Monthly Archives: April 2016

Its relationships that matter – more than a career in a brutalising profession

When people don’t feel cherished or cared for, and if they are employable,  they vote with their feet. When I went to my first job interview outside London the hospital offered me very good married accommodation, and by the time the interview came around I had been shown the accommodation and had a dig in the ribs from my wife and a thumbs up – as well as you had better get this job.. There is no junior doctors mess. 80% are female…. Continuity of care has gone. Over-management is endemic, and yet change is improbably slow. Fear and bullying abound.. Absenteeism in non doctors is one of the highest in the world.. There are other countries and jurisdictions who will cherish them, and some close at home with the old contract. No wonder over half could quit. The same errors have been made in General Practice, once the envy of every health minister in the world…

Dennis Campbell reports 25th April 2016: Junior doctors: ‘over half could quit NHS England over Hunt’s contract’

Survey finds negative impact on childcare and relationships are key reasons that could drive trainee medics away

More than half of junior doctors are thinking about quitting the NHS in England in protest at the contract Jeremy Hunt is forcing on them, a survey has found.

The research said difficulty in arranging childcare and the impact of even more anti-social shifts on doctors’ relationships with their partner and children were the key reasons for widespread disillusionment.

More than 52% of the respondents said they were likely to or will definitely give up medicine, or are considering moving to Wales, Scotland or abroad to avoid working under the health secretary’s new terms and conditions from August.

Respondents were asked how they would continue their career if the contract compelled doctors below the level of consultant to work more at weekends, overnight and in the evenings than they already do.

The contract Hunt is set to impose on trainee medics in England will extend the hours that count as part of their normal working week from 7pm-10pm on weekdays and include Saturday from 7am-5pm for the first time.

In all, 72 (6.84%) respondents said they will leave medicine. Another 206 (19.58%) said their future was uncertain, but they were likely to leave medicine.

Seventy-nine (7.51%) said they were considering a move to Wales or Scotland, where the devolved governments are agreeing new working patterns for junior doctors by discussion.

A further 199 (18.92%) said they were considering moving to Australia, New Zealand, Canada or another country.

“This survey turns any assertion that work-life balance will be improved for junior doctors under the new contract on its head,” said Dr Sethina Watson, a trainee anaesthetist and mother of four in Bristol, who carried out the survey. More than nine out of 10 of the 1,056 respondents were junior doctors, and 40% were either married to or in a relationship with a medic.

Watson said: “Jeremy Hunt’s rush to impose the contract threatens to create a potential timebomb that could explode as early as August as thousands of junior doctors struggle to find childcare or quit their jobs.”

The findings echo the concerns already raised by a series of leading doctors – including bosses of many medical royal colleges in a letter to David Cameron on Monday – that the revised terms and conditions for all junior doctors in England will deter recruitment and exacerbate the worsening shortage of medics.

Watson initiated the survey after the Department of Health’s equality impact assessment of the contract admitted that female junior doctors, including those who have children or other caring responsibilities, would lose out as a result of it.

The DH had not responded to a request for comment by the time this story was published.

Non doctors are not so lucky…

The costs and returns: facts and figures

Chris Smyth in The times 26th April reports: So who is right? The rival arguments

….More than 11,000 extra doctors will be trained over the next five years but they need to be employed on the right terms. …

In a graphic in The Times 26th April 2016 comparisons are available. According to the Times graphic 26th April 2016 it costs:

£508,000 to train a consultant, £385,000 to train a GP, £80,000 to train a nurse’ £70,000 to train a Physiotherapist

Earnings 10 years after graduation are:

Medical Male  £55K, Female £45 K, Economics Male £44k & Female £38K, Law Male £30K and Female £26K, Nurses and Midwives Male £28K and Female £22K

Average lifetime earnings are also shown, as are Pensions on retirement, under the present system (which is far less generous than it’s predecessor but is better than most others). You can download the graphic for clarity..

Counting the cost

Sources: Personal Social Services Research Unit; IFS; HSCIC Earnings Survey; Government Actuary’s Department.

