Agreed, again poor/insensitive choice of words on my part.Originally Posted by benny.c
I’ve said he should be paid more and his original post was spot on. You’re not reading what I posted.
Me too, so apologies for that. I should have just said you seem to be reasonably financially stable which is no bad thing at this moment in time.
Last edited by benny.c; 27th November 2022 at 12:32.
Aye but isn't that the rub...the big take away beyond I think the universally acknowledged point that you deserve more for what you do,...Even on 80k you're still struggling to make the nut, having to make it stretch by going to Aldi, buying some things second hand, no doubt forgoing certain things...that's nuts, only serves to illustrates how badly mismanaged myriad factors have been allowed to become...the UK got less liveable, society has become more bifurcated.
How the hell the millions on 20, 30, 40, 50k are going to live going forwards, it's going to mean profound, lasting changes to society...to paraphrase the IFS chap, you all just got a whole lot poorer.
Last edited by Passenger; 27th November 2022 at 12:50.
Correct
Hardest course to get into at university and then the level of study is horrendous.
An absolute affront to pay them on that level
I'd be voting to strike but also consider a career change .
We aren't on 80 as a household at the moment, far from it, as wife is on mat leave raking in around £600 a month.
Apologies I should've paid closer attention to your posts...the fundamentals still stand though, it's a high tax, high cost of living/ expensive old place.
Genuine question, how much do you think the UK should spend on the NHS? I think currently it's somewhere around c£136billion with c1.2 million employees. (stand to be corrected if it's far out). If we agree it's not enough, what figure do we think would cure the present problems we are seeing?
Started out with nothing. Still have most of it left.
Of the G7 group of large, developed economies, UK healthcare spending per person was the second-lowest (£2,989), with the highest spenders being France (£3,737), Germany (£4,432) and the United States (£7,736).
As a percentage of GDP, UK healthcare spending fell from 9.8% in 2013 to 9.6% in 2017, while healthcare spending as a percentage of GDP rose for four of the remaining six G7 countries.
Being as out of the G7 ours is the only universally free system, I would argue if we want to see a good system we need to spend more than Germany.
Wasn't there some bloke, fat chap, sloppy dresser, unruly hair, going around the country vowing, to spend 350 million more per week
So although the other countries were higher spending per person, it was a mixture of private and public spending then?
As the percentage of GDP fell, did GDP rise, so in real terms the spending was rising as well?
Started out with nothing. Still have most of it left.
People all agreeing that much more should be paid into the NHS for wages but where is this money coming from?
Via the taxes of others also being hard hit at the moment?
Cheers,
Neil.
The total sum of what's spent/per person is an indicator, but needs some clarification. E.g. ICU beds; The Netherlands has 6.4 beds/100000 people. The UK a only little more per 100.000. But Germany has 28(!) fully functional ICU beds/100000 people, complete with a trained staff. My former sailing buddy form my uni time, used to be a doctor in Paris right after graduation. (A master's title in French language & literature + a full education as a doctor; now an oncologist). From that source: French doctors are very quick when it comes to pills, medicine, casts for arm, wrist etc where we (Dutch) try to keep it as 'normal' as possible.
A pic. In Dutch, but I'm sure you're able to translate the names of the countries. ('Verenigd Koninkrijk' = United Kingdom).
Last edited by thieuster; 27th November 2022 at 15:01.
It was written on the side of the bus. Boris got this
Striking is the socialist method of applying market forces. Those that are needed by society will get what they want by muscle power and will end up being well paid due to strike action.
Those that have no muscle or those whose strike action is not noticed will just get nowhere and will become paupers and the rich workers will not give a damn.
You cannot really blame essential workers for taking advantage of their position.
That was what happened in the 1970s and is about to happen again. History will repeat itself.
The hardest hit back then were civil servants because when they went on strike, the government saved money and got the kudos of keeping taxes down. There was a strange situation in 1974 where inflation hit 24% and the civil servants had pay increases of low single figures and it was calculated that a retired civil servant on an indexed pension would soon receive more money than the person doing his old job.
