Recommended Posts

Nothing matters right now.  EU and/or bust.

Unfortunately true.

 

On the subject though, the latest number of inpatient beds in the NHS system were released and show another reason for the lack of beds:

 

General and acute beds (normal hospital ones) in England have reduced by 6.5% since 2010

Learning disability beds in England have reduced by 47% since 2010

Mental health beds in England have reduced by 18% since 2010.

(the definition of a "bed" is a patient bed that is in service and either in-use or ready for use by patient under the care of a consultant)

 

Anyone remember the 1980s when it was regular headline news when a ward was closed or threatened with closure?  12,875 beds have been cut from the NHS since 2010 with the disproportionate number of the cuts coming from the most vulnerable sectors.

Share this post


Link to post
Share on other sites

Sadly community services have not seen anywhere near enough financial provision to make up the transfer of demand from in patient to community patient

Share this post


Link to post
Share on other sites

Sadly community services have not seen anywhere near enough financial provision to make up the transfer of demand from in patient to community patient

Community services have had an even bigger hit but it's far harder to track those as there's no standard methodology.  It's easy to track hospital beds as they've followed the same methodology since 2010.  The Care Closer to Home bit really clamps down on community care even more and the former NHS organisations that were forcefully de-merged a few years ago are badly struggling to make them work now with the lower funding available.

Share this post


Link to post
Share on other sites

My evidence is only anecdotal and experiential....

My wife (community lead district nursing) and myself (senior learning disabilities community nurse) have both seen beds cut as a result of financial pressures or legislation... (mansel 01, 07).

In that time the demands, particularly on district nursing and in care management and health assessments in ld, have increased 5-6 fold upwards.

Similarly budgets to those community services have decreased in real terms.

In LD the govt own white paper- mansell - obliged local authorities and the NHS to form integrated team specific to ld.

Rotherham is indicative of many authorities who are reversing that legal requirement and disintegrating their teams in a reorganisation presumably as further fiscal pressure is biting...

Morale across community services is at an all time low

Share this post


Link to post
Share on other sites

Rosena Allin-Khan one of our overworked doctors has been elected as MP for Tooting, will she have to resign her medical job or can she do both.

We're repeatedly told by MP's and doctors how time consuming both jobs are.

Share this post


Link to post
Share on other sites

Rosena Allin-Khan one of our overworked doctors has been elected as MP for Tooting, will she have to resign her medical job or can she do both.

We're repeatedly told by MP's and doctors how time consuming both jobs are.

Probably go down to part time to keep her doctor accreditation active. There's an SNP surgeon who does a few shifts a month for that reason.

Share this post


Link to post
Share on other sites

And here's one where the doctors are wrong.  They complain that there aren't enough doctors who will sign up to permanent employment posts but then complain that the government is being unreasonable by insisting hospitals paying locums 55% more than permanent staff. And even then, only around 5% of hospital trusts stick to those limits, most grossly exceed that yet still have to fight to get the very rate sensitive locums to come to them.  Those few trusts that have followed the rules get stiffed by neighbouring trusts who just bribe all their locums to come work for them at higher, non-conforming, rates meaning the compliant trusts struggle to provide a service at all in some areas.

 

Why would you go permanent if by being a locum you can earn three to ten times your expected salary, get to pick your shifts and can be as flexible as you like?

 

It's not just clinicians the NHS have done this with, we had to do an exercise of reducing every contractor's day rate to fit within that 55% cap, the contractors got a choice, accept or leave.  It has caused quite a bit of damage to the work we're doing in the short term but the long-term financial benefits are quite considerable.

 

There's a huge industry in the agencies who provide these doctor and nurse locums, it's in their interest to get day rates as high as possible because they earn a percentage of it.  The greed of these agencies mixed in with the greed of a relatively small number of doctors and nurses is what has broken a system that used to work relatively well on trust.  Of course contractors should get paid more than permanent staff, their rate has to reflect that they don't get holiday pay, sick pay, guaranteed work, pensions and so on plus reward immediate availability, but I saw one nurse getting a rate that's around 350% of permanent equivalent and some doctors getting 800%+ equivalents.  I don't even have access to more than a small sample of the rates across England but I'd doubt if those were the highest paid ones.