Chris Smyth in The times 26th April reports: So who is right? The rival arguments

Government case
No one seriously disputes that care isn’t as good at weekends as during the week and the government has a duty and electoral mandate to fix this. Arguments about whether this claims 11,000 lives, 6,000 lives or some other figure shouldn’t distract from the need to tackle a real problem.

More than 11,000 extra doctors will be trained over the next five years but they need to be employed on the right terms. Compromises were offered on 16 areas of disagreement in the new contract, and the BMA was willing to talk about 15 of them. It was the BMA’s refusal to discuss any change to Saturday pay that led to the collapse of the talks.

The BMA agreed that the current contract was outdated and should be changed. After more than three years of talks the government was advised by Sir David Dalton, one of the most respected chief executives in the NHS, that there was no realistic chance of a negotiated settlement and the uncertainty was damaging the health service. Junior doctors are well-paid professionals and will become very well-paid consultants or GPs. The contract will not cut the total pay bill and no current junior doctor working within legal hours will get a pay cut. This is not about saving money.

Automatic annual pay rises for time in service are unfair and ought to be linked to performance. The government has offered protection for those who take time out for research or to raise a family. Maximum working hours will actually be cut.

BMA case
Anyone who has ever been in a hospital knows that junior doctors already work seven days a week. The health secretary has insulted dedicated professionals by saying they don’t. Any problems with weekend care are much more about the lack of consultants, diagnostic tests, other support services and social care.

If the government wants more doctors working at the weekend, it will have to pay for more of them. Otherwise care during the week, already overstretched, will suffer. Britain spends less than comparable countries on healthcare and the government should not pretend that the NHS can offer more without more resources. When the BMA agreed to negotiate a new contract in 2013, weekend care was not mentioned as a problem. Hospitals are making changes to working patterns to improve treatment at weekends without the need for a new junior doctor contract.

The BMA still has concerns about work-life balance. It is false to claim Saturday pay is the only point at issue. The government’s own equalities assessment says women, especially single parents, could be disadvantaged. Doctors need time for a family life and paying more for weekend work acknowledges it comes at a cost.

Junior doctors voted 98 per cent in favour of industrial action. If even a small proportion of junior doctors abandon an already-struggling NHS to work abroad, the impact on patients will be disastrous.

There is an issue between treating someone as a professional and as a tradesman. Your plumber will come out of hours, but at a price.

It is interesting that there are still too few applicants for Wales and Scotland for Medical Training posts, and they have the old contract. This may change next year if the strikes continue – and emphasises that there is no “NHS” – something WHO agrees with.

The way to control a profession is by overcapacity. Germany and Holland have done this for years, and once there is an inevitable loss abroad, the competition to stay becomes more intense. Also the pressure on pay rises is less.

We have neglected capacity in the Medical Profession for years now, depending on imported doctors from overseas, and especially from countries who can least afford to lose them. We have also prejudiced against male students coming into medicine by undergraduate rather than graduate entry. We have allowed the better suburb schools to win most of the places and these students have no intention of working in the shires or in rural areas.

Adverse selection is needed in recruitment, but it would also help to re-structure medical schools so that their “graduate” entry students were trained based in a community (DGH and GP based), using on line learning supervised by their Deanery.

Continuing to ration medical school places is wrong. With 11 applicants for every 2 places we might have 5 times the number…. Why not?

A striking day in the history of the health services. Mr Hunt has managed to facilitate a “first”, and break the record of 40 years without a strike for emergencies.. Is there a difference between a professional and a tradesman?

Should NHSreality not congratulate Mr Hunt – A striking day in the history of the health services. He has managed to facilitate a “first”, and break the record of 40 years without a strike for emergencies.. Across the country local news/media reports. The sympathy for juniors will disintegrate as there are more strikes and possible deaths, so it is worth recording todays reporting before it regresses. The immediate scapegoat should be Mr Hunt: please remember this in the weeks ahead. The longer term blame should be on the successive ministers of health who have trained too few doctors. We have yet to have the result of “Ambulance threatened strike” and the “consultant’s contract” negotiations. (Francesca Robinson – March 4th, 2016 in Hospital Dr). Is there a difference between a professional and a tradesman? Is it the “moral high ground“, and has it been lost by striking?

