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NHS future and Jeremy Hunt

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For the first time in a very, very long time, I agree almost fully with a Tory minister's speech on a matter of substance.  Jeremy Hunt gave a headline speech on the future of the NHS and he gets it right in many ways.

 

Although he's no Nye Bevan, he's happily taking on the doctor's union in reminding them that patients tend to be ill spread across an entire seven days, not just Monday to Friday.  About time.  That was a major failing of the Blair/Brown era where they gave doctors everything they asked for but got nothing in return.

 

Some of the innovation points in there are things that I'll be taking and beating people with that's been far too long in coming.


"When in deadly danger, when beset by doubt; run in little circles, wave your arms and shout"

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It's an interesting read.

 

The decision in 2003 to allow consultants to opt out of weekend working was disastrous for many patients.

 

I'm very glad to see that decision being changed.

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I've long argued that this should be the case. I have to work anti social shifts every month including Saturday/Sunday (day/night) Bank holidays etc. I aren't complaining: I get paid for it. But if it is deemed essential in a pretty trivial service like what I work in, how can it not be even more so in a job where literally, lives depend on it?

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Emily Thornberry puts forward what is presumably Labour's view of what Hunt is saying.

 

"Listening to Jeremy Hunt yesterday was more like eating a huge plate of junk food – which looks appealing at first, and fills you up, but leaves you feeling dissatisfied and slightly sick," she says.

 

It's a nice phrase, but I'm not sure that's the most constructive thing she could have said.

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Can we afford to run a truly 7 days a week NHS? Is there the amount of doctors , consultants , nurses available ?


Homer: How is education supposed to make me feel smarter? Besides, every time I learn something new, it pushes some old stuff out of my brain. Remember when I took that home winemaking course, and I forgot how to drive?

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i]Mr. Burns: Woah, slow down there maestro. There's a *New* Mexico?[/i]

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There was an item on the BBC Radio4 statistics programme some time ago which IIRC proved that the extra deaths at weekend statistic is based on faulty data.  TBH if the NHS is in a mess it's the Tories' and in particular Andrew Lansley's fault.  The milk is spilled all anyone now can do is to try and put some of it back in the bottle.


“Few thought him even a starter.There were many who thought themselves smarter. But he ended PM, CH and OM. An Earl and a Knight of the Garter.”

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Can we afford to run a truly 7 days a week NHS? Is there the amount of doctors , consultants , nurses available ?

Precisely. The concept is great. The reality however will cost. The recent 5 year forward view that was published by Simon Stevens indicated a huge financial gap which all the major parties promised to close. What appears to have been missed however now we're post election is that the funding requirement identified was the minimum in order to maintain the status quo. If more services are required, more finances will be required to match.


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Can we afford to run a truly 7 days a week NHS? Is there the amount of doctors , consultants , nurses available ?

Strangely enough i was in hospital today for a minor general aneasthetic op,i arrived a 8am waited until 11:15 for a bed to go to.

Two older blokes who arrived at 1pm for the afternoon session were sent home at 4:30 as the theatre would'nt have time to do them

So the 5 day week is still not possible,obviously its a shortage of qualified staff,you could throw extra billions more at the NHS and it still would'nt be enough as the skill shortage is obvious

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Precisely. The concept is great. The reality however will cost. The recent 5 year forward view that was published by Simon Stevens indicated a huge financial gap which all the major parties promised to close. What appears to have been missed however now we're post election is that the funding requirement identified was the minimum in order to maintain the status quo. If more services are required, more finances will be required to match.

The concept that consultants can't ask for ridiculous premiums for weekend work any longer is surely right.  That's a saving.  Then there's the current severe clampdowns on agency workers that will inevitably cut costs, it's now hugely difficult for me to recruit an interim and I get judged on them unless HR say there's a genuine reason why we can't find a permanent member of staff.

 

There will be plenty of mergers of CCGs, trusts and other NHS organisations over the next few years.  If done properly, and there's no reason why they won't, then that'll give good savings.  There are far too many CCGs as a start making idiot local decisions and not caring about the wider NHS, efficiencies or even if they can talk to the neighbouring CCG areas.

 

The Tories (and the last Coalition) aren't responsible for the lack of consultants now, that's firmly in the camp of Labour and underinvestment in doctor training given the years that it takes to get consultant grade.  What the Tories (and Coalition) are responsible for is not seeing the problem and fixing it for the next generation of consultants.


"When in deadly danger, when beset by doubt; run in little circles, wave your arms and shout"

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Not just a few billions either , would probably be tens of billions. You would need more staff , a consultant may take years to train. Something like 7\8 years , we would need to find the people and the money. It's never going to happen. What will is a few extra small bits may be done on a weekend.


Homer: How is education supposed to make me feel smarter? Besides, every time I learn something new, it pushes some old stuff out of my brain. Remember when I took that home winemaking course, and I forgot how to drive?

