Sack The Junior Doctors.....

[ChumpusRex]

So as I said invest in training to employ more junior doctors and nurses.....there are hospitals with all the equipment the wards and the beds but not enough front line staff employed by the NHS....plenty of managers and other back office staff.

The government doesn't want to do this. In fact, the government commissioned a major report about workforce planning for the NHS a couple of years ago. The conclusions were stark; far too many doctors and nurses are being trained. Urgent cutbacks in training places were needed. For the last 2 years, medical school places have been closed at a rate of about 6% pa.

The report suggested that rather than training our own, we should hire staff from abroad.

[spyguy]

On what basis where there too many?

Ive ono pinion either way. Just want to understand reasoning.

[ChumpusRex]

On what basis where there too many?

Ive ono pinion either way. Just want to understand reasoning.

No idea. None of my colleagues know. I'll see if I can dig up the report, but I can't remember who prepared it.

To everyone on the ground, the situation is of a catastrophic shortage of staff of all types. The reason why your private ultrasound clinic is all just the same staff as in the NHS is because there isn't anyone else to hire. Everyone trained is already working in the NHS with few exceptions.

[Bossybabe]

Private healthcare moves you up the queue and gets you a side room. In some cases earlier diagnosis may change the treatment you receive, if treatment begins before your condition otherwise would have worsened, but I don't think the quality of private treatment is better as such.

Private medicine is also sometimes practised in hospitals without overnight medical cover. I'd prefer non-strike NHS anytime.

[MrPin]

The government doesn't want to do this. In fact, the government commissioned a major report about workforce planning for the NHS a couple of years ago. The conclusions were stark; far too many doctors and nurses are being trained. Urgent cutbacks in training places were needed. For the last 2 years, medical school places have been closed at a rate of about 6% pa.

The report suggested that rather than training our own, we should hire staff from abroad.

Abroad eh? Actually I think abroad needs the doctors, and nurses they have trained.

[Bossybabe]

Yes there is a need for non clinical. Its just thats where they tend to dump/waste the extra cash.

Eyebrows should be raised when 50%+ are non clinical.

That's crap. Just F.Y.I:

Current health expenditure in the UK was 9.78 per cent of GDP in 2015. This compares to 16.91 per cent in the USA, 11.08 per cent in Germany, 11.01 per cent in France, 10.76 per cent in the Netherlands, 10.59 per cent in Denmark, 10.16 per cent in Canada, 9.05 per cent in Italy and 9.00 per cent in Spain.

The NHS was rated as the best system [by the Commonwealth Fund] in terms of efficiency, effective care, safe care, coordinated care, patient-centred care and cost-related problems. It was also ranked second for equity.

[Bossybabe]

Abroad eh? Actually I think abroad needs the doctors, and nurses they have trained.

I worked in one famous London teaching hospital that funded many places in the schools of nursing in the Phillippines. They recruited its graduates twice a year when I worked there. Perhaps they still do

[Bossybabe]

No idea. None of my colleagues know. I'll see if I can dig up the report, but I can't remember who prepared it.

To everyone on the ground, the situation is of a catastrophic shortage of staff of all types. The reason why your private ultrasound clinic is all just the same staff as in the NHS is because there isn't anyone else to hire. Everyone trained is already working in the NHS with few exceptions.

We're haemorrhaging doctors we trained to places like Australia and New Zealand because of the consultant-led service. Theirs are more consultant based. They also work in a more family friendly way.

[Bossybabe]

I was looking for this Bossybabe but couldn't find the source. Crap as it is, I believe the NHS is admired as an institution.

P

Yes, Paul, it is widely admired. I've just passed my 35 year anniversary working in the NHS (with 6 years' stroke leave!).

Stroke caused by stress at work, but I still defend the NHS.

It's a frustrating dichotomy of heroic hard work, brilliant minds and clinical hands together with breathtaking stupidity and ignorance. Just like a microcosm of the U.K.!!!

