Junior doctor strike

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workingmama
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Junior doctor strike

Post by workingmama » Fri Feb 26, 2016 12:34 pm

I heard on the radio yesterday that there were three more strikes planned, but for 48 hours each this time. I'm aware that I will almost certainly be in the most utterest minority, but I don't feel I support the junior docs on this one. Whilst I'm sure my lack of support won't have anyone sobbing into the night and fearing for a life of 654 hour shifts, nonetheless here are my pointless ramblings on the matter.

1. Opposal to a 7 day service: I'm from more of a 'why the heck not' philosophy. As a full time worker, I'd love to be able to access healthcare at weekends, and not just for inpatient either. For emergencies, I'm aware that I would currently be seen and well cared for, but by a more shoestring staff that I might receive on Monday to Fridays. I might receive longer waits for scans which aren't seen to be 'emergency', but might prove later to have been a key factor in helping me sooner, etc. The proposed deal specifically allows for no more than one weekend in a row working, and reduces (if I understand correctly) the number of long shifts in days in a row permitted. My brother in law looked half dead when he was a junior, and he did absolutely filthy long runs of days, so I'm definitely behind reducing those. I think juniors are overworked, but I don't understand (looking at the proposal) how this would make them more tired? (Explain it out to me in simple terms, someone?)

2. Opposal to reduction of overtime pay for weekends: I guess that would be lovely to give everyone who works at a weekend (dr or not) overtime, but the vast majority of people who work at weekends don't get a different rate for it (excepting evening/nights, which the docs would still get). The sad matter is that we can't afford to keep a great NHS going if we pay above what we can afford for it. I'm up for raising my taxes to support the NHS, but not to pay people to do their general day to day work on a Saturday. Sadly, I'm in the 'suck it up, if we're needed at weekends, that is when we work' camp. Me included. I'm definitely thinking that non-essential psychology should be more available at work and school friendly times.

3. 13.5% pay raise: Sorry dudes, I think you're fabulous, but I also think a lot of your nursing colleagues are fabulous, and they haven't seen a pay raise like that in forever. This is a bit more socialist than my other points, but I think the pay issue needs to be thought about within the context of a whole NHS, not the NHS plus the doctors. What can be afforded, what is needed, what cuts can safely be made, and what do we need to accept that the state system can't manage anymore? 13.5% pay raises might be in there in the context of a static economy.

4. Um, I had more, but I realised I wasted 25 minutes not writing my thesis, so I'm going to do that, and come back and grumble more later :lol: Feel free to start debating/sharpening pitchforks/etc.
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Re: Junior doctor strike

Post by CatFace » Fri Feb 26, 2016 2:33 pm

Hi workingmama - interesting post and thanks for voicing it! I hope you don't mind but I thought I would reply to your points from my position in the hope of learning more from someone with a different standpoint to me. I am for the Junior Doctors striking.

1) 7 day service: My understanding was not that the junior doctors are opposed to having a 7 day service for the NHS, but that the Health Secretary is not offering more money or doctors to do so. This means that the current level of staffing will have to cover it, which either means a) working more hours or b) services suffering in the weekdays. Additionally, the proposal for a 7 day NHS comes from some dubious data which is massively misrepresented (i.e. that people are more likely to die at weekends). Finally, junior doctors don't work on their own - so unless the Health Secretary is offering more nurses, porters, phlebotomists, radiographers, admin staff, health care assistants etc the juniors won't be able to do much more!

2) This point I'm not so sure about. I think the reduction in overtime pay has something to do with the fact that Trusts get fined if they overwork doctors, so once these safeguards are removed they are more likely to do so. Tired doctors = people dying

3) I think the 13.5% pay rise actually equals about 19% pay CUT in real terms (because of the difference in overtime pay). So they're being asked to work more for less pay - and they don't actually get paid that much in the first place.

This whole debate made me think a lot about my own privilege as a psychologist. I work Mon-Fri 9-5 and although I would be up for working at the weekends, I doubt I would do it for a fifth less money than I am on now. Happy for more people to expand or tell me if I have any of that wrong!

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Re: Junior doctor strike

Post by workingmama » Fri Feb 26, 2016 3:14 pm

Hi, thanks for the thoughts!