[

i]Mr. Burns: Woah, slow down there maestro. There's a *New* Mexico?[/i]

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Strangely enough i was in hospital today for a minor general aneasthetic op,i arrived a 8am waited until 11:15 for a bed to go to.

Two older blokes who arrived at 1pm for the afternoon session were sent home at 4:30 as the theatre would'nt have time to do them

So the 5 day week is still not possible,obviously its a shortage of qualified staff,you could throw extra billions more at the NHS and it still would'nt be enough as the skill shortage is obvious

You were in all likelihood bumped by an overnight emergency that kicked out routines from the operating room then the tidy-up and cleaning time that always comes afterwards.  One of those things that you could never get around without ridiculously expensive redundancy of premises, staff and equipment and I hope you can understand that an emergency always will trump routine surgery.  It's not obviously a shortage of qualified staff.


"When in deadly danger, when beset by doubt; run in little circles, wave your arms and shout"

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You were in all likelihood bumped by an overnight emergency that kicked out routines from the operating room then the tidy-up and cleaning time that always comes afterwards.  One of those things that you could never get around without ridiculously expensive redundancy of premises, staff and equipment and I hope you can understand that an emergency always will trump routine surgery.  It's not obviously a shortage of qualified staff.

No not really when i arrived everthing was on target as i was hoping to get back to work after dinner so i asked,what did shock me was the number of foreign (not be racist btw)upper skills persons ie doctors,surgeons and so on

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No not really when i arrived everthing was on target as i was hoping to get back to work after dinner so i asked,what did shock me was the number of foreign (not be racist btw)upper skills persons ie doctors,surgeons and so on

Because we made a decision years ago that it was cheaper to poach the doctors and nurses from poorer foreign countries than train our own.  Essentially shafting the poorer countries for our own benefit.  Yay for first world purchasing power.


"When in deadly danger, when beset by doubt; run in little circles, wave your arms and shout"

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Because we made a decision years ago that it was cheaper to poach the doctors and nurses from poorer foreign countries than train our own.  Essentially shafting the poorer countries for our own benefit.  Yay for first world purchasing power.

I lived in north america from 74 to 79 most if not all of the doctors/dentists i had to visit in those years were Brits,who had emigrated like my family at the time,they not only moved for a better way of life but also significant salary increase due to financing of the health service over there(insurance based).

This is something our NHS could never compete with even if we train our own they would do one for a better life and salary

Imagine what the NHS budget would be if we paid the salaries to the top brits to stay here

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I lived in north america from 74 to 79 most if not all of the doctors/dentists i had to visit in those years were Brits,who had emigrated like my family at the time,they not only moved for a better way of life but also significant salary increase due to financing of the health service over there(insurance based).

This is something our NHS could never compete with even if we train our own they would do one for a better life and salary

Imagine what the NHS budget would be if we paid the salaries to the top brits to stay here

The US pays twice per head in STATE FUNDING what we do in the UK, that's on top of the bankrupting healthcare costs to individuals for insurance and co-pay against it.  The number one cause of personal bankruptcy in the US is healthcare costs and the amount of money doctors take out of the system is second only to the insurers.  The US can go fornicate itself when it comes to what they do with healthcare and if our doctors and nurses want to sell their souls to it then that's their own moral choice.


"When in deadly danger, when beset by doubt; run in little circles, wave your arms and shout"

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The US pays twice per head in STATE FUNDING what we do in the UK, that's on top of the bankrupting healthcare costs to individuals for insurance and co-pay against it.  The number one cause of personal bankruptcy in the US is healthcare costs and the amount of money doctors take out of the system is second only to the insurers.  The US can go fornicate itself when it comes to what they do with healthcare and if our doctors and nurses want to sell their souls to it then that's their own moral choice.

My point was back in the 50/60/70 and even in the 80's we did train our own but after training them they would naff off for richer salaries,so it was alot easier to poach off poorer countries were our NHS salaries were higher.

As for selling their souls give over, given a choice of California or Crewe i know which one most would choose

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Cant see how GPs can staff weekends . My Wife works as a practice nurse , She is looking at going in a few years along with the other three nurses . Two health cares with lots of experiance have left and returned on less hours , two Drs are leaving within the nxt few months , how many trained people are around to replace people leaving - Not Many .

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Cant see how GPs can staff weekends . My Wife works as a practice nurse , She is looking at going in a few years along with the other three nurses . Two health cares with lots of experiance have left and returned on less hours , two Drs are leaving within the nxt few months , how many trained people are around to replace people leaving - Not Many .

Ask Labour they were going to pull loads out of the cupboard before the last election

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Cant see how GPs can staff weekends . My Wife works as a practice nurse , She is looking at going in a few years along with the other three nurses . Two health cares with lots of experiance have left and returned on less hours , two Drs are leaving within the nxt few months , how many trained people are around to replace people leaving - Not Many .

My GP surgery already operates on Saturday and has for years for pre-booked appointments prioritised for people who work.  They don't need to work Sunday as they meet all their daily needs via either face-to-face or telephone appointment.