Chris Smyth and Sam Coates report 26th April 2016 in the Times : Now ambulance workers threaten summer strike…. Tens of thousands of paramedics and ambulance dispatchers could go on strike after three unions accused Jeremy Hunt of breaking a promise on pay. ….

Across England local papers report the junior doctors strike. Reporters fail to mention that the doctors can move to Wales, Scotland or Ireland and keep their current contract.

Jessica Long in the EDP Norfolk: What you need to know about the junior doctors’ strike today

Over 1,500 appointments and operations have been cancelled in Norfolk as junior doctors prepare for the first all-out strike in NHS history.

Oliver Clay in the Liverpool Echo reports: NHS Halton CCG reminds residents of junior doctors’ strikes this week 

Patients should consider alternative services for non-emergency ailments and illnesses

Siobhan Ryan in the Sussex Argus reports: Hospitals facing major disruption as junior doctors poised for full walk-out

Joshue Coupe in Tonbridge reports: Maidstone and Tunbridge Wells NHS Trust prepares for junior doctors’ strike

Lyn Barton reports from Plymouth: ‘Patients will be safe’ say senior doctors in Devon and Cornwall as they support strike action

Jane Kirby in Sunderland Echo reports: Junior doctors begin first all-out strike in NHS history

Freya Leng in Cambridge reports: How will Cambridgeshire hospitals cope with junior doctors’ historic two-day strike?

Anuji Varma for the Birmingham Post reports: 4,000 appointments cancelled ahead of two-day junior doctors’ strike 

Keep the moral high ground…. Do something but don’t go on strike. It’s the public support which matters..







The effects of dishonesty, denial and the wealth divide in other systems needs to be considered in the UK

Wealthy people are usually healthier, especially if they are educated and have the opportunity to fulfil their potential in life. Self harm occurs across the social classes. A worrying report by Boer Deng from Washington in the Times 25th April 2016 reminds us that some systems are worse than ours, and going backwards. Drug abuse needs resources to support victims, rather than these same resources being directed at traffickers. Legalise and tax is a better solution to the drugs problem, and then we will have the resources to treat the victims. The denial Americans are suffering from has ideological similarities to the denial of the UK regarding our NHS. Just as they need an honest debate, so do we…..

Originally entitled “suicides among white women in US”, and then “White women in America are dying younger” reads:

A sharp increase in suicides and deaths caused by substance abuse has cut the life expectancy of white women in America.

According to a government report, lifespans for white American women fell between 2013 and 2014 by about five weeks, from 81.2 years to 81.1 years. All other groups of US women increased their life expectancy.

An analysis of death records by The Washington Post suggested that rural communities were worst affected. In some rural regions the death rate among white women in their forties had risen by 30 per cent. In some places, it had doubled.

The data extends findings published last year by Angus Deaton, the Nobel prizewinning economist, which showed mortality rates climbing among middle-aged white people in America. The study argued that a combination of economic distress and an increase in availability of opioid painkillers was to blame. White school leavers drove the overall pattern.

Another Washington Post analysis found a strong correlation between counties with high death rates and a large proportion of voters supporting Donald Trump.

The politics of health.. The Lemmings of the left leave a vacuum where Mr Stevens’ debate will not happen… Are we all lemmings as far as our health system is concerned?

Nov 22nd 2014 – A dishonest and covert dialogue is all that is happening at present.. Simon Stevens says he would like to change this.

The National Drugs problem: Stop Prohibition – even Mr Clegg might be getting there..

Self harm as a drain on the UK Health Services

Parents – private vaccinations for your children may be worth considering

In a letter to the Times 2 days ago, 25th April 2016, the authors argue the case for widening the Meningitis B vaccination campaign. They say that the “government’s vaccination advisory committee called for this…”

So the restriction/exclusion is not rationing, even from the patient’s perspective? NHSreality reproduces the letter in full, with apologies. Private vaccinations for your teenage children, before they attend university, may well be worth considering. The health divide thus increases in The Information Age, when it should be the intention of governments to reduce it.

