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

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

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

Time to put  your money where your mouth is, or perhaps your heart. 

It’s been two weeks since the junior doctor body voted no to the proposed contract. The contract designed to “create a seven day NHS”, which we apparently need to address “weekend mortality”. Except none of this is true. And after a year of beating our collective heads against the all, the message is getting through.
In a Parliamentary hearing in February NHS head Charlie Massey admitted he had no clue what a ‘seven day NHS’ meant or was, and no plan to create it. He was told he was ‘flying blind’ on the issue.

This week the same hearing sat Mr Hunt down, and found what we have all known all along; Mr Hunt broke his pledge to fund the NHS and lied about it. How can there be funding for an expanded service when there isn’t funding for the normal service? When the normal service is collapsing.

And while Jeremy and the managers of he NHS haven’t bothered to study a plan they claim was important enough to force junior doctors to strike over, somebody else has. Professor Bion researched the weekend ‘effect’ and staffing and said  ‘I’m convinced seven day services cannot be achieved within current funding”.

But this isn’t news. We’ve been saying it for a year. These are the sticks Jeremy and the department of health have used to beat a whole generation of professionals- the ‘spine’ of the NHS. These are the excuses they have made to replace existing safeguards on working time with flimsy untested alternatives, to discriminate actively against women and parents in medicine, to push morale in the NHS to an all time low.

So what would a rational response be? Your contract has been rejected by the majority, your reasons for creating and pushing the contract have fallen apart, you have a new fresh start in government. You would start over right? Rebuild good will?

Sadly no. Jeremy Hunt is forcing the contract through, and not only that he is now trying to blackmail the group opposing imposition in the courts, Justice 4 Health, by demanding at the last minute £150,000 in costs.

Without this money the court case will never be heard- Jeremy will be free to impose, although he knows this is illegal, and sets a dangerous precedent for every other NHS staff group behind us.

I’m tired, just like you. I just want this to end, just like you. But I also refuse to let our profession and NHS be destroyed. This is our watch. This is our responsibility.

Some of you are doctors, some of you voted No – this is why you voted No. You want a renegotiation, or a moratorium, then imposition must be stopped. It’s time to put your money where your mouth is.

Donate here.

Some doctors voted Yes- you might still want this contract. You might think it’s the best we’re going to get. The yes/no divide was bitter, acrimonious, and brought out the worst in us. A year long dispute as a united profession brought out the best of us. Whether you believe the contract is acceptable or not, we must all agree imposition is wrong. Put your money where your heart is, come together again, and support this cause.

Donate here.

If we don’t fight together, we will fail before we even begin.
Juniordoctorblog.com

The NHS is collapsing. Part 2: if the NHS were a patient, I’d be pulling the emergency alarm

It’s my job as a doctor to interpret trends and analyse hodgepodge information to predict an outcome. I look at the NHS and see a single direction of travel: collapse without rapid and drastic intervention.
In a series of posts we will look at exactly why and how this is happening. This is what I see- you can decide yourself what you see.

In the first post here, we looked at why the NHS budget must rise 3-4% per year just to stand still.

In this post we will see exactly how this isn’t happening and what effect it’s having.

Imagine the NHS is a person- and it is very sick.

When I first see a patient we are trained to go about their assessment systematically. We first check their airway is clear of obstruction and they can breathe.

What do health systems breathe? Money. Everything has a cost, even in a free at the point of service system like the NHS.

So let’s look at our patient’s charts- as demand has risen the NHS has suffocated without proper oxygen to feed it.

Already an alarm is flashing; hospitals went from £0.6 billion surplus in 2010, to the worst deficit in NHS history- £2.3 billion in the red. 


If I saw this nosedive in the hospital I would pull the emergency buzzer. We have second and third opinions here too- The Kings Fund called this

the most austere decade in NHS history.

Professor Don Berwick, patient safety tsar, said

 “I know no nation that is seeking to provide [modern] healthcare at … 8% of GDP let alone 7% or 6.7%, that may be impossible “

The government spun this crisis as hospital ‘overspending‘- but that’s the equivalent of telling a gasping patient that they are ‘overbreathing’. It’s estimated the NHS needs £30 billion to keep afloat by 2020- the ‘extra’ £10 billion promised by government hasn’t appeared, is actually just £4.5 billion and is nowhere near enough. A deflated armband for a drowning man.

