I vote for Jexit

Please see below extremely lazy buzzfeed-like sumamry post, a few choice images recycled from my facebook and twitter feeds.


 


Jeremy Hunt has to go.
The last two days have seen further junior doctor industrial action: full walkout of junior doctor support including emergency cover including A+E, the crash team, ITU, obstetrics and so on.

Contrary to the scaremongering from the hateful daily mail there have been absolutely no patient safety issues, obviously, as the care was expertly provided by experienced and dedicated consultants and allied healthcare professionals. And we are extremely grateful for their support.

And despite hostile sections of the media it is clear that patients and the public are largely supportive of the doctors. Whilst on-call last weekend an 85 year old gentleman I was seeing in resus with a fast irregular heart rate stopped my examination to ask whether I also supported the " young doctors sticking it to that nasty Mr Hunt".

On the picket line I attended this morning we received numerous heartening beeps from passing cars, buses and ambulances. Several of people came to talk to us and express their support, and it was also nice to see some very british members of the public awkwardly display nods and thumbs ups whilst walking past. An old man with a frame stopped across the road and applauded. Several consultants and members of the public also came by with donations of gratefully received food and hot drinks.

http://www.independent.co.uk/news/uk/politics/the-public-increasingly-blame-the-government-for-the-junior-doctors-strike-a7003056.html

The NHS is already straining under the current contract. There are not enough doctors to fill rotas, making each shift more stressful for the few doctors that work them. Having recently moved onto a medical job I can report that 0/4 of my 12 hour on call days had a full complement of medical staff; the remaining team were rushed off their feet to try and see all the ward medical problems and new admissions. 

This is a genuine junior doctor rota (names erased) from a different hospital. The boxes in yellow are represent shifts where there is currently no doctor allocated. These extra shifts are frequently advertised as locum jobs but without much success - it is unpleasant to work under such short staffed conditions and there is increased risks of making mistakes. Junior doctors are already tired from working 50+ hours a week and value their free time. New government policy to cap the hourly rate of such locum shifts removes any small remaining incentive to work further hours.

Jeremy Hunt frequently claims (lies) about increasing funding for the NHS, when actually it is facing real terms cuts. He expects to make doctors work harder and longer in the context of £20billion worth of "efficiency savings".  source

It is clear that a treacherous and callous government is taking a heavy heavy toll on junior doctor's morale.

GP satisfaction in the UK is plummeting. More and more (junior and senior) doctors are leaving - no sign of those 5000 promised new GPs.

The new contract is also explicit in its discrimination of women and those with disabilities

 - and may indeed be illegal according to Britain's equality watchdog.

The tactic seems to be to grossly underfund and destabilise the NHS to set the scene for private companies to rescue the profitable parts - this sneak privatisation is already happening and has been hastened by the conservative's 2012 health and social care act (then health secretary lansley responsible for this act now advises private companies how to profit from the NHS). 

Remember Jeremy Hunt himself co-wrote a book about how to privatise the health service. The NHS is paid for by generations of UK taxpayers and is valued most by the poorest and most vulnerable - the people who could not afford private health care (and the people who are unlikely to vote conservative.) It does not belong to the political elite and it is not theirs to sell.

Despite, and perhaps partly because of, the ongoing pressures facing the health service Junior doctors remain positive. Jeremy Hunt has inadvertently strengthened the profession as we unite against his government's abuses of the public sector. There is rekindled camaraderie amongst colleagues of different specialties, junior and senior, doctors and other healthcare workers standing together passionate in their defence of a world class free health service that is adequately funded, and fair for patients and staff. 

Picket line in Manchester April 26th 2016

Appendix

A good, simple explanation of the main concern:

youtubes

Four excellent videos

View on Flipagram

A letter

I'm still angry at the government.

But at least one MP understands what I mean: Famous Green Caroline Lucas has sponsored a sympathetic early day motion http://www.parliament.uk/edm/2015-16/539, so I wrote a letter to my MP at www.theyworkforyou.com to bring it to his attention.

                              


                                        Tuesday 20 October 2015

Dear My Local MP,

I have recently moved to constituency to begin work as a junior doctor
at hospital, and so have become one of your constituents. I am writing to
ask for your support in opposing recent changes to doctors' working
conditions and further to express my disappointment in the current
government's handling of the NHS.

I am sure you are well aware of the collective anger felt by doctors at
prospective contract changes. Much opinion and analysis has been
published in the national press, as well as on social media. I expect
many doctors will have written to you before now and you will have no
doubt seen coverage of the large demonstration in London last weekend.

I speak for many of my colleagues in stating that I believe the imposed
changes are damaging for a great number of reasons. The proposed
contract devalues doctors, patients and the NHS. 

