Is the NHS really over? Just the facts.

“You are entitled to your own opinions, but not to your own facts.”
Patrick Moynihan, four-time US Senator

Is the NHS failing? Research shows the introduction of factual evidence into a polarised debate actually makes the two sides less likely to agree than to agree. However, as a doctor I like cold, hard facts. In our line of work anything less is morally wrong and overtly dangerous.

So here is the NHS. Just the facts (with references). 

  1. The population of the UK is an estimated 65.1 million. 
  2. 1 in 20 GP surgeries have closed or merged since 2013. 57 closing down in 2016 alone.
  3. The NHS England budget is £117 billion for 2016/7 and will rise after inflation to £120 billion by 2019/20. 
  4. Every 36 hours the NHS will treat 1,000,000 patients. 
  5. Accident and emergency departments recorded their worst ever waiting times in 2016/7.
  6. Hospitals recorded their worst ever waiting times for elective surgery in 2015. 
  7. The NHS in England has 149,808 doctors, 314,966 nurses, and employs 1.3 million people. 
  8. 19% of NHS staff and 29.5% of NHS doctors are non-British
  9. The average age of recent migrants to the UK is 26.
  10. Healthcare costs change with age: a 20-year old costs an estimated £500 per year, a 65-year old £3750 per year and an 85-year old £7500 per year. 
  11. The population of the UK over 65 in 1975 was 1 in 8. Today it is 1 in 6. By 2050 it will be 1 in 4. There are 1.5 million people over 85 in the U.K today. 
  12. The NHS buys many drugs from Europe and the USA paying in Euros (€) and US dollars ($).
  13. Health tourism, foreign citizens using the NHS, costs the NHS an estimated £1-300 million per year. A new overseas surcharge recouped £289m in 2015. This is 0.3% of the total NHS budget. 
  14. Stationery costs the NHS £146m/year. 
  15. Compared internationally the NHS achieves above average outcomes, with average funding and below average staff numbers. OECD.
  16. Health costs rise each year in developed countries, above real world inflation. This is broken down into staff wage inflation, new technologies, population growth, new drugs and medical advances. 
  17. The NHS was estimated to require £30 billion by 2020 to meet predicted demand. To date, it has received £4.5 billion. 
  18. Social care is estimated to require £4 billion by 2020 to maintain current service. 
  19. The ratio of people working to those retired is called the Old Age Dependency Ratio (OADR). This was steady at around 300 retirees for every 1000 people working from the 1980s to 2006, but has now since started to rise. With retirement age changes, it will still increase by 20% by 2037 to 365.

So 1 in 6 of the UK population [1] is over 65 [11] at a healthcare cost in this group averaged at £3750 per year [10]. That’s 10.8 million people, which is £40.5 billion a year. The 1.5 million people over 85 require £11.25 billion a year. 

As the ratio of working people to those retired increase [19] and the population age [11] these costs will climb. Over the next twenty years these numbers will double, as the baby boom generation of post-World War Two retire and age.

Now for some opinions. Let me be clear. I’m not “blaming” old people. [https://mobile.twitter.com/kthopkins/status/819897520457392129] I’m talking about my father (77), my grandmother (82). These are people I love and care about. Day in and day out I look after their generation, and I see a system failing them, and not facing up to realities or requirements to provide them the care they deserve.

In healthcare the failings in one area tend to domino into others. As GPs close at record rates [2] and social care is progressively cut back [17] the burden on hospitals is doubled- both at the front end admitting unwell patients from the community and at the back end attempting to safely discharge them.

Unfortunately this is not how we are looking at the situation. 

Immigrants I hear you say? Back to some facts.

The median age of a recent U.K. migrant is 26, compared to the median national age of 40. [9] The average annual cost of a 26-year old in terms of healthcare is around £500. Which makes sense- how often does the average twenty old see the doctor? I went to the GP maybe three times in my twenties. The population doesn’t utilise healthcare equally, which is exactly why the NHS funding model works at all. 

I’d be remiss to not mention the other side of the equation; the large migrant population that work for the NHS. The NHS is the world’s fifth largest employer, employing 1.3m people. [7] 19% of all staff are non-British, 29.3% of doctors and 21.2% of nurses. [8]. 

Which is a good time to mention Brexit.

Applications for EU nurses have dropped , record numbers are leaving, and the NHS buys a lot of drugs from the continent in Euros (€) [12], which now cost more at current exchange rates. Additionally the NHS loses income from research subsidies to NHS hospitals and staff from the EU. 

But at least we’ll save money on health tourism? Right?

Health tourism costs £1-300m a year to the NHS [13] which is just 0.3% of the total budget. [2] In 2015 a new overseas surcharge recovered £289 million from this group. The aim of the surcharge is to make £500 million for the NHS by 2017, a £200 million profit.

So in summary it’s not about immigrants, it’s about realistic planning for the NHS to continue its excellent work as the population demographic changes. 

The NHS consistently achieves above average health outcomes for below average staffing per population and average OECD funding. [15] Although it may not seem like it, on a healthcare system level it’s one of the most efficient in the world. 

So is it failing? These are the facts.

GP waiting times are up, A&E [5] and elective surgery times [6] at record waits, while the NHS recorded its largest ever deficit last year, £2.45 billion in the red. The NHS is about £25.5 billion short of cash right now [17]. 

I’ll leave you to make your own opinion on that.

