Wednesday, 27 April 2016

Support For Junior Doctors

I suppose like many of us, I've been mightily impressed with the Junior Doctors campaign and in particular the sheer number of them prepared to be interviewed live on TV and radio. They have more than held their own against some tough questioning and it's understandable to make comparisons between their current battle and our failed one over TR. 

There are some very similar themes, particularly in the government deliberately clouding the issue with the endless repetition of the '7 day NHS' mantra and now trying to say it's all about a pay claim - all aimed at trying to break public sympathy for their cause. I notice a new twist is that the doctors 'are trying to bring down the government' and defy an election pledge for a '7 day NHS'. The latter was in fact just one line in the Tory manifesto, with no explanation.

I heard someone yesterday making the comparison between the junior doctors strike with that of the miners, but the difference 'being we've all met a doctor'. It's a good point and the public are still clearly behind the doctors because, lets be honest, who'd trust a politician in comparison, but just like our problem with the government, I suspect most people don't understand the underlying issues, which suits the government just fine of course. So, with this in mind, I was interested to find the following on Facebook which I feel explains things perfectly. 

--oo00oo--      

I have kept quiet on here until now about the junior doctor's strike but the time has come to stand up and say what needs to be said. Apologies in advance for the long essay, I will try to keep it simple. This is aimed at those of you who are not medical; those who are will know exactly what I am talking about.

If you simply believe what is said in the media, you might think that this is all about Saturday pay or even that junior doctors don't want to work at nights or weekends. It is depressing to overhear people express these views but hardly surprising given the public coverage of the issue.

So what exactly is going on? A junior doctor is any doctor who is not a GP or consultant who is in training to be one of those two. Most doctors spend 8-9 years as a junior but many stay as juniors for longer, especially female doctors who may take time out for families, academics who take time out to do research and doctors in specialities where training in two specialities is needed such as paediatric intensive care. I myself spent 14 years as a junior doctor so was still one aged 37. Junior doctors are the doctors you will see first when you go to A&E or get admitted to a ward and will be responsible for delivering your day to day care when you are in hospital. Junior doctors are covering the hospital 24/7, 365 days a year and always have done. And contrary to what you might believe from the papers, they don't have any choice in the matter, their contracts say they have no choice in working evenings, nights and weekends.

So what is all the fuss about? Well it is about being able to be safe. When I was a JD, I used to work ridiculous hours. In one job in my 1st year, every 3rd weekend I would go to work at 9am on a Saturday and leave at 5pm on a Tuesday. That was 80 hours in a row with sleep grabbed when the chances arose. It was dangerous and dehumanising and the even crazier thing was that I was actually paid at a lower rate for the unsocial hours than basic pay (1/3 of basic in fact).

Fortunately my generation of juniors was amongst the last to have to do that and things slowly changed. Now junior doctors get paid at a higher rate than basic for unsocial hours, that rate determined by the intensity of work in that speciality e.g. emergency room work would be a higher rate than dermatology. Standard hours are defined as 7am-7pm Monday to Friday (which are not exactly standard working hours for most people) and there are rules on the maximum number of hours per week and consecutive hours that can be worked. There are also safeguards in place so that if employers are consistently making juniors work beyond these rules, they can be fined; hence there is a disincentive for employers to overwork junior doctors, therefore they are not tired and dangerous 1990-style.

But work done outside standard hours is NOT overtime. These hours are contracted hours and have to be worked and, quite rightly, are paid at a higher rate than basic pay. In specialities where there is not a lot of emergency work, the majority of work is in routine hours, but areas like A&E, paediatrics, intensive care have a lot of work done in unsocial hours and attract a higher rate of pay for those hours. I stress again that this is not overtime; overtime is work done in addition to contracted hours. All doctors and nurses do overtime - staying late to complete work and ensure patient safety and very rarely if ever does anyone claim for these overtime hours.

But Jeremy Hunt wants to change the contract for junior doctors, his logic being that doing this will help to deliver the “7-day NHS”. Nobody is really sure what exactly this means. It may mean that he wants routine services such as outpatient clinics and planned surgery or scans for non-urgent problems to take place on Saturdays and Sundays, not just Monday to Friday. If this is the case then changing the juniors’ contract is not going to make this happen as without doing the same for (deep breath) consultants, nurses, porters, receptionists, pharmacists, operating department assistants, radiographers, physiotherapists and many other staff these things won’t be able to happen at weekends.

