“Your Life In My Hands” by Rachel Clarke. A juniordoctorblog.com review

“The unexamined life is not worth living”
Socrates

 

There’s an inextricable link between medicine and books. To a medical student books are both stepping stones and obstacles, huge tomes to surmount as much to absorb. Later, they become totems, a copy of the ubiquitous Oxford Handbook of Medicine, colloquially known as the “Cheese and Onion”, jammed into a scrub back pocket to ward off disaster and protect us from our own insecurities and our patients from our inexperience. Later still, books become mirrors, reflections that let us examine our own careers and lives.

Reading the rather wonderful “Your Life In My Hands” by Dr Rachel Clarke leads to it’s own examination. Dr Clarke writes with a prose that is both immediate and personable, dumping you straight behind the eyes of an NHS junior doctor, bursting bladders, blood-soaked scrubs, desperate tears and all. This book is a portal into our hospitals, coming at a time when it’s never been more important to be able to share the actual reality of the NHS frontline.

Full disclosure: I’ve met Rachel Clarke. We swam in similar circles during the junior doctor contract dispute. When she and Dr Dagan Lonsdale kicked off the 24-hour protest TimeToTalkJeremy, outside the Department of Health, I was working just up the road and went down to show solidarity. Unflappable, sincere, ever-smiling; she was hugely inspiring and extremely nice. A few days later I was sitting in the same chair.

Before this book landed on my doormat, I knew Dr Clarke was a great writer and a shining example of our profession. It was the parts that I didn’t know that made this book so surprisingly brilliant. Besides doctoring, her semi auto-biography takes the reader through her past life as a TV journalist, dodging bullets in the Congo, filming experimental deep-freeze neurosurgery in the US, casually bantering with Alastair Campbell and Prime Ministers. Weaved throughout this rich tapestry of past and present, Dr Clarke paints the powerful and undeniable picture of an NHS being failed through short-sighted politicking and chronic underfunding.

For me, reading this book forced me to re-examine my own career. Her descriptions are achingly accurate: of the crash-calls, the dark quiet moments with a dying patient’s family, the highs of a shot-in-the-dark diagnosis or a surprise success where it seemed impossible and the lows of the true tragedies, dealing with the pieces left behind. I have been there in every one. We all have. And now you have too.

And that is the true beauty of “Your Life In My Hands” – it brings to life with dazzling perspicuity, not a unique experience, but a ubiquitous one. This is a junior doctor’s life, as damn near as you can get without living it yourself. And even if you have, it’s worth reading for the mirror it holds back. I left medicine after the burnout of the junior doctors contract dispute, and then, like Dr Clarke, rediscovered my love for it again. Reading this book made me remember exactly why.

The NHS is consistently the number two top issue of concern in UK opinion polls. A “political football” to some, often those campaigning for it are accused of “weaponizing” the subject. The true power behind this book is Dr Clarke’s ability to humanise it. The irony of “Your Life In My Hands” is in it’s title, because once you’ve bought this book, you are holding a life in your hands. Once you’ve read it and experienced it, you will see the NHS one hopes, as we see it. And then, as Dr Clarke masterfully surmises, you will realise that the future of the NHS is not in our hands, but yours.

juniordoctorblog.com

Your Life In My Hands by Rachel Clarke is out now.

 

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Dear Other Normal Human Beings

I am writing to you, because, like myself, you are a normal human being.

You, like me, wake up in the morning and sleep at night, eat meals, sometimes with loved ones, sometimes alone. We are alike in our requirement for other people, for happiness, for security, for food, for warmth, for shelter.

You may have children, you may have brothers or sisters. You have, or had, parents, and perhaps were lucky enough to know your grandparents.

You may have noticed that many health professionals were becoming uncharacteristically vocal, leading up to the General Election. You may have thought them self-serving, morally bankrupt individuals, upset over their own pay packets.

I would like to explain to you, from one normal human being to another, what is going on.

