no reason to doubt them.)

I don't disagree with your second paragraph. In fact ISTM the whole concept is nonsense - Mr Hunt's whole approach seems to be predicated on the idea that 1,000 avoidable deaths evenly distributed throughout the week is somehow morally preferable to the same number of deaths bunched up at the weekend.

[ 18. April 2016, 14:42: Message edited by: Ricardus ]

Posted by mdijon (# 8520) on :

The other difficulty with the argument is that it is well established that patients presenting for care at the weekend are sicker than those during the week. I don't doubt that the quality of care is worse during the weekend given the staffing and facility levels. However the mortality benefits of equalizing it are unclear. It depends on how much of the difference is due to lower quality care and poorer staffing, and how much is due to sicker patients. No-one knows the balance so this would be an experiment.

Added to which Alan is completely right that the usefulness of increasing doctoring levels is limited in the absence of other resources.

If one considers that the majority of doctors are not engaged in regular checks of patients to flag up problems (nurses do that most of the time save a once-daily ward round by doctors), don't actually give any of the life-saving treatment directly (just write it down on bits of paper for other people to do) and don't actually do many of the scans or investigations required (needs laboratory staff and radiographers) then one gets some sense of the team-context that the average doctor needs in order to stand some chance of changing mortality statistics.

No team - no care.

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