1. My understanding is that the 'cut' in junior docs pockets would come from their not receiving the same amount for overtime. They would still be paid (obv!) but at normal Monday to Friday rates until 7pm Saturday (and then still higher overtime after that, or all day Sunday). They aren't being asked to work 'more' hours per doctor (imagine that I work Monday to Friday, versus my working Tues - Sat, but at the same rate of pay), but would certainly be paid 'less' because we are talking 'less than I would get if I was taking home a good rate of overtime for Saturday daytime'. The bits that I have read suggest that the Govt is suggesting that, rather than paying (say) 10 docs to work for five days per week including overtime, we could reasonably suggest that we can afford for junior staff to work for six days using the same amount of money (because we save on overtime on daytime Saturday). That doesn't mean that the same doctor works that sixth day, it means that there is money freed up to pay for another doctor to work that day, because we saved on overtime on Saturdays which is paid above the usual rate (they're not unpaid on any of the days that they work). Does that make any sense? It's not asking doctors to do more with less, it's suggesting paying each doctor less to work on a Saturday daytime, so that we can afford to pay for more doctoring hours. It's better for the Junior docs pensions too, because their basic pay raises (you don't get pensions calculated on overtime). It just sounds awful if papers are suggesting that 'DOCTORS GET LESS PAY'. They won't get less basic pay, they'd get quite a lot more, but wouldn't be paid so much overtime on daytime Saturday.

3. You wouldn't get a fifth less than you get now. You'd just work different days/shifts, on the same rate of pay throughout (other than antisocial hours and Sundays).

Hope that made some sort of rambly sense! :lol:
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Re: Junior doctor strike

Post by BenJMan » Fri Feb 26, 2016 4:19 pm

CatFace's first point for me is the entire reason I get so angry about this whole thing. The government are trying to say that this is just about junior doctors doing 'their fair share' by working weekends as normal days etc, and on the surface that seems somewhat (though not totally - who gets to decide which jobs work weekends and which don't?) reasonable. But there is no extra money coming in to the NHS for this cover, so increasing doctors time at weekends means reducing it elsewhere, it is yet another movement towards creating an NHS which can be stretched so thin all over that it cannot cope and can then be called failed/failing and in swoop the private organisations to say 'hey well, we can operate 7 days a week and save you some cash because we treat our employees like garbage anyway!'.

There was a great stop motion video done by a kid who was confused as to why people thought doctors could work all the hours with no down side, but for the life of me i can't find it!
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Re: Junior doctor strike

Post by miriam » Fri Feb 26, 2016 5:36 pm

Wow workingmama, you sure have been taken in by the spin - how unlike you!

The first thing is the context - this is a government with very strong vested interest in breaking the NHS so they can privatise it - this was the explicit goal in a Tory publication Hunt wrote before the election - and this seems like yet another attempt to alienate the NHS from the public.

Junior doctors get paid less than many other graduate jobs, and already work more hours. Their pay starts at £23k and it can be 8-15 years before they get onto the higher paid consultant scales - so this is already an untenable situation. There are already not enough doctors to cover 5 days of routine work plus 2 days of emergency work, so the idea that we can spread the same workforce thinner to make a 7 day NHS is a total fallacy - it will just reduce the quality of the weekday cover. Not only that but the shift patterns proposed will make the same workforce be more tired, less able to have a life outside work, less able to be carers, and earn less money than they do at the moment. It will decrease a workforce that already has an enormous drop out rate (did I read that a third of junior doctors don't continue a career in medicine) and reduce morale which is already at rock bottom.

The data asking for the seven day NHS was misinterpreted from pre-publication data, and says nothing about the fact that where there is only emergency cover, the people who seek help are more likely to already be in crisis.

The 13.5% pay rise is not enough to make up for the loss of the higher rate in a lot of their extra hours, and the net result is a significant pay CUT, with a typical 20% pay cut, but up to 30% pay losses for those who already work a lot of unsocial hours. There are many explanatory videos on youtube. This is one example.