I am a doctor. I decided to be a doctor before I really knew what decisions were, and can never remember wanting to do anything else. Once I knew how, I found the path, and worked my arse off. Six years, in secondary school, studying. Two years, in college, studying. I took four A-levels, I had 25% less free time than my friends, and when they were out, doing whatever they wanted, I was not. I was studying. Another six years at medical school, studying, and sometimes working to pay for the studying. The last three years of medical school I worked harder than I ever had, and the same hours as a full-time professional, sometimes way more. It even made me sick- in my final year I developed acute gastrointestinal bleeding. But, becoming a doctor was all that meant anything to me. So, I took my top grades and turned them in, in return I got fourteen years hard graft, and £50,000 worth of debt. [2]

Why is this important? Because, from the very beginning, I knew about sacrifices. As thousands of my colleagues have, as millions before me have, and millions will. I knew about sacrifice when I worked for a year before university, so I could afford the rent, when I missed my first family Christmas to work as a warden in student halls, so I could afford to stay at medical school. I knew about sacrifice when I missed nearly every other Christmas since, working, or sometimes studying. I knew about sacrifice when I’ve missed my friends weddings, my nieces and nephews birthdays, when everyone I knew was travelling, and I was studying, or working. Being a doctor, and it’s inherent position in society and in the hearts of the public, is irrevocably tied to sacrifice- it’s the dedication it takes to become, and to stay, a doctor, that by definition requires sacrifices to time, to personal satisfaction. All over the country right now, doctors and nurses, physiotherapists and occupational therapists, radiographers and ward clerks and all the other medical professionals are sacrificing their lives, minute by minute, to try to give you or your loved ones minutes, hours, days or years more. So, when, as a normal person, someone tells you doctors don’t understand ‘vocation’, you know now- it is beat into us before we even get through the door.

But, as a normal person, of course you understand why doctors would defend the NHS, would fight to protect it, and so vociferously attack it’s detractors. They have a vested interest, they want to keep their cushy salaries and great jobs, and the NHS is great for that.

Let me tell you straight: if I didn’t care about you, or my patients, I would be out there campaigning to close the NHS right now. I would make more money in the private sector in a  day than I would in two weeks of NHS work. I could also take my UK Medical degree, one of the most respected qualifications anywhere in the world, and go and earn 50-200% more in the US, Australia, New Zealand [3]. In the private sector, if I stayed after 5pm to look after you, the next thing you see after my smiling face as you exit the hospital, will be the bill on the doormat; ‘overtime’, ‘time in lieu’, ‘additional hours rates’ aplenty.

But, I, like you, have a family. I went to state school, and worked and grafted to pay for my six years at University. Without the NHS my grandmother would have gone blind, my father would have had several heart attacks, my mother would have died. I might have died. A private system would’ve bankrupted them, ended their hopes for a better future in order to pay to survive. I, like you, would do anything for the ones I love, and that is why I campaign to protect and improve the NHS. And that is why, when 5pm comes and goes, as does 6pm, 7pm and all the other hours in between, I, and every colleague I have ever worked with, stays for their sick patient. Because, one day, somewhere, for someone else, that patient will be their mum, or dad, wife or husband, son or daughter.

We have had, and always have had, the extraordinary privilege of one the greatest healthcare systems, pound-for-pound, in the world. The reasons for it’s great outcomes and low cost are debatable. But there are some reasons we never mention. This country has a medical school system of international renown, whose doctors, for the most part, qualify and stay exclusively working within the NHS. The staff of the NHS gives untold free hours to the profession; when I was a first-year junior doctor, I calculated I worked one day at work for £4.10 an hour. I used to get paid more at Tescos. But a very sick patient needed a lot of complex care, and so I stayed, and helped, and he survived: as millions of patients have since 1948. [4]

The moves of the current government against the medical profession are calculated: to deride working conditions, salaries, hours and deplete hospital resources, until a normal person, like myself, buckles under the social, financial and emotional cost. At that point, a sea-change of new, private hospitals will open, and we will go and work there. And our lives will be pretty much the same- different bosses, the same bureaucracy and probably better pay. But our lives, as normal people, will not. You will still pay taxes, a stripped-down NHS will persist, for no frills, emergency care only, but not for all the other healthcare needs of a 21st century population: you will need private healthcare. And that healthcare insurance will cost you hundreds of pounds a year, if not a month. And if you don’t have insurance, you will spend thousands of pounds on the simplest, quickest procedure [5]. And the NHS won’t be there for my family, or the families of normal people across the country.

