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:

On not striking

Today I went to work. I do this most days, but my arrival today was unexpected because this day I had planned to participate in a strike that the vast majority of junior doctors in England had voted for.

It was made clear by the BMA that this industrial action was a last resort. Doctors have never wanted to strike but we have been backed into a corner by a destructive health secretary unilaterally imposing a cruel and damaging contract on the medical workforce. The BMA balloted its members for industrial action and obtained phenomenal support from doctors collectively appalled at the decisions of central government. 

98% of those who voted (76% of those eligible, so 74.5% overall) said they would support strike action, a massive mandate for change and a clear sign, from those who know, that the government should re-examine their actions. The accusation that the BMA is merely a small band of "militant doctors" has been soundly disproved - essentially all doctors are willing to strike to prevent further erosion to doctor's conditions, ultimately to defend the NHS as we know it.

Compare this mandate with that of our government who received 36.9% of the vote, of 66.1% of the electorate: only 24.4% of the electorate gave their consent for the conservatives to vandalise our health service.

At the last moment the day before the strike Jeremy Hunt agreed to the BMA's conditions; lifting (temporarily) the threat of imposing a new contract and returning to meaningful negotiations via Acas. This was needlessly late in the day as there have been many, many occasions for the government to listen to the legitimate concerns of nearly all doctors.

I disagree with some of my colleagues who feel let down by the BMA. Some are angrily cancelling their memberships and have accused the BMA of weakness. Striking after receiving a reasonable truce would have been counter-productive in the extreme, leaving doctors open to accusations of greed and callousness. Striking is not our goal, it is our last resort tool in the struggle for a fair contract - its misuse would be very damaging to the public's perception of the profession and to our cause overall.  Right now I think we retain both the upper hand and the moral high ground. We're winning, and Jeremy Hunt knows it - so he continues to cast doctors as villains, openly lies and attempts to divide us to weaken our resolve. Not going on strike is a good outcome at this point. Not least because we save our innocent colleagues and patients from some inevitable and regrettable hardship and inconvenience.

Of course I would have enjoyed the novelty of standing at a picket line rather than enduring the often tedious and menial tasks I perform on the ward. I wanted to express the righteous indignation and fully demonstrate my depth of feeling for the profession and for the NHS.

And of course I still think Jeremy Hunt is a dishonest, smug, odious tosser and I don't trust his treacherous grinning weasel face with any aspect of managing the nation's health. 

But there's a much bigger picture: Doctors (and the health service and public sector as a whole) must remain united, dedicated and utterly professional in the struggle for fair treatment and the continued existence of the NHS. We have been gracious enough to give Hunt's first offer of conciliation the benefit of the doubt but if his arrogance continues we have the legal and moral mandate to strike in January.

Doctors feel attacked and denigrated, they have united to express this view and the secretary of state has been made to listen. The threat of imposing the new contract has been lifted for now, yet we maintain our mandate for industrial action should talks break downs. The most effective strike is one we don't have to do (yet).

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