Lastly healthcare costs rise year on year regardless [16] which is known as health inflation.  While this means healthcare gets more expensive, it’s also part of the reason life expectancies have risen across the developed world for the past fifty years.

So what will change things? 

Well for the long-term future we have a smaller number of people paying for the healthcare of a larger retired population. We can address this meaningfully in one of three ways;

  1. Raise retirement age. Unpopular yes, but I’m talking about my own retirement here. Supporting this with aggressive public health improvement would be sensible.
  2. Have more babies. The low birth rate of the 1970s shifted the OADR in the wrong direction. To restabilise the ratio we need more young people. 
  3. Increase immigration. Unpopular again, but still correct. Immigrants come with an education (80-90% of recent immigrants have completed full-time education vs 50% UK average) [9], low health costs for their working lives, and more likely to retire back to their origin countries. The Office for Budget Responsibility agrees – the public sector debt by 2050 is predicted to be 145% of GDP, but with immigration, 120%. 

A combination of all three is probably needed.

In the short term your opinion may not have changed. But if it has, there is really only a single fact that will change the situation. That’s your vote.

Write to your MP, handwritten is best. Find their address here.

“Dear Sir/Madam,

I want this government to prioritise and fund the NHS. I hold you personally responsible for it’s failings and will vote accordingly at the next general election. Please act wisely.”

Yours faithfully,
[Your Name Here]

But that’s just my opinion. 

Juniordoctorblog.com

References
Fact 1 https://www.ons.gov.uk/peoplepopulationandcommunity/populationandmigration/populationestimates/articles/overviewoftheukpopulation/mar2017

Fact 2
http://www.gponline.com/nearly-200-gp-practices-closed-2016-alone-nhs-data-suggest/article/1421367

Fact 3, 4 and 7
http://www.nhsconfed.org/resources/key-statistics-on-the-nhs

Fact 5
https://www.google.co.uk/amp/www.independent.co.uk/life-style/health-and-families/health-news/nhs-crisis-a-and-e-waiting-times-record-levels-leak-bbc-data-government-failing-to-grasp-seriousness-a7570791.html%3Famp

Fact 6
https://www.patients-association.org.uk/wp-content/uploads/2016/11/Waiting-Times-Report-2016-Feeling-the-wait.pdf

Fact 9
http://www.cream-migration.org/publ_uploads/CDP_22_13.pdf

Fact 10
https://www.google.co.uk/amp/s/amp.theguardian.com/society/2016/feb/01/ageing-britain-two-fifths-nhs-budget-spent-over-65s

Fact 11 https://www.ons.gov.uk/peoplepopulationandcommunity/populationandmigration/populationestimates/articles/overviewoftheukpopulation/february2016#how-are-the-characteristics-of-the-uk-population-changing

Fact 13
 https://fullfact.org/health/health-tourism-whats-cost/
https://www.nao.org.uk/wp-content/uploads/2016/10/Recovering-the-cost-of-NHS-treatment-for-overseas-visitors-Summary.pdf.

Fact 14
https://www.nao.org.uk/wp-content/uploads/2011/02/1011705.pdf

Fact 15
OECD. http://www.oecd.org/els/health-systems/health-data.htm

Fact 16
https://juniordoctorblog.com/2016/01/05/its-the-spin-that-wins/

Fact 17
https://www.parliament.uk/business/committees/committees-a-z/commons-select/health-committee/news-parliament-20151/spending-review-health-social-care-report-published-16-17/

Fact 18 https://www.kingsfund.org.uk/sites/files/kf/field/field_publication_file/Budget%20briefing%20July%202015%20final_0.pdf

Fact 19
http://visual.ons.gov.uk/uk-perspectives-the-changing-population/

The NHS underfunding is a choice. And people are dying. [video]

It’s really hard to capture and keep even the most interested and motivated persons attention long enough to explain how and why the NHS is being underfunded and the truly catastrophic impact of this.

This rather excellent video series does this perfectly. 

Share and RT, write to your MP. It’s your choice too; stand by and let the NHS die, or do something about it. 

Gagged and bound. NHS doctors today.

“The airline industry has learnt that pilots must feel they can speak out”

Jeremy Hunt, May 2016

Imagine this.

You are a doctor, resident in hospital, not quite a consultant. You are employed by the hospital, but you rotate through different areas and different hospitals to broaden your experience of different practices. This is designed to make you a better, safer doctor.
One day you come to work, and find you are the only doctor working- there is no one else rota’d to be there. You have to look after your own hundred patients, but now you need to look after two hundred more. You are desperately worried this is not safe. People might get hurt.
As you have been taught to do, as a doctor and a hospital worker, you raise the alarm. You phone your bosses and tell them, you phone their bosses and tell them too. You try your best to keep people alive.
A few months later you sit down with your bosses, and they feel you harmed the reputation of the hospital. They sack you. Not just from that job, but from all training. In a single swipe, your career is over.