So, I want this to reach as many normal people as it can. If you don’t act now, it will be too late. It might already be too late.

We care deeply because we can see the great good the NHS does, every single day. And I care because, like you, I care about the ones I love.

Where can you start?

June the 8th, 2017

At the polling booth,

Yours sincerely,

juniordoctorblog.com

[PART 2: A Factual Appendix]

-What normal people appreciate, are hard, solid, unflinching, facts. So here they are.

[2] Medical students studying now can now expect to pay £9000 pay a year as of 2015 for six years for most courses: that is £54,000. Most will require a student loan to pay living expenses for a full time course, at a further £5000 a year that totals £79,000 for six years study. Maintenance grants for the poorest students have been scrapped, adding an additional £10,000 debt as a minimum.

[3] Starting pay for any consultant in the UK : £75, 249. In the US: £111,799.80 for internal medicine, £183,152.91 for a radiologist. ($/GBP rate correct at time of writing). In Australia: a basic salary of £78,000 for internal medicine consultants, BUT this is for a 38 hour working week. Average overtime and up-scale pay between £92,526.97- £244,366.10.  Same with New Zealand for a 40-hour week, after average overtime and up-scale up to £128,039.69.

UK data: http://bma.org.uk/practical-support-at-work/pay-fees-allowances/pay-scales/consultants-england
US data: http://www.payscale.com/research/US/People_with_Jobs_as_Physicians_%2F_Doctors/Salary.
Australian data: http://www.imrmedical.com/australia-salaries-tax
New Zealand data: http://www.imrmedical.com/new-zealand-salaries-tax

[4] The NHS opened it’s doors, metaphorically, July 5th 1948. It’s first patient was a 12-year old girl with a liver condition. http://www.legislation.gov.uk/ukpga/Geo6/11-12/29

[5] This is incredibly interesting reading, although it is for claims, it is still very reflective of the actual cost. https://www.freedomhealthinsurance.co.uk/downloads/your-choice-procedure-payment-guide

Is being a doctor just a job?

You hear this phrase a lot; being a doctor is “just a job”, but funnily enough in widely different contexts. On the one hand, the “higher calling” of medicine is derided by some, who insist it’s “just a job” like any other. On the other, doctors under extreme pressure need to know sometimes that their work is “a job”, it should stay compartmentalised and allow them a life outside the hospital or surgery, to balance their own mental health against their working lives. 

Which is it?
I don’t think anyone who has working in any emergency setting with human beings would accept the derogatory label of “just a job”, whether that job is doctor, nurse, physiotherapist, pharmacist, fireman, policeman, or paramedic. The normal course of a human life is long periods of normality and stability, punctuated by “Life” with a capital L; births, deaths, marriages, divorces, comedy and tragedy. There’s only so much of that a human mind can take, few of us can stand constant turmoil and upheaval. That’s why the mental health of those in extreme situations suffers: refugees, long-term domestic abuse, and homelessness amongst others. 

Being in an emergency job such as medicine means you are party to a constant stream of Life events: births, deaths, monumental illnesses. All the things that intrude into our bubble of stability to rudely remind us of what we already know but wilfully forget: life is random, and hard, and cruel, and important, and wonderful. 

So medicine isn’t “just a job” in that sense: it’s an enormous privilege to bear witness and to help human beings through the hardest and most real times in their lives. 

But if you let that tragedy in too much, you expose too much of yourself to that constant stream of suffering, you run the risk of your own mental health, exceeding your mind’s capacity to process capital L Life events.

That’s why it’s important to know in a positive sense that medicine is “just a job” too.

Knowing it’s “just a job” means you know you can walk away, which validates and empowers that unconscious choice to walk back in again. 

We all chose to do something important with our lives, but we should all recognise that that was a “choice”, and take heart in that. 

We should always recognise that we chose to help others, and that no one has an infinite individual capacity to do so; that’s why we work in teams, that’s why we do go home, that’s why we should remember to look after ourselves so we can look after others properly.

So yes, medicine is “just a job”; you have the freedom to walk away at any time, and, I hope, be empowered to choose to come back again. It’s a job, yes, but it’s a job like few others; it’s an enormous privilege and it is honestly one of the best jobs in the world.
juniordoctorblog.com

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. 