And finally, MPs don't work a 7 day week (in fact, they are proposing to do just 4 days in the house of commons). Civil servants don't work a seven day week, and both get paid more. So it is very much do as I say, not do as I do.
Miriam

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Re: Junior doctor strike

Post by firegal » Fri Feb 26, 2016 6:16 pm

A very interesting (and really quite damning video) that shows just how poorly thought through the new contract has been.

https://www.youtube.com/watch?v=lMlA4gP ... e=youtu.be
(not an explanatory video, it's a clip from the Public Accounts Committee questioning Charlie Massey as I understand it)

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Re: Junior doctor strike

Post by BlueCat » Fri Feb 26, 2016 7:59 pm

I'd love a 24/7 NHS but I think the way to get there is by adding funding, not spreading what we've got even thinner
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Re: Junior doctor strike

Post by Randomswirls » Sat Feb 27, 2016 12:01 am

The reason I support it is if the junior doctors contract is imposed I feel that agenda for change will then be looked into as why pay nurses etc overtime when Drs aren't being paid overtime and that just becomes a really slippery slope. I don't currently work antisocial hours and whilst if my job requires it I'd work it I'm not sure I'd be so happy working for no extra pay due to this imposition?

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Re: Junior doctor strike

Post by Borrowed Cone » Sat Feb 27, 2016 9:47 pm

Randomswirls wrote:The reason I support it is if the junior doctors contract is imposed I feel that agenda for change will then be looked into as why pay nurses etc overtime when Drs aren't being paid overtime and that just becomes a really slippery slope. I don't currently work antisocial hours and whilst if my job requires it I'd work it I'm not sure I'd be so happy working for no extra pay due to this imposition?
If you think they aren't already looking at A4C, you are gravely mistaken...

It will hit all other AHPs soon enough, sadly.
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Re: Junior doctor strike

Post by Randomswirls » Sat Feb 27, 2016 10:26 pm

Oh I fully agree A4C is being looked at but I feel that if the new contract is imposed it will hasten the change so to speak!

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Re: Junior doctor strike

Post by miriam » Sat Feb 27, 2016 10:27 pm

Here is the video where kids explain the problem with the 7 day NHS:
https://www.youtube.com/watch?v=ymtFhwfyGjg

And one with Sue Perkins:
https://www.youtube.com/watch?v=nBUP_w168pk
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Re: Junior doctor strike

Post by workingmama » Mon Feb 29, 2016 9:47 am

Hmm, many good points, and I'm going to do more reading around it. I'm not agreeing with your point, Miriam, that my view is all about the spin, any more than I agree that other people's views are entirely influenced by the discourses offered by the other side. Bit of spin + bit of my own views= my stated opinion. That means that I am allowed to be wrong (and can be criticised for this) for myself, rather than our having to position this as my having been hornswaggled (but I appreciate the kind attempt to position my views as due to other people's boneheadedness! :lol: )

I love the 6 year old's lego video, but I think this doesn't take into account a major issue - we can't afford what we want/need anymore, and we need to find other ways of doing it. If doctors aren't being asked to work more hours (which they may well be if safeguards are removed), but are being asked to not take overtime for Saturday daytimes, I'm not sure that this can be entirely positioned as 'all about the patients'.

This link doesn't fully endorse/support my own views, but it highlights some of them:
http://www.adamsmith.org/blog/healthcar ... rs-strike/
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Re: Junior doctor strike

Post by miriam » Mon Feb 29, 2016 3:57 pm

Let's imagine that somebody is being paid £8/hour for 40 hours per week at a factory or shop. So their basic pay is £320/week, but they get time-and-a-half for their overtime, and consistently work an extra 20 hours in the early evening which earns them some income above the cost of the extra childcare. Overall their income is £560 per week, less the cost of the childcare. They decide that type of work is worth the effort for £560 per week, and they get a mortgage that requires them to have £560 per week to live and pay for childcare. Its tough, they just scrape through, but it is worth it because they are told that in 6-10 years from now they might make manager and earn double that.

Now imagine the bosses at the factory/shop decide that no overtime rate is available, but the overtime all has to be covered by existing staff at basic rate. The employee's income drops to £320 (they'd get paid £480 if they do the same 20 extra hours, but they will now make a loss on this overtime compared to the cost of childcare at antisocial hours) and they can't afford their mortgage and their childcare. They have to leave the profession, start all over again in a different job, and feel resentful that the terms have changed after wasting 6 years of their life on promises for the future they will never reach. That would be unfair, right? And it would unfairly discriminate against those who have dependents, for whom the working pattern makes a difference. Absolutely clear cut.