Fair? No. Safe? Definitely not. Legal? Surprisingly, and reprehensibily, yes.
At least according to a similar recent legal case against a junior doctor, Dr Chris Day, that decided that the sacking of a doctor for raising alarms over patient safety, for refusing to cover up negligence and potential harm to patients, is not only legal, but a ‘conscious choice of parliament’. The case is currently going to appeal in the Court of Appeal.
Does that sound right to you? As a patient? As a taxpayer? Your health service, at the absolute frontline, is staffed by junior doctors. These are the doctors that see you when you walk in the door, they will see you every day in hospital, they will do your surgery or keep your lungs breathing for you, they will resuscitate you if your heart stops beating. If there’s something wrong, you can guarantee, a nurse or a junior doctor will see it.
Legally- the hospital can’t sack a doctor for speaking up there and then. But doctors in training rotate department every 4-6 months and rotate hospital nearly every year. There is nothing to stop a ‘troublemaking’ doctor who points out dangerous care from having their career ended as soon as they move on to their next placement. A legal loophole, so dangerous it could swallow the entire NHS.
This has huge implications. Now we know this, many doctors, myself included, would think twice about speaking out. That in itself is a crime. We have mortgages and families- our livelihood cannot rely on the goodwill of pressured hospital managers. If a manager decides to, they can end your career, without recrimination.
I’d like to say the BMA and the GMC would step in to protect a doctor in this situation. The BMA proposed a clause in the new contract to cover this, but it’s legally flawed. The GMC have just been taken over by the department of Health, a conflict of interest in the making.

I’d like to say the Health Secretary, with his long term obsession with ‘whistleblowing’ and patient safety would help- but he himself spent taxpayer money cementing this loophole, keeping junior doctors vulnerable to dismissal for raising alarms.

How has this happened?

Well, all roads lead back to the government appointed body called Health Education England. Trainee doctors are employed by hospitals but hold a general training ‘number’ with HEE that delivers the doctors training over years, and partly pays their salary to their rotating hospital. This arrangement means they aren’t technically covered in law as our ’employer’, so can act with impunity in dismissing whistleblowers.

Funnily enough this is the same ‘training’ body that is threatening hospitals to cut funding for junior doctors if they don’t impose the contract upon them. This is how Jeremy Hunt dodged the legal challenge against imposition- by passing the buck, once again, to an organisation that can’t be sued, currently outside employment law. Proving they are legally our employers, as Chris Day is arguing, may have huge implications for further challenging the ‘imposition’ of the junior doctor contract.


Throughout this year we, as trainees, have fundamentally lost trust in the system. Through incidents like this, through the junior doctor contract dispute, through the years of increasing pressure on resources, target chasing and being ignored.
We have lost trust in the structures that run the NHS and their heads- Health Education England has proved it is neither interested in the ‘education’ of its members nor the ‘health’ of the patients they protect.
As long as we don’t get sacked, we won’t be ‘junior’ doctors for long. In time we will all be your consultants and GPs, the clinical leaders of the NHS. What then? Will we still carry a culture of fear and denial, instilled in us by a system that’s supposed to train and nurture us? Let’s hope not.

The future of a safe NHS depends on it. If you want to do something to safeguard that future, donate to Dr Chris Day’s legal fund here. He needs to raise £100,000 to continue his fight for whistleblowers everywhere.

Help make sure his voice, and all of our voices, are heard.

Juniordoctorblog.com

The future of the NHS and junior doctors is bleak. Can we change it?

It’s clear, despite widespread junior doctor support for further reasonable industrial action against imposition, that the BMA has folded. Now in full “supporting transition” mode, the early imposed trainees already report chaotic rotas, trusts skipping pay protection clauses and lack of coherent safety reporting structures. Many doctors have left, or are considering leaving, the BMA.

Obviously into the midst of this Jeremy Hunt puts the boot in. Keen to build on the perceived political capital of pushing the BMA into withdrawal and supposedly ‘winning’ his High Court case against the contract, he goes onto announce plans to chain doctors to the NHS for four years after qualification, and to replace the ‘foreign’ doctors that prop up the NHS as it is, with ‘homegrown’ doctors.  His plan to expand medical student places by 1500 a year starting from 2018 isn’t unwelcome – it’s just dangerously unrealistic and overtly xenophobic. Doctors entering medical school today will enter the workplace, chained to the NHS, in 2021/22.

What will life be like then?

Hospital Activity
It’s fairly straightforward to extrapolate UK demand by 2022, and the Nuffield Trust have already done the work [ref]**. They report from 2014 predicted NHS demand, expressed in bed days, will roughly rise by 1.7%/year. That means by 2020/21, demand will have risen by 8.7% and by 2021/22, 11% compared to today.

Funding

By 2021, bar any dramatic announcements in the Autumn statement, the King’s Fund predict NHS funding in real-terms will rise by £4.5 billion, a rise of 4%. However, the current deficit this year is £1.8 billion, so this is actually just £2.7 billion to spend, a true rise of just 2.3%*.  Meanwhile, hospital demand will have risen by 2020/21 to 8.7%, which means each extra pound will need to work four times as hard just to stand still. Given waiting times in A&E and surgery have never been longer and the current deficit is the largest ever recorded, the system already appears to be stretched to crisis point.  Imagining it can now stretch to accommodate an efficiency of four times what it currently  can achieve is lunacy.

This prediction also relies on being able to discharge patients, reducing pressures on hospital, but social care has also had it’s funding slashed, back to just 0.9% of GDP by 2020, with an estimated shortfall there of £3-3.5 billion. It’s not going to get better.

Hospital bosses know this, and have already spoken out. NHS Providers CEO Chris Hopson and NHS Chief Executive Simon Stevens have both said current funding is unsustainable .