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

Down the Rabbit Hole; Incompetence or Corruption?

If you read just this sentence, then read this; this Tory Government has ‘cooked the books’ on NHS finances, cut the budget far below what is safe or feasible, and let patient’s suffer to pursue a political ideology.

Want more information? juniordoctorblog goes down the rabbit hole. Watch your step – it’s a proper mess in here.


Let’s start at a beginning.

Here is a graph.

Here is the NHS budget (navy line). Here is the number of hospital ‘episodes’ (purple line). Here is the % of A&E attenders waiting over 4 hours (orange line), and here is the pan-NHS deficit (charted bars). A&E and hospital activity has risen predictably and steadily, while the NHS budget has fallen progressively behind, at a rate of ~0.9%/year, meanwhile hospitals started in 2010 with a £1.5 billion surplus, and will finish 2016 with a probable £2.3 billion deficit.

Bottom line: we are already doing more and more with less and less, and we are in trouble.

NHS 2010-16

Let’s walk on. Mind your step, Andrew Lansley has been in here.

How did we get to this point?

Well here is the Public Accounts Committee meeting into NHS workforce planning – the four heads of the NHS sat down in front of a parade of MPs and revealed they didn’t really have a clue what was happening, with ‘7-day NHS’ plans or with the ‘junior doctor contract’.

The bosses of the health service were told they were ‘flying blind’ on some of the biggest issues in the NHS at the moment.

During the proceedings the panel were rather anxious to find out how the NHS has fallen into such massive debt. It would seem that in trying to meet ‘efficiency’ targets, or ‘cuts’ as we would say, “they discovered that it was too ambitious and, as a consequence, they had to find temporary staff […] to help to meet safety parameters”. This was very expensive.

The problem with healthcare is when you try to ‘cut costs’ you often actually create larger costs. Look at social care – by cutting social care provisions e.g. carers and social workers, you save a little bit of money, but the patient waiting in hospital for a social placement is then stuck in a hospital bed with hospital care for longer – this costs a great deal of money.

The best way to explain it I have come across is this. Imagine you own a van, and every year you drive it a little bit further, and carry a little bit more. Now imagine you decide to make it more ‘efficient’ to save money. You make the van lighter by removing the car rack. A lighter van drives longer distances for the same money. To save a bit more money you stop taking the van to the garage. A year goes by, driving further, carrying more. Next the gearbox breaks, you could’ve prevented that if you’d gone to the garage every year. That costs more money, but rather than pay to replace it you decide to make more ‘efficiencies’. You sell off the wing mirrors and the bonnet one year, then sell the passenger seat, and the electrics the next. Before long you are driving further than ever before, on the same budget, but your van has no doors or windows. It’s not safe. You still won’t invest any more money, still want to drive it further. Next you sell the wheels and the engine. The budget is balanced, but the van is dead. A neighbour then says “Do you want to rent my van? It’s more expensive, and it’s not as good as your van was, but it’s all you’ve got.” Your neighbour is Richard Branson.

But I digress.

Let’s keep going. Here is a report to the public accounts committee on NHS finances, released this week.

Here’s a few highlights;

“The financial performance of NHS trusts and NHS foundation trusts has deteriorated sharply and this trend is not sustainable”

“There is not yet a convincing plan in place for closing the £22 billion efficiency gap and avoiding a ‘black hole’ in NHS finances.”

But we knew all that already. So who is to blame?

Let’s dig a little deeper. Watch your head.

Here’s some written evidence from an anonymous whistleblowing financial director of a NHS hospital – they were frightened to give their name publicly for fear they would lose their job.

They are concerned that “patient safety and quality of care may be compromised by trusts’ short term actions to reduce headcount” but even worse that financial directors are making ‘questionable adjustments’ to their accounts which are ‘merely window-dressing’ to their accounts to please ‘no 10 influence’. Through several dodgy practices, including a ‘Capital-To-Revenue’ Transfer scheme- which essentially means the Department of Health pays money to hospitals, which record revenue, and then pay it straight back to the Dept of Health, which record ‘capital’. When trusts find they cannot pay costs, like the wages of their staff, the government steps in, but only with large strings attached, that the hospital must make further cuts.

