Jeremy Hunt is spoiling for a fight. He’s picked the wrong one

The Health Secretary’s quest for a ‘seven-day-a-week NHS’ is fundamentally misconceived

14 November 2015

9:00 AM

14 November 2015

9:00 AM

It has long been rumoured that when Jeremy Hunt took over as Health Secretary, Cameron told him to do one thing with the NHS: keep it out of the headlines. Given that the NHS is an enormous institution, the public take an avid interest in it and it is frequently rocked by scandals and financial difficulties, this was no easy task. Until a few weeks ago, Hunt had managed it with aplomb. And then the junior doctor fiasco happened. It has been cataclysmic, one of the worst public relations disasters to rock a government department for years, and it shows no signs of abating. In fact, it’s likely that things will escalate even further when the results of the BMA ballot on industrial action is announced next week — junior doctors seem certain to vote to strike.

This would be an incredibly high-risk strategy for the medical profession and has the potential to be hugely self-sabotaging. At the moment, junior doctors have tremendous public support. But it could take only one needless, tragic death while they were on strike for the support they currently enjoy to crumble. Given the nature of the work doctors do, this is a very plausible outcome. No matter that a skeleton service would continue, with cover by consultants; the sheer number of junior doctors and their vital role in keeping the NHS afloat would inevitably mean that patients will suffer.

There is not a single junior doctor who wants to strike if there is another way out of this mess, and certainly none of them want to cause any harm to their patients. But they feel desperate. They are having ludicrous terms enforced that no worker would tolerate. Hunt’s much-publicised offer of a ‘pay rise’ of 11 per cent was in fact a masterclass in political spin and manipulation. People in the public sector — except, of course, MPs — don’t usually get increases of that sort.

It sounded too good to be true and it was. The offer was entirely disingenuous. It was pure genius because it subtly made it appear that the current row with junior doctors is about a pay rise, which it is not, and also that he had made a generous offer, which he has not. Even the way it was announced — through the press rather than official channels — meant that he got all the headlines while the BMA were frantically on the phone the next morning asking the Department of Health for details.

In truth, the dispute with the junior doctors was never about them asking for more money — it was started when Hunt tried to introduce contracts that would mean pay cuts. All the 11 per cent offer actually does is increase basic pay — when in reality most doctors’ salaries are substantially reliant on additional money from out-of-hours work, which will be cut. In real terms, this means a reduction in their income — a reduction which some estimate at about 26 per cent.

It’s not just about the money. Medics have raised significant concerns about the safety of the new contract, arguing that it would remove the financial penalties that stop hospitals from making doctors work excessive hours, and would reduce training opportunities.

Why on earth is Hunt doing all this? Some doctors have tried to paint him as a pantomime villain causing mayhem for the fun of it, but he is actually quite a decent man. While I might not always agree with him from the ideological perspective of how best to help the NHS, it’s hard to disagree with many of the things he says about it, and he seems to really care.

He is, though, a Gove-worshipper who wants to be blooded. He wants to do with health what Michael Gove did with schools. He wants to be seen as a strong statesman who has taken on something few would attempt and succeeded. Emboldened by the Tories’ new majority, he thinks now is the perfect time for that fight.

He may well have noble sentiments, but he has not thought this through and he has picked entirely the wrong battle. By tackling junior doctors, he has taken on one of the parts of the NHS that works quite well and which delivers amazing value for money. From the point of view of the clinicians, the fact that the Health Secretary fails to appreciate this is emblematic of how out of touch politicians are when it comes to the NHS. And what’s more, the goal he’s fighting for is misconceived.

The origins of the current problems over junior doctors’ contracts can be traced back to the government’s election pledge of introducing a seven-day-a-week NHS. When they first announced this proposal, many questioned where the money to do it would come from, and the government was unable to provide any answers. It seemed particularly strange given that not only was there no extra money in the NHS pot, but we have been constantly told that the NHS needs to make savings — to the tune of £30 billion over the next five years. It just didn’t make sense.

The answer they have stumbled on is to change the contract for junior doctors so that there is less distinction between weekdays and weekends, and to widen the definition of ‘normal’ hours so that doctors can work later without them having to be paid higher rates. Doctors could thus be expected to work Saturdays and late nights for no extra money.

In effect, the plan was to use the same number of doctors and just spread them more thinly over seven days. Unfortunately the proposed changes meant that the vast number of junior doctors who already work weekends or evenings would be significantly out of pocket.

The entire thing is completely avoidable because it’s based on a fundamental misunderstanding of what sort of NHS we really need. The government has been obsessed with a seven-day NHS, but this is a ludicrous pipe dream which they should give up on. They made the same promise five years ago and it failed to materialise, so they are clearly determined that the same won’t happen again. But given the shortage of money, and indeed of doctors, we need to be pragmatic.

The study showing increased weekend hospital mortality that caused so much panic has since been found to be flawed. Even so, of course we must ensure we provide the best care available to those who need it at weekends and out of hours. There is no doubt that consultant-led service improves the quality of patient care. A 2012 report by the Academy of Medical Royal Colleges cited dozens of figures which point to this.

But the government seems to have come up with a wish list of luxuries we simply can’t afford — hence the current fracas with the junior doctors. We need to make the distinction between hospitals opening for safety and opening for convenience.

It would seem far more sensible to look at areas of critical care — A&E, cardiac and stroke wards, maternity services, intensive care; the kinds of places where people are acutely unwell and need regular senior input — and focus our attention there. You’ll find that many of these areas already operate a seven-day NHS as far as the doctors are concerned. Paediatrics, for example, has long ago accepted the need for seven-day-a-week consultant input and have structured services accordingly, without recruiting more consultants.

We also need to accept that some specialities — such as dermatology or rheumatology — do not need to provide seven-day cover. While it might be nice, people simply do not need to have a dermatology outpatient appointment on a Sunday afternoon. Rather than promising the same service every day, we should be prioritising the areas where people are sickest and therefore in most need.

This leads on to the next issue — doctors are not actually the problem with delivering this anyway. Doctors do not operate on their own. In a hospital, they are part of a much bigger system and reliant on many other professionals and services to do their job. It’s no use having a team of doctors seeing patients if there aren’t the services in place that they need in order to do their jobs. You can’t safely discharge older patients unless they’ve been assessed by an occupational therapist, for example.

To run a truly seven-day NHS you’d also need to ensure that there were radiology services, so that people could have scans. You’d need a fully staffed endoscopy suite. You’d need to have fully staffed physiotherapy, speech and language therapy and psychology departments. You’d need full-capacity admin teams to book in appointments, and porters to collect and transfer patients. When you see it like this, the doctors are just a tiny cog in a very large machine.

The government have made a mistake. They did it with the best intentions — they wanted to improve the NHS and improve patient safety. They latched on to the idea of a seven-day NHS without really thinking it through or understanding the issues. They should focus all their attention on ensuring that the critical care aspects of what hospitals do — which is where the sickest patients are — are fully staffed and operating at maximum efficiency. Junior doctors are already working flat out in these areas.

Jeremy Hunt needs to accept that he has made a mistake by pushing a blanket seven-day-a-week NHS agenda, and get back to negotiating a reasonable new contract with the junior doctors that doesn’t mean they will be taking a pay cut.

And the BMA need to be gracious in this, accept his climbdown and reopen the negotiations to ensure that junior doctors get a decent deal and, most importantly, that patients are kept safe.

Got something to add? Join the discussion and comment below.

Max Pemberton is a doctor, columnist for the Daily Mail and the editor of Spectator Health.

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Show comments
  • There’s two separate issues here, one is over terms and conditions of junior doctors pay and the other is over how completely the NHS relies on them to run hospitals at nights and weekends. Given we’re talking about people just out of medical school with limited practical experience the first thing we should be doing is making this second issue not a thing. There’s not enough experienced doctors in and awake in hospitals over the weekend/nights and that’s a serious problem borne-out by the statistics.

    The fact we’re even talking about junior doctors striking and people dying because of it proves beyond all doubt that night/weekend cover is out of control.

    • TheOriginalBlackPudding

      “…we’re talking about people just out of medical school with limited practical experience… ”

      … but we aren’t! The term “junior doctor” encompasses any doctor below Consultant. So that can be doctors who’ve been working as registrars for years, not just pre-registration/F1/F2. I suspect the government is only too happy for the term to be used this way because it clouds the picture.

      • I realise it isn’t all, but it is a significant majority at nights and weekends, yr 1/2 doctors and nurses are for most intents and purposes running hospitals. The statistics back up how risky this is. I understand they’re technically qualified doctors but they’re not experienced with everything that can happen.

        • John

          Rubbish I’m a senior registrar and therefore a junior Dr. I am often the most senior anaesthetist in my hospital at night, except when I call my consultant in when needed. I have over 10yrs experience and have given 3000 anaesthetics. Yr 1/2 Drs do not run the hospital at night.

        • DTAston

          The number of F1/F2 doctors on call in any particular hospital out of hours will be roughly the same as the number of registrars (especially for general medicine / general surgery). Few acute specialties do not have registrars on site 24 hours a day 7 days a week at the moment – and this has been the case for years. F1/F2 doctors are not “running hospitals at weekends and at night” (although it is true to say that the NHS couldn’t function without them).

          I am an anaesthetics and intensive care registrar. I am a “junior” doctor and left medical school in 2003 – 12 years ago. I am a member/fellow of two royal colleges (physicians and anaesthetists) and I am just finishing a PhD. I am by no means of “limited practical experience” but I am still technically a “junior” doctor because I won’t be a consultant for another couple of years.

          How experienced do you want doctors who are “awake at weekends and nights” in hospitals to be before you accept that we’re professionals who know what we’re doing – and certainly are experienced enough to be able to manage serious problems until consultants arrive (if necessary)? I hope that the statistics that you claim support your argument are not those constantly quoted by Hunt about weekend mortality – as anyone with any statistical literacy (including the authors of those original papers) acknowledges that it’s not as simple as he makes out, and there is certainly no basis for assuming that increased weekend mortality (if it actually really exists) is a consequence of the different out of hours staffing rotas.

        • Egerton Yorrick

          As the others have said, year 1/2 doctors are not running anything.

          • Running was a poor choice of word.

  • NHS expenditure is now two and a half times greater (£50bn – £125bn) since 2000 and yet all we seem to get is outrage over “cuts” or dire warnings of how many hours or days there are left to save it. When is someone in government going to get a grip and enquire exactly where all that new money has gone and report back to tax payers accordingly?

    • Ed O’Meara

      We already know. PFI deals. Privatisation has been the NHS’s financial ruin, and will soon be touted as its saviour.