The contract fundamentally changes the way doctors get paid, such that
they would expect no increased pay for working evenings or Saturdays.
This  allow rota managers to significantly worsen the working
conditions of all doctors, and will result in a significant pay cut for
doctors already working difficult rotas.

The contract would remove safeguards against doctors working long
hours. Doctors could be coerced into routinely working longer than
their contracted hours, further demoralising and fatiguing those in the
profession.

The reason for this change appears to be to work towards a 7 day health
service. The benefits of a full 7 day (elective, as emergency cover is
already 7 day) NHS has been grossly overstated by the government. Many
people would welcome the huge increase in staff (and funding) required
to achieve a full 7 day service, but unfortunately there has been no
suggestion of this.

Without extra funding and extra staff the alternative solutions would
be either pulling doctors out of their weekday jobs to cover the
weekends - and the NHS is already straining to operate Monday to Friday
- or increasing the working week of doctors by approximately 40% more
hours. Both are directly harmful to doctors and patients. The contract
would also pave the way for other healthcare professionals to be
expected to work at the weekend and/or face (further) pay cuts
themselves so these concerns will be soon also directly felt by nurses,
consultants, porters, radiographers, ward clerks, physiotherapists and
so on, and on, and on.

There is already a large retention and recruitment crisis in the NHS.
Training positions in many specialities remain unfilled and demands of
patient care are only barely met with expensive and less efficient
locum staff. As doctors decide that the working conditions are no
longer tolerable then the working conditions for those remaining get
worse still as they must shoulder the annually increasing burden.
Obviously this situation is already bad for patient care, and the
problem will only be exacerbated as this contract will force many
doctors out of the NHS to better jobs in the UK or abroad.  I am very
concerned that an understaffed NHS will not survive much longer.

It is painful to watch as my profession and the NHS continue to be
undervalued, misunderstood and mismanaged. I do not have confidence in
the Secretary of State for Health's ability to protect the nations
health. I urge the Secretary of State to listen to his workforce and to
engage in meaningful talks. Unfortunately this has not occurred as yet
and many doctors feel forced to take the uneasy decision to vote for
industrial action in the coming ballot. I sincerely hope there can be a
strike-free resolution that allows doctors to feel valued, patients to
receive excellent care and shows investment in the future of the
National Health Service.

I strongly believe that the NHS is worth fighting for and so I would
like to ask your support for Early Day Motion 539: Junior Doctors (tabled
19/10/15), and also to ask what you and the Labour Party will do to protect
doctors, patients and the NHS.
Many thanks for listening to my concerns. I look forward to your reply.

Yours sincerely,

Dr O
MA MBChB 





On the 5th of November I got a fairly supportive copy paste reply, albeit vague and without reference to the Early Day Motion I asked support for.
 (re-copied and pasted here with names removed) 

Dear Dr 

Thank you for your recent email regarding junior doctor contracts.

The Labour Party is currently leading on this issue in the House of Commons. Last week, we secured an opposition day debate on the matter where we called for the Government to drop their plans for a new junior doctor contract. We also put forward new proposals which are fair for staff and safe for patients.

Ultimately, the Labour Party believes that it is wrong for the Government to want to pay some junior doctors less to do the work they do now. Labour is concerned that the removal of safeguards which prevent junior doctors having to work excessively hours may leave them too exhausted to provide safe patient care. Jeremy Hunt should recognise the increasing public concern on this issue, stop his high-handed demands and demonstrate a willingness to compromise and prioritise patient safety.

I can assure you that this issue is a priority of the Labour Party’s. In opposition, we will continue to follow this matter closely to hold the Government to account.

I have also offered to meet with a group of constituents and junior doctors who are concerned about this matter.

Please do not hesitate to contact me again if you feel that I can be of any further assistance with this or any other matter.

Yours sincerely

One more junior's voice

So many people have taken to the internet to express a lot of what I am about to reiterate too. Much of it is written with greater thought, clarity and passion than I can hope to here. But there is no defense in omitting such an important topic from my so-called blog. A few plagiarised images will have to suffice in trying to express these concerns.

I really have no idea what the general public know or think about what is happening to the NHS as I type this. All of my professional contacts and a large proportion of my personal ones work for the NHS in one way or another, and each of them feel similarly numb and impotent and downhearted by the situation we find ourselves in. The current handling of the NHS via its funding, organisation and staffing very directly affects me and the people I know. But it also directly affects every single NHS user as chronic underfunding of services and maltreatment staff will inevitably lead to cracks that will continue to erode the service and endanger patients.