Bottom line: NHS trusts may have been ‘cooking the books’ in order to appear as if they are not making massive cuts and crumbling under the massive pressure of No.10 and treasury underfunding.

It’s hard to decide whether this is incompetence on the behalf of the department of health, or deliberate underfunding from David Cameron, to move to privatisation, which, without a democratic mandate, is corrupt.

In the meantime we cannot afford to staff our hospitals properly, we cannot afford to cope with the demand in A&E and into this crisis the government impose a completely unmodelled contract on junior doctors, and decide to pursue ‘7-day’ services and the ‘safest healthcare system in the world’. It’s as if the Titanic is sinking and the captain wants everyone to rearrange the deck chairs.

Where shall we go from here?

So, in 2009 David Cameron takes over the country. George Osbourne and Andrew Lansley take huge amounts of money out of the health service, while demand rises and rises. Later Jeremy Hunt, with aggressive No.10 and Treasury influence, continues to do the same, only now there is no slack to give, and the system starts to implode. This is a political ideology driving shambolic managers with few options to either ‘cook the books’ or get fired, and in the meantime the NHS is in the midst of the biggest crisis in it’s history. As it looks, it could be the last one- this time next year there won’t be an NHS if things carry on like this.

It doesn’t sound good for the Department of Health and Mr Hunt. Apparently some scallywags are taking them to court.

Anyway, I’m off. Make your own way out.

juniordoctorblog.com

 

 

 

The government aren’t listening. Time to make them.

The junior doctor contract dispute has taken its toll; eight gruelling months, three major protests, four days of strike action, and 54,000 angry, articulate, dedicated individuals.

We have staged sit ins, delivered giant books, set up fake betting shops, supported two hugely successful choirs and one Christmas number one, created fashion lines, and even collaborated with a Time Lord or two. We have become our own investigative journalists: uncovering dubious research practice, revealing departmental incompetence and lies, and documenting tragic cases of the government’s spin causing real patient harm. We have become our own researchers: revealing flawed data, misrepresentation of statistics and huge holes in the government’s ‘evidence’ arguments. 
We are not giving up anytime soon.
Why are we doing this? David Cameron and company would have you believe we are grabbing for a payrise, grabbing for free weekends and better perks. Many of you know by now this is simply untrue.
What we are terrified of is an imposed contract, unmodelled, uncosted, and unbelievably unsafe. The NHS is on its knees- the knock-on effect to recruitment and retention alone, not just for junior doctors but all NHS staff, could collapse the entire service.
So what next? How can we make a government listen to our concerns.
This. We, a group of patients, doctors and NHS staff, are proud to announce the initiation of a second independent judicial review into the junior doctors contract.
We are not the BMA- they have challenged the government as an employment dispute, on equality grounds.
We are challenging them over patient safety- patients who are concerned an already underfunded NHS cannot cope with the government’s insistence on ‘7-day’ services without additional funds or additional doctors. We have huge gaps in cover already- 60% increase in rota gaps for doctors, 50% increase in agency nurses in a single year. 9/10 junior doctors have said they will resign if the new contract goes ahead. Even if 1/10 actually leave- for locum work, abroad, pharmaceuticals, or even simply stop being doctors- the system will crumble. Then the nurses, the pharmacists, the AHPs, the consultants, the GPs will undergo the same.

We have instructed renowned Human Rights and judicial review specialist law firm, Bindmans LLP, to investigate the legality of the decisions of the Secretary for Health. We will ask for a wide-ranging review into the impact on staffing, costing and the evidence for need and benefit of imposition. We will force the government to finally listen, and come up with the so-far missing evidence to back up months of wild claims and false promises.
At the very least we will see the necessity, and take the time to consider the biggest gamble in the history of the NHS. At best, we may finally prove that the DoH and government have been peddling smoke and mirrors, and find the real reasons for the underfunding, the enforced contracts, the increased privatisation. Most importantly, we may avert catastrophic patient harm.
What can you do to help?