Next we look at the circulation, which is how the blood flows through the body and delivers life to the vital organs. What is the lifeblood of the NHS? The staff.

And we are haemorrhaging out. Just like our real blood the NHS system is made up of lots of essential components; doctors, junior and consultant and GP, nurses, midwives, paramedics, pharmacists, health visitors, radiographers, physio and occupational therapists, clerical and secretarial staff, cleaners, security. The list goes on. Every single staff group is suffering.

In the last two years the number of vacant posts for doctors has increased 60%, the number of gaps in nurse’s posts 50%. GPs are contemplating mass resignation, community pharmacies face mass closure, and the cuts to student nursing bursaries mean fewer nurses will be enticed into training. And junior doctors? Alongside most NHS staff junior doctors have already taken a 25% paycut in real terms since 2008, and certificates to leave the country are on the rise.


Now thanks to a toxic contract dispute they are leaving training in England; first choice applications to Scotland and Wales jumped 30-40% vs 2015, and first year training was under recruited in England for the first time in history.

The NHS needs a rapid and skilled workforce transfusion, and to stop bleeding staff burnt out by demoralising leaders and working environments.

The next step in a real patient is to assess their brain- so who are the brains? Well, Jeremy Hunt is still Secretary of State for Health, a man who looked at the above gasping and bleeding patient and declared “the NHS needs to go on a ten-year diet“. I think we need a brain transplant.

Then we assess the vital organs. What are the vital organs of the NHS? A&E, GP and cancer care. Let’s look at some test results. A&E is crashing- wait times over 4 hours just hit the highest in history, with just 81% of patients seen in target time compared to 98% just 8 years ago.


A&Es are closing and downgrading due to lack of staff and funding and no plan to cope with demand when other local departments close.

GPs are closing at record rates– and some being sold privately for more money, and for the last two years we are consistently missing cancer targets.

And let’s not forget the huge problems in social care funding. Even if we resuscitate our dying patient, we can’t forget that their house is caving in as well.
In the midst of all of this the government want to launch a ‘seven day service’, and deny there are any problems at all. Some NHS leads are even starting to leave reality altogether and claim ‘we don’t need safe staffing levels’.
Imagine a crowd of very concerned doctors and nurses around a very sick patient, tubes and wires and monitors blaring, and in jumps Mr Hunt, trying to shoo attention away and declaring “He’s just overbreathing and needs a good diet is all!”. As a doctor I would be within my rights to have him thrown out of the hospital. I can’t seem to get him thrown out of government though.

And as our leaders withhold the vital oxygen our patient NHS needs, as they fail to address the profuse haemorrhaging and the multi-organ failure, we have to ask why? Why would a responsible government be so wilfully ignorant of such catastrophe? And can we hope to resuscitate?
Find out in our final instalment;

The NHS is Collapsing Part 3: The collapse is a choice, not a necessity. 

Juniordoctorblog.com


Read the other parts in this series: The NHS is Collapsing.

Part 1: A Life in a Day of the NHS

Part 2: If the NHS were a patient, I’d be pulling the emergency alarm

Part 3: The collapse is a choice, not a necessity.

The NHS is collapsing. Part 1: A Life in a Day of the NHS 

So May is in, Hunt stays, Brexit means Brexit. It’s all change in a crazy week of politics. But what hasn’t changed is the NHS is still about to collapse. May will likely be the last Prime Minister to oversee its demise.

It’s my job as a doctor to interpret trends and analyse hodgepodge information to predict an outcome. I look at the NHS and see a single direction of travel: collapse without rapid and drastic intervention.
In a series of posts we will look at exactly why and how this is happening. This is what I see- you can decide yourself what you see.

In this part we will simply explain why the cost of modern healthcare rises every year just to stand still, which is fundamental to understanding the funding needs of the NHS.
This is difficult, but I think best explained if you simplify the entire health system as treating a single person, let’s call her Beverley.

Beverley is born in 1948- her birth is at home, with no healthcare professional, midwife or monitoring. Several of Beverley’s siblings are also born this way- unfortunately two die before they are one. Sadly an uncle has a heart attack at 52 and passes away.

Beverley grows up, and fortunately remains healthy. She marries, Bob, and she has her kids in 1968. She has every one in a hospital, with a midwife. One requires surgery. Beverley’s own mother has a stroke and dies at 63. Bob decides to stop smoking.