      • post_x_it

        PFI is NOT privatisation.
        PFI is a horrendously destructive fudge which was enthusiastically embraced by Labour as a way of introducing ‘private’ money under the mantle of a public monopoly.
        Privatisation is where all the assets, profits as well as risks and responsibilities are fully transferred to a private owner/operator.
        Under PFI, all that happens is that a private investor ends up with a juicy guaranteed ultra long-term return, while the public sector retains all the risks and responsibilities and sacrifices all its flexibility to boot. It is the worst of all possible worlds, and to a large extent responsible for many of the problems now evident in the NHS. Labour must NEVER be let anywhere near it again.

    • DTAston

      Healthcare is expensive, and is only going to get more expensive as technologies and pharmaceuticals, etc move on and the population gets older and fatter and more unfit.




      My interpretation of the above is that the UK spends less on healthcare than many other systems in Europe and a lot less than the US (first link, KingsFund) but is now getting to the point where we are spending so little that it is becoming unsafe (second link, OECD report). However, we do the best that we can with the relatively small amount of money we have and use it comparatively efficiently (third link, Commonwealth Fund report). While there are certainly areas where the NHS could be (a lot) more efficient, it’s hard to see where a further 20bn ‘efficiency savings’ are supposed to come from.

      If you have any doubts as to the extent of the problem, try visiting your local hospital sometime this winter.

  • ndeaks

    This is the most balanced commentary on the junior doctors debate that I’ve read. Yes – Hunt is making a principled stand, and here it is eloquently argued that it is the wrong one. Max is right. Hunt is sacrificing the good will of some of the UK’s brightest young minds and forcing them out of the NHS.

  • Marcus

    As an interventional radiologist, I agree with all of the above.
    To emphasize a point you made:

    For me to perform an interventional procedure requires at
    least 2 nurses and 2 radiographers. The reason 2 are required is because save
    for the doctor, the remainder require mandatory regular breaks.
    But that is just one procedure; if you want me to perform 2 procedures, I
    will need 2 nurses in recovery as well.
    So if you want me to preform a procedure on a Saturday, you have to pay for at
    least 5 extra staff to work on a weekend, more likely 7. And the nurses and
    radiographers unions ensure their staff are paid accordingly.

    The solitary doctor is the cheapest part of the equation.

    However, as you say: a 24 hour thrombectomy (blood clot removing) service
    for strokes = makes sense, saves lives and should be implemented, as is the
    case in other countries.

    • commenteer

      And how many staff would you need in the private sector, I wonder?
      I well remember a senior urologist, then the Chief Executive of a hospital in the north west, discussing how many operations for a common urological complaint could be performed per theatre session. He then mused that he got through three times that number, of course, in his garage theatre at home on a Saturday morning.
      To an outsider, the dispute outlined by Dr Pemberton feels rather like the unreformed industries of the 1970s.

      • corranhornrogue9

        Your silly fantatises are easily checked with a quick look at the facts. The NHS is much cheeper than private run healthcare systems

        • HJ777

          If you look at the facts, you will see that it isn’t.

          For example, the OECD says we spend the average of its members but get a lower than average quantity and quality of care for our money.

          Similarly, the Economist Intelligence Unit says we rank 16th out of 30 countries for healthcare spending but only 28th for the healthcare resources we get for the money.

          • corranhornrogue9

            Are you kidding me? all that figure says is that we have less beds and doctors, you need to look at the outcomes. Any way the countries that spend less are japan (devalued yen) Italy israil Spain Portugal, south Korea Greece check republic Poland Chile Hungary mexico turkey. the countries that are even remotely comparable are france and germany in terms of populations which spend far more. The reports outcomes are for health (which includes the effect of out bad diet) and illness where we do better than average. This is by far the worse outcomes reporting I have seen for a while in many other tables we do far better,

          • HJ777
          • corranhornrogue9

            I read the data their analysis just uses the 28/30 figure for beds and doctors which in no way judges the outcomes of the healthcare system which is important. it doesn’t help if you have a 1000 empty beds its if the patients get better that matters. As i said the facts, not some nonsense right wing anysis

          • HJ777

            The OECD study looks at outcomes. It says that in Europe, only Greece and Ireland have less cost-efficient systems.

            The EIU study does look primarily at resources but it doesn’t just look at numbers of beds and medics. Clearly you have not read the whole thing.

            Now please provide the independent evidence to support your assertion that the NHS provides cheaper care than privately-run systems. Remember, the measure of cheapness is not just how much you spend, but what you get for your money.

            If you are going to make such an assertion, I would hope you would either back it up with some evidence or withdraw the assertion.

          • corranhornrogue9

            It looks at beds medics and equipment. if you get better out comes with less beds medics and equipment that makes you more efficient. The data you provided in your eic report backs me up 16/30 in costs 14/30 in outcomes. The comparable populations are countries like Germany France Netherlands, not poland, we are cheaper than the comparable western European countries that have privately run systems in the data your provided. the fact that we are not cheeper than countries like mexico is hardly discouraging.

          • HJ777

            You confuse the level of spending with cheapness.

            You cannot point to any independent eviidence to support your claim.

          • corranhornrogue9

            You provided the outcomes 14/31 you provided the cost 16/30. there you go unless your point is your evidence was not independent. you cherry picked the report because the anyasis was misleading there are plenty other reports that back me up but i dont need to find them because yours does it for me

          • HJ777

            I suggest that you read the whole EIU report if you think it says that.

            You assert there are ‘plenty’ of other reports that back you up but you can’t cite any. That is telling.

          • corranhornrogue9

            i did read the whole thing and the analysis is not backed up by the data

          • HJ777

            You didn’t have time to read it.

            You are talking nonsense. You just deny what it clearly says.

          • corranhornrogue9

            look i have showed to you that your silly 28/30 claim is crap. you must except this. surely we can both dismiss the appalling analysis in the article.

          • HJ777

            ‘Except this’?


            It clearly says 28th out of 30 for the resources we get. You may think its ‘crap’ but you haven’t show that it is. You mistake your assertions for fact.

          • corranhornrogue9

            yes I clearly have showed that it is crap. its the outcomes that matter the report cherry picks the data and ignores outcomes. Would you go to the hospitol with the most number of MRI machines or the one where the patients get better.

          • HJ777


            “Overall, The EIU report ranks the UK at just 28th out of 30 OECD countries for healthcare resourcing, whereas it ranks 16th out of 30 on healthcare spending. This suggests that the UK isn’t getting the best value for money.”

            “The UK is mediocre in terms of outcomes.”

            OECD summary:

            “About average spending per capita”

            “The quantity and quality of health care services remain lower than the OECD average while compensation {i.e. pay] levels are higher. Reinforcing competitive pressures on providers could help mitigate price pressures, e.g. by increasing user choice further and reforming compensation systems”

          • corranhornrogue9

            Oh ffs. I cant argue with someone who thinks the efficiency of a healthcare service can be judged by counting the number of MRI machines. You ask me to point to a study. I have done yours. your looking at the wrong data. if you want to pay more to go to a hospital full of empty beds and piled to the wall with MRI machines, then fine. but don’t tell me its efficient. The reason Im not going to site studies is not because they dont exists, a simple google search will show you they do as I have looked at several, but because I dont need to. your own data shows that the countries we pay more than are for the most part less economically developed, or in the middle of massive financial crisis (or have a devalued currency). look at the counties that pay more, they are the roughly similar to ours, france and germany for example, but pay ALOT more. Our outcomes are quite respectable considering how much less we spend than them (it is in the realms of £1000 per person per year). The fact we do this with less staff and less stuff is an indication of our efficiency. better outcomes for less money. And this is all in your right wing nonsence article, which ignores its own data because it wants to say how horrible inefficient the nhs is and instead counts the mri machines. Factor in the cost of PFI form new labour and capital under-investment by tories before that and we are getting good value for money indeed.

          • HJ777

            What part of:

            “About average spending per capita”

            “The quantity and quality of health care services remain lower than the OECD average while compensation {i.e. pay] levels are higher. Reinforcing competitive pressures on providers could help mitigate price pressures, e.g. by increasing user choice further and reforming compensation systems”


            “The UK is mediocre in terms of outcomes.”

            don’t you understand?

            And where are these ‘plenty’ of examples that back up your assertion? You haven’t provided one.

            If they are as numerous as you make out, you should be able to point me to them with no further ado. But it seems you can’t.

            So your assertion is just that: an assertion, not fact.

          • corranhornrogue9

            Ok last post im afraid. “The UK is mediocre in terms of outcomes.” but It spends lest for that mediocrity, hence the efficiency. The report glosses other this then talks alot of crap about counting resources. Its hardly devastating evidence for my point of view but it least it points towards my argument, At no point does it back up yours. Sorry its more satisfying to shove your own data in your face than going through the common wealth fund so you can find some data about how the NHS has less parking spaces per capita.

          • HJ777

            So, to summarise:

            You have no evidence for your claim that the NHS is more cost-efficient than privately run systems. The ‘plenty of reports’ that you claimed back you up ,simply don’t exist.

            I’m glad we’ve clarified that.

          • Xiao_zhai

            This might clear up some of your doubts. It’s not exactly the most recent data.


            Please note however, the costing does not take into account the cost of living in individual countries. The NHS ranked very favourably on a lot of the parameters excepting one. Others might be ahead but the absolute different is probably small (I do not have the exact figures) I assume as such Because of the pretty standardized practice and guidelines on medical practices around the world, it would not allow a big difference in mortalities, otherwise it would be a negligence.
            Like most healthcare system around the world, you can only wring so much out of the staff’s dedication.
            It’s always easy to target the higher income earners. But we got to ask ourself, considering the hours worked, the qualifications required, and the responsibilities of the jobs, how much would we think is a fair wage per hour worked? During normal banking hours? And outside banking hours? As I can see, the U.K. government had already expanded the doctors’ “normal hours” even on previous contract. Should their hourly wage be 1.5 times yours? 2 times yours?

            Lol. They keep reporting my post as spam.

          • HJ777

            That would be the Commonwealth Fund report that ranked the NHS 10th out of 11 for outcomes.

            The Commonwealth Fund that ranks a country highly for ‘equity’ if it denies a treatment to everyone compared to a country where (say) just 10% can’t access that treatment.

            The Commonwealth Fund that has the head of the NHS on its board.

          • corranhornrogue9
          • HJ777

            So your ‘plenty’ of other reports consists of one non-working link.

          • corranhornrogue9

            sorry it was a joke it was meant to link back to your report

          • HJ777

            So you can cite precisely no reports that support your assertion.

            So much for your claim that there are “plenty”.

          • corranhornrogue9

            I believe that you misread the paper, it says that greece and ireland and the uk could make the most from efficiency savings, it does not say that they are the most inefficient.

          • HJ777

            It says that they have the greatest scope for efficiency improvements compared to the best. This makes them least efficient.

          • corranhornrogue9

            No it does not mean that. Read the report you linked to.

