The Medic and the Medici

There are several issues exploding, yes, they are literally exploding in the faces of people all around us, especially in the UK. The first event is ‘Leaked Brexit email claims David Cameron has ‘starved’ NHS‘ (at http://www.theguardian.com/politics/2016/apr/01/senior-tories-brexit-vote-leave-attacks-david-cameron-letter-nhs-staff).

This article gives us the following quotes: “David Cameron and Jeremy Hunt must accept responsibility for this – they have starved the NHS of necessary funding for too long.” The claim is more than outlandish, it is for all intent and purposes a clear fabrication. So who is Cleo Watson? What evidence has she produced? These two elements are important. Apart from her short time with the Vote Leave campaign, she is an unknown. This letter is also a clear visible act where both Michael Gove and Boris Johnson need to question their support for this group. Michael Gove gave his reasons clearly and well written in the Independent. Boris Johnson has his business and governing mental experience regarding the link between the UK and the European Union. I am on the fence, yet to some extent I am leaning more and more heavily towards Brexit. Yet I want to do this on the facts that matter, people need to vote based on actual facts. Cleo Watson is just making a joke everyone needs to ignore. This we see when we take the following facts into account:

#1. 2011, NHS pulls the plug on its £11bn IT system, a system abandoned after 9 years of spending and no result.

#2. 2013, The NHS says it has lost millions of pounds in the last year because of the number of patients failing to turn up for appointments.

#3. 2015, The NHS saw the worst performance by A&E departments since records began in 2010, with only 91.4% of patients being seen within the four hour target time.

#4. 2016, Nurse staffing levels, missed vital signs observations and mortality in hospital wards: modelling the consequences and costs of variations in nurse staffing and skill mix.

Now, this is not about laying blame with the NHS, yet serious questions need to be asked. You see, only the arms industry has at times the luxury to blow away 11 billion and not feel the consequences. It’s pretty much the operation expenses of the Patriot Missile system in the US. Oh wait, the UK cannot afford that system, so it selected the Aster which gives more bang for the buck (50 missiles more bang for the buck). It had issues after that in both quality and availability. In addition, a study to be completed in 2017 is costing the NHS half a million.

There are other issues that play, they are all with the NHS; the issue is that these things just happen. Any machine has cogs that aren’t pulling their weight, they are there in case something else goes wrong, or they are in support, or even just idle because the system requires them to be. The response in the Guardian was also direct: “A senior source at the Department of Health hit back by claiming the government had provided an additional £10bn for the NHS and said that “every Conservative MP stood on a manifesto to deliver this package”. They added: “So we expect every Conservative MP to have absolutely nothing to do with this letter”“, which for the moment might sound very correct, but within all this a serious question remains. How could any project go this far out of bounds? In a time when the NHS is not smothered to death, but only a step away from drowning in costs and costings, we must demand a firm hold on expenses. Yet, this goes a lot deeper than just expenses, you see in all this, especially in regards to the squandered £11bn, questions must be asked of the political side, did they interfere, was there interference at all and how did that explode costs? That is an equally important question in this race for comprehension.

So as we see one part nullified from Vote Leave. We are not done, not by a longshot. You see, these matters are tried again and again. This becomes more outspoken when we see ‘Female doctors may be forced to quit over new contract, experts say‘ (at http://www.theguardian.com/society/2016/apr/01/female-doctors-new-contract-medical-royal-colleges). Now, let’s be fair. There was always a small chance that this was the Guardian entering its own April fool’s day article of the year. Yet that part can be ignored when we read: “The MWF is worried that will force female doctors who are mothers to try and find childcare at those times. The new contract could breach junior doctors’ right to a family life under the Human Rights Act“. In addition there is “Dr Roshana Mehdian, one of the leaders of the junior doctors’ campaign against the contract, criticised the DH for saying that women should make “informal childcare arrangements” if they are affected by having to work more antisocial hours“. When we look against “This is ludicrous in the 21st century when childcare costs are spiralling and access to out-of-hours childcare is limited. This discriminates against women, single parents and working couples“, we must ask ourselves ‘Are these doctors on drugs and please can we get some of them?’