 

There was even one clinical commissioning group (local groups that decide how NHS money should be spent) who spent £500,000 on two agency senior managers in a year.  Really?

 

A caveat: there are a lot of bank nurses and other staff members who don't make that much out of bank or contractor schemes, the NHS employers and agencies have it sown up so that employers get reasonable rates, agencies get a nice profit and staff get just enough extra that they'd struggle to better it in permanent employment.  Remember that when trying to lump them all together.

 

The greed of a small few has caused this and I actually support the government's actions in clamping down on it, they have had to be hard on it because they've spent the last five years trying to do it through negotiation and good-will with absolutely no action or effect.  Hunt and NHSE have realised that they either go in with absolute rules or it'll never resolve itself.  Next will come the punitive action against the chief execs who refuse to follow the rules.

Share this post


Link to post
Share on other sites

In addition to my above post, there's some nasty politics going on in the NHS and both sides are to blame.  There are no "good guys" on this argument.

 

On one side, persistent dicking around by the government has meant we have a genuine shortage of emergency medicine doctors, it's one that's been known for at least a couple of years that it's getting to breaking point, there's now about 1000 unfilled emergency doctor vacancies.  This is an area that private medicine cannot do either so I just don't get the wilful neglect by Hunt on this issue.  It really is wilful neglect.

 

On the other side, Leeds Teaching Hospitals Trust had to put out an emergency "all hands' notice to its non-emergency doctors asking for cover for weekend shifts, even those without emergency department experience.  The locum agencies and locums have made a decision to no longer staff this Trust because they're following the government's rate caps.  Even when the hospital agreed to break the caps because they were desperate, and were quite close to decisions to downgrade the emergency department temporarily, the agencies and locums still boycotted the hospital, choosing to go work in hospitals who had absolutely no care for the caps at all.  Utterly shameless narcissism by doctors who'd happily see emergency patients go untreated than buckle to actually quite reasonable rate caps.

 

So, you have a government that doesn't give a damn and locum doctors who don't give a damn, stirred by private staffing agencies who are annoyed at a small loss of profit.  This leaves the genuinely caring doctors employed by the NHS in a dire and desperate state giving the best care they can but understaffed or with junior doctors who have no experience in the trade.

 

It's not one that can be fixed anytime soon.  To be fair to Hunt, he is putting a bit of money into training more emergency doctors but nowhere near enough, he's giving a drop of water to a thirsty beast.  It needs more, much much more.  On the locum doctors, I have far less tolerance, to suit their overblown views of themselves they'd happily see emergency departments close.  To the hospitals who blatantly breach the cap and go well beyond limits, your chief executives deserve to lose their job and be booted permanently from the NHS.

Share this post


Link to post
Share on other sites

All the West Yorkshire trusts have a gentleman's agreement that they won't break the agency cap pay rates to prevent doctors just moving to the next trust. Hopefully they'll continue to hold firm, and not be beholden to locums and their agencies.

Share this post


Link to post
Share on other sites

All the West Yorkshire trusts have a gentleman's agreement that they won't break the agency cap pay rates to prevent doctors just moving to the next trust. Hopefully they'll continue to hold firm, and not be beholden to locums and their agencies.

Isn't Leeds Trust in that group?  They breached that cap last week out of desperation.

Share this post


Link to post
Share on other sites

Isn't Leeds Trust in that group? They breached that cap last week out of desperation.

Yes it is. Desperate times, desperate measures I guess, but it just shows how ridiculous the system has become. Breach cap in these circumstances, trust gets it in the neck. Trust close ED due to lack of staff through national shortage, trust gets it in the neck. What do they do?

Share this post


Link to post
Share on other sites

Yes it is. Desperate times, desperate measures I guess, but it just shows how ridiculous the system has become. Breach cap in these circumstances, trust gets it in the neck. Trust close ED due to lack of staff through national shortage, trust gets it in the neck. What do they do?