          • HJ777

            I read it. You are wrong.

          • corranhornrogue9

            No you are “Potential gains are derived from an output-oriented data envelopment analysis (DEA) performed with one output (life
            expectancy at birth) and two inputs (health care spending and a composite indicator of the socio-economic environment and
            lifestyle factors). They are measured by the number of years of life that could be saved if efficiency in country i were to be
            raised to the level implied by the estimated efficiency frontier while holding inputs constant and under the assumption of
            non-increasing returns to scale.”

          • corranhornrogue9

            I dont need to provide the studies because you provided them for me bhahah go read the oced report you linked it says the opposite of what you think. it says that privately run ones have higher admin costs,

          • HJ777

            It says that the UK produces no internationally comparable data on administration costs.

            In any case, higher admin costs does not mean lower efficiency.

          • corranhornrogue9

            Sure the oced report dosnt really come to the conclusion that any system is better but it certainty doesn’t say what you think it did. and the statements it makes on administration are interesting arnt they.= 🙂

          • HJ777

            it says exactly what I said it says. Clearly you are hard of understanding.

          • corranhornrogue9

            “Potential gains are derived from an output-oriented data envelopment analysis (DEA) performed with one output (life
            expectancy at birth) and two inputs (health care spending and a composite indicator of the socio-economic environment and
            lifestyle factors). They are measured by the number of years of life that could be saved if efficiency in country i were to be
            raised to the level implied by the estimated efficiency frontier while holding inputs constant and under the assumption of
            non-increasing returns to scale. “

          • HJ777

            Precisely. It looks at what the life expectancy gains would be if countries were as efficient as the best.

            It doesn’t not, however, look just at life expectancy to produce its efficiency comparison in the first place. It covers that in a separate analysis.

            You are wrong.

          • corranhornrogue9

            but the bit you quoted about greece and ireland is not based on a efficiency comparison

        • commenteer

          Cheaper for whom? Do your figures take account of the many millions of pounds spent on private health insurance, as droves of companies and private individuals now consider this essential?

          • corranhornrogue9

            yes they do take it into account. Despite idiots spending money on pointlessly exspensive private treatment as a whole we all pay less

          • commenteer

            Those ‘idiots’ include all the upper tier NHS hospital management teams, who usually have private health care as part of their pay package. Perhaps they know something you don’t about NHS care.

      • Marcus

        I don’t disagree that the process could and should be
        streamlined. So let’s tackle that first, before just getting more doctors in.

        Also, as you site the private sector: it is getting far more cumbersome than it
        used to be, primarily due to litigation concerns.

        Another key area to look in to.

  • Clive

    I don’t believe it is true to say that junior doctors have unequivocal public support. They did have and then they started pulling stunts like tweeting that they were at work at the weekend. That just looked like a gimmicky ad campaign to knowledge-free punters like me.

    The study on weekend deaths does not appear to have been ‘flawed’ if this is what you mean:
    …It still comes up with the same conclusion…
    …Freemantle et al confirm that their 2013-14 findings were “qualitatively similar to the corresponding results from our previous analyses”, which found relative risk increased by 11 and 16 per cent respectively….

    I imagine, anyway, that the whole 7-day a week policy was mainly aimed at primary care. This piece seems to support that and to support the need for 24/7 care:

    The Spectator piece also says that the NHS needs to save £30bn over the next 5 years but that has already been accounted for. The government put in £10bn http://www.nhsconfed.org/news/2015/07/budget-confirms-10bn-funding-commitment, so the net saving required is £20bn. The Stevens report said that the NHS could save £22bn http://www.theguardian.com/public-leaders-network/2014/oct/27/nhs-savings-simon-stevens-report-cuts so the NHS appears to be ahead of the financial agenda.

    • danbrowne

      The “weekend effect” is still under debate and the evidence is still unclear. It has shown correlation but there may be significant confounding factors. Nonetheless, BMA and royal colleges are all committed to improving 7 day service and this article clearly outlines what will be necessary to do this.

      22bn figure probably comes from govt offering another 8bn in manifesto.

      The current offer from Hunt is complex. Doctors already working for the NHS will continue to earn the same as they do now with special “pay protection supplement”. This means that they will not get their normal increase in salary for moving up a grade, but will not see their salary fall. This is therefore effectively a pay cut.

      New doctors to the NHS will face something like a 10-15% pay cut once out of hours pay is taken into account as they will not receive the pay protection supplement. Some specialities, especially those with non-resident on calls may be especially hard hit.

      The safety concerns are important to remember. The service is already struggling during the week. Emergency Medicine is in a dire state. Spreading doctors more thinly across 7 rather than 5 days will worsen the quality of what is available in the week and put patients at risk. This is not the BMA behaving like a protectionist union. It is the truth.

      There are currently disincentives (essentially financial penalties) for hospitals that deliberately understaff departments so doctors work well beyond their contracted hours. Hunt intends to remove these and replace it with a vague concept of regulatory oversight. Given that many doctors already regularily work well beyond their contracted hours despite the current financial penalties, this is quite scary for a lot of junior doctors.

      As the recent OECD report outlined, the UK is spending less as a proportion of GDP on healthcare than many other countries. We also have significantly lower numbers of doctors and nurses per head. In the face of an ageing population and underfunded social care, this is why the NHS is not performing as it should.

      • HJ777

        We have a disproportionately lower number of medics and nurses than can be accounted for simply by lower spending.

        How do you explain that?

        • danbrowne

          Really? France has 3.3 doctors per head. UK has 2.7 per head.
          Spending as % GDP in UK is 9.3% in France 11.6%.

          France spends 20% more on health and has 22% more doctors.

      • Clive

        I don’t see how ‘new doctors’ can face a ‘pay cut’ ? They will be offered a rate of pay and take it or leave it. That’s the usual state of affairs in the private sector, why should the public sector be any different ?

        ‘Safety concerns’ do not appear to be preventing junior doctors from considering a strike. Why is that ?

        Financial disincentives should not be the way regulations are enforced. It should be by regulatory oversight. Why are you saying the proposals are ‘vague’ ?

        The UK ought to have a performance edge in healthcare that means we spend less. We should have lower administrative costs because of the lack of an insurance-based system and we should have better preventative measures because the NHS should be better integrated with British society.

        It is true to say that several of the statements in the piece are not true. That has rather destroyed Max Pemberton’s credibility – at least with me, for what that’s worth.

  • Phil Whitaker

    excellent, sensible article. Jeremy Hunt should read, reflect and act on it – now.

    • Dj

      I agree! Very well-balanced, which must be difficult to write given the balls up J Hunt has made/is making. I still can’t fathom why the government put a homeopathy believing layperson in charge of the national healthcare system. Ludicrous.

      • post_x_it

        When was the last time any Health Secretary did anything useful?

    • Tom

      Agree completely.

      I wonder if JH has talked himself into a corner and now can’t see any way out other than ploughing on.

      • post_x_it

        Dave needs to put him out of his misery.
        He sacked Gove who was on the right track and whose reforms were succeeding in the face of fierce resistance.
        And then he hangs on to Hunt. Why?

  • Rupert

    Why shouldnt we have a 7 day NHS? Especially when we pay doctors so much money and allow them to do private work on their 4 days a week they get off???

    • danbrowne

      NHS is already 7 days. Consultant are paid a lot and some do private work. Juniors not so much and we don’t do private work.

      • Rupert

        Junior Doctors work EU hours. And are free to do locum work, or any other work they please. They also earn well over the minimum wage or starting salaries at other businesses.

        • TS

          After how many years’ training?

          Someone’s bitter about being an estate agent…

          • Rupert

            Nope. Bitter that rich doctors are whining when we have so many people starving and dying in Syria.

          • Egerton Yorrick

            You’ve chosen to express your upset about Syria by commenting on an article about junior doctor contract reform?

          • Rupert

            My point is that I don’t mind rich guys like Cumberbatch lecturing the government to give more money to refugees who have nothing. What I don’t like is millionaire doctors lecturing and blackmailing the government into giving themselves even more money for doing even less work. Especially when we are running a deficit.

          • Egerton Yorrick

            Where do you get this idea about millionaire doctors? Junior doctors don’t want more money *or* to do less work. They do *not* accept the need for the government to impose more hours and a pay cut when they are already working flat out and for considerably less than the global “rate” for their labour.

          • CharlieFDevon

            millionaire doctors?? You are bonkers! What paper do you read? If doctors are millionaires they are not working for the NHS

          • Rupert

            Do you know any doctor over 40 who isn’t a millionaire?

          • mattoid

            oh roops, you really are a troll after all aren’t you. nobody, but nobody, is that stupid.

          • Renu

            I don’t think it is appropriate to compare Syrian refugees plight to contracts for junior drs. Please educate yourself before providing logically fallacious comments.

          • Lynne Roper

            People are dying all over the world, people are dying in the UK. So let’s make doctors poor?

          • Jenny

            You are so out of touch.
            Doctors are NOT on huge salaries and they HAVE TO PAY for all their OWN EXAMS. If you complain about them so much then why are you not one. Answer because you weren’t clever enough. So just shut up about something you know nothing about, you jealous out of touch person!

          • Rupert

            So if I complain about banker bonus’s its because I’m jealous i’m not a banker? Or if I complain about Blair’s corruption its because I’m jealous I wasn’t a PM? Maybe its just because I don’t like privileged group using their privilege to rip the rest of us off.

          • Jenny

            I am the mother of a Junior Doctor so I think I know a little more than you to be able to comment. Their basic salary is around 23K with other allowances added on. Nowhere near the amount that you keep going on about! After having to excel at everything to get into medical school in the first place, they then spent 6 years training to be a doctor, 3 of which were at Oxford, I worked for nothing over this time to help them achieve this. Now they are going to be short changed by this government who have spent lots of money in training them. A huge loss to the NHS. Result: They will move to a country that appreciates their talent and I will have have to put up with them being on the other side of the world…….. So thank you Mr Hunt.

          • Rupert

            estate agents make a fortune from doctors as they love investing in property.

        • Egerton Yorrick

          Yes, you’re right; after achieving the highest possible grades at school and passing one of the most intense degrees over 5-6 years at university, they are paid a professional salary. That salary, for a first year doctor working a 40 hour week, is around £23k. Yes, they can earn extra money for working out of hours (although this isn’t a matter of choice – hospitals rota doctors to work the hours they are needed) and can locum. Many doctors do not want to work locum shifts but do so because there is *literally* no-one else to run the service or look after the patients if they don’t.

          In terms of hours, I routinely worked 2-3 hours extra *every day* without pay in my first year as a doctor. In my last UK clinical job, I worked 7.30am to 8.30pm five days a week and those same hours every fourth weekend. My last ever UK clinical shift ran for a straight 26 hours because there was no-one else to take over.

