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The new NHS thread

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I've closed the strike thread as it's now a bit redundant given talks have started again.  Hopefully we can start a nice new NHS thread to discuss all the upcoming changes.  If the strike stuff starts up again then I may start a new thread.

 

Jeremy Hunt and SImon Stevens (head of NHS England) today defined to the Commons Health Committee what it means by 7 day NHS.  It doesn't mean a 7 day NHS, it means a 7 day acute hospital service with these definitions:

 

1: All emergency admissions must be seen and have a thorough clinical assessment by a suitable consultant as soon as possible but at the latest within 14 hours from the time of arrival at hospital

2: Hospital inpatients must have scheduled seven-day access to diagnostic services such as x-ray, ultrasound, computerised tomography (CT),magnetic resonance imaging (MRI), echocardiography, endoscopy, bronchoscopy and pathology.

3: Hospital inpatients must have timely 24 hour access, seven days a week,to consultant-directed interventions that meet the relevant special.

4: All patients on the Acute Medical Unit, Acute Surgical Assessment Unit, and Intensive Therapy Unit and otherhighdependency areas are seen and reviewed by a consultant twice daily; Once transferred from the acute area of the hospital to a general ward patients should be reviewed during a consultant-delivered ward round at least once every 24 hours, seven days a week.

 

I'm not sure too many people could disagree with that, even in the hardest lines of the militant wing of health unions.  The biggest impact will be on consultants rather than junior doctors, junior doctors do all of that anyway and are usually well covered in rotas.  What that does mean though is that the junior doctors contract really was all about cutting costs rather than improving the NHS, well, who would ever have guessed that one.

 

Not sure where they're going to get the money to pay for point 2 as the expensive bits of that is outsourced to the private sector in the majority of England.

 

Also, not sure where they're going to get the money to pay all those extra consultant hours.  If they think junior doctors are an irritable lot the wait until the harrumphing that'll come from touching consultant contracts!  Also, many of the points are for Emergency Medicine Consultants which is one of the hardest roles to fill in medicine already, never mind when it changes to fully 7 day working.

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Additionally, they also confirmed where the £22bn of savings will come from:

 

1. NHS England has said £6.7bn of the NHS savings needed by 2021 will come from pay restraint, pharmacy cuts and central budget reductions

2. A further £1bn will come from savings on non-NHS provider contracts and CCG running costs

3. £8.6bn will come from provider savings, driven through 2 per cent a year efficiency requirement in prices

4. However, plan also assumes £1.2bn net reduction in agency spend, in response to higher than expected 2015-16 provider deficit

 

The other £4.5bn will be non-NHS cuts to the DoH stuff funded through councils.  There's some pain that'll hit the community side hard once the targets are confirmed.

 

So, point 1 is £6.7bn of real terms cuts.  Point 2 is £1bn of real terms cuts.  Point 3 is £8.6bn of real terms cuts.  Point 4 is a genuine saving.  I suppose they get some credit there then.

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I thought it was my homeopathy joke that killed the thread.

 

Looks like *unt is in damage limitation mode.

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Additionally, they also confirmed where the £22bn of savings will come from:

 

1. NHS England has said £6.7bn of the NHS savings needed by 2021 will come from pay restraint, pharmacy cuts and central budget reductions

2. A further £1bn will come from savings on non-NHS provider contracts and CCG running costs

3. £8.6bn will come from provider savings, driven through 2 per cent a year efficiency requirement in prices

4. However, plan also assumes £1.2bn net reduction in agency spend, in response to higher than expected 2015-16 provider deficit

 

The other £4.5bn will be non-NHS cuts to the DoH stuff funded through councils.  There's some pain that'll hit the community side hard once the targets are confirmed.

 

So, point 1 is £6.7bn of real terms cuts.  Point 2 is £1bn of real terms cuts.  Point 3 is £8.6bn of real terms cuts.  Point 4 is a genuine saving.  I suppose they get some credit there then.

 

Hang on a minute, you and others on here have been complaining for ages about privatisation and how private companies are making too much money out of the NHS. Point 2 is partially directed at them and Point 3 is totally directed at reducing sums paid to private companies. So they're addressing the issues you have complained about and now you are complaining about them doing that !