What will that look like on the ground? Well, resources will be diminished, pushing people out of hospital beds will become more commonplace, and with no staff budget more and more hospitals may have to close departments due to lack of staff to run services safely. Here is a list of sixteen hospital departments that have closed this year. Expect this to grow. This might mean working in hospitals without services on site, sending patients miles away and arranging urgent transfers to other hospitals, which is less safe, and very time-consuming, to already overstretched staff.

Training/workforce

As of 2015, there were 41,165 consultants and 36,919 GPs in the NHS,  plus 54,000 junior doctors, with 25% of them trained overseas, either EU or non-EU. For GPs and consultants, the NHS plans to increase this by 5000 a piece, or 14% by 2020. However, new workforce modelling predicts we may need as many as 12,000 more GPs to run a thread bones service, and 24,000 to run a safe and well staffed one.

I can’t find the numbers of junior staff required, but if we simply match demand in 2024, 14% compared to today, the ‘extra’ doctors would need to be 7560 more than today. It would taken ten years to catch up to demand, by 2034. That’s a huge deficit to walk into.

There’s of course a plan to expand the numbers of non-doctors to fill the shortfall;  non-medical endoscopists, surgical assistants, physicians assistants are all already active in the NHS. What this will mean for junior doctors is hard to gauge – it may help training, it may hinder, and a lot of work will need to be done to work out how workplace issues such as medicolegal responsibility and training will be impacted by the increasing use of non-medical staff doing work previously done by junior doctors.

And that’s of course assuming all the ‘foreign’ doctors are allowed to ‘stay’. Theresa May claims they can stay until at ‘least’ 2025, but why would they? If even 10% of the overseas trained doctors left the NHS in the next ten years, it would be utter cataclysm.

Morale

Needless to say, being chained to an organisation for four years, that requires you to stretch four times more work out of it’s resources compared to today, that’s missing thousands of staff, with hospitals in various states of closure, might dampen morale.

The imposition of the new contract for junior doctors of course will only make all of this worse. As budgets are tightened further cuts will need to be made to staff groups – the strikes this year will be far from the last to hit the NHS.

NHS

Ultimately all of this speculation relies heavily on the idea an NHS will still be the main provider of healthcare in the UK by 2024. Looking at the staffing, financial and patient demand projections, no credible plan emerges to preserve the NHS. Services will slowly degrade, and more and more private options will come available. Already a private Uber-style service is emerging into the current GP crisis. This could be the snowball that starts the avalanche, as more and more wealthier citizens are pushed towards private healthcare.

My point here is the battlefield ahead is perilous, for patients and staff, as we are guided by NHS bosses that are unheard and ministers either deliberately or incompetently steering us towards rocky shores. Whatever Jeremy Hunt’s plans, 1500 doctors a year will not make any impact whatsoever in 2024, far from being ‘self-sufficient’, and we will have huge crises in senior staff and resources that no amount of fresh-faced ‘homegrown’ graduates will solve. If our hardworking and invaluable overseas staff leave, the NHS will collapse instantly.

 

That’s the future of the NHS and junior doctors – bleak isn’t it?

So what are you going to do about it?

juniordoctorblog.com

 

*This assumes there will be no deficit for the next three years – an extremely tall assumption. More likely, there will be no extra money whatsoever.

**barring some huge paradigm shift in medicine, or an epidemic disaster. Brexit may count in this respect – the fall in the pound vs the Euro has made medicines more expensive, and the loss of research grants has made teaching hospitals poorer.

 

 

This is everything wrong with Jeremy Hunt’s tenure as Health Secretary

Yesterday in the Mail Hunt made at least two completely bogus claims;
1. He ‘won’ the judicial review into imposition and gained High Court backing for the junior contract

2. Post Brexit he is going to remove foreign doctors and replace them with ‘homegrown’ trainees 

There’s been enough of heated opinion lately- so let’s just serve cold hard facts.
1. The Justice 4 Health team took Hunt to court on three premises- that a) he does not have power to impose the contract b) that he acted without clarity and transparency and c) he acted irrationally. Despite a lot of press spin saying Hunt won, he actually just dodged the issue, by claiming that he never imposed and ‘no junior doctor’ thought that he was. As in last week’s blog here is the many instances that Hunt said he was. 

The case pushed Hunt to clarify in law that he isn’t imposing the contract, simply passing the buck to local hospitals. The judge also found he could’ve acted with less ambiguity but found it hard to demonstrate the high legal threshold for irrationality.

So far from ‘winning the case’, Hunt was forced back from claiming falsely he was imposing leaving local negotiations with hospitals now a real possibility.

Secondly, Hunt’s plan to replace foreign doctors with ‘homegrown’ talent is as laughable as it is xenophobic.
We are already in the midst of a workforce crisis- applications to medical school dropped 13.5% in the last 5 years, and increasing numbers of junior doctors are leaving training and the country. On top of this, the existing doctor workforce increasingly cover the work of two or more doctors- 7 in 10 doctors work in departments where at least one doctor is missing, 2/5 of consultant posts are unfilled, and 96% of doctors work in wards with nurse shortages. 
To add insult to injury, health education England, the body that funds training of so-called ‘homegrown’ talent, has had its budget slashed by £1 billion next year– all on Hunt’s watch.

Now around 25% of the doctor workforce are non-UK, and 10-15% of all NHS staff. 