          Needless to say I am now working overseas in a country that understands the importance of recognising vocation and hard work. I suggest those of my colleagues still left in the NHS should just get out.

          • Rupert

            Did you leave the UK because you wanted to make more money or wanted to leave the NHS set up? I can’t believe any doctors would leave the NHS for the money as GPs make a fortune and can choose the hours they work.

          • Egerton Yorrick

            I left to take up a research job overseas so I can spend a few years seeing my baby son grow up. I would like to return to the NHS but would have to reconcile that with the constant paperwork, political interference, gaps in rotas that need covering at short notice, and (if I may) claims from government, media, and others that we are somehow living in the laps of luxury.

            I can’t speak for NHS GPs but I don’t recognise your description from the experiences of those that I have spoken to. Most developed countries pay doctors more than the NHS: GP friends of mine have moved to Australia for twice their NHS salary and considerably better T&Cs.

          • Rupert

            See lots of your issues are over the NHS.

      • Ralph

        As someone who should be biased towards the medical profession considering the number of them in my family the idea that the NHS is a seven day service is simply laughable. I say this based on personal experience of two of this countries ‘leading teaching hospitals’ and what the doctors in my family have told me. If were you work runs a full service seven days a week then please could you tell me its name as its unique.

        • willshome

          No hospital needs to run a “full service” seven days a week. Indeed patients would get pretty miffed if they were told they had to have their regular check-up on a Sunday – especially elderly people who have no problem turning up on weekdays but may not be able to negotiate public transport when there’s engineering on the line.

          • Ralph

            I’m sure an elderly patient that had been waiting months for an operation would be ‘miffed’ to have it at the weekend, so I’m sure would be working parents who wouldn’t have to take a day off work to take theirs kids to the hospital, or too the thousands who have worse outcomes at weekends.

          • mattoid

            perfectly reasonable, I’m sure it’s sensible to do ingrowing toenail ops at three A.M. on sunday.

    • TS

      Yeah, thinking about it I can’t even imagine why doctors are so highly paid in the first place.


      • Rupert

        Because they promised Gordon Brown they would work weekends if he gave them a huge raise and then they went back on their word and decided to work 3 day weeks.

        • TS

          Never has someone’s name suited their persona so much. What do you do, pal?

          • Ralph

            Do go play elsewhere.

          • mattoid

            “I work in finance”
            We need say no more.

          • Rupert

            I work in finance. And I don’t demand that the tax payer pay me 200k an hour and install infinite nespresso in my common room. I mean what other job do people have a common room where you just sit and chat during working hours???

          • CharlieFDevon

            Doctors do not have a common room and no drinks or food is provided. They work long hours- I was a GP partner working 16-17 hour days! We do not have enough doctors being trained. Rupert go and troll elsewhere

        • Lynne Roper

          Often I’ll see a GP at 8 in the morning, and they’re still there at 8 in the evening. They work long, hard hours. They earn on average £70k. That’s a reasonable amount for the level of knowledge and skill involved. Check your facts.

          • Rupert

            GPs still can choose the hours they work and still earn a great salary. What other business has that? Also in the modern age we have to have a 7 day NHS as many companies make it difficult to take time off work to see a doctor and it would reduce waiting times.

          • ButcombeMan

            From the Telegraph. Maybe your “facts” are less than complete?
            Laura Donnelly, Health Correspondent
            10:00PM GMT 24 Jan 2014
            The number of family doctors earning more
            than £100,000 a year has quadrupled in less than a decade, according to
            evidence submitted to the annual NHS pay review.

            Official documents show that more than 16,000 GPs are being paid
            six-figure sums, including more than 600 on more than £200,000.

            Nine years ago, just 4,000 were paid more than £100,000 a year.

            The evidence to the annual pay review by NHS England, the central body
            which controls most of the health budget, suggests any pay rise for GPs
            is unaffordable, with a £30bn black hole in the health service projected
            by 2020.


            With such funding constraints, the pay review body is urged “to consider very carefully what, if any, uplift is appropriate for 2014/15” before making a
            recommendation next month.

          • Lynne Roper

            Yours is from 2014,

            And another more recent piece from the Telegraph:


            My MP earns £460,000 as a barrister, plus his MP’s salary.

            GPs have a difficult job, and they’re not paid a ridiculous amount for what they do – an certainly not for a 3 day week as the comment I was replying to stated. I’m not a doctor by the way, I was until very recently a paramedic. My pay plummeted since 2010, and people still think public sector workers have it cushy because it suits the government to play us off against the private sector.
            Propaganda spews from this lot at the rate you’d expect in wartime.

          • ButcombeMan

            Doctor or not. In my opinion you are now putting out chaff.
            GPs are plainly adequately paid.
            The contract obtained under Labour seems to have rewarded them well for doing less.

          • Lynne Roper

            I’m trying to make the point that this government will support ridiculously high wages and bonuses for financial services and public services higher management, while denigrating the professionalism, skill and work ethic of public service front line staff, as though we don’t need to be the best.
            Nobody works in our world for money, but we expect to be fairly treated. GPs who earn 100k work 80 hours a week. If they do 3 days, they work 2 or 3 elsewhere like AMU, or they’re part time, in either case they’re not earning 100k. The bureaucracy is massive now.
            Don’t forget CCGs either.

    • willshome

      You really are a Rupert aren’t you?

      We DO have a 7-day 24-hour NHS, for everyone who needs it. No one needs to have their ingrowing toenail sorted out in the early hours of a Sunday morning; you may though, need emergency care then if you come off the road after a drunken Saturday night. This in itself explains the vast majority of the “excess deaths” for weekend admissions that Jeremy Hunt is using to justify his ludicrous new contact, which is going to be hugely unsafe and will undoubtedly cause deaths. It is already causing deaths as some people have delayed seeking medical help until Monday to avoid the wholly imaginary “dangers” of being admitted at the weekend.

      And you are obviously confusing junior doctors who work full time (very full time) in the NHS and those consultants who combine NHS and private work.

      • Rupert

        All NHS doctors work EU hours. They also get very healthy overtime. Having to run a GP clinic on Sunday isn’t that hard when you get paid 1mil a year.

        • Lynne Roper

          Where are you getting your info? The Daily Mail? You have no idea.

          • mattoid

            Definitely a Rupert

          • Michael Barnes

            This nincompoop of a ‘man’ is too challenged to understand or is just a troll..!? Either way he is wasting oxygen and potentially depriving other sentient beings.

        • Michael Barnes

          Are you for real?!

  • Xiao_zhai

    This might clear up some of your doubts. It’s not exactly the most recent data.
    Please note however, the costing does not take into account the cost of living in individual countries. The NHS ranked very favourably on a lot of the parameters excepting one. Others might be ahead but the absolute different is probably small (I do not have the exact figures) I assume as such Because of the pretty standardized practice and guidelines on medical practices around the world, it would not allow a big difference in mortalities, otherwise it would be a negligence.
    Like most healthcare system around the world, you can only wring so much out of the staff’s dedication.
    It’s always easy to target the higher income earners. But we got to ask ourself, considering the hours worked, the qualifications required, and the responsibilities of the jobs, how much would you think is a fair wage per hour worked? During normal banking hours? And outside banking hours? As I can see, the U.K. government had already expanded the doctors’ “normal hours” even on previous contract. Should their hourly wage be 1.5 times yours? 2 times yours?

  • willshome

    One thing that this article doesn’t mention is that Jeremy Hunt is actually pretty dim. He actually couldn’t see that the statistics didn’t justify his argument – even when the people who compiled them said they didn’t justify his argument.

  • Chris Hobson

    These doctors are spoiled brats from the middle class.

    • Egerton Yorrick

      I think you posted this message in the wrong place as it is clearly irrelevant to the subject of this article.

    • Micky Moo Mar

      oi u are a mug! we hav worked very hard to be where we are! We dunt deserve to be treated like this !111!11!!

    • Lynne Roper

      They are from different classes, and they care about everyone. Many chronic and life-limiting illnesses are caused by poverty and deprivation – doctors care about that. So don’t randomly condemn them based on class hatred. By the way, I’m a middle class paramedic. I care deeply about people no matter where they come from. I won’t tolerate the NHS and its staff, who work incredibly hard and under often very difficult circumstances, being treated like dirt by someone who has no idea of their worth. You don’t work in the NHS because you want loads of money.

      • blandings

        “They are from different classes”

        No they’re not. They’re bourgeois and they don’t care about me any more then I care about them.

    • mattoid

      And what brat class are you from, Einstein?

  • DrPlokta

    Dermatology only needs to be a five-day-a-week service, but it makes no sense to have the “down” days be Saturday and Sunday when working patients can more easily attend appointments. How about having the five days be Thursday through Monday with Tuesday and Wednesday off?

    • mattoid

      How about doctors and nurses and support staff get to have families like everyone else?

      • ButcombeMan

        Ah that would be like the shop workers, Firefighters, Police Officers, Airport workers, Coastguard, Rail, Bus and other transport workers, TV and radio staff etc etc

        Going into medicine surely comes with a commitment to working more than 9 to 5 on five days of the week. Just like so many other trades.

  • DrPlokta

    The basic problem here is that the medical profession through the BMA is conspiring to stop there from being enough junior doctors, so that they can all have a career path that lets them eventually become consultants. In most industries it’s not expected that everyone will rise to the top, and it should be the same in medicine. We need more junior doctors working shorter hours, and it needs to be accepted by everyone that most of them will be junior doctors for their entire careers, and only the best ones will become consultants.

    • Mike Henley

      The medical profession have no control at all over medical student numbers. They are set by government in the UK, as they are in nearly every industrialised country. In medicine everyone is in the top 1-2% of academic ability. They are all grade 8 violin, etc, etc, etc. So to say that some must be failures would simply be a waste of the talent. Overall there do need to be more doctors. That is the problem. The government doesn’t want to pay for it.

      • Clive

        From 2012:
        …He said: “The NHS of the future needs the right workforce in place to make sure patients get the best care. The Government is taking action now so that patient’s needs will continue to be met in 2025, and money is not wasted training more doctors than the NHS requires, who could end up having to go abroad to find work.

        “Regular robust contingency planning ensures there is a close match between medical school places, the future demands for care of patients in the NHS, and junior doctors’ training posts so that supply meets demand.”

        The Department of Health commissioned the Health and Education National Strategic Exchange (HENSE) to make recommendations on the size of the workforce.

        A mismatch between students graduating from medical school and the number of jobs as junior doctors has threatened in the last two years with a last minute scramble to find extra posts for all graduates.

        In addition, junior doctors face fierce competition for training places to continue their work towards becoming consultants and GPs.