 

Also, part of Point 1 is not necessarily a cut. Everyone knows the NHS pharmacy costs are far too high, from the amounts they pay the Pharm companies through to the handing out of unnecessary pills like Smarties. If they can negotiate reduced costs with the Pharm companies then that isn't a cut, its a saving. If they can cut out unnecessary medicine dispensions then that is also a saving.

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I thought it was my homeopathy joke that killed the thread

 

 

No, it was probably my rant in favour of the Doctors, and defending our wonderful, world renowned, world admired NHS that got the thread locked 

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Hang on a minute, you and others on here have been complaining for ages about privatisation and how private companies are making too much money out of the NHS. Point 2 is partially directed at them and Point 3 is totally directed at reducing sums paid to private companies. So they're addressing the issues you have complained about and now you are complaining about them doing that !

 

Also, part of Point 1 is not necessarily a cut. Everyone knows the NHS pharmacy costs are far too high, from the amounts they pay the Pharm companies through to the handing out of unnecessary pills like Smarties. If they can negotiate reduced costs with the Pharm companies then that isn't a cut, its a saving. If they can cut out unnecessary medicine dispensions then that is also a saving.

No... part of the Lansley reforms saw core parts of the NHS turned in to semi-private companies and moved outside of the NHS banner.  Many of the community care parts of the NHS are now employee owned Community Interest Companies or similar.  That's what that's directed at mainly.  I've seen the budget hits that these organisations have had to suck up already and more iscoming.

 

On the pharmacy costs, one of Hunt's big drives is to push many bits of care outside of hospitals where possible.  A worthy goal.  Part of that includes getting pharmacists to offer far more diagnostic and advice services for things that fall just below GP level review; pharmacists throughout England are getting access to the Summary Care Record system to assist with that.  Now, they're being subject to funding cuts at the same time as being expected to do far more for it; the government's own assessment is that thousands of pharmacists will go out of business.

 

Hospitals and mental health trusts are classed as "providers" even if they're 100% NHS organisations.

 

On medication costs, we actually have some of the cheapest pharmacy costs in the world for generics due to mass-scale purchasing and other stuff discussed on other threads.  We also have dedicated analytics teams who analyse prescribing patterns.  For example, if a GP prescribes lots of antibiotics or non-generic drugs, where generics are available, this is picked up by medicines management teams and GPs are asked to explain themselves; repeated infringement without excuse will see GPs lose money from their contracts.

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And done.  That's all it took Mr Hunt, a bit of willingness to talk and things would happen.  Since he seemed to be overruled over the junior doctors contract, talks have been productive and a deal has been reached.  To those who thought, repeatedly and loudly, that this was all about pay, the actual per-hour amount doctors will receive has been reduced by 3.5% from the contract that Hunt was adamant would be imposed.  The key parts include lots of extra protection for patients while also recognising that doctors occasionally do need to sleep.

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And the bits I missed on my earlier briefing:

 

- there's now an enhanced premium paid to support recruitment in emergency medicine, psychiatry and oral and maxillofacial surgery.  Those are the bits that just do not get the numbers of trainees or qualified consultants necessary to run a safe NHS.

- NHS junior doctors who want to offer themselves out as locum must exclusively do so to the NHS through the staff bank system.  This is key as it means the private hospitals can't just offer stupid rates to junior doctors to get them to cover their staff doctor roles at nights.

- junior doctors now get whistleblowing protection for the first time.  Really?!  I asked about this and apparently doctors could be legally discriminated against for whistleblowing until now...

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If Hunt possessed an ounce of decency he would resign immediately. I shan't hold my breath. :dry:

Unfortunately, the half pound of decency left within the current Tory ranks spreads too thinly for any of them to have an ounce each.

Perhaps Hunt and Morgan can be introduced to the Celebrity Death Match model of selection, with the winner resigning.

Edited by Northern Eel

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And done.  That's all it took Mr Hunt, a bit of willingness to talk and things would happen. 

Exactly the same could be said of the BMA.  You'll notice that weekend working is not being paid at premium level as it was previously.

 

Incidentally, these talks have been going on for three years.

 

Personally I think what created this breakthrough was the fact that a number of senior medical figures came out and basically told the BMA/junior doctors that there should be no more all out strikes.  I don't think public support would have lasted.  It was already down following the first all out strike on what it had been at the time of the previous strikes.