The 7-day NHS may refer to emergency work. If this is the case then it already exists. Junior doctors are already there at night and at weekends. The proposed contract changes are not going to change the numbers who are there as there is no plan to increase the total number of junior doctors. What is proposed is that the definition of normal time changes from 7am-7pm to 7am-10pm Monday to Friday and from 7am to somewhere between 5pm and 10pm on Saturday. This means that employers could make junior doctors work more unsocial hours as they have redefined as standard hours. It is true that the basic rate of pay for standard hours will be increased by 13%, which sounds great doesn’t it? Except that for the emergency specialities as above that routinely have a lot of evening, night and weekend work, what is currently paid at an enhanced rate will be paid at standard rate; even at 13% higher for standard rate, total pay for junior doctors in these specialities will drop considerably, maybe by as much 30% for some. Doesn’t sound so good now really.

And, of course, there will be the same number of doctors but spread over 7 days rather than 5 so there will be weekdays where there will be fewer juniors than there are now. A great analogy I heard was to imagine that you have a 10-inch pizza cut into 5 slices. You decide that 5 slices isn’t going to fill you up so your mum cuts the same pizza into 7 slices and tells you that you’ll be full with that. But she won’t get you a bigger pizza.

So same number of junior doctors spread more thinly is going to reduce cover on weekdays as compared to now. And weekdays are when not only emergency work but also routine planned work that also needs input from junior doctors takes place so this will have a detrimental effect on waiting lists for clinics and operations as well.

Junior doctors with children will be hit particularly hard, especially those who have junior doctors spouses, as more unsocial hours will be worked. Childcare is generally difficult to get hold of outside of 8-5 on weekdays; the department of health have actually said (with no hint of irony) that in this situation, family members who are non-medical and don’t work evenings or weekends should be asked to provide child care to get over this problem! It is very likely that couples could go several days without actually seeing each other or their families if rotas do not coincide.

But what about the increased deaths at weekends we have been hearing about? Actually, the statistics have been completely misrepresented and even the authors of the research paper that gets quoted regularly have pointed this out. The statistic was that if you are admitted to hospital on a weekend, your risk of dying within 30 days of that admission was higher than if admitted midweek. Your risk of dying is very low anyway and that very low risk is marginally higher (but still very low) if admitted on weekends. This is probably because admissions to hospital in the week consist of not only sick people but also well people coming in for routine things, whereas at weekends you would tend to avoid hospital unless you were desperately unwell and most likely would leave things as long as possible and so be sicker when you got there. Interestingly they also showed that if you were already in hospital on a weekend, having been admitted in the week, your risk of death within 30 days was lower than it would have been. Either way, there is no evidence of cause and effect in terms of numbers of junior doctors around at weekends. The so-called weekend effect has also been seen in the USA and Australia too so it isn’t peculiar to state-funded health as opposed to private insurance-based systems.

Interestingly the misrepresentation of this study has led to ill people actually avoiding hospitals on weekends and delaying presenting till Monday with potentially devastating consequences. Have a look online for the ‪#‎hunteffect‬. Scary.

Another worrying thing about the proposed new contract is that it takes away the safeguards against juniors being made to work ridiculously long hours. Whereas currently there is a mechanism that makes it in the interests of an employer to ensure the hours are not exceeded, the new contract removes these safeguards. It does suggest that each hospital trust has a “guardian” to whom junior doctors can flag up concerns about their hours but this “guardian” will also be a senior member of the trust who has no obligation to actually do anything about these concerns. I think back to my days as an exhausted junior doctor and it scares me to think that such unsafe and dangerous hours could make a return.

The pay scales are also changing. There has been automatic pay progression as you gain experience and seniority until now. The new system means that there are fewer points where pay is raised. This is not necessarily a bad thing as it can be argued that you shouldn’t get a pay rise unless you deserve it. But remember that over 10 years can be spent as a junior doctor in which time you are likely to acquire husbands, wives, children and mortgages; many existing junior doctors have made their financial plans for the next few years based on the expectation that there will be pay progression. One part-time junior doctor who has worked with me told me that if the new contract came in she would no longer be able to pay her mortgage and would have to sell her home. 


Bear in mind that these are young people who have spent at least 5 years at university accruing debts from both student loans for living expenses and now also £45000 in tuition fees before even starting work. The new pay scales do not reflect the levels of responsibility taken by junior doctors at different stages of their training at all which makes no sense whatsoever. For female doctors who are likely to take time out to have children and then return to work part-time, the consequences on their income will be huge. The department of health actually acknowledged that women would be hit unfairly but suggested that this had to be accepted as an unfortunate consequence.