We are not an organisation- we are simply individuals who care deeply about the future of the NHS. We are crowdfunding our case here, at CrowdJustice. Follow us on Twitter and Facebook as #JustHealth. We are off to a great start, but need at least £100,000 or more to fund such a complex and important legal action. We will possibly need more to keep going, and it will be only your support that will make this possible.
For years I have ranted on about trying to save our NHS. Many of you agree, but ask “what can I do about it?”
This. You can do this.
We can save our NHS. We must.
Juniordoctorblog.com

Exhausted? Of course I am.

imageJeremy Hunt’s strategy now is to exhaust the junior doctors.” Guardian 1/2/16

I am, like many of my colleagues, indeed, exhausted.

I’m exhausted of going to work to find huge gaps in the rota where doctors used to be, where nurses used to be, where physiotherapists and OTs used to be. I’m tired of never seeing a contract, never being able to plan to see my family. I’m exhausted by the deaf ears of faceless administrators.

I’m tired of endless top-down reorganisation, target-chasing and publicity managing. I miss looking after patients. I miss training to be a better doctor.

I’m exhausted by the media. I was on BBC radio during the last strike, and a rather hostile presenter asked me “Why are you on strike? Why aren’t your doing your job”. I gave a PC, measured answered. But what I wanted to say was this ; “I’m striking today to protect the long-term health of patients. That’s my job. But what about you and your fellow ‘journalists’? Are you doing ‘your job’? When a Secretary of State and Prime Minister can say anything and it is reported verbatim; unscrutinised,unchallenged and uninvestigated? When they can lie about stroke care, perinatal care, weekend hospital care, consultant cover, NHS funding, NHS safety and privatisation and not a single journalist will take the time to report the utter lack of credibility on any health issue in any way? I’m doing my job to the best of my ability- are you doing yours?”

Sigh.

I’m exhausted by the politics and the endless endless lies and spin. I’m tired of having to counter the same propaganda ad nauseum. A ‘seven-day NHS’ sounds great- but what is it? Is it urgent emergency care? We already have that. Is it routine care? We don’t need and can’t afford that- not when the NHS has never been poorer. Can we make it better? Of course- but we need investment, policy based on evidence not sentiments. Should I go to hospital at the weekend? Emphatically, categorically and unreservedly YES.

I’m sick of noxious columnists pumping out toxic nonsense; d’Ancona, Baxter, Lawson, Vine…the cogs of the Tory spin machine are many, and they are all dirty.

Most of all I’m exhausted by fighting for an NHS on the brink of destruction- and the public remains wholly unmoved. When you go to the doctor and she tells you something is seriously wrong- how do you respond? Do you then go to the Daily Mail to fact check it? Do you ask for a balanced opinion from a government think tank, deeply invested in privitization? I’ll declare my vested interest right here; I’m a junior doctor and I think the NHS is the best healthcare system for my patients- in equity, in outcomes, in value for money. Now the junior doctors are striking, the GPs are resigning, the consultants are halfway between both. The student nurses are striking, the staff nurses are planning, and pharmacies are closing. Meanwhile NHS services are already being sold- to Virgin, Circle, TDL. Domestic and domiciliary have been private for years already. PFI hospitals are £80 billion in debt for £10 billion of services – does that sound efficient to you?

The end of the NHS is here- not in five or ten years, but here, now, collapsing from August. Do you really believe this government is ‘the party of the NHS?’

Did you vote for this? Did you look at the Tory manifesto and read the pledge ‘Seven Day NHS’ and think- “That’s got my vote, now bulldoze the thing and where’s that private health insurance brochure?”

We haven’t explained ourselves properly and for that I wholeheartedly apologise. The junior contract is simply a means to make lucrative weekend work cheaper, and reduce the pay bill and pension bill on hospitals for private takeover. There really is no other reason to do what the government are doing. They don’t care about the safety of patients- they’ve cut hospital budgets in relative terms the deepest in NHS history, we have less doctors and spend less % GDP on healthcare than most of Europe, and they tried to suppress reports on safe staffing levels for nurses. They don’t even care about ‘balancing the books’- the NHS will be £2 billion in debt this year. The national debt in 2007 was £500 billion, now it’s £1.6 trillion. In 2007, the deficit was £41 billion – now it’s £90 billion. I hear your cries of ‘the financial crash’. Exactly- and here is the cost- years of private debt generated by illegal banking practices absorbed into the public purse. Banking and corporate tax evasion remain unchecked. The NHS and every other public service for sale. It’s a crime too huge to see.