NHS Confederation quoted the Commonwealth Fund:

[url=http://www.nhsconfed.org/resources/key-statistics-on-the-nhs]

The junior doctors will learn that they can't fight this system. The seniors are now withdrawing support. I'm willing to bet there'll be a small uplift in one small part of the new pay structure and they'll all come back to work.

Speaking as someone who has worked in medical education for years, if individuals aren't careful, they'll jeopardise their training and end up taking up to a year longer to complete this part of the training as they're only allowed 14 days out of work on top of annual leave without jeopardising it.

[ChumpusRex]

Found the report:

https://www.gov.uk/government/uploads/system/uploads/attachment_data/file/213236/medical-and-dental-school-intakes.pdf

Since it was published, medical school places have dropped faster than the report originally suggested.

The report is long and boring, but the key issues behind their recommendation to reduce training provision are:

- reduced dropout rate (as a result of "dumbing down" of medical training)

- skill mix (using non-medically trained staff to do certain medical jobs)

- increased staff productivity

- higher retirement ages

- improved staff retention

[One-percent]

Yes there is a need for non clinical. Its just thats where they tend to dump/waste the extra cash.

Eyebrows should be raised when 50%+ are non clinical.

I know it is a different sector, but I was told by an FE college principal that the balance of staff in an FE college is 75 to 25 percent. Any normal person would imagine that the 75 percent would be teaching staff with 25 percent in non-teaching support roles. I kid you not, it is 't'other way round. No wonder the public sector is fecked

[Bossybabe]

Found the report:

https://www.gov.uk/government/uploads/system/uploads/attachment_data/file/213236/medical-and-dental-school-intakes.pdf

Since it was published, medical school places have dropped faster than the report originally suggested.

The report is long and boring, but the key issues behind their recommendation to reduce training provision are:

- reduced dropout rate (as a result of "dumbing down" of medical training)

- skill mix (using non-medically trained staff to do certain medical jobs)

- increased staff productivity

- higher retirement ages

- improved staff retention

That's extremely interesting. So, under the guise of reducing junior doctors' hours to comply with the European working time regulations, and reducing training time to consultant level down to European levels for reciprocity of qualifications, the government has systematically upskilled nurses and deskilled doctors. Now we're leaving the EU.

Ten to fifteen years ago, we were giving nurses jobs traditionally done by juniors, like finger over femoral artery in groin, following angioplasty, which took about half an hour, ostensibly to release doctors to jobs that would enhance their training and reduce their hours of work.

The result was the nurse consultant and doctors who are qualified to be consultants but who haven't seen the breadth that their predecessors saw. Plus a government that now wants to be an importer of pre-trained doctors.

Major dumbing down.

[spyguy]

That's crap. Just F.Y.I:

Current health expenditure in the UK was 9.78 per cent of GDP in 2015. This compares to 16.91 per cent in the USA, 11.08 per cent in Germany, 11.01 per cent in France, 10.76 per cent in the Netherlands, 10.59 per cent in Denmark, 10.16 per cent in Canada, 9.05 per cent in Italy and 9.00 per cent in Spain.

The NHS was rated as the best system [by the Commonwealth Fund] in terms of efficiency, effective care, safe care, coordinated care, patient-centred care and cost-related problems. It was also ranked second for equity.

Careful on this.

The NHS fails a lot if people just by being so clogged up.

The high equity score is because everyone can access the system. Ut scores low on outcomes as oeolle do not gett seen early enough and theres poor aftercare/checkups.

Personally, they need to introduce £20 GP appointments to filter out hypocondriacs. Then seperate geriatric care.

[spyguy]

That's extremely interesting. So, under the guise of reducing junior doctors' hours to comply with the European working time regulations, and reducing training time to consultant level down to European levels for reciprocity of qualifications, the government has systematically upskilled nurses and deskilled doctors. Now we're leaving the EU.

