Metro, 2017 ISBN: 978 1 78606 451 6
The author worked originally as a journalist before training as a doctor. The book covers aspects of her training, and work in the NHS, together with the facts about the junior doctor's strike in 2016. I have picked out the important facts - but urge you to read this.
The UK's NHS is 'under-doctored' due to not enough funding. The OECD's 2015 Health at a Glance report showed that the UK has 2.8 practising doctors per 1,000 head of population, lower than almost any EU country, inclusing Poland, Latvia and Lithuania. Per 1,000 head of population Italy has 4.0 doctors, Germany 4.1, Austria 4.8 and Greece 6.1 doctors.
The NHS is understaffed, resulting in staff covering two jobs due to gaps in rotas.
In 2015 Jeremy Hunt wrongly claimed 6,000 (later he raised this to 11,000) avoidable fatalities due to consultants refusing to work at weekends. He also claimed consultants opt out of weekend working, then offer themselves as locums with 'extortionate' rates of pay. The truth is otherwise as RC points out.
- Consultants are always there to lead the Saturday and Sunday ward rounds, and are then available by phone as and when needed - at any time of day or night.
- The weekend opt-out is only for elective care (i.e. planned operations or extra weekend outpatient clinics) - and does not apply to emergency care.
- Without additional doctors, nurses and other health professionals, the only way to roster more people at weekends is to take people off weekday duties or work longer hours overall.
- Working longer hours is unsafe. Fatigue levels at the end of a busy shift can impair mental acuity more effectively than exceeding the alcohol limit for driving.
Bed blocking is due to social services underfunding which means that home care plans and support are not available in time.
Cardiac arrests in hospital: 25% survive to be discharged. Cardiac arrests in the community: less than 10% survive to be discharged, even with prompt transport to A&E.
2016: The NHS in England, Wales and Northern Ireland was short of over 23,000 nurses, 6,000 doctors and 3,500 midwives. Hunt likes to claim an additional 10,000 doctors since the Tories gained power in 2010, but this equates in reality to 5,000 when part-time doctors are factored in. And with a rising UK population, there is actually no increase in the number of doctors per head of population.
In 2016 around 10% of junior doctor training posts were unfilled, and the exodus of young doctors worsened after the 2010 election. In 2011 75% of doctors continued in training posts after completing the first two years of practice, this steadily declined to 67% in 2012, 64% in 2013, 58% in 2014 and 52% in 2015. Leavers have gone overseas, often to Australia or New Zealand. Some specialities (e.g. paediatrics) have a critical shortage of trainees.
Hunt wrongly claimed a minority of doctors working over 56 hours a week were paid "what's called colloquially in the NHS 'danger money' " - no doctor (working or retired has ever heard of this money.
The morning the doctors' strike ballot opened, Hunt said there would be a 'whopping 11% pay rise for junior doctors' but the 11% was in basic pay only, and was offset by huge cuts elsewhere to pay for anti-social hours. The overall effect was likely to be a pay cut for many. The result was that 98% of doctors voted to strike.
Hunt claimed that no doctor would work longer than currently, the new contract reducing overall hours from 91 to 72 per week but the new contract had to deliver 7 day services 'cost-neutrally' - which is simply not possible. (The BMA had under duress, conceded the principle of 7-day services cost-neutrality.)
Junior doctors move from job to job every 3, 4 or 6 months in order to gain experience across the range of medical specialities. This makes life difficult as rosters can be allocated without any notice due to a lack of forward planning by managers.
Women are discriminated against in the new contract. The pay of part-time doctors (80% of whom are women, is set to rise more slowly than for full-time posts. The government admitted this but proposed such doctors find 'informal, unpaid childcare arrangement for evenings and weekends'. In 2016, women made up 60% of the profession.
All of the above leads to rock bottom morale, which is linked to sickness and lower standards of patient care. NHS England estimates sickness absence costs the NHS £2.4 billion per year. If sickness absence were reduced by only one day per person per year, the NHS could save £150 million, enough to pay for 6,000 additional staff full time.
12 Jan. 2016 Junior doctors' strike. Hospital picket lines supported by other hospital staff and the public. Hunt then claimed further 'terrifying' increases in weekend mortality - all this data is contested and challenged by leading academics in the field. The extra deaths from strokes, emergency surgery and newborn babies is mostly if not entirely due to emergency admissions - and would have happened if the admission were on a weekday. Hunt ignored the finite number of doctors, nurses, porters, radiographers, lab technicians and administrators for extra weekend activity. Fantasy politics.
2017 With the state of the NHS still in crisis, Theresa May then blamed GPs for failing to offer proper 7 day services, putting pressure on hospitals and ordered practices to be open 7 days a week or lose some of their funding.
Rachel Clarke writes 'While there are, no doubt, ingenious ways of driving up NHS efficiency, merely shrinking the workforce and rationing the care the NHS provides is the opposite of clever.
Note 1. Jeremy Hunt was in PR before becoming an MP, thus has many years of practising how to spin news to a specific viewpoint.
Note 2. My daughter is a nurse working in an endoscopy clinic, shift hours are long, and every few weeks she is on call overnight and at the weekend to assist with emergency surgery - it is draining to have returned hone from one call out only to get another within the hour, and then to work a day shift the following day. Other specialities place the same demands; she previously worked in cardiac intensive care.
OECD report: Health at a Glance 2015.
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