Edited by Saintslass

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- NHS junior doctors who want to offer themselves out as locum must exclusively do so to the NHS through the staff bank system.  This is key as it means the private hospitals can't just offer stupid rates to junior doctors to get them to cover their staff doctor roles at nights..

That will be another hit to the pay packets of junior doctors.

 

I can't see the junior doctors liking this agreement very much.

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Exactly the same could be said of the BMA.  You'll notice that weekend working is not being paid at premium level as it was previously.

 

Personally I think what created this was the fact that a number of senior medical figures came out and basically told the BMA/junior doctors that there should be no more all out strikes.

I'll respond to you as you just won't stop digging.  The senior medical figures, i.e. the consultants, knew they were next if the junior doctors buckled.  Plus the NHS Chief Executives and NHS England have had the finger stuck up to them robustly by the junior doctors when they tried the threatening route, it's only once they agreed to talk again rather than threaten that a compromise was reached.  The revised contract protects patients, protects doctors and is cost neutral compared to now, it adds key points that protect the future of the least glamourous but critical parts of the NHS, mainly emergency medicine and psychiatry, and was a genuine compromise by both sides.  You simply can't seem to accept that junior doctors have accepted a lower pay deal in order for that money to be reinvested in the hardest hit parts of the junior doctor world.

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That will be another hit to the pay packets of junior doctors.

 

I can't see the junior doctors liking this agreement very much.

But they did.  The lefties who wanted to break the government, as accused on the other thread, were the ones who signed the agreement on behalf of the junior doctors and were happy with the outcome.

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I'll respond to you as you just won't stop digging.  The senior medical figures, i.e. the consultants, knew they were next if the junior doctors buckled.  Plus the NHS Chief Executives and NHS England have had the finger stuck up to them robustly by the junior doctors when they tried the threatening route, it's only once they agreed to talk again rather than threaten that a compromise was reached. 

I wasn't thinking of the consultants.  Didn't the GMC and another body speak up against continued strikes?  I can't remember which was the other organisation. 

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But they did.  The lefties who wanted to break the government, as accused on the other thread, were the ones who signed the agreement on behalf of the junior doctors and were happy with the outcome.

They had little choice, and they haven't secured the Saturday pay that they were seeking to secure on behalf of the junior doctors.  In fact, the junior doctors' pay has decreased further, which rather suggests the BMA didn't get much of what it wanted, since Saturday pay was indeed one area in which the BMA and the government consistently disagreed. The junior doctors have even had their cozy locum arrangements withdrawn.

 

The junior doctors have still to vote on this agreement.  It will be interesting to see what the outcome of that vote is.

Edited by Saintslass

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They had little choice, and they haven't secured the Saturday pay that they were seeking to secure on behalf of the junior doctors.  In fact, the junior doctors' pay has decreased further, which rather suggests the BMA didn't get much of what it wanted, since Saturday pay was indeed one area in which the BMA and the government consistently disagreed. The junior doctors have even had their cozy locum arrangements withdrawn.

 

The junior doctors have still to vote on this agreement.  It will be interesting to see what the outcome of that vote is.

Do you really not get that it wasn't about pay?  A deal that sees them lose money compared to the contract that the vast majority of junior doctors voted to strike against is now acceptable.

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Do you really not get that it wasn't about pay?  A deal that sees them lose money compared to the contract that the vast majority of junior doctors voted to strike against is now acceptable.

Actually, since I posted, I have read the agreement, as opposed to the thumbnail sketch I had read earlier.

 

Of course it has been about pay.  The reduction you referred to for example has probably come about because the junior doctors are retaining some enhanced pay at weekends after all, which I find disappointing because personally I don't see why they should have enhanced pay at weekends when few other professionals do.  Anyway, a lot of the agreement was about the hours worked, the enhancements, the safety guardians (which were in the pre-all out strike proposals anyway), those with caring responsibilities, locum jobs (which they can still do and still get more than normal pay for), and working time limits (which the doctors themselves were regularly breaking and seemingly still want to).

 

Here is the agreement, for those who haven't yet seen it: http://www.acas.org.uk/media/pdf/g/6/Junior-doctors-contract-agreement-18-May-2016.pdf

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Actually, since I posted, I have read the agreement, as opposed to the thumbnail sketch I had read earlier.