Ten to fifteen years ago, we were giving nurses jobs traditionally done by juniors, like finger over femoral artery in groin, following angioplasty, which took about half an hour, ostensibly to release doctors to jobs that would enhance their training and reduce their hours of work.

The result was the nurse consultant and doctors who are qualified to be consultants but who haven't seen the breadth that their predecessors saw. Plus a government that now wants to be an importer of pre-trained doctors.

Major dumbing down.

I dont think upskilling Nurses is a bad idea.

The NHS operated as a kind of upstairs downstairs class system

[spyguy]

No idea. None of my colleagues know. I'll see if I can dig up the report, but I can't remember who prepared it.

To everyone on the ground, the situation is of a catastrophic shortage of staff of all types. The reason why your private ultrasound clinic is all just the same staff as in the NHS is because there isn't anyone else to hire. Everyone trained is already working in the NHS with few exceptions.

Again, thd non clinical staff is not limited to hospitals. The DOH is a vast waste of money.

[porca misèria]

If the target of the NHS is to make everyone live as long as possible, it will always need more money.

Personally, and I speak as someone who is much nearer the end of my life than the beginning, I would like to see the NHS spend money on treating the cases which are easily treatable and cost effective, rather than spend bucket loads of money to make me live for another few years.

Surely its better to spend £100K on treating 20 people with a good prognosis than blowing the lot on one person who is going to kick the bucket in a few years anyway.

It's not people with a few years who consume all the resources. If an otherwise-healthy 90-year-old has an accident, they should be properly treated and brought back to full health.

I think the distinction you meant to suggest was between those patients with a prospect of a decent recovery and those being kept in a zombified state with no prospect of returning to life.

In a way the National Institute for Health and Care Excellence (NICE) does this by publishing guidelines on the cost-effectiveness of treatments, which provides a justification for them to be rationed by the NHS bodies that are responsible for paying for them. The guidelines are just guidelines, not rules, they're not perfect and lots of people are afraid of the word "rationing" but the idea is there.

It was a nice idea, until politicians inevitably started subverting it.

Just a general observation on nationalised industries, in that whatever you give them will be spent. Are you saying that the NHS is different?

It looks a lot like an instance of Parkinson's law. Yet the NHS of Parkinson's day was tiny and ultra-efficient compared to today's bloated monstrosity.

Current health expenditure in the UK was 9.78 per cent of GDP in 2015. This compares to 16.91 per cent in the USA, 11.08 per cent in Germany, 11.01 per cent in France, 10.76 per cent in the Netherlands, 10.59 per cent in Denmark, 10.16 per cent in Canada, 9.05 per cent in Italy and 9.00 per cent in Spain.

According to whose spin do those figures resemble a like-for-like comparison?

[Bossybabe]

Again, thd non clinical staff is not limited to hospitals. The DOH is a vast waste of money.

Arguably the biggest waste of money in the service.

My ex colleagues in Medical Personnel have wasted vast amounts of time writing and rewriting the new junior doctors' contracts four times this year because of this débâcle. I'm well out of it now.

[MrPin]

Interesting posts on recruitment/staffing strategies for the NHS. Thank you Chumpus, Bossybabe and Will for your insights.

I can't help thinking NHS workforce strategy is intertwined with UK higher education strategy.

Not just about importing qualified Dr's and Nurses from overseas, the plan is to import and train foreign students given they are more 'profitable' and likely to pay their own training costs, contributing to the 'boom' of the higher education market, as well as plugging workforce gaps in the NHS.

Hence the withdrawal of bursaries for Nurses. Lots of noise that UK student numbers will fall. They don't really care, as the plan is to get overseas students in paying £40k for 3 years of training.

P

I hear your words. Work with few younger people with tremendous loans to pay off. I avoided this con by a few years. Amazingly University chancellors seem to be doing very well out of it.

[knock out johnny]

According to whose spin do those figures resemble a like-for-like comparison?

