Junior Doctors, Senior Problem

For the benefit of non-UK readers, you probably know that we have something called the National Health Service (NHS) which is basically free health care to every British person so we don’t need to pay private health bills, although some do opt to do so. This was the major demand of the people post WW2 and it was established by the opening of the first NHS hospital in 1948, by the then health secretary, Aneurin Bevan.  As you can imagine, the NHS is a massive organisation with pools of money to help care for and keep British people healthy. The issue here that as the NHS is state owned, the medical staff; doctors and nurses are working for the State, similar to the military, so their pay is decided by the government.

The British government set out to keep junior doctors working seven days a week but without a pay rise, to save money over the weekend, of course, junior doctors in England (where this is happening) are not too happy about working longer shift for the same or less money. But who is to blame?

The government knew this was going to be a problem, clearly to force junior doctors to work longer for less money was going to stir up a hornets’ nest and yet, after going to battle against teachers, local government, the police military, they still haven’t seemed to learn any lessons.

The problem of the cost of the NHS isn’t solved by just attacking different groups. Most people accept that the government has to do something about the cost, it expensive and overstretched and needs fixing, as does the military, the banks, the BBC,  local government and education, but the politicians just don’t spend any time actually working out a viable scheme, or of they do then they are woefully inadequate at finding solutions.

Junior doctors make up a third of medical staff in the UK, around 55,000  – here is where the issue starts. A junior doctor starts off earning around £22,000, which is a good wage to start with, almost the nation’s average, but you have to add in un-social hours and difficult working environment, so it’s understandable that doctors can earn up to 40-50,000 pounds – however, anything higher starts the strain and the problem is that more senior doctors, consultants, and general practitioners (local doctors) are earning 70k upwards, with many earning more than 100k – which is excessive and causing the problem.

It is very expensive to train to be a medic, but when you grow to a senior role you can then move into the private sector and supplement your NHS salary with an equally good private one. Hence the massive increase in doctors children going into private education – they have much more disposable income than they have ever had before. The NHS isn’t a cash cow but there are some who are killing the goose that lays the golden egg as those at the top work part time in the NHS for a full time salary (and a very big full time salary) So how do we fix what is a growing problem, one which will only get worse as people get older and society is less capable at looking after an aging population. Putting junior doctors on sensible hours for a decent salary – 35-hour week shift for £25,000 is fair but we need a government brave enough to cut the senior and GP’s salaries to bring them more in line with a rational salary scale for the profession with sensible increments as they go up the ladder. The other problem is that hospitals are run by trusts which are government owned but allowed to be managed by a large raft of non-medical staff and the over management of the NHS puts millions of pounds into the pockets of ‘executives’ that don’t add any value to the organisation.  That needs to be slimmed down and again, they need to be put on a sensible salary scale – the old adage ‘you have to pay more to get the best is rubbish’ If there is one common pay scale across the country then you remove that entirely. And before some vested interest pipes up, no they are not competing to attract people from industry – there are plenty of good administrators who will do the back office work of running a hospital for a decent salary structure.

So here is my solution Mr. Hunt. Strip the top layer of management roles away create a board of procurement that buys for the whole of the NHS instead of each trust doing it themselves and have central ordering. With the technology we have today we could set up a ‘next day delivery service’ amazon style, for our health service. We then have a slimmed down management/admin in each hospital. Next, renegotiate consultants wages and make them work shifts so they do actually work 35 hours a week minimum but we have 24/7 cover. Same for GPS, as health care can’t be 9-5.

Medical students should be funded, so no student fees for them, making the five/ six years an investment by the country and doctors and nurses can qualify without their wages being bitten into with repayment loans. Reinstate Matrons and senior nurses, placing them back on wards where they belong (and used to do a fantastic job) so they run the hospital on the wards, instead of working behind a desk, and make it harder for people to sue the NHS – so unless it ruined your life you shouldn’t be able to sue it at the drop of a hat, this isn’t America.

GPS need to be better trained and tasked with doing minor surgery in their local medical centres, rather than clogging up the hospitals with their constant referrals. Finally, Mr. Hunt, go after supermarkets and sweet companies with a health tax to reduce the sale and promotion of so much rubbish food that is creating obesity which will then fund the burden they place on the health service.

The argument will carry on and, yes, of course, junior doctors should feel valued, comfortable and confident in their work, but lifting their wages and not tackling any of the million of issues wrong with the NHS is just going to lead us down a path to its inevitable destruction, and undo all the hard work our post-war heroes did for us by creating it. As usual in British society, we have to tackle the problem from the top, not the bottom, we have got more admirals than ships and a whole lot of mismanagement!

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