 

Of course it has been about pay.  The reduction you referred to for example has probably come about because the junior doctors are retaining some enhanced pay at weekends after all, which I find disappointing because personally I don't see why they should have enhanced pay at weekends when few other professionals do.  Anyway, a lot of the agreement was about the hours worked, the enhancements, the safety guardians (which were in the pre-all out strike proposals anyway), those with caring responsibilities, locum jobs (which they can still do and still get more than normal pay for), and working time limits (which the doctors themselves were regularly breaking and seemingly still want to).

 

Here is the agreement, for those who haven't yet seen it: http://www.acas.org.uk/media/pdf/g/6/Junior-doctors-contract-agreement-18-May-2016.pdf

Right.  Last post on this from me.  This contract is cost-neutral to the NHS and has exactly the same total outlay in terms of pay and benefits as the one that they voted to strike over.  The difference is that the vast majority of junior doctors will get LESS pay than the former that was to be imposed with the money being used to shore up a lot of protections that were cut.

 

If it were truly about pay then why would the representatives who were vigorously against the contract to be imposed agree and sign up to this one despite it offering LESS money?

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Right.  Last post on this from me.  This contract is cost-neutral to the NHS and has exactly the same total outlay in terms of pay and benefits as the one that they voted to strike over.  The difference is that the vast majority of junior doctors will get LESS pay than the former that was to be imposed with the money being used to shore up a lot of protections that were cut.

 

If it were truly about pay then why would the representatives who were vigorously against the contract to be imposed agree and sign up to this one despite it offering LESS money?

They haven't agreed to it yet.  The junior doctors still have to vote on the proposals.

 

The offer was for a 13% pay rise if the premium pay was disregarded for most of Saturday (ie not evening).  Doctors are still being offered 10% to 11% plus graduated weekend extra pay based on how many weekends they work in a given period.  No enhanced pay if a doctor works one weekend in eight, for example, but enhanced pay in graduations for more frequent weekend working.  And night time working still comes with enhanced pay, at I think 37% (I'm going off memory there).

 

I am not entirely sure the pay IS less than originally.  I can't remember what percentage of pay the enhanced weekend rate was.  I would have to look back and then see what 11% plus the graduated enhancements came to in order to know whether they have taken a hit.  But even if they have taken a reduction, it was inevitable.  Nobody, and I mean nobody, would have tolerated all out strikes by doctors.  If the doctors reject this deal now they will seriously put their reputations at risk as they are getting a whole lot of stuff.

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They haven't agreed to it yet.  The junior doctors still have to vote on the proposals.

 

The offer was for a 13% pay rise if the premium pay was disregarded for most of Saturday (ie not evening).  Doctors are still being offered 10% to 11% plus graduated weekend extra pay based on how many weekends they work in a given period.  No enhanced pay if a doctor works one weekend in eight, for example, but enhanced pay in graduations for more frequent weekend working.  And night time working still comes with enhanced pay, at I think 37% (I'm going off memory there).

 

I am not entirely sure the pay IS less than originally.  I can't remember what percentage of pay the enhanced weekend rate was.  I would have to look back and then see what 11% plus the graduated enhancements came to in order to know whether they have taken a hit.  But even if they have taken a reduction, it was inevitable.  Nobody, and I mean nobody, would have tolerated all out strikes by doctors.  If the doctors reject this deal now they will seriously put their reputations at risk as they are getting a whole lot of stuff.

Why can't you take Craig's word for it.  He works for the NHS?  He ought to know the facts.

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Why can't you take Craig's word for it.  He works for the NHS?  He ought to know the facts.

I linked to the actual agreement.  I am taking that as 'the facts' because that is what the agreement contains: the facts. 

 

The BBC reckon neither side has won: http://www.bbc.co.uk/news/health-36327930

 

But that's the nature of ACAS negotiations I guess.

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I linked to the actual agreement. I am taking that as 'the facts' because that is what the agreement contains: the facts.

The BBC reckon neither side has won: http://www.bbc.co.uk/news/health-36327930

But that's the nature of ACAS negotiations I guess.

Exactly: willingness to talk and compromise.

Presumably Hunt is being reprogrammed to stop saying that the contract is going to be imposed without further discussion so the strikes are meaningless.

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