I'm just waiting for someone to pipe in and tell us Cuba is the way the country should go

[Bossybabe]

Careful on this.

The NHS fails a lot if people just by being so clogged up.

The high equity score is because everyone can access the system. Ut scores low on outcomes as oeolle do not gett seen early enough and theres poor aftercare/checkups.

Personally, they need to introduce £20 GP appointments to filter out hypocondriacs. Then seperate geriatric care.

I agree on charges for GP appointments. But I'd go further and charge people who dna. I work in a dental clinic where there are charges for treatment but we still get dnas- mostly by people on benefits who don't pay. They don't value what they don't pay for. My GP practice is surprised if I call to change or cancel an appointment. Apparently it rarely happens. But then, so do appointments these days.

[spyguy]

I agree on charges for GP appointments. But I'd go further and charge people who dna. I work in a dental clinic where there are charges for treatment but we still get dnas- mostly by people on benefits who don't pay. They don't value what they don't pay for. My GP practice is surprised if I call to change or cancel an appointment. Apparently it rarely happens. But then, so do appointments these days.

A friend works in a clinic at the local hospital.

They get beaten up for treatment rates.

Theres a finite number of appointments they can do a day.

1/3 do not show. They never ring, so they cannot rebook appointment.

[spyguy]

The comment on people on benefits wasting time and money is very true.

Another friend, a GP, wastes so much time with benefits people.

Charge £20 a visit.

[grasshopper]

I agree on charges for GP appointments. But I'd go further and charge people who dna.

No thanks. That just means employing more people to push paper around the system instead of spending it on treating patients.

It would also mean that some people who need treatment would not attend because they might not be able to afford it.

The principle of free at the point of service is a good one. We should all have access to good quality healthcare irrespective of our financial status.This IMO is the mark of a civilised country.

The link below gives good insight into the strengths and weakness of the NHS and US Health Care System. It is written by a chap who has lived for long periods in both counties. I found it very interesting and well worth a read.

http://uk.businessinsider.com/an-american-uses-britain-nhs-2015-1

[SarahBell]

A friend works in a clinic at the local hospital.

They get beaten up for treatment rates.

Theres a finite number of appointments they can do a day.

1/3 do not show. They never ring, so they cannot rebook appointment.

The way doctors appointment work is you speak to someone and confirm a mutually agreeable time in the next day or so at a location reasonably close to your home. (Well ok, as mutually as you can get when there is no choice of appointments)

the way hospital appointments work is you get a letter through the post confirming a date that might or might not be suitable, at a time that may or may not suit, at a location usually several miles away from your home. The way to change is it usually to cancel it and start the process again.

The comment on people on benefits wasting time and money is very true.

Another friend, a GP, wastes so much time with benefits people.

Charge £20 a visit.

But the people on benefits would be exempt.

[Clarky Cat]

No thanks. That just means employing more people to push paper around the system instead of spending it on treating patients.

It would also mean that some people who need treatment would not attend because they might not be able to afford it.

The principle of free at the point of service is a good one. We should all have access to good quality healthcare irrespective of our financial status.This IMO is the mark of a civilised country.

The link below gives good insight into the strengths and weakness of the NHS and US Health Care System. It is written by a chap who has lived for long periods in both counties. I found it very interesting and well worth a read.

http://uk.businessinsider.com/an-american-uses-britain-nhs-2015-1

The principle of free at the point of service is good. However it then assigns zero value to it. An analogy (as politicians are always comparing healthcare with supermarkets) would be to make everything in Tesco free. Rather than just taking what they need, people would take anything they wanted, even if it went to waste. Stock would run out, and the limiting factors on getting things that you needed would be how fast it could be produced and restocked, and how long it takes to queue to get into the store.

As it is free, the limit on demand is the supply. Supply never keeps up with ever increasing demand, as there is no mechanism for it, so the only way that things are controlled is by waiting time and unavailability of treatments.