Nhs Cuts Start In Earnest

[Bloo Loo]

Absolutely shocking!

Actually, I think people in practice value both their renumeration and any satisfaction they can derive from their work.

of course, they are ENTITLED...silly me.

Managers, who do Administrative work, clearly need to be compensated for their lack of satisfaction at work.

[Si1]

The basic problem is that in anything other than the short term (like a locum) many Consultant Psychiatrist jobs are simply unsustainable. They simply don't have the money to make the stress & hassle tolerable. Dealing with seriously emotionally tormented individuals in a hostile blame culture with box ticking, meddlesome micromanagement is grim.

makes an argument for de-centralised market based providers, surely

in such an environement then if they can't get the staff they have to sort out their work environment and offer a better pay package, fine, and in areas where staff ARE very readily available, offer less

[Bloo Loo]

The basic problem is that in anything other than the short term (like a locum) many Consultant Psychiatrist jobs are simply unsustainable. They simply don't have the money to make the stress & hassle tolerable. Dealing with seriously emotionally tormented individuals in a hostile blame culture with box ticking, meddlesome micromanagement is grim.

imagine what its like to be treated by this "system".

The Doctor is paid to pretend to care about you.

Edited July 28, 2011 by Bloo Loo

[mirage]

of course, they are ENTITLED...silly me.

Managers, who do Administrative work, clearly need to be compensated for their lack of satisfaction at work.

I made no claims about entitlement. I was amused at your faux shock/disappointment that someone in the health service might be motivated by remuneration. If it is a response to some of the more breathless lobbying from that sector I can see where you are coming from, but it is hardly a surprise, or even wrong.

I agree that across-the-board wage cuts are in order for those who have done relatively well under the last administration. Better for everyone concerned that this is agreed now rather than imposed by the IMF. This would hardly solve the inefficiencies inherent in a monumentally large organisation like the NHS but it would sure save some money. Specific adjustments may need to be made for shortage specialities like psychiatry for example (although money isn't really the issue there as much as working conditions) but overall I think a blanket approach would lessen the internecine warring and sense of unfairness at selective nibbling at the public sector bill.

[Bloo Loo]

I made no claims about entitlement. I was amused at your faux shock/disappointment that someone in the health service might be motivated by remuneration. If it is a response to some of the more breathless lobbying from that sector I can see where you are coming from, but it is hardly a surprise, or even wrong.

I agree that across-the-board wage cuts are in order for those who have done relatively well under the last administration. Better for everyone concerned that this is agreed now rather than imposed by the IMF. This would hardly solve the inefficiencies inherent in a monumentally large organisation like the NHS but it would sure save some money. Specific adjustments may need to be made for shortage specialities like psychiatry for example (although money isn't really the issue there as much as working conditions) but overall I think a blanket approach would lessen the internecine warring and sense of unfairness at selective nibbling at the public sector bill.

I agree, you are talking about the medicine in the NHS.

what people object to, are the layers upon layers of Admin, much of it for its own sake.

[Si1]

I made no claims about entitlement. I was amused at your faux shock/disappointment that someone in the health service might be motivated by remuneration. If it is a response to some of the more breathless lobbying from that sector I can see where you are coming from, but it is hardly a surprise, or even wrong.

no, it is slightly surprising, only certain sectors are motivated extensively by money, and the price they pay for this is short term positions and jobs that could be gone in 6 months (high flyig city jobs and certain corporate contracting roles)

the fact that NHS specialists both hold safe permanent positions AND get paid spectacularly well is extremely disquieting as a statement of their professional ethics

[nohpc]

The first step to achieving that is to top the Daily Mail making front page news of patients who have been denied pointless biologics therapies costing 25k a year due to 'postcode lotteries'. En passant, Roche's products are the most egregious in that regard.

Easy to say when you're not the one needing the treatment.

Something tells me you'd be up in arms if it directly affected you

[mirage]

no, it is slightly surprising, only certain sectors are motivated extensively by money, and the price they pay for this is short term positions and jobs that could be gone in 6 months (high flyig city jobs and certain corporate contracting roles)

the fact that NHS specialists both hold safe permanent positions AND get paid spectacularly well is extremely disquieting as a statement of their professional ethics

I think there are many even higher paid and secure positions in law and finance. Nonetheless, you can certainly argue that many medical positions offer a high risk-adjusted remuneration.