        The government has long aimed to be self sufficient in junior doctors, training enough to meet the needs of the NHS, without relying on overseas doctors nor losing British trained medics to lucrative posts in Australia, New Zealand and America.

        Reducing the number of medical student places by two per cent from next year will have an impact in 2025 and further reviews should be conducted every three years, the report said.

        Even with the reduction there is expected to be 27,000 more doctors working in 2025 than last year….

    • Michael Barnes

      You seem a little ignorant of the ‘basic’ way the BMA, GMC and government arrange things and the structural requirements of a highly developed society. There is very little conspiracy from the BMA towards creating consultants; I anything it is the latter. The government has repeatedly kept numbers down due to the cost of training. You are correct that there should be many more doctors working more normal hours!
      The workforce plan for last 15 years should have been something like the following:
      Most ‘juniors’ would go into primary care after a more extended, mixed training programme both in and out of hospitals(approx five years post-graduation). The term ‘junior’ would be attributed only to those fresh from basic training i.e. the first 5 years, not 40 somethings with more than 12 years experience. Hospital doctors would be “hospitalists” with accreditation in whatever specialism – these might be called Associate Specialists or Junior Consultants. The more junior hospitalists would be ‘Registrars’ who would be on 4 or 5 year training programmes. They would still be “generalists” with a sub-specialty expertise. Those with more esoteric, super-specialist knowledge developed during research periods or AFTER becoming Consultants would be Clinical Lecturers, University Professors and Senior Consultants within their particular sub-specialism. The bulk of hospital work would be led and provided by the Specialists and Junior Consultants with good general knowledge and only the rare conditions would need the supermen/superwomen Seniors and Professors. Most GPs, of course, would have a greater degree of sub-specialism and work in larger practices rather than in small groups. GP training, having been more extensive would facilitate some GPs to still practice in hospital or pull some much needed skills into primary care for the benefit of sicker, frailer patients. None of these ideas are that new; they have floated around for at least a decade. The medical profession has at times resisted some individual changes mainly because they were not joined up and were poorly thought out. Sadly the government has failed to invest properly in medical training and appropriate workforce planning because of the need to significantly increase taxation. There has been a perpetual reliance on relatively wealthy middle-class families, both UK born and foreign born to supply the medical work-force. Historically this was sufficient but with the changing demographic the numbers will simply not add up…!? Intelligent young people will go where they are valued and respected especially those who are £55K+ in debt. The question remains whether the government will pursue it’s hands-off agenda and allow British medicine to be ‘privatised’ or whether they will adopt a more scandanavian direction.

  • CharlieFDevon

    Quite a good article Max but I take issue with your comment that Hunt and the Government care about the NHS. They want to dismantle it and replace it with a much more expensive and poorer quality private service which will enrich them and their mates! Read Hunt’s book all about this if you do not believe me

    • blandings

      “They want to dismantle it and replace it with a much more expensive and
      poorer quality private service which will enrich them and their mates!”

      The cunning swines!
      Memo to self: Vote Labour, Right On!

    • Pankhurst

      I agree and cannot understand why this point has not already been made it is as obvious as the sticking plaster on a gaping wound.

      The Tories have been opposed to a national health service from day one, now is their opportunity to totally dismantle it.

      The private profiteers have been circling like vultures since 2010.

      Can anyone honestly say that OUR NHS, with emphasis on OUR as we have funded it is getting better?

      Do you not think for one minute that dedicated staff in the NHS including nurses and HCAs etc are not exhausted and totally demoralised. The Keogh and agrsnics reports both clearly highlighted that the care is there but the resources are not that is staff shortages.

      As a regular user of the NHS because of a chronic Illness I can only speak as I find and OUR NHS is not going down the slippery slope it is falling over the edge thanks to unwieldy unnecessary costly reforms and ideology..

      • Pankhurst

        Sorry that should be Francis report.. I pad got a mind of its own…

  • Mel Rose

    Excellent summary of the situation

  • Anthony Kilcoyne

    Deliberately backing Junior Doctors into a corner!


    They need a scapegoat for when every Trust fails to balance it’s books (most already in the red!) and fail to manage demand over the Winter maybe?

    It wasn’t our chronic mis-management, it was the Doctors striking you see…..

    Typical Political blame-games by DH and the Politicians they advise 🙁

    Yours suspectingly,


    • andyrwebman

      It’s not unfeasible that you are correct, but it seems a very risky strategy for any government. Therefore I remain sceptical.

      • Anthony Kilcoyne

        Agreed, but year 1 of 5 is when to take largest risks and they can always ‘Spin’ a climb-down as finding more money for our valued junior doctors etc, if it goes terribly wrong at any point.

        So the fallback position is relatively safe and worth it IF it distracts/blame-shifts the DH and politicised management failures, elsewhere !!!

        Anyway, why wouldn’t the BMA expose failed reforms already, most Trusts in the red and failing badly already, so attacking already over-stretched Junior Doctors is just another Gross error in a series of many, so the BMA are not surprised at such mismanagement from the Top-Down as usual etc.

        That way they scupper the distraction plan and force the DH and Politicians to become solution-based via proper negociations, fairly!

        Yours helpfully,


  • taffyboiy

    Put your money where your mouth is Max and get this article into the Daily Mail where you usually write. If you honestly mean the stuff in this article and aren’t just playing to the gallery – then see to it that it reaches the the biggest market of readers you can. All the junior doctors I know have been at great pains to put their side of the story throughout (on social media particularly, but anywhere they can) since they know strike action ‘out of the blue’ will be viewed unfavourably. It’s obvious though, even to me as a bystander in all this that YOU have a great opportunity to properly help the junior doctors you are claiming to stand by here by educating as many people as possible to their current battle.

  • ExamineIslam

    Clearly if we weren’t importing millions of low paid or unemployable foreigners we would have more money for the NHS for the people who actually pay for it to exist. This is especially true for Muslims who marry their cousins and hence have a far higher proportion of genetic problems of the most awful sort in their children – all of which the NHS pays for. Most Muslim women don’t work and again the state foots that bill. Muslims have far more children than other races, but the cousin marriage means they are of lower IQ and again cannot go on to significantly contribute to tax receipts. Perhaps if we had a government who would deal with this massive problem the money would not be so tight that we can’t afford to pay for healthcare for upstanding citizens.

    • InebriatEd

      I just don’t know where to begin…. So much stupidity…racism… sexism…ignorance.

      I can only hope this is ironic!

      • andyrwebman

        Prove it. Certainly there is a higher incidence of marriage to cousins amongst certain races, and this does indeed result in genetic abnormalities.

        Thus, in order to refute it you would have to provide good solid statistical evidence that this wasn’t an Islamic problem. As for the rest of the arguments, they are all falsifiable if you can find the evidence.

        What you have actually done is assumed that because you don’t like it, it must be false. You have not proved yourself right, you have acted as if you are entitled to be right.

        Not a very ambitious way of trying to write something that isn’t stupid or ignorant. Must try harder.

        • mattoid

          Immigrants consistently pay more tax and take less in benefits than those born in Britain. There. That ok?

          • Bristol_Boy

            Not the majority of immigrants that those who complain are complaining about.

          • MC

            I’m not sure that “those who complain” are distinguishing between groups of immigrants.

          • Bristol_Boy

            Do you wonder why?

          • MC

            Yes, because the superficially economic/fiscal arguments against racism (pressure on public services, housing, no room) are code for “we just don’t like foreigners”.

          • Bristol_Boy

            I ask again, do you wonder why? as events unfold now and previously is it any wonder that ‘don’t like foreigners’ is becoming the watchword. Are you so blinkered to what is going on around you? there is pressure on services, housing, jobs, in fact every aspect of society, apart from the instigators of the problem of course.
            We were told glibly by the political parasites that as Britain has an aging population we need this ‘invasion’ of immigrants, so there you have it, it isn’t the British that is causing the pressure so it must be the increasing influx of untold and unwanted immigrant numbers.
            Now we have yet more atrocities by murderous creatures that detest us, do you advocate as do many liberal bleeding hearts that we should just carry on and ignore these events, pretend they are not happening?
            That is certainly what the political parasites would have us do!

          • MC

            Yes I do wonder. Because saying “immigrants that contribute nothing are bad” or “terrorist immigrants are bad” is a truism. Of course that’s bad and wrong and to be criticised. We do not disagree about this.

            Eliding those people with British immigrants (be they white Irish ones from a while ago, or brown Indian ones from more recently, or white European ones from more recently-still) who work hard, pay taxes and become as British as anyone else is wrong.

            Your posts suggest that you can’t tell the difference between the two.

          • Mary Ann

            It is hard to guess that.

          • Errm, a one word answer “Bullsh(I)T

          • Terry Field

            Source of data?

      • Mary Ann

        I’ve looked at some of his other comments, he means it.

      • monsieur_charlie

        He is right though.

    • Mary Ann

      The NHS would collapse without migrant workers

      • monsieur_charlie

        What has that got to do with anything?

      • Terry Field

        All European states train their own people; in quantity. And employ hem on permanent contracts because there is adequate local skilled staffing.
        They Fund the system by hybrid income.
        Have MASSIVE parallel private supplied capacity. And both know and control costs.
        And, unlike the NHS, do not have a history of refusing to treat, and of murdering patients by neglect or much worse.

      • post_x_it

        Yes indeed, the NHS is excessively reliant on imported labour.
        This is not a cause for celebration. It is a failure of epic proportions.

  • davidraynes


    The efficiency of Heathrow or any other airport or even airline, is not affected by the day of the week, it runs properly because the people who work in the industry understand when they enter it, that it operates for much more of the day than 9 to 5 and all days of the week not just Monday to mid afternoon Friday.

    Health care should be no different. Hospitals and all the kit in them represent a huge capital investment.

    Ryanair and Easyjet are efficient because they work their capital assets.

    So Hunt is correct. Even if the destination of a balanced 7 day system is going to be hard to get to

    The Doctors who do shift work should be paid a basic salary plus a flat rate allowance for their shift commitment, NOT “overtime”.. They should have appropriate time off and overall limits on hours served, both by individual shift and in the month.

    “Overtime” as a concept, corrupts behavior, both of those doing it and of those who have to manage it.

    Those doing it end up often, trying to screw the system, those managing it get to spend more time managing the money than managing the work for maximum effectiveness. .

    • mattoid

      Did you actually read the article? Where is the money coming from? Same number of doctors, more hours, less pay. And of course all those pesky jobs that need to be done by the thousands of ancillary and admin workers. I can guarantee you that there are times of day and of the week when Ryanair are not fully staffed.

      • davidraynes

        I said, the destination is going to be hard to get to. I am not interested in supporting the protectionist, often overtime based mutterings of junior Doctors

        The present system under uses, the expensive capital assets that our hospitals are,

        So Hunt is correct, in concept.

