Thousands To Join First All-Out Doctors' Strike

[naomi24]

// Doctors are concerned they will be under pressure to work longer hours, risking patient safety.//

… but they don’t mind risking patient safety today when they withdraw emergency cover at A&E and intensive care units. Hypocrites!

http://news.sky.com/story/1684491/thousands-to-join-first-all-out-doctors-strike

[Peter Pedant]

Mushie - drama queen - you aint gonna die today ....

Ok answer : you sue the consultant treating you ( and his employer )
which iiiiiiis the usual answer - £200 please - NEXT !

[mikey4444]

Naomi....imagine a world where there are no women doctors, dentists, nurses, architects, Police Officers, Ambulance personal, lawyers, engineers, etc, etc.....they all require "specialist and lengthy training"

[Sqad]

Jim, the whole article wasn't available but....

\\Our previous study of all NHS hospital admissions in England during the financial year 2009-10 indicated that admission at the weekend (Saturday and Sunday) was associated with a significantly increased risk of in-hospital death compared with midweek admission, but being in hospital at the weekend was associated with reduced risk of death.1 These findings were replicated in an analysis of 254 leading hospitals in the US.1\\

Clearly, up until 6 years ago, the patients admitted over the weekend were disadvantaged. So, if you believe the statistics, what has happened over the past 6 years to improve the situation......? the absence of a Labour Government?( sorry that was tongue in cheek).
Again i cannot comment further as i have no access to the article.

[jim360]

"It’s utterly shameful that [junior doctors] have left A&E and intensive care units without cover."

This is not really fair; cover has been provided, at the expense of non-emergency care. A&E will be operational today and tomorrow, as will ICU, as senior doctors step in to cover the gap. Obviously capacity won't be at 100% but it should be near as dammit.

All the same, I stand by my position that if this strike doesn't change the government's position then that should be the end of the matter, and junior doctors should back down.

[jim360]

Sorry you can't access the whole article, Sqad; I've reproduced verbatim various sections I think are key. I was considering uploading the thing to a file-sharing site somewhere but the below will have to do. In essence the picture hasn't changed much in six years; the problem is that there's no clear idea what to do about it. In particular, junior doctors' contracts seem a bit more like the product of a government that wants to look like it's doing something rather than actually doing something about the problem.

A couple of the key stats:

- Admission on Saturday or Sunday is associated with an approximate 10-15% increased change of death, reducing to 7-10% increased risk once the higher proportion of severely-ill patients admitted on those days is taken into account.

* * * * *
Summary conclusions below:

"Our analyses show that, although fewer hospital admissions occur at the weekend, patients admitted on Saturday and Sunday are sicker and face an increased likelihood of death within 30 days even when severity of illness is taken into account. This finding is similar to that of our previous analysis. In the current analysis we also detected a smaller increased risk of 30 day mortality among patients admitted on Friday and Monday, suggesting a more generalised 'weekend effect.' Our analysis of 2013-14 data suggests that around 11 000 more
people die each year within 30 days of admission to hospital on Friday, Saturday, Sunday, or Monday compared with other days of the week... These observations
are not unique to the NHS in England... There is evidence that junior hospital doctors feel clinically exposed during the weekend and that hospital chief executives are concerned about levels of weekend cover."

That last point is arguably rather informative: junior doctors *already* provide cover over the weekend, but lack the support they need. To me, it seems that the message from this paper is that the targeting of junior doctors by the government is unjustified as an attempt to address the undoubted problems of weekend care.

[naomi24]

Jim, //Obviously capacity won't be at 100% but it should be near as dammit. //

Sorry, it doesn’t wash. The burden of responsibility that these people are imposing upon their colleagues today by withdrawing their services from emergency care is indefensible – in my opinion.

Mikey,// imagine a world where there are no women doctors, dentists, nurses, architects, Police Officers, Ambulance personal, lawyers, engineers, etc, etc.....they all require "specialist and lengthy training"//

You’re over-egging it a bit with some of those professions!

[fiction-factory]

Can anyone tell me what the main issue of difference is please between the government and the doctors. The main soundbites from the BMA seem to be about the changes meaning more tired doctors and therefore a risk to patient safety. I thought the idea was to put a cap on the hours and to spread the same amount of cover over 7 days. I can see that they may already be too tired but I don't see how this makes it worse

[mikey4444]

Naomi....not at all. All those professions require training, lengthy or only medium lengthy. To deny women the chance of working in these areas is tantamount to outrageous.

I am very surprised that you are not supporting women's rights to have their chosen career. I am sure if I suggested such a opinion, you would be up and fighting straight away, and quite rightly too.