But you are jumping to conclusions about motivation here. If you are talking about doctors, I don't think many of them are "extensively" motivated by money. Certainly no more than in other sectors. Not many go to medical school with the primary intention of becoming rich, though I'm sure many are aiming for a secure and well paid job. Of course, once established in the upper echelons, the more financially competitive have a keen eye on their merit awards and pensions - what do you expect of human nature?

I think it would strain credibility to suggest that, say, IT workers do not in general consider remuneration to be at least a major factor in their choice of activities.

[mirage]

imagine what its like to be treated by this "system".

The Doctor is paid to pretend to care about you.

They're not paid to pretend to care about you. They are paid to treat you.

Some of them are great, some pretty shite. The majority "care" but frankly I would rather have an uncaring one who nonetheless treats effectively. Anyone can care - you're not going for a kiss better.

[Lagarde's Drift]

They're not paid to pretend to care about you. They are paid to treat you.

Some of them are great, some pretty shite. The majority "care" but frankly I would rather have an uncaring one who nonetheless treats effectively. Anyone can care - you're not going for a kiss better.

Utterly naive. A kiss better is exactly what many people need. Unfortunately these days it is couched in complication. look at patient complaints, most people get pee'd off more because of a shite bedside manner or lack of communication or other some such inconsequential shite.

[mirage]

Utterly naive.

Not one of my problems, I assure you.

A kiss better is exactly what many people need.

Absolutely. And a consultant psychiatrist is about the least cost-effective way of delivering that possible.

Unfortunately these days it is couched in complication. look at patient complaints, most people get pee'd off more because of a shite bedside manner or lack of communication or other some such inconsequential shite.

Of course. I said treat effectively and part of that is establishing adequate relations and does require a degree of empathy.

My point remains true that consultant psychiatrists are not remotely "paid to pretend to care".

[aussieboy]

And I shall post it 1000 times more.

Anything to increase your value-free post number up, I suppose.

Easy to say when you're not the one needing the treatment.

Something tells me you'd be up in arms if it directly affected you

That was the point.

[Si1]

I think there are many even higher paid and secure positions in law and finance. Nonetheless, you can certainly argue that many medical positions offer a high risk-adjusted remuneration.

But you are jumping to conclusions about motivation here. If you are talking about doctors, I don't think many of them are "extensively" motivated by money. Certainly no more than in other sectors. Not many go to medical school with the primary intention of becoming rich, though I'm sure many are aiming for a secure and well paid job. Of course, once established in the upper echelons, the more financially competitive have a keen eye on their merit awards and pensions - what do you expect of human nature?

I think it would strain credibility to suggest that, say, IT workers do not in general consider remuneration to be at least a major factor in their choice of activities.

agreed, but this only serves to emphasise that the NHS in its current form is flawed, as socialism (which the NHS embodies) presumes that this human trait does not exist

[aussieboy]

I agree, you are talking about the medicine in the NHS.

what people object to, are the layers upon layers of Admin, much of it for its own sake.

At some point, you'll have to tell us what comprises these layers and layers of management that you see in your mind. Perhaps you envision phalanges of smoking cessation officer/gay and lesbian doctor right officer/pension fund admininstrator chimeras sitting in ivory towers lighting cigars from fifty pound notes before retiring at 40 on more money than you earn despite not being as clever as you (which I suspect underlies your issues)

Anyone who thinks that any significant organisation can operate without management is a fool. Those who propose sacking employees who don't see patients seem not to understand that the major effect of that will be to force those who do see patients to undertake tasks that do not involve seeing patients and for which they are not trained, in which they have no experience and are for which they are not motivated to undertake.

So, when these frontline staff who undertake essential back office work then fall below the magical 10 patients per day ratio, what do you do? Sack them too? Can you see where this is going?

I'm no big fan of management for management's sake but the last thing I want is to be taken away from the wards and dragooned into undertaking the kind of tasks that Analysis has been kind enough to elucidate. Having him/her posting on her has been unreal: someone with actual first hand day to day experience of what they are talking about. I'm surprised no one has called troll.

[Si1]

At some point, you'll have to tell us what comprises these layers and layers of management that you see in your mind. Perhaps you envision phalanges of smoking cessation officer/gay and lesbian doctor right officer/pension fund admininstrator chimeras sitting in ivory towers lighting cigars from fifty pound notes before retiring at 40 on more money than you earn despite not being as clever as you (which I suspect underlies your issues)

Anyone who thinks that any significant organisation can operate without management is a fool. Those who propose sacking employees who don't see patients seem not to understand that the major effect of that will be to force those who do see patients to undertake tasks that do not involve seeing patients and for which they are not trained, in which they have no experience and are for which they are not motivated to undertake.