        But I accept getting from where we are to where the health system should be, is going to be tricky. Sorting doctoring out, is at the heart of it.

        If people do not want to work outside Office hours, they should not go into health care.

        We are going to need to put more money into health anyway,

        Feeding more into the present, producer interested system, will not produce the efficiency gains needed by consumers and society..


        • BFenton

          You seem very misled as to how Junior Doctors are paid and what hours they work.

          “If people do not want to work outside Office hours, they should not go into health care.”

          It quite literally impossible to work as a Junior Dr and not be assigned out of social hour shifts. That is not the issue, and if you think they don’t work weekends and night shifts already I would invite you to actually visit a hospital during those times as you will find them. The issue here is they are taking the same number of doctors, increasing the number of hours that need to be covered and then reducing what you get paid for doing them. If I have 10 doctors who need to cover 500 hours of work a week, and then I increase it to 700 hours of work a week, but I still have 10 doctors (it takes 5-6 years for an increase in doctors being trained to actually reach the NHS aka graduate). I now have each doctor working more hours, in a service that is already riddled with overworked staff that put patient lives at risk.

          Then to add insult to injury, you’re told all those extra evening shifts where you’re on shift 24 hours straight, or those 3 weekends you worked this month, will be paid no different to if you had been working 9-5 for many of those hours. So now you’re a highly educated person, with a very expensive degree, who is being forced into a large pay cut with very unsocial hours, who doesn’t actually have to stay in the NHS. No one would accept those changes if it happened to them.

          People with medical degrees can walk into many careers with ease, and with British medical degrees being well respected, can transfer to essentially any healthcare service in the world. What do you think will happen if you cut pay and increase hours?

          As a final year medical student myself with 51 thousand in tuition fees alone, and a total debt of around 100,000, I along with many others will be much more enticed into other careers where I will earn more, not having to sign my life away working even more obscene hours so a family life is impossible and actually pay my debt off.

          And that’s before you even start talking about the amount of money that has gone into training me paid by you the tax payer. So at the end of the day when you create such unrealistic working conditions for a group of people with the qualifications to move to another healthcare system in another western society to be paid more and work less, or follow your friends with 3 year degrees who are already earning more than you will for several years whilst you’re still living in student house shares studying hours a day after working (read:unpaid placements) 40 hours a week, don’t be surprised when they all up and leave and it’s the NHS and the patients that suffer.

          Show me a single other field of work where people who already work nights and weekends (and overall don’t get paid as much as the public imagine for doing it) are told they will take a significant pay cut and be required to work even more unreasonable unsocial hours. Those worst affected are the fields of medicine with the most unsocial hours, the back bone of the NHS like emergency care. I’d love to see another career open it’s arms gladly to those changes.

          And then add on top of all that your view of efficacy – even the very paper Hunt has misrepresented to support his views concludes that the financial impact of running a full time elective NHS system would cost much more than the amount of lives it saves. And in a system where your entire costing for treatments and care are decided if they are allowed using a threshold for how much it costs to provide per quality adjusted life year (QALY), the figures already show that a “7 day” NHS isn’t cost effective. So in the end it’ll be great when you have all this staff around all weekend but no money left in the pot to actually provide cost effective treatment.

          • davidraynes

            Well a lot of words that do not say much. Just more of the same special pleading and fighting against change.

            A lot of medically qualified commentators do not seem to understand the basic concept of working the fixed assets harder to gain efficiency.

            A major hospital is best viewed as a production system for making ill people better and yes I have visited a major hospital at a weekend and seen the almost morgue like state of those enormously expensive fixed & at that time, under utilised, assets.

            The destination Hunt aims for, of working those fixed assets harder is correct.

            Gerry Robinson did a TV program about it years ago, clinicians were resistant then, it seems they still are.

          • Staff in the NHS are not unfamiliar with change.. happens every time we have an election… what the problem is here is Hunt just stepping up and imposing a contract on the staff… This “you will do as I say” attitude is similar to that imposed on such groups as say “slaves”? and thats what Hunt wants them all to be…. to just “shut up ans do as you are told”.

          • Terry Field

            So you like a politicised, soviet style Labour created health model????

          • A what??? My comment was raising the problems concerned wit politicians sticking their noses into the NHS every election time with the hope of scoring a few easy votes…. if we want to go political on it, why did cameron say no reorgnisation of the NHS then appoint lansley to do just that, then he makes such a balls of it he is kicked upstairs to the House of Lords… Now we have hunt whose idea of negotiating is a 24 point document, including the mythical 11% payrise…. not delivered to the BMA who he is negotiating with but “megaphoned” all over the press.
            He then delivers a 24 point document for his proposed “negotiations” of which 23 are none negotiable.. the other point is conditional on what ever is agreed lasting 2 years then we all just have to give in and agree with hunt.

            Only you seem to have an idea of “soviet style Labour created health model…

          • Eric Y

            Fixed assets can’t be worked harder without the additional funds for recruiting, training & paying more staff & the backup logistics, as the article clearly stated and which Jeremy Hunt isn’t putting on the table. Overstretched existing staff can’t magically cover an additional 48hours without extra resources. Your casual dismissal of valid arguments shows you have your entrenched position and aren’t interested in proper debate.

          • davidraynes

            Calm down and read what I wrote.
            I agree more resources need to be put into the NHS.

            That does not mean, that as a first step, the Doctors should not discuss a different way of payment to give better, more flexible cover, for a longer period.

            The problem with Max Pemberton’s nonsense is that he says this:

            “The Health Secretary’s quest for a ‘seven-day-a-week NHS’ is fundamentally misconceived”

            That is just ridiculous rubbish. He must be an an intelligent man, is he really saying that sweating the fixed assets a little more is just not worthwhile? Is he really that stupid? It is what business always tries to do as part of basic efficiency improvements.

            I repeat, this, in my view, is an old fashioned debate, of producer interests, resistant to change, refusing to listen to common sense and the interests of consumers. There is also an issue of the welfare of Doctors to be discussed..

            There is no point at all in throwing money at the current system, as Labour did, if no one will talk about efficiency gains and efficiency options.

    • Rob Gilliam

      “The Doctors who do shift work should be paid a basic salary plus a flat rate allowance for their shift commitment, NOT “overtime”.

      This is, in fact, what happens – junior doctors are paid a basic salary to cover their Monday-Friday commitment, then an increment that is intended to recompense them for the fact that they will be rota’d on-call during “unsociable hours”, so the more hours their rota means they will do late into the evening/overnight/at weekends, the higher their banding supplement.

      Junior doctors do not get paid “overtime” at an hourly rate except when they volunteer for additional shifts beyond their rota commitments, e.g. to cover a weekend when there is a gap in the rota, e.g. due to an unfilled post in some specialty.

      The problem with the proposed contract is that the DoH wants to make “unsociable hours” start later in the evening and to exclude most of Saturday from this definition, essentially meaning that hospitals can rota their junior doctors onto a 6-day week, every week, without penalty if they wish. Given most junior doctors are aged between their mid-20s and mid-30s, i.e. when many are getting married and having children, you can understand their response to this potential threat to their family life, especially given the scarcity of nursery provision into the late evenings and at weekends.

      DoI: married to recent junior doctor (now consultant – wait until Hunt tries to push through his changes to their contract; if the consultants strike then you’ll have to shut the hospitals, as junior doctors are not allowed to work without consultant oversight).

      • davidraynes

        You make my point for me. The Doctors should not strike. They should negotiate.

        The vision of something nearer to a 7 day a week service, is very much in the public interest, however difficult it is to achieve, because the capital value of the resources used (just like an airplane) is so enormous. We need to get to a situation where we sweat those public assets.

        Change is difficult for very many people., The Doctors are set in an old fashioned way of running their business that does not meet the public need. it HAS to change. Hunt is right.

        If the Doctors accept the vision, they just might get public sympathy. If they strike they will not.

        I spent 20 years of my 36 year public sector career, on basic pay plus an allowance to meet “all hours served” plus a “welfare agreement” to ensure I did not work too many hours.This carried on into relatively senior management roles where availability for consultation was 24 by 7 by 365. I rarely felt overworked though I sometimes did many more hours than normal for a Doctor.

        That sort of system I suggest, should be the Doctors stance. If Hunt had any sense it would be his,

        • Rob Gilliam

          Jeremy Hunt should offer to negotiate in good faith – the BMA JDC left negotiations when NHS Employers refused to accept safeguarding doctors’ wellbeing and patient safety as a requirement for the new contract.

          Since then, JH has stated that he will enforce the contract on doctors (in England) regardless of the outcome of the negotiations, and that he is only open to negotiation on one of the 20-odd points at issue.

          I feel sorry for you if you had to work a regular 6-day, 48 hour week for 20 years, although imagine the effect on your family and children if it had been your wife who had to do it (or, as is the case with many junior doctors married to other junior doctors, if both of you had to do it).

          • davidraynes

            Plenty of airport staff work 4 days on 3 off, with each day of 10 hours. That is actually quite a useful concept to think about, for both the Doctors and Mr Hunt.
            It allows for example a rolling, 8 days on four off, covering all days of the week. That might not suit all situations but it is the sort of flexible thinking that seems to be missing from the debate.

            In the end more money will need to go in, but the present system is so sloppy and lacking in customer focus, that no more should be thrown at it.

            Hunt has the right concept, to work the fixed assets harder.

          • And the assets have the right to say no…. and withdraw their labour,

          • Terry Field

            And be replaced.

          • Steve

            By whom? There are staffing *shortages* in many medical professions. You yourself pointed this out in another post.

            Withdrawing their labour, incidentally, actually means leaving the profession (I’m mentoring two medics wanting to switch away from medicine into my field right now) or leaving the country, much more than it means strike action. That is a shitload of very expensive training down the pan, much of it taxpayer funded.

          • Ha…. you seem to be ignoring the inconvenient fact that it is perfectly legal for the Junior Doctors to withdraw their labour… You seem very anti the Jnior Doctors, care to tell us why?

          • Jambo25

            Who by?

          • Steve

            Oh, this was your subtle way of winking at everyone and saying “just kidding, folks!”, right? Because you surely know that junior doctors already work considerably tougher shifts than 4 days on, 3 days off, 40 hours total, right?

            For example, it took about 10 seconds of googling to find this example, from a non-political (ie non-moaning) discussion of shift patterns for junior doctors:
            “I’m a registrar and I do all funny shifts. Last week I did 4 x 12 hour shifts 7pm-7am Tuesday-Friday. The week before, I did 4 x 12 hours 7am-7pm and some overtime.

            Some weeks I’ll work 10 days straight if my wife isn’t working conflicting shifts or my family can help. There isn’t a robotic pattern to our shifts.”