We are well below the European average in hospital beds per person and doctors per person in the NHS as we are- yet Jeremy Hunt plans to push away up to a quarter of the workforce, cut the training budget to train less doctors who are already doing two or more doctors work, and make no plans to actually address the drop in ‘homegrown’ talent already, a direct repercussion of Hunt’s own morale plummeting war against the profession. 
Those are the facts. Unfortunately if you read the Mail comments you will see why Hunt would ignore them; there’s a segment of the populace that laps up this anti-immigrant posturing, even if it’s completely insane as an actual plan. 

This is everything wrong with Hunts tenure as Health Secretary- politics before policy before patients. The NHS will only continue to suffer if it goes unchallenged. 
Juniordoctorblog.com

Junior doctors are left with few options, none good. What now?

Today the independent judicial review into the junior doctor contract imposition legality, put forth by the five junior doctors who make up Justice 4 Health, closed.

Justice Greene found in favour of the government, upholding their peculiar defence that Jeremy Hunt never actually imposed a contract, leaving it up to local hospitals to decide if they want the new contract or not. This, despite the fact that Jeremy Hunt has repeatedly hit the ‘nuclear button’ of imposition in TV interviews, parliament and speeches. Here is a quick video with some obvious examples;

As ludicrous as it seems, legally we have told all of this was an ‘irrelevance’ and although the judge suggested Jeremy Hunt could’ve been less ‘ambiguous’, the High Court rules that the contract was never imposed in the first place. News to 54,000 doctors, and no doubt many patients who were adversely affected by strike action against imposition. This final legal clarity prompted the question; if Jeremy isn’t imposing, who is? Well it would seem hospital trusts are imposing , and therefore can we now negotiate directly with them?

NHS Providers quickly tweeted to crush this speculation – they want a nationally agreed contract, and suggest there will be no local negotiations.

This of course follows in the same week that the BMA JDC have decided to suspend further strikes, and instead are now calling a symposium to which they have extended Jeremy Hunt an invite- whether he will turn up or not remains to be seen. Seeing as how he hasn’t turned up  to any of SEVEN crisis meetings in the last year at his OWN organisation I’m not holding my breath.

So junior doctors are left with few options. None of them good.

The first question is – do you accept the contract or not?

 

If doctors accept working under this contract, that still disadvantages women and LTFT workers and still is worryingly untested, then they must actively engage to make it work. This means forming local doctor forum, helping develop easy apps to exception report and challenging behaviour anywhere in the hospital that doesn’t meet the terms of this contract. If things go south, as these early rotas from obstetrics and gynaecology and emergency medicine anecdotally suggest, doctors must be vocal, and the BMA must back it’s members, although their powers may be severely limited.

If you don’t accept thev contract;

You essentially have few options. A lot will depend on how well organised doctors are from this point forward – with the BMA in full retreat this seems unlikely.

  1. Leave training – the imposition of the new contract is for trainees – going out of programme, into locum work, into research, or even abroad will mean you continue working as a doctor, but you aren’t subject to the terms of the imposed contract. For those at the end of training, finishing up and then moving abroad is a sensible option.
  2. Try to negotiate locally- whether individually or en masse doctors could offer to stay on the current contract, or organise a mass resignation against rota and contract conditions. Despite the bluster of NHS Providers it seems unlikely that hospitals will force a new, ‘cost-neutral’ contract at the expense of all their doctors. That is contingent of course on Health Education England, the training body of doctors, not imposing the contract by the back door and pulling funding for trainees who do not comply with the new contract.
  3. Offer your own contract. This isn’t as mad as it sounds – making a counter offer is a standard employment arrangement in most industries, just unheard of in the NHS. A contract that doesn’t discriminate against women, pays for study and has fair and safe rota arrangements isn’t too much to ask. But it seems unlikely.
  4. Bide your time. The contract is scheduled for review in 2018 – rumour has it Jeremy Hunt will be gone by then, and this may no longer be such a contentious political issue. With sufficient evidence of poor patient care and unsafe rotas, a renegotiation may be viable.

However, consider the context of the NHS. Over the past three years by every indicator the NHS has fallen into decline – waiting times, deficits, and now even hospital department closures, due to lack of staff. A new Autumn Statement might bring more money to the NHS, but having been through it’s most austere decade in it’s history, it’s even-odds whether there will even be an NHS at all come 2020.

For me, I left full-time training in August and have no plans to return. This contract dispute highlighted a multitude of problems with training to start with – but the utter contempt our NHS leaders, our government and their solicitors, and even some of our own seniors have held their trainees in appalls me. It has become a toxic environment for training and working. As a flexible worker I feel appreciated and needed, train and study when I need to, and most importantly, see and look after my family.

It’s up to the individual doctor what they do from here. If you can live with the contract, live with it. If you can’t, then find some way to find someplace you can. I fear too many will find that place outside of the NHS. With a collapsing union, a rejected judicial challenge, a toxic training environment and a complete lack of political will to shore up the health system, can you blame them?

 

juniordoctorblog.com

 

 

Diary of an NHS Patient – 2017

2nd January 2017
New year, new diary! Just moved to our forever-family home. Nice area, good primary just round the corner for Charlie and we are only twenty minutes from Dave’s work. Only issue is they just ‘downgraded’ our local A&E– but I’m not worried, although Dave thinks I’m a hypochondriac! GP is local and there’s a big hospital a short drive away. Anyway, back to unpacking!

3rd March 2017
Finally got round to signing us all up at the GP- it’s such a faff. They wanted to see all our passports, and could only sign us up between 1-2pm on Wednesday. Who can manage that? Charlie had a cough for a few weeks so that finally pushed us to join. Waiting time bit long though- two weeks! Oh well. He’s fine.