You see, there is no denying that the MD’s in this world work really ungodly hours. I do not think it is fair, yet the current system does not have that much margin to work with. In addition, a personal view is that any woman who now goes into medicine, who also wants to be a mother needs to realise that she can do one or the other, not both. Those in the medical and legal industry tend to work an easy 50-60 hours a week. Unless those women have chosen to marry a househusband, that option is gone! All this bickering and especially Dr Roshana Mehdian who not unjustly stated “This is ludicrous” is forgetting that in the old days the man worked, the woman stayed at home. Now, if we accept (and I do), that someone has to be with the kids (to some extent), in an age where a man and a woman can make the same fortune, she must also realise that if she is making the fortune, she needs to realise that Mr Mehdian might be expected to be at home to raise the kids. In a bad analogy I would rephrase this into, you can’t be a hooker and expect to be given the options of a virgin. One excludes the other. And in an age of spiralling childcare costs, the cost of living went up for all. This is not about fairness, this is about reality and realism. Because only labour seems to feed the public the idea that all can have a job, free education is a given and childcare is priced under the tax deduction act, those who believe will not have a life, not have a family and they will not have any money left.

The article calls for another two quotes that have relevance and importance. The first is “The DH analysis, published on Thursday, has intensified the long-running dispute between the profession and ministers over the contract. There is particular unease about its statement that “while there are features of the new contract that impact disproportionately on women, of which some we expect to be advantageous and others disadvantageous, we do not consider that this would amount to indirect discrimination as the impacts can be comfortably justified”“, the second is: “This contract is a huge step forward for achieving fairness for all trainee doctors”, a spokeswoman said. “For the first time, junior doctors will be paid and rewarded solely on the basis of their own hard work and achievement. That is ultimately what employers and the BMA they want and everyone deserves: a level playing field.

You see, these might seem like two sides of the same coin, but I reckon they are not and this is a lot more of an issue that some might realise. You see, the Guardian and the Independent are both on the same side when we see “the measures would discriminate against single women“, I disagree! From my point of view, being a single parent and in law or medicine is massively stupid and selfish. It is clearly given at the beginning of your career, already in University for some that the immense amount of hours made will equally mean that being a parent (in any other way than the old way is the real story that will not be a reality). I reckon that any person becoming a parent whilst working 50+ hours a week is a bad parent and should not be allowed to be a parent. You can’t have it all and for the most, most of the population knows this to be a truth. Is it possible down the track? That remains to be seen, there is a clarity that unless the economy does not drastically improve the family life for many will be a mere concept that will never become a reality to many couples. Nourishing any act in that direction is self-delusional.

Is it fair?

Of course it is not, but the current economy is not about fairness, in all fairness the previous administrations should not have pushed this government with a 14 hundred billion pound debt, but that happened and until now, no serious acts have been performed to rein in spending and to reign in debt, which is part of all this as well. The full contract can be found at http://www.nhsemployers.org/case-studies-and-resources/2016/03/junior-doctors-terms-and-conditions-of-service. I am not going to bore you with the contract as such, because some of the elements discussed require a person much more versed in contracts than I am. Yet, I feel that it is imperative to mention: “The work schedule for a doctor on a general practice training programme working in a general practice setting should reflect the 2012 COGPED guidance or any successor document on the session split during the average 40-hour week that comprise a minimum full-time contract. Any additional hours of work above 40 must be included in the doctor’s work schedule and linked through to the curriculum, as per those for doctors in hospital settings“, which we see on page 28. This part has a reference to “The doctor’s actual total ‘new contract’ pay at appointment to the first post and subsequently at appointment to each new post under these TCS will be calculated as per the provisions of Schedule 2 of these TCS” I cannot state whether this is fair or unfair. Yet there is one given, there is no mention of gender here. I have seen how Emma Watson gave her speech at the UN (I am completely in support of this), yet when we see equality, for me it means on all fronts. This also implies that you do not get to have a career and be a mother. You see, in that same view, nearly every man worked every day (and sometimes nights) and did not get to be a father, they merely became the provider of the family. We have to accept that, because the rent and the food must be paid for, in that same light women will have to face that too. So, they do not get to complain that as a single mother there are debilitations. So is this what the Department of Health claims to be, a ‘level playing field’, or is there another side? You see, Dr Roshana Mehdian did not convince me of her side with: ‘when childcare costs are spiralling and access to out-of-hours childcare is limited’, in that same light, it took two to tango, so why is the child not with the father? If there is true gender equality that question is fair and valid. Of course, reality tends to be not in equal measure and we would accept that, but in all this when we see the pressures in the medical profession, it makes sense that having an equal weight responsibility means that in the medical and legal profession, having a child will impact your value on that market, merely because your head was not in the game, for 15 hours it was with your own bundle of joy. That premise is valid, it will make massive sense for some to start a family, but in equal measure it means that it will either cost you a family or a career. We have come to the stage that both is no longer an option, especially as a single parent. From my personal viewpoint, raising a child is a career all in itself. Now answer the following question honestly: “How can you have two careers and do right by both?