            Let me say this very clearly: the problem of how to get junior doctors to work flexibly, including at weekends and at nights, was solved more than 50 years ago. They all do it, they all expect to do it, it is utterly routine. This is an argument about how much money they get to do it, and how much of it they have to do.

            And it is getting reeeeally boring to keep having to point out that if you want to sweat your fixed assets more, it’s *not enough* to get the junior doctors to add one type of work (planned) to the other work (unplanned work, inpatient care) they already do at weekends. If you want to work your CT scanner harder, you’re going to need to find radiographers, consultant radiologists, receptionists, porters, HCAs etc as well. The only way that’s going to happen is to pony up more cash.

          • davidraynes

            I have agreed ad nauseam that more money will need to go in. Stop ducking the core issue.

            The issue posed by Pemberton is the concept that “full-fat health care” (as against weekend skeleton staffing) is possible,practicable or realistic.

            Be clear, it absolutely is. His article is ridiculous.

            Lots of industries provide much longer full customer service, with that on weekends indistinguishable from that on week days.

            If, in preparing for a much larger population, with a substantial older element, we want to squeeze the sunk costs and the fixed running costs, of large hospitals, we need as a nation, to start moving to that now. It will be incremental, it will be difficult. The current, morgue like state of large hospitals at weekends, is unsustainable.

            If you have trouble understanding this need. Try looking at health care from different “viewpoints”.

            Commentators from the profession, only seem capable of imagining their own viewpoint, mostly that of “the provider”.

            The viewpoint of customers is very different. Not only do they want service to be largely indistinguishable by day of the week, they also want (and society needs) the unit costs brought down over time, by sweating the fixed assets..

          • Steve

            Now hold on a minute! I’m not ducking *anything*! *You* were the one that asserted doctors needed to work 4 days on, 3 days off like airport staff, not me. You thought it was important enough to raise, so how about acknowledging that you did not know that doctors already worked considerably *more* demanding shift patterns than this? I presume you’re not willing to acknowledge this because to do so would directly undermine the comparison you were seeking to draw between airport staff (flexible) and doctors (inflexible).

            I’ll wait to see if you’ll now acknowledge this point, or if you’re just here to argue without listening.

            On the further points you raise in your post:You are assuming that there is a difference in kind between your position (“full fat healthcare”) and Pemberton’s (“skeleton staffing”). There is indeed a material difference between the two of you: you would want a dermatology clinic to be open on a Sunday, because you would argue some patients would use it; he would say that’s a waste of resources. But this is a difference of degree, not kind. You both agree A&E, critical care, etc should be open at the weekends. You both agree that fixed assets should be well-used. You both agree junior doctors should work at the weekends. You both agree that opening up more services at the weekend will require more money (although you disagree about the timings).

            Where you have a true substantive difference is this: does what Jeremy Hunt is doing help move towards opening up the services at the weekends (nobly fighting provider interest), or is it a misconceived effort that will backfire. Ie you think his tactics are laudable, Pemberton thinks (and I agree) they’re spectacularly counter-productive, because they don’t tackle a substantive component of the challenge of opening up more services at the weekend. Getting the junior doctors to work weekends isn’t hard. Shifting to “full-fat healthcare” without spending more money now *is* hard. I’d say it’s impossible.

            In any event, your approach (and Hunt’s) to the question of efficiency, value and productivity is, to my mind, fundamentally flawed, because it entrenches current models of care, which are inherently expensive. It also risks creating supply-induced demand, and tilting the balance of care yet further away from preventative and primary care. It focuses on the productivity numerator (ie input available per unit output) at the expense of the denominator (ie how many units are needed).

            We need to move to radically lower cost, radically higher productivity models with much better outcomes. Many of these models are now well established in developing world countries and are at least as good quality as US / UK / EU healthcare but dramatically cheaper: for example, Aravind Eye Care, Narayana Hrudayalaya cardiac hospitals and LifeSpring maternity care.

            I’m all for thoughtful reform and better use of fixed assets, and for tackling provider interest. I was a huge fan of what has been done in London on stroke, for example, which has saved hundreds of lives and delivered better cheaper faster care. But this is not thoughtful. It’s stoopid stoopid stoopid. I can’t see how it can begin to deliver what Hunt has set as the overt goals, ie 7-day working, so I presume that there are other goals he has in mind.

          • davidraynes

            Well you at least, are getting there.

            I agree that many medical treatments at one time quite advanced, are (barring the occasional hiccup) standard procedures that can be delivered more productively.

            You also though, have a habit, common to many debaters, of putting words into my mouth. I emphatically did NOT suggest that Doctors “needed to work 4 days on, 3 days off like airport staff”. What I in fact said, was that was a useful concept to think about, a rather different thing.

            NOR did I say I necessarily wanted a dermatological clinic open on a Sunday.

            We have a measure of agreement about radically lower cost/radically higher productivity models. The difference between us is that I say that to get there, the capital investments in major hospitals need to be worked for more hours than they currently are and that it will inevitably include weekends.

            What I note about some health care workers, like Pemberton above and today Le Fanu (Daily Telegraph) is they do not understand the need to increase productivity, they do not apparently understand about sweating fixed assets and fixed overheads. these are intelligent people but apparently value for money and how to get it, eludes them. Maybe that is how the NHS affects people.

            I suggest, if one started with a built, fully equipped major hospital and a blank sheet of paper headed “Staff needed” in business efficiency terms, and to maximise outputs against committed fixed expenditure, one would not conclude one was only seeking staff for 9 am Monday to half way through Friday afternoon, with only A&E and care and maintenance at weekends.

            When I walk round my nearest major hospital, that seems to be the way things are.

            There are I observe, other frustrations in the system, A&E has alongside it at weekends, a GP clinic open to all, but myopically any prescription written by a GP there, cannot apparently be fulfilled by the almost always open hospital pharmacy. There must be an explanation, I can imagine what it is, Could it be overcome, should it be overcome?

            Of course.

            Physicians need to heal themselves and their system. The high profile public commentators do not seem willing to even try.

          • Does this “concept” also include the responsibility of rewarding his “assets” for working longer..?

        • Lets look at Hunts negotiations… he has supplied a 24 point discussion document to the BMA.. but 23 points are non negotiable…. Thats not negotiating as I would know it.

          • davidraynes

            I have not followed the detail of the negotiation enough to comment with knowledge. So I will leave that to others Barri.

            All I am essentially commenting on is this nonsense, which heads up the Pemberton article.

            “The Health Secretary’s quest for a ‘seven-day-a-week NHS’ is fundamentally misconceived”.

            It is plain to anyone with a modicum of the most basic, business common sense, that the huge capital assets represented by major hospitals need to be made to work harder. I give some examples where that is done in my other post.

            So when I hear a Doctor write such utter rubbish, I am immediately suspicious that his opinion is just old fashioned, trade union based, producer interest, masquerading as serious comment.

            Hunt is right about the destination. Pemberton is wrong.

          • Hi David,

            We do already have a 24 / 7 NHS… if we accept that the NHS is open all day every day then you have to ask what is hunt is actually trying to achieve..

            Lets take his change in standard hours…. with the tories being the party of “family life” I cant see how that reconciles with them declaring “standard working hours” all day every Monday to Friday and Saturday to 10:00pm… that leaves 2 hours on Saturday and all day Sunday as tory family time.

            Im not a unionist… but will support people when I feel they are being railroaded or unfairly treated.

            Thank you for your comment.

          • Terry Field

            They are employees. The employer can issue a contract. That is how it is in the big wide world. And that is as it SHOULD be.

          • The employees already have an “AGREED” contract, the law give them the right to stand up for themselves including the withdrawal of labour if changes are being “FORCED” upon them.. And this is as it “SHOULD” be.

  • Malcolm Knott

    ‘The study showing increased week end mortality … has since been found to be flawed.’

    As has the research showing that doctors’ incomes will be reduced by 26%.

    The BMA is a trade union and this is an argument about money, complete with the usual ‘nobody wants to go on strike’ mantra.

    • mattoid

      Absolute rubbish. You don’t know doctors.

      • Terry Field

        We know them.
        They are understood. Their preferences and conceits are plain to see.

    • MC

      Can you cite any research showing that doctors’ incomes won’t drop under the new system? The only detail I could find was a DOH calculator which said that, but only because of “protected payments” which expire after a couple of years.

      So . . . no one will lose out, for two years. Rather different than the spin from the DOH.

      • Malcolm Knott

        It’s the 26% I query. My income falls sometimes. That’s how it is in the private sector, otherwise known as the real world.

        • MC

          In a professional job that requires higher degrees where you’re working for an entity (rather than for yourself)? I’m a lawyer working for a firm and my pay has not dropped in the past 10 years. During the financial crisis it was frozen (and the entry level salaries dropped) which is a real term cut not not a numerical cut. This will be the case for most of the larger firms, though of course some people were let go.

          I think doctors get paid fine, especially at consultant level, but if we’re going to talk about cuts from a starting salary in the 20s, after six years of university, where you’re looking at your lawyer, accountant, banker, tech friends earning twice that after 3-4 years of university, you’re going to end up with a staffing shortage.

          • Malcolm Knott

            I’m a lawyer, too. And when you say, ‘During the financial crisis … entry level salaries dropped’ you illustrate my point. (NB. The NHS is in a financial crisis.)

          • MC

            Umm, it doesn’t illustrate your point in the slightest.

            1. I was talking about NQs, whose salaries dropped (after years of increases). Those salaries went up by several thousand a year until around 8 years pqe. NQ salaries are now back to normal. This involves changes to junior doctors generally. In lawyer terms that’s NQs to 8-10 years pqe. A cut across the board.

            2. The contract is stated to be revenue neutral. So it will have absolutely no effect on the NHS’s financial crisis. Neither Hunt nor the DOH have said it has anything to do with solving the NHS’s financial woes. Not sure why you’re suggesting that’s the case.

          • Terry Field

            IT always will be. The model is insane; soviet; lunatic.
            The creation of the cynical and evil Labour Party.

          • Michael Barnes

            That is the central most absurd issue with the “11%” pay offer spin. Apart from being quite disingenuous this pay cut is a ‘mean’ calculation which would particularly penalise the very specialisms where there is a workforce shortage!! Those groups e.g. Paediatrics, Emergency Medicine, Obstetrics would earn less gross income from 2019 and the NHS Trusts that are struggling most would flog these ‘juniors’ for longer resulting in more resignations and even more vacancies. What sort of neanderthal thinks that is an intelligent strategy to maintain services? A serious brain drain is a serious possibility or simply a career in medicine will become the preserve of the upper middle classes. The underlying theme from HMG is the desire to dismantle the NHS mainly because they are so frightened of the need for explicit rationing. Doctors are being used as the fall guys.

          • Terry Field

            You do non-sequiturs well, and logical analysis is a strange to you.