Beverley gets older. Her first grandchild is born in 1988, in hospital with electronic monitoring and emergency caesarean. Beverley’s second grandchild is born at 25 weeks, and spends three months in the new intensive care baby unit. Stressed grandparent Bob has a heart attack- he is rushed into hospital and has an emergency procedure to open the blood vessels in his heart. He is at home in time to hold his new granddaughter for the first time.

Beverley and Bob stride on, both retiring at 65. On their 50th wedding anniversary Beverley feels odd, can’t find the words to toast, and can’t raise her left arm. Her daughter dials 999- Beverley has a stroke, just like her mother. Fortunately she gets to hospital and 30 minutes later she has had a brain scan and a clot buster is being infused into her arm. She makes a full recovery, and goes back home a day later.

The junior doctor looking after Beverley spots a shadow on the routine chest X-ray she has. She is diagnosed with lung cancer.

Bob is going spare. They meet the specialist, the cancer is treatable and they start right away, six rounds of radiotherapy then weekly chemotherapy. It’s hard, and Beverley goes into hospital twice with complications.

Halfway through Bob has lots of abdominal pain and throws up some blood. Rushed to hospital he has an emergency camera test into his stomach – he’s developed a stress ulcer, which they clip and repair. He’s in hospital for a few days. Gratefully Bob and Beverley return home.

Beverley goes into remission, but is very frail now and is falling a lot at home. Now in their 80s, Bob gets chest pain trying to look after them both, and Bob needs three more stents put in to open blocked heart vessels. Bob and Beverley ask for some social services support at home- a carer comes once a day.

Overnight one night, Bob passes away in his sleep. Beverley is distraught, but at the funeral she asks her daughter; “Where’s Bob?”. Concerned, her daughter takes her to the GP. It’s clear Beverley now has dementia. She is moved first to a sheltered flat, then a residential home, then a nursing home.

She dies in hospital of a severe pneumonia at 83.

This isn’t a sad story- this is modern life and modern healthcare.
Why did i tell you this story? To show you how healthcare has changed. Let’s look at some facts.
In 1948 the average female life expectancy was 71. In 2016 it’s 81.5.

Beverley’s mum died at 63, while Beverley lived into her 80s. People are living longer.

Why? Better healthcare, better immunisations and prevention, better nutrition.

But also diseases that were previously fatal are now treatable. Mortality for conditions such as coronary artery disease have halved in fifty years- Beverley’s uncle died of a heart attack, but Bob survived two. Stroke survival and stomach bleeds are now readily survivable where fifty years ago they were not.

But these treatments are very expensive- the technology to open blood clots through vessels is super high tech and costs £3000 a go, advanced chemotherapy and radiotherapy treatment costs can run to hundreds of thousands per person, and intensive baby care costs £12,000 a week.

In short- we can do more every year, so we do. And those that we save live on as survivors- but this comes at a cost.

The cost of healthcare per year for an 85 year old is around 4x that of an under 65. The proportion of the population over 65 will rise to 25% by 2040. And alongside that the population is growing, by around 30% since the start of the NHS- so there are 30% more Beverley’s and Bobs than we started with.

So more people, who need more treatment, are treated with more medicines and survive more to need more treatment in the future. And let’s not forget they will need more social care.

This is why the NHS needs 3-4% more funding every year.

That seems like a lot- it’s a tremendous challenge. But we aren’t rising to it as our neighbours are. Of the G7 countries we currently spend the 2nd least on healthcare, well behind the US, Canada, Germany and France.

With the current healthcare budget under the Tories, we will be spending just 6.7% GDP by 2020- lower than Lithuiania and Hungary.

Despite that the NHS is still consistently ranked as one of the best healthcare systems in the world. In 2012 the US commonwealth fund found it the most efficient, safe and accessible system out of all countries ranked, and also spent nearly the least.
Whew.

So now you now that the NHS needs a rising budget to meet rising demand, like every other modern country. Yet we aren’t funding it anywhere near that level, and we aren’t meeting that demand.
In short, the NHS is about to collapse.
Find out how in;

The NHS is collapsing. Part 2: if the NHS were a patient, I’d be pulling the emergency alarm.

Juniordoctorblog.com


Read the other parts in this series: The NHS is Collapsing.