Similar choices are available for those below 70 wishing Shingles protection.

Sir, The government states that widening the MenB vaccine programme is not cost effective, despite the largest parliamentary petition in history, which culminates in today’s parliamentary debate. The Meningitis Research Foundation and 269 scientists and clinicians have written to the health secretary highlighting flaws in this argument.

The NHS budget is finite, but the cost-effectiveness rules which prioritise NHS spending undervalue prevention of severe childhood illness by placing disproportionate emphasis on immediate versus future health gains. Evidence shows that the public prioritise prevention of death or disability in a few people over mild illness among many people, yet the rules do not reflect this.

The government’s own vaccine advisory committee called for this bias to be addressed in 2013, giving rise to a cost-effectiveness working group. The latter’s recommendations will strongly influence how NHS funds are prioritised, and for the sake of transparency we urge the government to publish its recommendations for wider consultation without delay.

We also urge ministers to commit funding for a MenB vaccine evaluation in teenagers, as immunising this specific group could stop the spread of the disease and protect the whole population.

Dr Simon Nadel, St Mary’s Hospital, Imperial College London; Vinny Smith, CEO, Meningitis Research Foundation; Dr George Kassianos, Royal College of General Practitioners; Professor Neena Modi, president, Royal College of Paediatrics and Child Health


No Problem – we will “log out”…

The politicians do not seem to realise that many of the 80-90% female doctors in England are happy to stop work. Most of them are at a stage in their career when it would be natural to have a child. Most of them are from the good schools in the suburbs, and by the very nature of the selection process they are from well heeled families. (Not all I grant you, and those that are not will almost certainly be working now). Their (admittedly large if no help from bank of Mum & Dad) debt seems irrelevant to the lifestyle choice they have before them, and they have been well trained to be a parent.. Logging off/out seems a natural choice..

The natural result of our selection processes is to create a group who have a perverse incentive to stop running on the hamsters wheel of the English Health Service and have a rest.  If they felt they had to work, there are plenty of places in the other UK regions (notably Wales) but there have been no more applications for speciality training or GP training places outside of England – yet and its summer.. Yes Private Health Insurance will seem attractive. GP could be like Dentistry and Physiotherapy soon, and already psychologists are going private… Covert rationing by commissioners and trusts is responsible. Patients now know that emergencies are not covered in England… so move to Wales?

images (3)

Matthew Weaver reports in the Guardian 25th April: Junior doctor quits live on TV as BMA considers permanent strike – Leaks show how crisis could escalate if government fails to respond to this week’s 48-hour walkout

and Dennis Campbell reports: Junior doctors: ‘over half could quit NHS England over Hunt’s contract’ – Survey finds negative impact on childcare and relationships are key reasons that could drive trainee medics away

Rowena Mason tries to add a political twisted knife: Corbyn accuses Tories of undermining NHS so more patients go private – Labour leader questions whether National Health Service funds have been slashed in effort to promote private healthcare

Alex Matthews-King in Pulse April fools day reports: Third of GP trainee positions remain unfilled across the UK following first round of recruitment whilst GPjobs announces you can “Browse 426 live GP and Practice staff jobs”

The government is keen to recruit unethically from other countries and particularly those without English language and UK Cultural tradition knowledge. The standards have to fall if their target of 600 immediately and 6000 over 10 years is to be met. (UK GP recruitment)

Last year (2015) speciality training was difficult and the competition was very variable. Most competition was for inner city hospitals by suburban family students.

March 2014: Medical Student debt – time for government to change policy on doctor recruitment

Women (& medical students) “.. from poor homes storm the best universities and Medical Schools

Safety fears over doctors who trained outside EU – open up more medical student and GP training posts urgently

Plaid Cymru plan would wipe junior doctors’ debts in Wales

Gender bias. The one sex change on the NHS that nobody has been talking about

Only 52% of doctors completing foundation training chose to enter specialty training

He took out private health insurance!