[fiction-factory]

jim- I know like me you have probably seen the statistics about deaths for people admitted at weekends. I have heard analyses on More or Less and seen other analyses and I wonder if the figures have been misused. I think one factor is that the sort of admission that takes place at weekends is more likely to be urgent than one that occurs in midweek, so we may not be comparing like with like. Nevertheless there was a manifesto commitment to a 7 day NHS and provided a way can be found to make it work it does seem a step in the right direction

[Sqad]

mikey......one is not suggesting that NO women should train as doctors, but that the number of successful applicants of women medical students should be reduced. Some years ago 10+ perhaps, there was a plea for medical schools to allow MORE women for training and they responded.
Many of my friends are women doctors, but all i am saying is the numbers should be returned to pre 70's.

For the NHS to allow so many women doctors with all the benefits, one must question the affordability. Are they cost effective?

[naomi24]

Mikey, //I am sure if I suggested such a opinion, you would be up and fighting straight away//

I wouldn't - I never did go for the Women's Lib thing - but that said I note you haven't told sqad his opinion is outrageous. Can't think why. ;o)

[jim360]

So far as I can tell the single bugbear is over the level of pay on Saturdays between 7am and 5pm. The government proposals are to cut this by some amount that I'm not quite sure of, while raising the overall basic pay level so that the pay cut isn't too steep -- but, in essence, they treat Saturday as a "normal" working day as opposed to "unsociable working hours". The BMA disagrees and wants Saturday to be seen as unsociable, and therefore given a higher pay rate. Again, so far as I can see, this "higher pay rate" is in comparison to the new basic salary rather than the current enhanced rate for Saturday, ie the BMA are seeking for current Saturday pay levels to be broadly the same as they are now. On everything else an agreement has been reached (I think).

With respect to the "weekend effect" of increased deaths, as I've mentioned earlier this is not something that disappears when you take into account increased severity of the conditions that people admitted on weekends often have; it is there, albeit not too sharp, regardless of the condition. Patient care on weekend admissions does not meet the weekday standards, and everyone on all sides accepts this. Again, the question is why junior doctors are being targeted for changed terms when it's not at all apparent that they should be targeted so.

[fiction-factory]

Thanks jim. Yes, someone mentioned the premiums for Saturdays being an issue on Radio 4 today, but whenever I hear BMA spokesmen or striking doctors they always seem to say it's not about the money, it's about patient safety or to protect the NHS. It seems there is a section in government out to break the BMA (similar to miners' strike) and a section of the BMA who want to see of Jeremy Hunt as they do not want an NHS secretary interfering in what they see as their area.
However I note that so many doctors support the BMA so maybe there issues of importance that haven't been communicated very well.

[Bazile]

This dispute is obviously at an impasse .

Cameron sees it as his Thatcher , miners , moment .
He cannot be seen to give in to the doctors and therefore in the background he is prodding Hunt to get on and crush any resistance .

[jim360]

"...whenever I hear BMA spokesmen or striking doctors they always seem to say it's not about the money, it's about patient safety or to protect the NHS."

I must admit I can't quite reconcile this statement with the fact that what is left is, as far as I can tell, only the Saturday pay levels. Possibly it started out that way; the contract negotiations have rolled on for a long time and the initial government offer was probably rubbish. Perhaps there's something I'm missing, or it could be that junior doctors are prepared to accept the contract (with modifications to Saturday pay) despite still feeling that it doesn't address patient safety. It is true that the philosophy behind the government's offer is to try and improve weekend care by moving some junior doctors from weekday shifts and towards weekend ones -- in which case the weekend care is maybe slightly improved but only at the expense of care during the rest of the week. This could amount to having the same amount of deaths overall, just spread more evenly. Or, at least, that was the fear of the BMA when this all started.

[fiction-factory]

It has been said (but may not be strictly true) that there is a few extra billion pounds going in that should help, so perhaps there would be a small overall increase in the number of man(woman etc)hours worked under the planned changes- otherwise, as you say jim, improved care at weekends would be at the expense of care on weekdays.

[fiction-factory]

Interesting phone in now on Radio 4 You and Yours.
Another junior doctor has just been on saying "it's all about patient safety in the longer term". I wish the person chairing the show had pushed to ask why.
Another one said "we already do a 7 day week 2. So what's the issue.
Others have said it's discriminatory as it's more difficult for women to work weekends.
Another one- "we would work more and be paid less". If that is true than the doctors have a case but I would like to see an independent assessment to validate that
"Introduction of privatisation of NHS". Two have just said this is why they are fighting. Surely the are conflating issues here

[jennyjoan]

A junior doctor was interviewed this morning - she has been "junior" for 12 years. Pardon!!! - When does she become senior.

[Mamyalynne]

JJ, there's no easier way to answer that other than a straight copy..

//Doctors typically may be junior doctors for 5–15 years, and this may be extended by doing research towards a higher degree, for example towards a Doctor of Philosophy or Doctor of Medicine degree. In England there are around 53,000 junior doctors. The term non-consultant hospital doctor or NCHD also has currency in the Republic of Ireland.//

[Peter Pedant]

// A junior doctor was interviewed this morning - she has been "junior" for 12 years. Pardon!!! - When does she become senior.//

when she becomes a consultant

when senior registrars existed - they were counted as seniors too