The BMA junior doctors committee walked out of talks with the Department of Health because the DH’s definition of negotiation was that they would reserve the right to do what they wanted if they didn’t agree with what the committee was suggesting. In other words, they did not want to negotiate so there was no point in the BMA trying. This is why industrial action was proposed because there was no other way to try to get Jeremy Hunt to talk. Sadly, even when negotiations restarted, he could not see that without a bigger pizza nothing was going to improve patient care and in fact things would be worse and so talks stopped. He has now said he is imposing the contract and that is that, he won’t talk anymore. When a strike ballot (of, let’s face it, intelligent reasonable and educated people) has a 75% turnout and 98% vote in favour, it is clear that there is a serious problem with the DH’s thought processes and they need to listen. It is highly improbable that a small bunch of radical lefties have brainwashed 50000 intelligent doctors who have been trained to analyse information and draw conclusions, much as the press like that idea.

If you have read this far, please take it on board and share with your friends. I’ve tried to keep it simple (even though it may not seem that way!) The public is not getting the full story from the TV and newspapers and if this contract is imposed then we will all be on the receiving end of the consequences eventually.

I’ll stop there for now but will write some more about what will happen on the days of the full strike (April 26th and 27th) and why you should not have to worry about what may happen on those days if you or your family have to come to hospital.


Dr Ravi Jayaram

28 comments:

  1. Staff in the NHS have enjoyed incremental rises of 3-4% during the current pay freeze, whilst we in Probation have had no more than 1%. I see other parts of the public sector as our rivals, not people to show any solidarity. Once they progress to being GPs or Consultants then they will be earning at least £56k or £75k respectively (source: NHS careers). That's more than twice the median UK salary. So forgive me if my level of sympathy towards junior doctors is 0%.

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    1. And that is the attitude of some probation staff that has led to the downfall of the service! Selfish

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    2. @Anon 07:21 - what an imbecilic comment. Junior doctors do an entirely different job, paid by an entirely different department. In what possible way are they "our rivals"? Your kind of race-to-the-bottom, create competition where there is none attitude suggests you're a Tory - and if you're still a Tory in Probation, then quite frankly you are a fool.

      If NHS staff have continued to receive incremental pay rises (and I'm not so sure that they have) then good on them - it shows what happens when you have a set of skills that are in demand and short supply. There's the other side of the market for you - a proper wage and decent working conditions.

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  2. Bhs stores asset stripped and pensions squandered! Can we even trust that we will have any pension from theze corrupt companies? Is it worth even paying into them now? I was promised backpay in my payslip this month and low and behold , nothing!

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  3. At least they get paid for their unsocial hours and overtime. We're expected to do it for free.

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    1. I do have sympathy for them though and applaud them for standing up to the government. If it wasn't too late we and Napo could of learnt a thing or two from them.

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    2. @Anon 08:01 You should still be able to get unsocial hours payments, and TOIL if you're working over your contracted hours. If you don't, why are you still doing it?!

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    3. Toil means nothing in probation if you have a JDFI manager loading you up with work and waiting for you to miss a target.

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  4. I support the junior doctors.

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  5. I do understand the issue and we need to stand together. It would be more effective to summarise the essay above. I gave up half way through. Summarise and put it back on facebook!

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  6. re 8 01 and 8 36 - the writer did say everyone works overtime, but rarely does anyone ever claim for it. And you asked the question 836, why are you still doing it if you are not claiming? Well, as a retired PO of 18 yrs work, I saw many officers working late and not claim. I rarely kept to the standard hours, coming in as early as 7am at times,in the summer and rarely later than 8 30am. At the other end of the day, there were often still people in working, and more than one person worked up till 9pm occasionally, also coming in sometimes at w/e's. I was almost always the last one to leave though, and would get the job of checking that windows were closed, doors locked and computers switched off. And then setting the alarm. I did it in reverse the next morning, not unlocking officers' doors, but I did unlock the reception office door and cupboard to sign in and set out the in/out book and diary. People would do H.V.s on the way to work, or on the way home. I would often work through lunch break, as would others. And write PSR's at home, in the days when they were handwritten,(and typed by your admin officer) and you were not being a slave to Oasys. (On more than one file I had paperwork with our cat's paw prints on, after coming in late at night and walking over them on the floor as he greeted me!) And in post TR days, after my retirement, I was aware of a dedicated PSR writer being there until 11pm several times a week, and one officer staying until the early hours ie 1am. Whether they ever claimed overtime I don't know, but I doubt that any manager would accept that. I know my manager would tell me they could not have sanctioned TOIL even if I applied, as my hours were unacceptable. In the last few months before retirement I worked anything between 50 hrs and 70 hrs a week, which included going in on a Sunday occasionally to see a trusted client near the end of his SSO, while his partner waited outside in the car, as he was temporarily working away and coming home w/e's. And yes, it did affect my family life, and my health for several weeks after retirement, when I suffered the pre-warned adrenalin drop and was ill for weeks!