I spent 4 years at medical school, and 7 years at university in total. Clearly it wasn’t a particularly efficient way of gaining employability, but even the most decisive school leaver must spend a minimum of 5 years as a student before they qualify as a doctor – and current students now pay £9,000 per year for the tuition fees alone. As a recent graduate I might spend ten or more years as a junior doctor, but even if I were to choose the fastest possible path, and succeed at every hurdle along the way, they would need to spend at least five years before becoming a GP or consultant.

Not even two months into this journey the government brutalise the system by pushing through a contract universally opposed, representing a long list of kicks not least of which is an expected 10-40% pay cut for trainee doctors. This takes junior doctor pay to pre-2000 levels and is a near-fatal blow to the morales of staff throughout the country. Furthermore the contract redefines "social working hours" to include 7am-10pm, 6 days a week. The BMA, with backing from doctors, made it clear that this was unacceptable and were unable to negotiate from here but the contract will be rolled out from Aug 2016 regardless.

 This is not the way I expected to start the career I had waited so long to begin; feeling betrayed, undervalued and impotent. We feel we deserve to be treated better, and it is this that is ominous for the future of the NHS. Even before this recent revelation I was well aware that there are far far more attractive employment opportunities for doctors outside of the UK, most foundation doctors I’ve spoken to had entertained the idea of leaving the NHS, either for a few years or permanently .There is a current retention crisis; doctors are choosing to retire earlier or change careers, and there are unfilled training posts in several key specialties including GP and A+E. As things stand these problems can only be significantly worsened in years to come. Understaffing is already a huge problem, with gaps only superficially filled with expensive locum and agency staff. The cycle is bleak:  inadequate staffing causes increased stress and mistakes, the service is less satisfying for staff and patients and so more doctors drop out of the game.

I do a small amount of e-mentoring for prospective medicine applicants, and I am quite often a source of information and advice for applying friends and family or work experience students at hospital. I now feel that it would be dishonest to recommend this path for the nations bright, optimistic and dedicated students. There are certainly other careers that pay far better, careers where you might feel respected or valued, and possibly even where you might have a better chance at a work-life balance.

This is a very good account about the situation, from the point of view of an ITU trainee doctor, and another excellent one here from an A+E trainee.

According to the BMA it costs about £260,000 to train an FY1 doctor, and a further £300,000 to train them to consultant level. New doctors will now find it difficult to even pay off their loans. It simply does not make sense in my head to invest so deeply in training medical staff only to be apparently unconcerned when many of them feel they have no option but leave the NHS. To me it sends a message that there is no concern for the future of the NHS, it seems that consciously or not the NHS is being set up to fail so that in the not-too distant future we are led to believe that the NHS is an unworkable idea  and privatisation is the only solution.

The level of outrage amongst staff, both junior and senior, medical and non, has been visceral and overwhelming. We share a keen sense of injustice but are struggling to find a constructive voice. Today my facebook wall is alive with righteous anger, though the audience reached may often be mostly other junior doctors. We cannot sleepwalk towards deeply unfair, short sighted and dangerous reforms and I will begin by joining many others in writing to my MP. It seems clear to me that a well funded and well functioning health service (available to all) is of vital importance to a nation, and a workforce that is present without resentment is essential for this. It is a message that I have no confidence that Jeremy Hunt has heard, and we are becoming exasperated at his continued inability to understand the issues surrounding healthcare delivery, and his continued refusal to hear the concerns of the public or the professions.  Clearly the recent petition re a vote of no confidence achieved very little despite overwhelming support (220,000 signatures and Mr Hunt did not attend the debate). I am concerned that the collective voice of doctors in the UK will continue to be ignored and some sort of strike action becomes unavoidable. I doubt this can be achieved without alienating the public or putting patients in harm’s way but there is far too much at stake to do nothing.

Some background and media coverage
http://www.bma.org.uk/working-for-change/in-depth-junior-and-consultant-contract/junior-doctor-contract-negotiations-home

http://www.independent.co.uk/voices/comment/i-dont-blame-doctors-for-walking-out-of-pay-negotiations-with-the-government-10506483.html

http://www.theguardian.com/society/2015/sep/18/junior-doctors-new-contract-cut-pay-40-per-cent

http://www.telegraph.co.uk/news/health/news/11875628/Junior-doctors-threaten-strike-over-new-contracts.html

http://metro.co.uk/2015/09/20/doctors-are-being-pushed-to-strike-over-new-contracts-which-will-risk-patients-lives-5399640/

From the Facebook page of Dr Philip Lee MBBS MRCP(UK)(Geriatric Medicine)
Consultant Physician in Acute Medicine and Care of the Elderly