So, when these frontline staff who undertake essential back office work then fall below the magical 10 patients per day ratio, what do you do? Sack them too? Can you see where this is going?

I'm no big fan of management for management's sake but the last thing I want is to be taken away from the wards and dragooned into undertaking the kind of tasks that Analysis has been kind enough to elucidate. Having him/her posting on her has been unreal: someone with actual first hand day to day experience of what they are talking about. I'm surprised no one has called troll.

the above just goes to show how you simply do not understand management or markets

the suggestion has not been made that front line staff should replace management on a one to one effort basis, you simply emphasise your own misunderstanding by saying that you think they will

and if you think they can't, then ask yourself how many management decisions are required in order for you to get your car serviced, and by whom (including non managerial staff such as supervising engineers), and then you will begin to understand markets

[Si1]

At some point, you'll have to tell us what comprises these layers and layers of management that you see in your mind.

I've met them

(and the reason Analysis is not called a troll is because for all the world he comes across as genuine, I think everyone can see that)

[Analysis]

At some point, you'll have to tell us what comprises these layers and layers of management that you see in your mind. Perhaps you envision phalanges of smoking cessation officer/gay and lesbian doctor right officer/pension fund admininstrator chimeras sitting in ivory towers lighting cigars from fifty pound notes before retiring at 40 on more money than you earn despite not being as clever as you (which I suspect underlies your issues)

Anyone who thinks that any significant organisation can operate without management is a fool. Those who propose sacking employees who don't see patients seem not to understand that the major effect of that will be to force those who do see patients to undertake tasks that do not involve seeing patients and for which they are not trained, in which they have no experience and are for which they are not motivated to undertake.

So, when these frontline staff who undertake essential back office work then fall below the magical 10 patients per day ratio, what do you do? Sack them too? Can you see where this is going?

I'm no big fan of management for management's sake but the last thing I want is to be taken away from the wards and dragooned into undertaking the kind of tasks that Analysis has been kind enough to elucidate. Having him/her posting on her has been unreal: someone with actual first hand day to day experience of what they are talking about. I'm surprised no one has called troll.

Well said.

To give an example, think about an overnight in-patient who goes for surgery. That person needs:

A doctor to manage their condition (more than one may be involved for compex illness such as cancer)

Nursing care round the clock

Food (catering department)

Clean environment (cleaning)

Safe environment (estates)

Admin (medical notes, test results etc)

All of the above for theatres + anaesthetists + operating department practitioners (to manage equipment) + nursing (more than one often per case) + porters (to get the patient to and from theatres)

Then all of the additional 'backroom' roles such as IT support (radiology, information management systems, radiotherapy treatment planning are all electronic now and some of these systems are highly complex, not plug and play), etc etc

All of these groups need managing, otherwise you would have dirty wards, or no food etc. Although the public mostly hear about doctors and nurses on the news, there are many more people involved in the process. Remove some of these people and your frontline staff have to take up the slack. Catering managed badly? Can't leave the patients to starve, so the nurses will have to sort something out.

[Analysis]

How much has your doctors and consultants pay and bonuses gone up since 1997?

I have never had a bonus. Pay rises are usually set at the rate of inflation, but are currently 0% for 2 years against 5%pa RPI. Pension costs rose by up to 1.5% of gross salary in 2008 and are set to rise by a further 3 or 4% of gross salary.

I did get a bonus when I worked abroad. Interesting scenario that, as I was able to combine an increase in salary etc with continuing to do the work I like doing.

Edited July 29, 2011 by Analysis

[Analysis]

here we see, from the horses mouth, what "the caring service" is really all about...personal enrichment

Update on the Harley Street exodus - we have actually lost 3 staff there now. Turns out defector 1 is being paid £1000 a pop to secure staff from the NHS. Not that hard really; he nominates someone suitable, they get an offer significantly above current salary and conditions and off they go.

[Bloo Loo]

Well said.