    But I recovered and am enjoying family life and young grandson, and to answer your question 'why?', it was all to enable me to try to keep up to date with recording, while still giving clients your best. And there was actually something quite soothing to have the office to yourself, playing soothing music on CD's/cassette tapes(!) on my ghetto blaster!! I loved Probation, will always wonder about some vulnerable clients, and will always mourn its passing. RIP.

    And good luck all you doctors. Like probation as it used to be, it's not a job, it's a vocation.

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    1. Where to start? Its a job, a good job, a job I enjoy but a job. My family is more important. I do not have a vocation I have a job, I am not going to kill myself by massively overworking. Vocations are for monks. I know this is an unpopular view on here with all the look at me and how hard I worked for my clients crew.

      I put it to you that you can think TR is a mess, you can think that we need to be well trained and professional, you can think that we need to be skilled and empathic people. And you can still say that in the best of all possible worlds I would be sat on a beach drinking pina coladas. Inn fact that is MY vocation. Sadly I cannot afford it and have to work for a living.

      Sorry these self martyring look at me and my sacrifice posts make me want to scream. I had people cross picket lines cos they were "there for their clients".

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    2. re 1537 from ML at 11 27- I am sorry for you - you clearly feel bitter about other people not sharing your opinion - quote 'I could scream'. I presume you are one of a new breed of officers(not all of the new entrants I must add) who does not really care about offenders' nightmarish lives, their families and their victims. And caring is a self fulfilling joy, but with your current attitude you will never feel the satisfaction and glow of seeing people turn their lives around, and occasionally feeling that you may just have saved another child from a life of abuse.

      But it sounds as tho' you are not bothered about that anyway - you have the sun, the sand and the pina colada- what more can anyone want? - yes, that may be a nice holiday, but what a sad vocation.

      But you have missed the 'old days' when we did have fun, and laughed with each other at work and had frequent team nights out, knocking back the beer, the odd vintage wine and even pina coladas.... Now the ramshackle workplaces are so soulless, with people desperately trying to keep up the workload of so many other staff who have left, (in the mad world of deafening office noise, or no office at all). They have no time or energy to have decent pressie collections, and great leaving do's, as every time someone leaves, that's someone else's case load rising.

      And remember, you cannot be a martyr if you are enjoying what you are doing as it is not a sacrifice. And as for my health, I was barely off sick all the years I worked, simply because I rarely felt ill. I buzzed with adrenalin to enable me to do a job I loved. It was only when I left that my body reacted - but I did not know that would happen and I soon recovered. I am now 70 and still help people in different circumstances, wherever I can, including being a charity 'volunteer' I may add,'cos I am a martyr - not. But when I see videos of hundreds of children from impoverished countries, every year, with joy and delight on their faces as they open shoeboxes of goodies at Christmas, my (and others) eyes stream and I know that all the hours I, and thousands of other volunteers around the world have worked, have been worth the effort. A glass of wine and a sun tan can never give you that feeling. I love the love we give, and the love we receive - a bottle of wine and an overdose of sun cannot love you, they can only makes you stupid, or sick, or worse.

      Now please tell me that you were just kidding.

      and I have just noticed 1652's comment- you have put it better than my meanderings. well said.

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    3. I was first told I had a vocation when I was a civil servant the last time in 1986 by a tory minister. He said that because I had a "vocation to public service" I was not going to get a pay rise.
      I now see people working themselves into an early grave so that they can get this pig of a mess to work. I have watched them do this for the last 20 years, going the extra mile, covering up for the fact that we are under resourced and over worked. And what did we get...budget cuts.
      I cannot go into sainsburys and say "I have a vocation here is my card, please give me a discount on my pina colada!"
      To invoke Godwins law and paraphrase Goebels, "I hear the word Vocation and reach for my revolver".
      You have done yourself no favours, your clients no favours and me no favours by this self sacrifice.