An answer not easily given, because it is not an easy question!

What is a matter of concern is that the political parties (on both isles) have taken certain stances, both are debatable and both have had little options and the shortage that was strangled upon these parties is equally a problem. By trying to maintain a medical elite in the UK, the balance shifted. You see, when we consider the Social structure within the United Kingdom as it was, where the upper class included the barristers, judges, dentists and doctors, yet were also in the middle class. We see a shift after WW2, so those who were in the high field tried to keep themselves and their family in that higher echelon, therefor rejecting fiercely a foreign infusion of highly needed talented workforce. After WW2 this became a shift towards a services-dominated economy with additional mass immigration. The medical profession, due to unrealistic standards saw their workforce diminish over the last 10 years giving us the issues we see nowadays. Consider the following response “I wrote my exam on 12 Dec 2015 and got my result 24 Dec 2015. I promptly went online and started the application and 2 days later I got the Pearson Vue testing reference number and booked and paid $280 for the computer based Test of Competency. I could have sat this next week but I chose to sit it on 2 Feb to give myself more time to practise as I can’t afford to fail. So far the process has been really smooth and quick“, another voice was a lot less positive, but there could have been a clear issue of timing involved. Overall the issue remains that by making a transfer of knowledge so hard, especially as some applicants have degrees in Commonwealth nations, it seems to me that some players are trying to dampen the influx of foreign talent, which is just my personal view in all this.

This path could have been smoothened out by the politicians a long time ago, but it seems that schooling and re-schooling nurses does not sound as sexy as a new innovative IT system (which didn’t work anyway). Last I get to that list of 4. The first one is old news now, but 11 billion is a lot to lose and it has to come from somewhere. The second one is one that can be dealt with. If the patient misses two appointments, they can either pay a penalty fee for not cancelling in time. Cancelling an appointment is just a phone call away. If you forgot it, there is a fair assumption that there was not a pressing medical need (I know the ice of that statement is very thin). In all this we must realise that doctors work ungodly hours, so steering clear from giving them additional pressures seems to be a given first. A task at which, as I personally see it, Jeremy Hunt failed miserably at present. The third in my list is the one I would give A&E a pass for. My reasoning is that the skewed scale that A&E works with has not been properly adjusted for growth in patients and stagnating staff numbers. We get these numbers from http://www.parliament.uk/briefing-papers/sn06964.pdf, where we can see in the introduction and the summary that the title ‘Accident and Emergency Statistics‘ is ever so slightly misleading. I wonder what Carl Baker had in mind with this paper and what purpose it serves. It seems to ‘focus’ on the +4 hour people way too much. The one summary number that does matter is ‘There were 4.0 million emergency admissions to hospital via A&E in 2014/15 – up 4.8% on the previous year’, which only paints a partial picture. You see, ‘Chart 2: Annual A&E attendance, England, 2004-2015‘ seems to tell the story, but other ways could have been more explicit to deal with the issue. Over a period of 10 years, the attendance of the minor injury units nearly doubled. Yes it doubled! The major injury unit also rose, but not by a large part, although, from just over 13 million to close to 15 million is still a growth that is not to be ignored. This report ‘writes it off’ as a mere 10%, which still amounts to 1.4 million additions. Yet in all this staffing levels are not addressed at all, leaving this ‘work’ with some uneasy questions. What I like the most is the disclaimer at the end. “This information is provided to Members of Parliament in support of their parliamentary duties. It is a general briefing only and should not be relied on as a substitute for specific advice. The House of Commons or the author(s) shall not be liable for any errors or omissions, or for any loss or damage of any kind arising from its use, and may remove, vary or amend any information at any time without prior notice

So how does staffing levels in answer to 4 hour waiting times not assist? From this I must question what the Rt Hon Jeremy Hunt MP had in mind with this writing? From my point of view, a bad paper does not make the NHS look bad, it makes the Secretary of State for Health look bad not less good than he should look, especially as he should be fighting for the plight of the members of the Department of health, a side I have yet to see at present. He has been called a lot worse by many, it seems unproductive to go that way. What is matter of urgency is the fact that the Prime minister needs to ascertain if Mr Hunt is the right person in the right place and if not, he needs to get someone there that will take the side of the doctors and fast, because at present they do have the power to let it all collapse, and woe be onto the administration that is governing when that happens.

 

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