10th April 2017
Still haven’t got an appointment for the GP! Charlie is looking a bit peaky- it’s been too long now. Phoned up for emergency appointments but the GP never has a free slot. I heard from Linda next door they might have to close- can’t maintain the practice on the funding they’ve got. Never mind. Plenty of other NHS GPs around. Even had a leaflet for a private GP through the door today- £40 an appointment. Bit steep. But booked one anyway. Dave didn’t mind.

17th April 2017
The private GP seemed very nice- referred Charlie for lots of tests though. Dave is worried- he thinks it’s a scam. I don’t. I saw the GPs face- he thinks Charlie is really sick. He asked us if we wanted to stay with the NHS- is that really a thing now? I don’t think we can afford any more private tests. He’s sending us to our local NHS children’s department.

24th May 2017
Waiting for an appointment is agonising. Lost our nerve tonight when Dave thought Charlie coughed up some blood. Everyone was a bit flustered so we went to local children’s A&E- except it was closed. Lack of staff. What the hell does that mean? I’ve never heard of a hospital being ‘closed’. What do we pay our taxes for if not the NHS? We got redirected to another hospital, had a minor divorce-level fight outside the A&E and then decided just to take Charlie home. Our appointment is next week anyway.

1st June 2017
Charlie has cystic fibrosis. I’ve spent hundreds of hours looking all over the Internet and everywhere about it. The specialist at the hospital was very nice- but we were still all in tears. We have another appointment next week. It’s still settling in- my child will always be unwell. I don’t know how to handle this. We tried to see the NHS GP this week- just to touch base. They’ve closed for good. I went back to the private GP for an appointment- looked a lot busier. Had to wait a few days this time. Saw a different GP for £50 this time. Wasn’t very helpful. What a waste of money.

10th Oct 2017
Charlie is managing on his inhalers and things. The NHS department at hospital is great- we have the mobile of Sandra, the nurse specialist for Charlie and any problems just call her up. Heard some mutterings about closing the hospital, ‘centralising’ services. Sounds like a good idea, but Sandra reckons many services like theirs will be cut in the reshuffle. Off the record she said the hospital might close entirely. I left pretty frightened, imagining losing such a lifeline for us. Wrote to my MP when I got back. Why are all the NHS services shutting down?

2nd Dec 2017
Sandra called- they are being moved to another hospital, and their service halved. More ‘efficiency savings‘. She’s not covering anymore- it’ll be a duty nurse system now. I did the maths- our local specialist children’s hospital is now forty miles away. Just shy of 45 minutes by car. What we will do in an emergency? Dave is starting to get chest pains when he’s carrying Charlie up the stairs. We can’t afford to go back to the local private GP right now, the next closest NHS GP isn’t accepting new patients. Just ignoring it now, and hoping.

5th Jan 2018
More leaflets through the door- private health insurance companies offering discounts. Our local NHS hospital has just been taken over by a private firm. Me and Dave had a huge row, and then decided to look into private health insurance. We both believed in the NHS, but it’s clear that it’s not going to survive unless the government step in.  Plus Dave is self-employed and so am I- might be a bit trickier. We will struggle through.

20th March 2018
Got insured with Health Co. – few others in the street did the same. Quite steep for me and Dave – lots of cancer stuff on both sides of our family, plus we both run our own businesses. Dave went to  an appointment on the very next day- Health Co. GP sent him straight to the heart doctor at the private hospital. Long story short- Dave needs a stent in his heart- not a heart attack, but pretty close according to the doctors. Thank god we got the insurance when we did. Charlie has been good.

1st April 2018
Dave had his heart op today- says he’s feeling much better. Stayed in a nice room in the Health Co. ward- had to pay an excess though, £500. A lot more than we could afford. Really weird feeling as a 1970s child having to worry about money and healthcare in the UK. Anyway- no worries. Everyone’s at home and everyone’s well.

9th April 2018
Health Co. sent us a huge bill today. They say Dave isn’t covered for his op, because he had pre-existing symptoms. Altogether they want nearly £9,000. We were aghast. We tried contacting the NHS hospital to see if they would cover us – we still pay taxes. An hour of ringing got me to a stressed sounding secretary who just laughed in my face. We tried to move back to cardiology at our local NHS hospital- but they don’t do outpatients anymore. Have to raid the savings, probably add a bit to the mortgage too. Need to get the hang of this insurance business better.

15th June 2018
Charlie is sick again – looks like his cystic fibrosis. Went to a great Health Co. GP who wanted to send us to the Health Co. hospital. The hospital wanted to know is Charlie insured. We thought he was- – the hospital says not. An hour of furious tears on the phone turns out they are right- he was excluded because of his cystic fibrosis from a regular family policy. We could pay out of pocket, but the nice Health Co. GP said that might costs hundreds of thousands of pounds. We’d have to sell our house. So I called Sandra- she told us to drive to her NHS hospital, even though it’s an hour and half away. I never expected to be choosing between  money or my family’s health. How did this happen? Anyway, we drove to the ‘central’ children’s hospital – and they rushed Charlie to their high-dependency bay. He’s stable now. Dave and I can’t seem to talk to each other, every conversation turns into blaming the other for the insurance rubbish. Bad night for everyone.