To give an example, think about an overnight in-patient who goes for surgery. That person needs:

A doctor to manage their condition (more than one may be involved for compex illness such as cancer)

Nursing care round the clock

Food (catering department)

Clean environment (cleaning)

Safe environment (estates)

Admin (medical notes, test results etc)

All of the above for theatres + anaesthetists + operating department practitioners (to manage equipment) + nursing (more than one often per case) + porters (to get the patient to and from theatres)

Then all of the additional 'backroom' roles such as IT support (radiology, information management systems, radiotherapy treatment planning are all electronic now and some of these systems are highly complex, not plug and play), etc etc

All of these groups need managing, otherwise you would have dirty wards, or no food etc. Although the public mostly hear about doctors and nurses on the news, there are many more people involved in the process. Remove some of these people and your frontline staff have to take up the slack. Catering managed badly? Can't leave the patients to starve, so the nurses will have to sort something out.

no one denies there is management required.

Its the amount of management required that is at issue.

You forgot to mention Diversity Policy at the Care Point......that deffinately needs to be managed, communicated and effected by a whole tier of uselessness.

[Bloo Loo]

Update on the Harley Street exodus - we have actually lost 3 staff there now. Turns out defector 1 is being paid £1000 a pop to secure staff from the NHS. Not that hard really; he nominates someone suitable, they get an offer significantly above current salary and conditions and off they go.

was this defector a doctor?

[PopGun]

[strawman]It seems obvious to me the only real way of stopping all these public sector bashing posts, is for the private sector to jump start the economy and realign private and public pay back to the long term trend.

To help businesses achieve this, I propose a 50% cut on all salaries over £25k. All bonuses and pension contributions withdrawn and fed back into corporate balance sheets. This will enable the corporates to reinvest this extra capital into more employment, which in turn will feed back into the wider economy and result in more tax revenues and less welfare payments.

A little pain now for a lot of gain later. I can’t see any flaws in this what so ever.[/strawman]

[tahoma]

[strawman]It seems obvious to me the only real way of stopping all these public sector bashing posts, is for the private sector to jump start the economy and realign private and public pay back to the long term trend.

To help businesses achieve this, I propose a 50% cut on all salaries over £25k. All bonuses and pension contributions withdrawn and fed back into corporate balance sheets. This will enable the corporates to reinvest this extra capital into more employment, which in turn will feed back into the wider economy and result in more tax revenues and less welfare payments.

A little pain now for a lot of gain later. I can’t see any flaws in this what so ever.[/strawman]

Peter is being robbed to pay Paul. Try telling Peter that you are cutting his pay because Paul has then spent too much, and you might find he either does not bother earning anything to be robbed in the first place, or disappears.

The Public sector needs the Private one f*ck of a lot more than vice versa. Your feelings on this matter are immaterial, reality is picking up the gavel on this matter as we speak.

[Shrink Proof]

Poor pay

Consultant in Older Adult Psychiatry Salary: £76,666 - £102,608 pa rata

You're missing the point. I wasn't saying that Consultant Psychiatrists are badly paid. I was trying to point out that even at these rates 1 in 7 posts are vacant or being filled by a temporary locum (for whom the NHS pays MORE, to attract them - er, why can't they recruit at these pay rates?). Pay rates for Consultants are the same across all specialties, so a surgeon makes the same, yet most other specialties are almost fully recruited. This means that there's something about the nature of jobs in Psychiatry that makes them unattractive. It's in the patients/taxpayers interest to figure out what this is; after all, if we're paying out we should expect to get high-calibre care delivered by a reasonably consistent team, especially considering the long-term nature of many mental health problems.

Over worked

Working pattern: 32 Hours/Week

Consultant in Adult Psychiatry. My job - working pattern 60-65 hours per week + every 8th night & weekend on call, called out of bed about 60% of those nights (and having to work on the next routine day). Assaulted by a patient approximately annually. When I started in 1989 my support was a junior doctor & a secretary; now it's a junior doctor & half a secretary (who, when she's on leave isn't covered so I either type my own letters & stuff or admin isn't done). A nine year old PC - I only got email in 2002 but the managers had it years before. I could continue but it's tedious & wouldn't be believed by the "everyone in the public sector works 2 hours a month as a diversity champion" brigade.

As I said, not in any sense underpaid, it's something to do with the nature of the job...

[PopGun]

Peter is being robbed to pay Paul. Try telling Peter that you are cutting his pay because Paul has then spent too much, and you might find he either does not bother earning anything to be robbed in the first place, or disappears.

The Public sector needs the Private one f*ck of a lot more than vice versa. Your feelings on this matter are immaterial, reality is picking up the gavel on this matter as we speak.

Then save your bandwidth and enjoy the ride.