I’m exhausted. Yes. And alone, perhaps, defeated. But I’m not alone. 250,000 doctors in this country, 400,000 nurses, 150,000 allied health professionals. 19 million families. 66 million people.

Dear other normal human beings, join us, and help save our NHS, if we can.

Second Junior Doctor’s Protest, Saturday 6th February, 12.00 Waterloo Place, London

Second Junior Doctor’s Strike, Wednesday 10th February, picket lines at every local hospital.

juniordoctorblog.com

How to Sell The NHS: Appendix 1 – Dealing with Troublemakers

284

Dear Dept Of Health,
I am very pleased to hear you have been following my step by step programme; “How to Sell off the NHS; A Users Guide“.
Obviously you seem to have hit a bit of a bump with the junior doctors- but always happy to troubleshoot a good privatization! Here’s a quick road map to where you’ve gone wrong and what to do to get back on track!

Mistake #1 – You didn’t smear everybody beforehand. A good smear campaign is like suntan lotion- if you don’t get it everywhere then it doesn’t work! Excellent work on attacking GPs and Consultants- but you forgot those pesky junior docs! Nice catch up efforts [1]– but surely you can come up with something better than Facebook holiday snaps?

Mistake #2 – Doctors aren’t miners. [2] Nurses aren’t miners. No one in this situation is a miner. You don’t have to dress up as Thatcher every Halloween. You’ve forgotten the first rule of dismantlement- keep it quiet.

Mistake #3-  Stop being surprised doctors don’t want to screw over other doctors. Nice try with ‘pay protection’ [3]– but you realise this just highlights exactly how much the next generation are getting cut by? Doctors tend to be doctors forever and it’s hard to avoid your junior colleague’s eye for 40 years. You’ll get a squint.

Mistake #4 – You p***d off the anaesthetists. You probably don’t know this but every doctor, at some point in their training, had to phone the anaesthetist and grovel for help. Usually when they were right up s**t creek, minus paddle. No doctor would think hacking them off is a good idea. You could’ve hated on histopathologists until the cows came home by the way. Missed a trick there.

So what to do? Well here’s an idiots guide to breaking the strike and getting those dirty no good training docs into some great cheap labour for the privatization wagon.

1) Keep on spinning – it doesn’t matter what’s true or not. Keep using selective phrases from research about weekend mortality, [4,5] and then mention junior contracts straight after. Hopefully people won’t notice they’re not linked at all. [6] Like when the newspapers put a giant picture of someone they hate on the front page next to a completely unrelated story with an offensive headline like ‘SEX OFFENDER’. Smear them for being militants [7], or trotskyists [8], or extravagant jet setters [9] or even women [10]. Eurgh. Bloody pacifist militant socialist aristocratic 50% of the population.

2) Take the opportunity to completely bury any other problems- cut the NHS bursary [11,12] (oh? You didn’t manage that), carpet the NHS reinstatement bill [13], and quietly suppress safe staffing level reports and whistle-blowing junior docs. [14,15] Keep TTIP super quiet [16]- holy Boris bikes you don’t want the public nose in that!

3) If you get challenged on statistics you’ve used don’t worry- get this phrase made up on some rubber stamps “there is clear clinical evidence of [insert whatever you are wrong about here] – and we make no apology for doing something about it”[17,18,19,20] Stamp it on every response from angry academics who actually wrote the research you have misrepresented. Don’t worry about investigative journalism- pretty rare to find any these days.

4) If you aren’t winning here – just hire a few £million worth of extra spin doctors [21]. Way more value for money than real doctors.