Juniors consider indefinite strike

The winter of discontent turns into the Junior Doctor Spring revolt …. no sign of this dispute ending anytime soon.Full article via link below at DOCTORS.NET

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Juniors consider indefinite strike 2322/04/2016

Junior doctors could stage an indefinite strike if the government refuses to withdraw imposition of a new contract, according to leaked emails reported yesterday.

The Health Service Journal said it had obtained an email chain between members of the British Medical Association’s junior doctors committee.

In the emails, sent last week, committee chair Dr Johann Malawana set out possible courses of action if next week’s all-out strike does not force the government back to the negotiating table.

The journal also reports a second email leak – this time from NHS Improvement – allegedly canvassing for information about junior doctors refusing to “engage” with management about preparations for next week’s strike.

Medical students likely to quit UK

A recent BMA survey of medical students found many ready to move abroad to improve their post graduate opportunities, perhaps a few more will leave or  move into other post  graduate opportunities as the inequities of the new contract drive away those planning on starting families or working part-time.What cannot be underestimated is the profound effect this dispute has had on morale and  the future thinking of many of our most highly trained graduates .


From DOCTORS.NET full article here

Medical students ready to quit England over contract 18 22/04/2016

Many medical students are thinking of dropping out of medicine because of the junior contract dispute, a survey shows today.

As many as 82% of students said they would be “less likely” than before to make their medical career in England in the survey conducted by the British Medical Association.

And some 34.3% said they would now “less likely” to continue their career in medicine.

The survey found the majority of students are now considering working outside of the UK or moving to jobs in Scotland, Wales or Northern Ireland – or working in the private sector.

Some 94% of students said their enthusiasm for working in the NHS had reduced because of the dispute.

Some 1,197 students took part in the survey.

BMA medical student committee chair Charlie Bell said: “The fact that such large numbers of medical students are considering abandoning medicine altogether or working outside the NHS in England shows how far ministers have eroded the trust of the future generation of doctors.

“Almost every medical student surveyed said they were less enthusiastic about working in the NHS……….


Things are going nuclear over the NHS – cartoon. This is the era for “soft targets”. Quality of dying reflects this..

In The Guardian 20th April 2016:  “Sick Notes” – Things are going nuclear over the NHS – cartoon

Jeremy Hunt may have abandoned his ‘nuclear option’ of imposing a contract on junior doctors, but the issue still has a toxic afterlife

Pressure mounts on Jeremy Hunt over handling of junior doctors’ dispute

Health secretary retreats from claim he has right to impose contract – but threat may mean he has misled parliament

Sarah Johnson 22nd April reports: Healthcare staff, how do you feel about an all-out junior doctors’ strike?

Whether you’re a junior doctor going on strike, or a nurse or consultant working in a hospital, we want to hear from you

Scott Murray in The BMJ reminds us that “cradle to grave” is simply not true. End of life care still not living up to public and doctors’ expectations (BMJ 2016;353:i2188 ). The quality of death and dying is being reduced, partly because of staff shortages, partly because of lack of teamwork and tribalism, partly because of unshared electronic notes, partly because of inadequate training, partly because of changes to the GP contract and partly because of funding insufficiency over many years. In general the public has accepted this covert rationing because the victims don’t vote, and they assume it cannot be changed… Dying people are a soft target, just like smokers, the obese and the mentally ill. Surely it is better to know what is excluded, and then we all can as groups, families or individuals plan for the deficit?


Dennis Campbell reports 22nd April 2016: Smokers and obese people ‘soft targets’ for NHS savings, say surgeons

Royal College of Surgeons says financially challenged clinical groups are restricting access based on lifestyle factors

Update 23rd April 2016: Chris Smyth in the Times – Thousands are still dying thirsty, hungry and in pain

Thousands of people are dying hungry, thirsty or in pain, a survey of more than 20,000 grieving families claims.