      I also love the fact that you have all decided that I am some sort of heartless uncaring bastard because I don't subscribe to this martyrdom complex. I do the job because I care, I do it well, I do it properly and I GO HOME. It is not my life.

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    4. There is a balance to be had but I really do think you can do a good job and be a great probation officer and keep to your hours. In the long run it's better for your health and better for your family and better for your clients.

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    5. There is a balance but a lot of it depends on having a manager and management team that is not always on your back for you to get everything done. They actually create the bad office cultures where staff work from dawn till dusk, on weekends too. This is so they (managers) can take all the credit for the work we do while they sit at home, type out meaningless appraisals and fill in poxy spreadsheets. Don't fall into the trap of overwork and toil you never take, instead work 9-5 and go home.

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  7. From an MOJ Facebook Website: -

    Train to be a Probation Officer -
    ================================

    " Being a probation officer means being part of a close, hard working team. Learn about some of the things you can do to make working alongside unfamiliar faces more comfortable."

    "8 Teamwork Tips for Working with Unfamiliar Co-Workers
    How to work with someone new and maximize your chances for success."
    https://www.facebook.com/TrainToBeAProbationOfficer/posts/978866938817311




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  8. Scream all you like 15.37. Personally i would not criticise your stance at all and you probably do well emotionally to take this stance. However who are you to try and denigrate people who see their job as a vocation and view empathy as a key asset? I think you are projecting your own issues onto other people. By all means take your individualistic approach but why do you feel the need to undermine the more pro social views of others? I have clear boundaries and am no martyr..that signals self abuse. I look after myself and my family and do not allow service users to use me as an emotional punch bag but i stand up for the profession i joined and the service users i work. That is my role as a practitioner!

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  9. Respect to the doc for the post,and come on colleagues, let's not fall out over that which we used to exercise and enjoy......autonomy, to do the job as we saw most productive, satisfying and effective! Sadly, that has largely gone, and it's a struggle to achieve anything worthwhile! Be kind to each other, after 32 years in, it takes all sorts and change has always been the challenge for us and our clients!

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  10. As the parent of a junior doctor and a PO, I assure readers they are trying so hard to save the NHS for us all. We do have something in common and that is they have been treated appallingly by the nasty tories. If you want to see the power of the junior doctors go to http://youtu.be/uK7DRJx9nbU
    it will give you a laugh!

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  11. These doctors are destroying the nhs. There just money grabbers

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    1. Wait until you are working weekends without extra pay. Hope many more services will the Tories destroy whilst lining their own pockets.

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    2. Many probation staff are forced to work evenings and weekends without extra pay. I see many working until late evening or come in on leave because of a PSR allocated at the last minute, or due to having delayed deadlines to meet because of time wasted on a recall, because the computers don't work or pointless team meeting.

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  12. If anything, the junior Doctors dispute is bringing home to me just how futile it would have been for us to have pursued a more comprehensive programme of industrial action.

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  13. Ignoring the last comment.

    15:37 I completely agree with you. Sorry to those who loved the job and have since retired. In the past you inspired me and I still enjoy hearing about your experiences and successes and sometimes very funny stories! I am genuinely happy you can look back on your career in this way. However, the way I see it is that the job used to be about helping people. Maybe back in those days I would have really put myself out to the detriment of family etc.

    However the job isn't about helping people anymore. It's about controlling them, monitoring them and typing away on a computer to try and show others you are doing those two things in case anything goes wrong.

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  14. We all need to conserve as much energy as possible to survive the tremendous changes happening in the Probation world.I work for a CRC and feel as if the whole organisation is perched on the edge of a cliff - the operating model is due to be published and the tension is palpable. Having worked through so many changes in 20 years in Probation, this is definitely going to be the most far-reaching in terms of changes in organisational culture and identity. Staff are worried, nervous, anxious, angry,complacent and in denial. Turning up for work on a Monday morning and surviving the working week from one weekend to the next is an important goal for survival. Maybe things will turn out better than anticipated. Who knows? At least we have a job which pays the mortgage and feeds our children

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  15. 2044 -Exactly! You have hit the nail on the head! Thank you. But there was always an element of control too since we still challenged, confronted, warned, threatened, breached, punished and recalled where appropriate.

    and your comment differs to 1537 in that you appear to understand the difference between then and now, with some criticism of the post TR changes, whereas 1537 appears to be happy with the job as it is now.

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