5). Pretend like you’re not actually responsible for this -take every opportunity to ‘slam’ your own organisation. [22,23] Make a slam book. If this isn’t demoralising enough why not leak some ‘well-placed’ sources as veiled threats on the news to get your point across. [24]

6) And whatever you do- don’t sit down with the doctors in a public place. [25] They spend their lives accruing knowledge and applying it in life saving situations – in a head to head debate you will definitely get shown up as a disingenuous moron. But flush out those handy think tanks [26] you pay so much for and get them out there as ‘balanced’ opinion holders. No one will notice their huge conflict of interest as privatisation lobbyists taking cash from big tobacco on the side. [27]

7) Money. Don’t mention it unless preceded by the phrase ‘extra’ [28] or simply total up expected underfunding as five yearly totals so they sound huge. Ignore the fact this is complete nonsense. [29,30] Pretend hospitals are like houses or supermarkets- people understand those. If you cut a hospital budget- that sounds bad, but if you tell a hospital to ‘live within their means’ [31]– well, that’s just good old fashioned common sense.

And don’t worry if you lose your job. Some very friendly chaps at a grateful private health company will greatly appreciate all that you’ve done for them while fondling the public purse. They really appreciate it. REALLY. [32]

And the best news of all? Even if you p**s off every doctor and nurse in the country they will still give you the same world class service they give every patient if you need them, any hour of any day. Phew. Idiots.

Juniordoctorblog.com

 

[1] http://www.donotlink.com/htxh
[2] http://www.theguardian.com/society/2015/nov/19/nhs-bosses-pressure-hunt-arbitration-junior-doctors
[3] http://www.nhsemployers.org/your-workforce/need-to-know/junior-doctors-contract/faq
[4] http://www.bbc.co.uk/news/health-34598335
[5] http://www.huffingtonpost.co.uk/2016/01/13/junior-doctors-jeremy-hunt-professor-nhs-stroke-deaths_n_8973206.html
[6] https://juniordoctorblog.com/2016/01/11/the-hateful-eight-an-exploration-of-the-evidence-presented-for-jeremy-hunts-weekend-effect/
[7] http://www.donotlink.com/hady
[8] http://www.donotlink.com/i20t
[9] http://www.donotlink.com/hu3o
[10] http://www.donotlink.com/hwtn
[11] http://www.bbc.co.uk/news/business-34919523
[12] http://www.bbc.co.uk/news/uk-35263402
[13] http://www.theguardian.com/society/2016/jan/26/caroline-lucas-green-party-labour-repeal-tory-nhs-reforms
[14] http://www.telegraph.co.uk/news/nhs/12110806/AandE-units-may-be-short-staffed-half-the-time-secret-guidance-says.html
[15] http://www.54000doctors.org/thecase/2-what-is-whistle-blowing-protection.html
[16] http://www.theguardian.com/business/2016/jan/26/anger-government-blocks-ttip-legal-documents-nhs-health-service
[17] http://www.theguardian.com/politics/2015/oct/15/doctors-cabinet-office-investigate-jeremy-hunt
[18] http://www.independent.co.uk/life-style/health-and-families/health-news/plan-to-put-price-tag-on-nhs-medicines-is-a-headline-grabbing-gimmick-says-journal-10444508.html
[19] http://www.mirror.co.uk/news/uk-news/jk-rowling-supports-junior-doctors-6650327
[20] http://www.mirror.co.uk/news/uk-news/furious-junior-doctors-deliver-giant-7221155
[21] http://www.independent.co.uk/news/uk/politics/labour-accuses-government-of-hiding-rising-special-advisers-bill-a6775561.html
[22] http://www.donotlink.com/i212
[23] http://www.belfasttelegraph.co.uk/news/uk/jeremy-hunt-slams-nhs-over-utterly-unacceptable-failure-to-probe-deaths-34276082.html
[24] http://www.bbc.co.uk/news/uk-politics-35298370
[25] http://medlines.org/2015/11/24/jeremy-hunt-snubs-nhs-junior-doctors-strike-debate/
[26] http://www.donotlink.com/i217
[27] http://www.tobaccotactics.org/index.php/Adam_Smith_Institute
[28] http://www.itv.com/news/update/2015-04-11/jeremy-hunt-we-can-fund-extra-money-for-nhs/
[29] http://blogs.channel4.com/factcheck/factcheck-george-osborne-generous-nhs/22104
[30] https://juniordoctorblog.com/2016/01/05/its-the-spin-that-wins/
[31] https://www.facebook.com/JeremyHuntMP/posts/992474864129700
[32] http://www.theguardian.com/politics/2015/oct/20/andrew-lansley-advise-firms-healthcare-reforms