One in eight people is not getting the food or water they need as they approach death, while more than half of those dying at home are in pain some of the time, the Office for National Statistics poll found.

The survey is the first since the abolition of a checklist that a review found led to dying patients being refused food or drink under harsh protocols. The report found that little progress had been made since the review.

Simon Chapman, of the National Council for Palliative Care, said: “Very little is changing. What’s good remains good and what’s poor remains poor. We need to see improvements in the areas that are lagging.”

The survey of families found widespread dissatisfaction with rushed hospital nurses, who in a fifth of cases were said not to have usually treated the dying with dignity and respect. Overall, 13 per cent of families disagreed or strongly disagreed that the patient’s need for food or nutrition was met in their last two days, while 12 per cent disagreed that their relative was helped to receive fluids. Ten per cent said that their relative’s pain was not relieved.

Fran Woodard, of Macmillan Cancer Support, said the latest findings showed that basic failings persisted. “Dying people and their families should never be left in such terrible distress in this day and age,” she said.

“It is disgraceful that almost one in four carers felt that someone dying of cancer did not get good care overall in their last three months of life.”

Each year in England about half a million people die, mostly in hospitals, which are rated once again as the worst places to die, with 31 per cent saying care was fair or poor. This compares with 18 per cent who said care was fair or poor in care homes and 21 per cent in hospices. Pain relief was best in hospices, where two thirds said their relatives never suffered, compared with 40 per cent in hospitals and 19 per cent at home. Hospice staff were also reported to be most respectful of the dying.

Ros Taylor, of Hospice UK, said: “We urge the NHS to harness the expertise of hospices, especially on pain relief, good communication and support for families, so that high-quality care is available to people at the end of life across all settings.”

The phasing out of the Liverpool care pathway for dying patients in 2014 was meant to usher in more individualised care. An audit by the Royal College of Physicians reported last month that staff were free to act with compassion.

Scott Sinclair, head of policy at the charity Marie Curie, said, however, that people’s experience of the care they received before death had not changed substantially. He said: “There are still areas of concern around pain relief for people at home.”

Quality of dying is post-code rationed

Cradle to grave? Why the cost of dying is rising.

Mid Staffordshire NHS trust fined for ‘avoidable and tragic death’ – we may all need an advocate..

Family advocates needed? Hospital patients at risk of falls as ‘thousands cannot reach walking sticks’..

Plan your hospital advocate…. NHSreality warned you that it was happening near you. The problems of Mid Staffs and Sussex Mental Health services are endemic, and Christmas is not a time to be ill..

Doctor-assisted dying – The right to die: Doctors should be allowed to help the suffering and terminally ill to die when they choose

The NHS and ‘cradle to the grave’

Briefing Paper: Who cares for Care? Is there going to be a Care Crash? The Time Bomb is ticking..


Health care and the Welsh elections – comparative analysis and graphics with England

There are graphics for cataract, coronary by pass, hip surgery and coronary angioplasty. In all but the latter there is divergence or a big difference.

Those living on the border have a choice. They can register in Wales for “free prescriptions” and then when they need choice of specialist/centre of excellence they can register with a GP in England and have access to “Choose and book”. The emperor has no clothes..NHS Emperor naked

Border Issues – When we will need border controls? Bevan’s “frontier” issues..

NHS ‘postcode lottery’ denies Welsh nurse £70,000 treatment for rare stomach cancer because the hospital is across the border in England

NHS ‘postcode lottery’ denies Welsh nurse £70,000 treatment for rare stomach cancer because the hospital is across the border in England

60% jump in patients kept waiting past scan deadline – Wales declines faster and experiences “Frontier” issues

Frontier issues: Patient in Wales fights to be treated in England

Naïve and childlike Politicisation of Health – civil unrest and internal migration are possible

Why are so many charities supporting an “un-rationed” Health Service?

Devolution of health to Wales was a mistake?

Patients and the professions are ready to ration health care strategically, without devolution. It’s the politicians and the managers who won’t hear of it because the strategy might mention rationing. Englnad v Wales 2012 (2014)