17th June 2018
The NHS has really changed- much of the hospital is actually just private companies that have taken over different sections. I’m signing all sorts of documents about insurance and waivers and declining ‘optional’ extras. Whole wards of the NHS buildings are empty. It’s scary.  The NHS staff haven’t changed though- Charlie’s paediatric team are the same amazing, hard-working angels they’ve always been. Sandra has been in every day- she looks awful. I’ve never seen her so stressed. I caught her for five minutes to catch up and thank her- I asked her how’s work- and she started crying. Most of her colleagues have left the NHS side, she’s the last cystic fibrosis nurse left in the county for the ‘uninsured’. She gets heartbreaking phone calls like mine every five minutes. She has to turn many of them down. She can’t cope. Every month they get less funding and are told to be more ‘efficient’. She’s close to retirement she told me, so she said she was determined “to see it out”. Her career? I asked. No, she said, “the NHS”.

21st Aug 2018
Charlie is back at home. We did two months driving an hour and a half a day to be with him. We took it in shifts, so Dave and I haven’t really been in the same room for more than twenty minutes for 8 weeks. Our relationship is struggling, but at least Charlie is better. I managed to get him back on a Health Co. policy- but the costs are phenomenal. We had thought about a second baby, and if my business had done better maybe even a third. Now we will settle for Charlie. Health Co. gave us a card to show private ambulances to get to our local hospital. Our GP is private, all of Dave’s cardiology appointments are now private, at huge cost, but at least we are covered.

10th Jan 2019
Dave’s mum had a stroke. She’s 92 and the first we heard about it was a call from a care home telling us she can’t pay. We were shocked. She’d been sent to a ‘central‘ elderly care ward fifty miles away, and then sent back to a care home near Dave’s brother. Obviously Dave’s mum was still on the NHS. Apparently there is supposed to be free coverage for the elderly, but it doesn’t cover care costs. We went to the care home- it seemed nice enough. It’s all private though- the manager was a lovely man, who explained we basically had two options; sell Dave’s mum’s house, the house he grew up in, or move her to the NHS subsidised home a few towns away. We went to the NHS one- bit shocked by how run down it looked. Social care apparently has been cut just as hard as the NHS was– it’s all basically private now unless you can’t afford it. We are selling Dave’s mums house.

3rd May 2019
I found a breast lump today, in the shower. It felt like a hard rubbery knot, just under my right breast. Scared and anxious the first thing I did, still in my towel, was go to the Health Co. policy documents in my office. I read them three times over- trying not to linger on the ‘C’ word, but also making damn sure that if I go to the doctor now, we won’t lose our house. Only when I was sure did I go tell Dave. I felt sick watching his face as he felt it too. We booked into a private GP appointment- have to wait a week now, and still have to pay £60 excess.

30th May 2019
Had all our scans, tests, appointments, re-appointments. It’s a low grade breast cancer. Hasn’t spread- it’s an operation, then chemotherapy for a few years, then done. Sort of relieved, sort of mind-bogglingly terrified. All private staff, all the way through. Dave and Charlie have been very supportive. Hasn’t cost too much in excess payments etc. No holiday this year but let’s get some perspective. Op will be next week.

12th June 2019
Op went well, back at home on tablet chemotherapy. The doctor offered me radiotherapy as well- I thought that was a good idea. Booked in next week.

3rd August 2019
A bill arrived today. Another bill. I can’t cope with this. It’s for some aspects of my cancer treatment- apparently the company made an ‘error’, a lot of treatment was ‘extra-contractual’, bottom line; they won’t pay for it now. The CT scan that gave me the all-clear was ‘extra’, the radiotherapy treatment was ‘extra’, all of the nights in hospital with side effects were ‘extra’. The ‘extra’ cost is £192,000.
I keep looking at that number, wondering how it ever came to this.
My mum had cancer- she had a thyroid lump ten years ago. I went to all her appointments, in and out of NHS hospitals, specialists, scans, surgeons. She’s fine. And she never once paid a penny more than her taxes. What a different world we live in now.

5th November 2019
If I sell my stake in my accounting firm, Dave sells his business and goes back as an employee, and we sell our house and downsize we can just about make the payments without declaring bankruptcy. Charlie’s insurance is gonna hit us hard though.
I saw Sandra in the paper today- I spotted her face protesting in a crowd outside her NHS hospital. Shut down, no funds and not enough staff they say. I text her. She’s retiring now. She’s seen it out, and for her the NHS is over.
For the rest of us as well it seems.

3rd Jan 2020
I did some research. We were all told private companies came to ‘save’ the NHS, that healthcare was no longer ‘affordable’.
But compared to our neighbours the NHS didn’t cost very much- just under 8% of GDP in 2015, well below what Germany and France were spending. We were told that more money was being given to the NHS, but it never really was. Compared with demand the last ever decade of the NHS was also it’s most austere. 
Now we can just get by without the NHS- but only just, and we were fairly well off. I worry for those that aren’t. Every day I worry about the next treatment for Charlie or what if my cancer comes back? How will we afford the co-payments and excess charges?
Now the NHS is still around, but it’s gone in all but name. It’s for emergencies and the unemployed and poor only. Basic healthcare. I don’t pay any less tax- more money goes on my family’s hospital bills than ever before.

1st July 2020
A new government is about to be elected. I’m going to campaign hard for the NHS to return. Too many of us are suffering its loss. But no mainstream party has a realistic plan to restore it. It’s simply too late.