I don't think Leeds Trust had a choice on it so they get a pass on the issue but there are some other Trusts I can name where the CEs should be taken outside and flogged for their blatant disregard.

Share this post


Link to post
Share on other sites

I don't think Leeds Trust had a choice on it so they get a pass on the issue but there are some other Trusts I can name where the CEs should be taken outside and flogged for their blatant disregard.

Agreed. Trusts need to work together on this for it to work.

Edited by gazza77

Share this post


Link to post
Share on other sites

Yes it is. Desperate times, desperate measures I guess, but it just shows how ridiculous the system has become. Breach cap in these circumstances, trust gets it in the neck. Trust close ED due to lack of staff through national shortage, trust gets it in the neck. What do they do?

 

You know the answer to that! Bring in the private sector. Seventh Cavalry to rescue - all the way to the bank, which rescues them, too!

 

I'm not cynical. I'm furious. And I can't do a damn thing about it.

Share this post


Link to post
Share on other sites

You know the answer to that! Bring in the private sector. Seventh Cavalry to rescue - all the way to the bank, which rescues them, too!

 

I'm not cynical. I'm furious. And I can't do a damn thing about it.

The thing is that this is one area where the private sector CAN'T help.  There's no money in it at all, emergency medicine is funded on a model of: in, triage, patch up, out, with very little high-income value work but lots of areas that cost a lot of money.  Private hospitals send private patients in emergency situations to the NHS because it's just too damn expensive for a private company to run one.

 

That's what really annoys me, it's just gross and wilful negligence by Hunt allowing it to get to this state, he doesn't even have the excuse that he's trying to privatise by the back-door.  There is no excuse at all for it.

Share this post


Link to post
Share on other sites

Do you know something, ckn? It's no wonder the people voted to give the politicians a damn good kicking. On reflection, I can't blame them.

 

If I can find time, I'll post the tale of my step-daughter's dentistry agony.

 

As a taster, after dialling 111, she was told there wasn't a single emergency dentist in the whole of North Yorkshire and that her best bet was to get it seen to while she is Crete. I don't know where to begin.

Share this post


Link to post
Share on other sites

Do you know something, ckn? It's no wonder the people voted to give the politicians a damn good kicking. On reflection, I can't blame them.

 

If I can find time, I'll post the tale of my step-daughter's dentistry agony.

 

As a taster, after dialling 111, she was told there wasn't a single emergency dentist in the whole of North Yorkshire and that her best bet was to get it seen to while she is Crete. I don't know where to begin.

The Yorks & Humber area has had especially big kickings over the last few years, the Lansley reforms really weren't kind up there.  The NHS Home Counties areas look north and see what it could be like if they were really screwed by the government...

Share this post


Link to post
Share on other sites

It is a fair bit of a surprise given the BMW recommended it.

I'm not that sure the doctors were ever really interested in a negotiated settlement.  They just want it all their own way.  Or rather 58% of 60+% do anyway.

 

Given that the BMA recommended settlement Hunt should just go ahead and impose it.

Share this post


Link to post
Share on other sites

Pay deal to be imposed?

 

May is going to be rather busy when she gets in.

I think it will be sorted before then.  I don't think the government or the country for that matter can allow doctors behaving badly to undermine much needed stability in the coming months or distract from the much more important business of negotiating our way out of the EU.

Share this post


Link to post
Share on other sites

I think it will be sorted before then.  I don't think the government or the country for that matter can allow doctors behaving badly to undermine much needed stability in the coming months or distract from the much more important business of negotiating our way out of the EU.

 

 

You think the doctors will shut up and walk away if the pay deal is imposed?

Share this post


Link to post
Share on other sites

Create an account or sign in to comment

You need to be a member in order to leave a comment

Create an account

Sign up for a new account in our community. It's easy!

Register a new account

Sign in

Already have an account? Sign in here.

Sign In Now

  • Recently Browsing   0 members

    No registered users viewing this page.


League Express - Online Now

League Express - Every Monday



Rugby League World - Sept 2018

Rugby League World - Sept 2018

Rugby League Books On Sale Here