Now imagine that the bosses at the factory decide that they are going to pay £9/hour to offset this 'no extra pay for overtime' rule. It's a raise of £1 per hour (12.5% increase), so they can make the workers sound ungrateful, but the actual take home pay is now £360 if they do no overtime, or £560 if they do it. But the option of not doing the overtime (the only scenario in which there would be a net gain in pay) has gone - everybody has to do it, and there is no reward for doing more of it. The pay bill for the factory remains the same, and there is more work done, improving the profit for the owners. The basic salary has risen, and the overall income for the average worker is the same, so who could moan about that? But the actual take home pay for the worker who now has to pay 20 hours of childcare at unsocial hours, with the extra cost of £160/week, is a net reduction of that amount from their pay - a 29% loss - and makes the job untenable. The same would be true for someone with a dependent adult relative to care for. The headline figure of 12.5% increase in pay is misleading, because the people who are the most vulnerable in the system actually end up 29% worse off.

Here, the motivation is to increase profits for the owner of the factory/shop. In the NHS the same budget now pays profits to private companies (as spending increases have not kept pace with the increases in demand from an aging population and ever more expensive medication and treatments).

You say the budget of the NHS is finite, but really it is determined by other spending choices. For example, the choice to give tax breaks to multinational companies, to not pursue tax fraud, to not close tax loopholes, to raise the threshold for inheritance tax, to not charge any more council tax above the top band even for owners of multi-million pound properties, to spend billions on questionable military action, to give politicians (who already earn more than double the average income) 11% more income during a period everyone else's wages have pretty much been frozen, etc etc. We've elected a government who are systematically siphoning money away from the poorest and most vulnerable people in society to give to the wealthiest. And the entire media (perhaps with the exception of the Guardian, who are a charitable trust, and the BBC who are being systematically attacked) are skewed to the same perspective of justifying this horrific new position by blaming scroungers and immigrants. If I think about it too much it just makes me want to cry.

(Just to be explicit: This example is one I made up, worked to represent actual take-home earnings and typical hours of a junior doctor and the proportions of pay lost and gained, but does not include specifics about the rates of antisocial hours pay or the various additional payments that are being lost in the new deal imposed).
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Re: Junior doctor strike

Post by workingmama » Mon Feb 29, 2016 4:25 pm

We agree with at least 90% of what you said, I absolutely don't think that my point in any way means that I think we should be taking our eye off the range of shocking and well dodgy calls made by the current (at least) government, and I think in our troubles we stand with our fellow migrants and scroungers (I'm all for a bit of scrounging, and will do so wherever possible). I agree with all of that, and absolutely follow your maths (all very decent maths!). The bit I get stuck with is the calculation that was shown (can't remember by whom) showing that, by use of current rotas, it was worked out that fewer than 1% of doctors would be less well off in monetary terms, and those were the ones who currently work a horrendous number of hours? That stat sounds convincing (to me), seemed to make sense, and claimed to be based on the actual working data of docs.
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Re: Junior doctor strike

Post by BenJMan » Tue Mar 01, 2016 12:54 pm

The figure they normally use is "No doctor working 'contracted hours' will be less well off". Which is utterly misleading as no junior doctors works 'contracted hours', they all work huge amounts of overtime and if they actually worked only their contracted hours, the NHS would collapse. They also like to use that contracted hours term to be VERY woolly about what they are referring to, so sometimes they use it to only refer to weekdays for example, which doesn't at all account for the changes, it's all spin.

The question to ask in the end is, this is a profession of people who are intelligent, articulate and generally pretty reasonable, and could earn a truck load more money doing what they do privately, or in another country, but they don't, so if it were all as reasonable as the government claims, why on earth would they strike? I deal with a lot of junior doctors and the strike days genuinely upset and worry them, they don't want patients to suffer on those days and they have gone out of their way to try and make sure that doesn't happen, but this is an issue that they and the BMA feel so strongly about that they are willing to take some risks, I guess when I look at both sets of people and ask who do I trust to be making the right and ethical decision, it's the doctors, not the government.
I think a hero is any person really intent on making this a better place for all people ~ Maya Angelou.

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