        • Mary Ann

          Thankfully most of the NHS has still not been privatised. It feels kinda grubby for shareholders to make a profit out of the suffering of others.

          • Malcolm Knott

            Shareholders are the people who put up the money. There’s nothing grubby about money but it doesn’t come free.

          • ButcombeMan

            So all those shareholders in GSK and the rest of Big Pharma, are grubby are they?

            All those shareholders whose companies make expensive NHS kit are “grubby” are they?

          • Terry Field

            What an utterly cretinous, really profoundly ignorant, misdirect and absurdly antique comment.
            You display bigoted ignorance.

  • Sean Grainger

    Well at least Pemberton is honest in his arrogance of his trade. Last week I was sent to the Maida Vale Cardiac/Diabetes clinic for a check on a murmur. There were two receptionists and a traffic flow of about one person every 15 minutes. The cardiac receptionist refusd to handle a diabetes patient. Both could have been replaced by a touchscreen system I first saw in Dallas in 1987. This stuff is embedded in the ludicrous anachronistic NHS and we can see it but the Pembertons don’t want non scalpel wielding observers commenting let alone doing anything. The only rigour in the system is rigor mortis.

    • Mary Ann

      It’s still less that half the price of the American system and benefits a much greater proportion of the population.

      • Sean Grainger

        Interesting claim. Where do you get your numbers from?

        • Steve

          It’s pretty widely known and not at all controversial (although the causes and significance are).

          US health spend was 17.1% of GDP in 2013; UK health spend was 9.1%. So not “less than half” but not far off.

          The UK has essentially universal coverage (i.e., the entire population has access to care that is free at the point of delivery). The US was estimated to have about 32m uninsured (9m lower than the previous year, thanks to the ACA).

          • Terry Field

            It is not clever to have a cheap, queuing, poor-out-turn drug-denying, badly staffed, poorly supplied system. It is a sign of political control and the irrelevance of the individual.
            Soviet medicine is nasty, not praiseworthy.

          • Steve

            1. So far as I can see, that has nothing whatsoever to do with my comment. The previous poster asked what data supported the claim that (a) the US spent twice what the UK did on healthcare, and (b) the US had worse coverage than the UK. I supplied answers to those questions.

            2. You make absolute rather than relative claims about the UK, implying that the UK is unusual in having queues, poor out*comes* (you didn’t really mean out-turn, did you? That is a technical NHS financing term), drug restrictions, staffing shortages and weak supplies. And you use “cheap” in a pejorative sense which, given the trajectory of health spend across the entire developed world, is completely mad. When you find a system that is not bedevilled by waits, poor outcomes, drug — and indeed treatment — restrictions, staffing shortages and weak supplies, do let the rest of us know. (Hint: it’s not the US, where payors and providers are now introducing population health management, ACOs, HIEs etc precisely to address several of these points).

            3. That poster child for unbridled capitalism, Singapore, whose health system is regularly ranked as among the very best in the world, has extensive and active political control of its health services. Price regulation, coverage regulation, supply regulation, out-of-pocket costs regulation, national electronic health records, direct state provision of services… all terribly “Soviet” — they even have polyclinics just like many ex-Eastern bloc countries.

            But I suspect you’re more interested in rhetoric than fact.

          • Terry Field

            You make no relevant comments. You are not worth responding to. Go away, fool.

          • Steve

            Really? That’s the best you can do? A dull little insult like that? I mean, it’s obvious you’re not going to attempt to respond to the substantive point, because, well, that would require actual thought, as opposed to just bashing away at your keyboard, and you’re obviously not a big fan of actual thought what with the non sequiturs, fallacies, inability to understand evidence, etc etc.

            But the least you could do is provide a moderately amusing or creative insult, rather than sounding like Mr Sodding T… if not for me or for other readers, for your own sake. Surely it gets boring trotting out hackneyed cliches? A really imaginative insult is something to be savoured, but “go away fool”? You’re serving up Blue Nun here. Have a little class, man. Come up with a bottle of Pinot Grigio at the very least, since you can’t afford the Montrachet Grand Cru.

            The one quirk I did like, however, was the nod to Escher in how you chose to respond to me by saying “You are not worth responding to”. It takes a special something to declare to the world in just six short words that you are the kind of muppet who responds to things that *you yourself* don’t think are worth responding to. As we’re all friends here (I mean obviously, not, but stay with me), why don’t you admit it: there’ve been times when you’ve crapped in your own bed and then got cross with yourself about the mess, haven’t you? Honestly, stick with the adult nappies and you’ll be fine. You can practise taking them on and off and sitting on the potty, and you don’t have to spend time here responding to things you don’t think you should respond to, and God will be in his heaven, the birds will be twittering in the trees, and all will be right with the world.

          • DennisHorne

            Yes, nappies, the man’s obviously an ignoranus.

          • Steve

            Nicely done, Dennis!
            See, Terry? As Dennis elegantly illustrates when talking about you, a little play on words is all you need to upgrade an insult from ho-hum to funny and interesting.

      • Hamburger

        I’m not sure that the American system is what anyone should be aiming foe or using as a comparison.

      • Terry Field

        The most basic US public hospitals have much better health metrics than the NHS. The US system delivers much, much better out-turns.

        • Carole Mosco

          Not true: I lived in the US for 25 years and saw the same problems as in the NHS. These are problems endemic to any large system, which of course doesn’t mean we shouldn’t try to change things. Examples: wrong limb on my daughter marked for surgery – twice. When i pointed this out to administrator, she laughed, as if this was a truly hilarious occurrence. When I wrote to the hospital, I got no response at all. Example: husband injured in cycling accident was helicoptered (unnecessarily: ambulance would have been fine) to local hospital. Tho we were fully insured (at a cost of over $1800 per month), they wanted $36,000 (yes, thirty six thousand) for a 7 minute helicopter ride. It took 3 years, and a lot of determination, to bring the fee down to $5000 – whereupon we discovered that it was against State law for them to charge at all. Example: friend having heart attack was nastily told by emergency room receptionist that it wasn’t his turn. He survived because he was in fact a consultant at that hospital (in another department) so he walked past the yelling receptionist and saved his own life. I could give many more examples, but you can google US healthcare system outcomes yourself for more info. Final small gem: 45% of US bankruptcies are caused by health expenses.

      • Terry Field

        No; not true,it does not benefit huge numbers who receive third rate medical care and dangerous amateurism in many quite dreadful local hospitals.

    • Malcolm Knott

      I sympathise, Sean. I needed a follow-up hospital appointment some time ago.
      Man Behind Desk: ‘We’ll send you an appointment.’
      Me: By post?
      MBD: Yes.
      Me; ‘What if it’s not convenient?’
      MBD: ‘You’ll have to phone in and ask to change it.’
      Me: And then you can send me a new appointment?
      MBD: Yes.
      Me: By post?
      MBD: Yes.
      Me: What if that’s also not convenient?
      MBD: You’ll have to phone in again.
      Me: ‘Why can’t you give me an appointment now?’
      MBD: [clearly losing patience] ‘No we don’t do that.’
      Me: How soon will I hear?
      MBD: I can’t say. You’ll have to wait till you hear from us.

      • Michael Barnes

        I empathise. Reminds one of HMRC or any other underdeveloped government service… However this has nothing to do with junior doctors!

        • Malcolm Knott

          I agree, and here’s where doctors have my sympathy. It must be hard to see your salary under attack when you are doing your best but are surrounded by waste and inefficiency. Harder still when the system requires you to behave inefficiently.

          • Terry Field

            No, overtime premium payments.

      • Terry Field

        Stalin would be proud of it.

  • paul

    Hunt the Tory **** !!!

  • Bayesian_Rationalist

    Excellent, balanced article. Thank you.

  • Binky Tatler

    The amount of money, and last year it was reported in a Newspaper as £100 million spent in 2014 on Interpreters across NHS and other legal services provided in this Country

  • This paragraph undermines the article:

    “In effect, the plan was to use the same number of doctors and just
    spread them more thinly over seven days. Unfortunately the proposed
    changes meant that the vast number of junior doctors who already work
    weekends or evenings would be significantly out of pocket.”

    The EWTD and the appalling ‘New Deal’ regulations will not allow doctors to be spread ‘more thinly’ without some sort of payback. The current financial penalty for breaking these rules may become harder to enforce, as it applies to their ‘out of hours’ pay banding, which under the proposals will apply to a smaller chunk of their salary. However, this financial penalty is a desperately bad idea, and Hunt would not be doing his job properly if he didn’t have a go at the current juniors’ contract, which periodically screws the taxpayer and the employers, whilst damaging training, particularly in the surgical specialties.

    It is primarily about money. See also the GP’s contract. The juniors need to work with Hunt and open genuine negotiations. Neither side is entirely in the right.

    • Terry Field

      OF course it is about money!
      So it SHOULD BE!

  • Terry Field

    The article is cretinous. By international standards, the British NHS is antique, very dangerous, full of arrogant and in many cases comparatively overpaid doctors, and starved of funds and capacity because of the soviet model that all intelligent and aware people see it to be, but will not say so, in order to keep the hordes of the peasantry in the dark.(not my description, that is how these people think)
    I just bet this Pemberton character is in BUPA, Nuffield or in some way advantaged so as to have non-NHS options,
    Britain is more like India than an advanced western state.
    The 7 day system is only novel in Britain.

    • MC

      1. Explain how doctors are overpaid? By any measure (Western Europe, Oz, US) they are paid less than their peers.

      2. You have never been to India if you imagine healthcare is in any way comparable.

      3. By international standards, the NHS is extremely cheap and does a good job on a budget. I live in the US where the outcomes are not that much better but cost twice the price. I may get a slightly shinier hospital but that’s only at the expense of limited/no healthcare for many, and an extreme cost to my employer.

      • Mary

        Well said MC Terry Field is the cretin.

        • PJLennon

          Well said Mary and Terry.

  • gorditoo

    “The government have made a mistake. They did it with the best intentions — they wanted to improve the NHS and improve patient safety.”
    That’s not true. They have done their outmost to wreck the NHS so people start paying private insurance.

    “They latched on to the idea of a seven-day NHS without really thinking it through or understanding the issues.”
    They never think before acting. We have plenty of examples about their ineptitude.

    “They should focus all their attention on ensuring that the critical care aspects of what hospitals do — which is where the sickest patients are — are fully staffed and operating at maximum efficiency.”
    I hope they will start doing that for a change.

  • Aryan_Pride

    This article is obviously satire. So children (who will grow up to be adults someday) don’t have rights to their bodies but parents and “communities” do? The author sounds like a pedohphile. He is trying to say that sexually mutiliating children is a human right.

  • Groundswell

    Found out this week that if you call an ambulance in Aus or NZ – you can expect a fat bill.
    Anyone spot the safety hazard implicit in THAT?