 

There's one massive area I know covering about 1m people (I know this because I get the stats) where for 95% (and some weeks 100%) of normal business hours there's an urgent GP appointment available via 111 within 5 miles of their home within one hour.  They can even get an urgent out-of-hours hub appointment within an hour for the vast majority of non-business hours.  Despite that and a persistent education effort, there are crippling A&E pressures due to daft people going there for things that are clearly not emergencies.  These same people then are the most likely to complain about A&E staff getting a bit stroppy with them for bringing their precious offspring in for a minor sprain.


"When in deadly danger, when beset by doubt; run in little circles, wave your arms and shout"

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I would like to see subsidised places at university for medicine, nursing, radography, physio, etc to encourage more people into these professions. I appreciate that this is no small undertaking and increasing the teaching facilities at the universities is not a quick and easy thing to do.

 

As mentioned there is the risk of these people achieving their qualifications then heading abroad or into private practice but this is inevitable and maybe some minimum period of NHS work could be required post-graduation.

 

We want more doctors/nurses then we need to provide facilities and incentives for them to train as well as making their working life more bearable. If it weren't for a slight f'up in my maths a-level I would have been a medic, but to be honest I've no regrets knowing much more about the demands placed upon them and I'm quite happy with where my career has led.

 

Being a medical doctor certainly has it's financial rewards, but often less-so than similarly qualified professionals in other lines of work and requires a lot of commitment to get through the initial training but then to continue with the ongoing requirement for further qualifications and professional development.

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I don't see the point about all these nurses, junior doctors and NHS support careers posting pics and blogs of them working on a weekend, we know they do, that's not the point.  The point is that very few consultants do and a reasonable number of those who do get paid exorbitant fees for doing so.  I've seen nothing that shows that the consultants recognise the indisputable fact that if you're admitted via A&E at a weekend that you're 15% more likely to die, the bulk of evidence is that the senior medical experts just aren't there until Monday when they're so busy catching up that things get missed.

 

So, I'm happy for them to challenge government policy but at least do so while acknowledging that the government is trying to fix a shameful record of weekend deaths and come up with alternatives rather than acting like petulant toddlers being told to clean up their mess.


"When in deadly danger, when beset by doubt; run in little circles, wave your arms and shout"

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I don't see the point about all these nurses, junior doctors and NHS support careers posting pics and blogs of them working on a weekend, we know they do, that's not the point.  The point is that very few consultants do and a reasonable number of those who do get paid exorbitant fees for doing so.  I've seen nothing that shows that the consultants recognise the indisputable fact that if you're admitted via A&E at a weekend that you're 15% more likely to die, the bulk of evidence is that the senior medical experts just aren't there until Monday when they're so busy catching up that things get missed.

 

So, I'm happy for them to challenge government policy but at least do so while acknowledging that the government is trying to fix a shameful record of weekend deaths and come up with alternatives rather than acting like petulant toddlers being told to clean up their mess.

 

My experience - and it's anecdotal so not data - is that if you need a consultant at the weekend you will get one.  But that there are fewer around because there are very few pre-booked lists or appointments.  This covers, over the past ten years, neo-natal, paediatric, A&E and fracture admissions in Bucks and East Sussex.  I suspect that rather like GP coverage it massively varies by CCG area.  The consultants I know - and I do now know a few - do work weekends.  Not every weekend but on a rota basis and distinct from time when they are 'on call'.  They do get extra for weekends but it is substantially less than they get for seeing private patients. 


Build a man a fire, and he'll be warm for a day. Set a man on fire, and he'll be warm for the rest of his life. (Terry Pratchett)

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My experience - and it's anecdotal so not data - is that if you need a consultant at the weekend you will get one.  But that there are fewer around because there are very few pre-booked lists or appointments.  This covers, over the past ten years, neo-natal, paediatric, A&E and fracture admissions in Bucks and East Sussex.  I suspect that rather like GP coverage it massively varies by CCG area.  The consultants I know - and I do now know a few - do work weekends.  Not every weekend but on a rota basis and distinct from time when they are 'on call'.  They do get extra for weekends but it is substantially less than they get for seeing private patients. 

That's fair enough but I've seen more than a few critical incident reports where on-call consultants refuse to come out when called.  There was one even that made the papers where the consultant was at a dinner party and refused with a severe consequence that came from a junior doctor making a wrong call.


"When in deadly danger, when beset by doubt; run in little circles, wave your arms and shout"

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That's fair enough but I've seen more than a few critical incident reports where on-call consultants refuse to come out when called. 

 

I'm sure that happens and, again, from experience there are some consultants who go so far above and beyond you wonder how they ever see their family ... and there are others who you think must have forgotten what the inside of their hospital looks like.  I think the idea that there is no cover outside office hours which Hunt was pushing is so wrong as to be a nonsense, and the idea that the NHS is staffed entirely be selfless uberfolk is also not true but a bit nearer reality.


Build a man a fire, and he'll be warm for a day. Set a man on fire, and he'll be warm for the rest of his life. (Terry Pratchett)

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