Part 1: A Life in a Day of the NHS

Part 2: If the NHS were a patient, I’d be pulling the emergency alarm

Part 3: The collapse is a choice, not a necessity.

I have a simple question Mr Hunt- what is the rush?

Today Jeremy Hunt announced a return to imposition. He justified this despite an emphatic rejection of the contract by 58% of the referendum voters, to end the ‘impasse’ after three years and failing to agree a contract. 
But the one question no one has answered for me is “what is the rush?”
Now the government would argue that they are keen to get on with their ‘seven day NHS plans’, despite the fact that the NHS is about to announce even greater spending cuts, George Osbourne has abandoned his surplus target for 2020, and record number of staff gaps for doctors and nurses are being recorded. Categorically, there is no plan for a seven day NHS, vis a vis there is no seven day NHS. What did we get instead? “Junior doctors are now a third cheaper”. There aren’t any more doctors- in fact many have now fled for Australia and Scotland. So no more doctors on weekends- just a third cheaper.
And whatever happened to the ‘weekend effect’- suddenly missing from what was core Hunt go-to doctrine? Well new evidence has dispelled this effect, making it more an artefact of how dodgy data was collected, and subsequently misrepresented. We’ve covered this before. Put simply- there’s no weekend effect for this contract to address.
And even if there were, junior doctors already work 7 days a week, no study ever linked junior doctor staffing to any ‘effect’ and the one study Jeremy likes to quote actually found 100% medical coverage across every day of the week. So this contract fight arose from a political position that has since crumbled away.
So what’s the rush? What’s the benefit of imposing a contract, which is legally fraught, onto a highly mobile professional body, highly
Motivated already to leave? 

Now the government might turn back and say- well it’s been three years, and we still haven’t got anywhere.
Be that as it may- but why can’t it be three more years? If this was genuinely all about making patients safer, which it certainly doesn’t now, then why not take the time to actually achieve that?
Let me tell you about the contract. It is going to cover every NHS England hospital- so every patient in England will be affected. 
The central Guardian role for protecting doctors from exhaustion, a key concern about this contract, has been rushed through in weeks- but practically no planning has been done. 

Some hospitals have recruited this role for a mere 4 hours per week, looking after 1200 doctors. That’s just 12 seconds a week per trainee. Is that sensible or practical?

There is no plan for how human resource departments will be able to cope with the sudden ten-fold increase in complexity in the pay and rostering schedules, nor any plan for how educational supervisors, busy doctors in their own right, are now expected to take on a huge additional workload, another key part of safety completely mismanaged.

We don’t have an effective means of whistleblowing without getting sacked. Put simply- if I find a horrendous breach of patient safety neglected by my hospital management, and blow the whistle to protect patients, I can be sacked from my training post with impunity. Is that a good thing?

Lastly negotiations were still in progress to address the key discriminatory parts of the contract. As it stands it still will mean the careers of female medics are more difficult Than they are now. We are bleeding staff and resources in the NHS- what is the possible benefit of rushing a contract through that will lead to fewer doctors on shift, not more? Is that good for patients or staff or anyone at all?
You might argue that the BMA agreed this contract, and therefore it’s okay to impose it. Which is a rather paradoxical argument from just a few months ago when we were told the BMA were misleading us, now we should blindly follow?
 Certain social media commentators ardently claim we are naive and childish. We are a group of people with an average of two university degrees each, twenty plus years of education, an average age of around 33, and many of us mothers and fathers ourselves. 

We understand perfectly.
We understand the rush is a political expediency- politically this needs to be out of the news cycle, politically it needs to be off the front page, politically this needs to be out of the next election cycle. But I’m sorry, we aren’t creatures of politics.
We are doctors responsible for human lives; and we see a contract that will push more of our colleagues away from the bedside, stretch the doctors that remain, and leave no means to correct continued unsafe working. I’m not exaggerating when I say this contract imposition may hasten the end of the NHS, and has the very real potential to kill people. It’s not a decision we take lightly or naively. It’s also not a decision or negotiation to rush. 

So Mr Hunt, I ask you again: what is the rush?
Work with us for a year to improve the safety mechanisms we have, to retain less than full time staff, to restore the morale and hope of us all. You keep telling us we are the ‘backbone of the NHS’. You are about to break it.
You don’t need a doctor to tell you that’s a rather fatal idea. 
#listennotimposition
Juniordoctorblog.com