I’d wish I’d done something when I had the chance.

Juniordoctorblog.com

If you want an NHS, save it yourself

It was July last year that something changed- Jeremy Hunt took to the podium and started a fight, claiming doctors had a 9-5 attitude, attacking our professionalism. But that fight was just a scuffle in a longer battle for a free at the point of access healthcare system, and it’s a battle that’s over. We lost.

This time last year I was on the street, on my own, staging a one man protest against a government dismantling the NHS and getting away with it. On my birthday a month later I organised a group protest, a Crash Call for the NHS, to raise awareness. Since then we’ve been on the streets, on your televisions, in your newspapers. The NHS is going under, we said, it isn’t safe, we said, people are dying. 

But the government spin machine is immense, and effective, and perceptions have barely changed. 

I was going to write a blog about this suspicious article in the BBC, claiming consultants are overpaid, right as consultants went back to contract negotiations of their own. I was going to point out the average overtime payment is just each consultant doing 6 hours a week more, compared with their basic salary. I was going to point out aberrant arrangements like the one in the article were locally agreed, to save struggling hospitals from huge government fines for waiting lists, despite their underfunding and understaffing. I was going to point out that huge numbers of consultant posts are unfilled, nearly 40% in medicine alone, and that unspent salary cost far outweighs the cost of any ‘overtime’ consultants earn for covering those same gaps. I was going to point out yet again how the government is spinning and dog-whistling and smearing while the NHS goes under.
But I’m not going to. I tried to write a blog full of facts and hope and fight, but I find facts are useless, my hope is gone, and the fight has left.
I wrote before how exhausted we are of all of this, but it’s only got worse and it’s about to get catastrophic

If you read this and think “well the NHS is a lazy, inefficient and rubbish health system, that should be replaced”, then good for you- it’s exactly what will happen. Just check you can afford the co-payments, or insurance premiums, or whatever comes next.
If you read this and think “this can’t happen, but what can I do?” Then think harder. 

Because whatever you do next will have to come from you. This doesn’t have to happen, but sitting at home doing nothing will definitely let it. 

If you want an NHS, save it yourself. 

My name is Dr Dominic Pimenta, GMC 7304248. 

And I quit.
Juniordoctorblog.com

Labour, left, right or other, could learn something from the junior doctors 

We’ve had some rough times in our profession. Sometimes it feels like we work in a building that’s being demolished, and Hunt and friends are wearing ear-protectors and smiling, oblivious to our screams.
The frustration seeps in, and bubbles up between us if we let it-but the one thing that got the junior doctors dispute going, kept it going and pushes it still, is unity.

98% of doctors voted for industrial action. We had a forum of 68,000 doctors able to each have a voice. These are amazing levels of cohesion. The yes/no vote on the contract became bitter- that screaming frustration came through the cracks as we pulled in opposite directions. 

Which is of course exactly what our true adversary, Jeremy Hunt and co, wanted.

I felt a surge of hope again this week. The emergency campaign to raise funds for justiceforhealth against imposition hit £120,000 in just 48 hours. We remain united. We fight on.

I want to apply this model to Labour.

Full disclosure- I’ve voted all over for many years: Lib Dem, then Labour, then Corbyn. 

Now no one will disagree Labour is in a mess. Neither will any Labour supporter disagree the Tories are rampaging across the country and tearing up the welfare state. My red line issue is the NHS and the Tories are well on the way to forcing total collapse.

The back and forth between Corbynistas and Blairites/Eagle-Eyes/Smithies has been childish, moronic, insulting and divisive. On both sides. 

I think no one can disagree Corbyn has failed as a leader. His PR is rubbish- yes you can blame the media, which has been more biased against him than any political figure in recent years, but that just means he needed to work harder. Dropping press releases at the wrong time, allowing damaging behaviours by supporters to become dominant narratives, easy gaff after easy gaff for tabloids to run.

Contrast that with Boris Johnson’s PR team that plastered over exit signs at his Brexit resignation speech JUST SO THERE WASN’T A PHOTO OF BORIS AND AN EXIT SIGN. That’s PR we need in spades. 

But you also cannot argue that the wider Labour Party has also failed. Failed to capitalise on the huge influx of support and interest in Labour with Corbyn. Failed to create a cohesive opposition in followership- every labour MP voting against the leader made more headlines than the vote itself. The image of a fractured useless opposition is going to lose more votes than Corbyn ever would. 

But whatever your opinion the lesson I want to impart to you, Labour, left, middle or other, is one of unity. Watch the television interviews of junior doctors arguing over strikes, or the debate on channel 4 after the yes/no contract vote. I give you examples of how a group can fundamentally disagree and still work to a common purpose. We still treated each other with respect and civility.

In Labour, we can still agree that the Tories will ruin this country and destroy the NHS. We can still agree that whoever the leader the opposition needs as tight a team as the government.

If Corbyn stays, will the anti-Corbyn crowd stay and work with him? Unity is the only way we will win, returning to the backbenches to continue sniping will only serve the Tories.

If Smith wins, will Corbynistas stay on, and support the party that just destroyed their dream? Yes, you must. Because ultimately the party should be bigger than all of us, and if you want to change it you have to stay.

Please remember we are literally squabbling over deck chairs on the Titanic, while iceberg Tory rips the country asunder.

Working together brought out the best in us as doctors. In Labour we have to do the same. Or we will lose everything.
Juniordoctorblog.com