Yes taxes. The UK cannot have it's cake and eat it. If we want a free at the point of access healthcare system we need to all be taxed for it. If we don't and would prefer to move to a more private healthcare system then so be it but in the long run that would cost more per head for most people in health insurance. The NHS is stinking good value for money but that is partly because it runs on goodwill of it's staff. The goodwill has run out.
And the people being more highly taxed would be striking for more pay etc etc ad infinitum.
Cheers,
Neil.
Ah the "blue pill".
"Once is happenstance. Twice is coincidence. The third time it's enemy action."
'Populism, the last refuge of a Tory scoundrel'.
I am not actually sure that would be true. Low wages tend to lead to strikes, not high taxes - in this country anyway.
At least with taxes, the burden is shared among society rather than the poor sods that were stupid enough to choose a career in the public sector because of their silly values and morals.
They could start with the money wasted on HS2 or dodgy PPE deals! There’s always money it’s about priorities, don’t be so naive.
At least with taxes, the burden is shared among society
Taxing those who are also already on the bread line and earning well under 44k a year.
So you want to tax people who probably cant afford it so you dont have to dabble in to your savings?
Last edited by Franky Four Fingers; 27th November 2022 at 15:54.
lolz it's so unequally shared it's not funny.
A bit, yes, with a heavier load on higher earners. It is those on under 44k that will be hit far harder than a small tax rise when the NHS no longer provides them with healthcare.
Surely part privatisation is the answer. Pay as you go with the price being based on ability to pay.
In my opinion yes, you are right. Starting with a £10 fee to see or speak to a GP which you don’t need to pay for if you, for example, qualify for free prescriptions.
Not sure this will happen though as it will not be a vote winner. You see most of the UK feel entitled to healthcare but are not very inclined to pay for it in anyway. Hence, the mess we are in.
Last edited by watchstudent; 27th November 2022 at 16:13.
Situation in this country now where we have thousands of low earners who cant afford to look after themselves due to rising costs, I'm rather staggered you’d like to see those kinds of people put in to a worse situation so you didn't have to dip in to your savings. So genuine question here…..paying you an extra 10+k a year, that would clearly help you but would it make for a better NHS? You could argue the additional load on the NHS caused by people becoming ill due to not being able heat their homes, malnutrition etc as a result of higher taxes could put it in to a worse situation.
If you can try to move away from me, personally, that’d be good because it isn’t that relevant.
But yes, one of the first parts of improving the NHS is to retain the talent we have and plug staffing holes with permanent staff rather than more expensive locum or agency staff. If you pay people like they would be paid in AUS/NZ then they won’t move there! They will stay in the NHS. If you improve staffing then the job becomes better and safer for staff and patients. Then you attract better people into the roles.
So yes, paying “me” 10k more a year will help the NHS be better.
Would you rather have a doctor making your life or death decisions be content at work and not be overworked and sleep deprived? Because it has been proven that decision making gets worse with fatigue and stress.
Last edited by watchstudent; 27th November 2022 at 16:26.
National crisis on all fronts these days sadly. Many strikes in many sectors guaranteed.
Tbf people are only asking for the higher wage economy which was promised once we left the EU?
Yes. That's how public services work.
The NHS cannot function due to lack of social care places shortages (wages are even lower) so all the old folks clog up beds that are required for new patients & the full ambulances sitting for hours outside.
Everyone says give the NHS more money but this won’t fix the problem, just look at all the levels of management sucking the balance sheet dry & these are paid more than nurses in many cases doctors/specialists the higher you go!
Get rid of the red tape & all the duplicate management jobs & free up the cash to sort the problem.
If you don't pay doctors enough there won't be enough doctors.
The grades needed to gain acceptance onto a medical degree are high and similar to requirements for Law, Economics courses at good universities. So instead of being a doctor someone decides instead to go to LSE to study economics, enters UBS after the degree is completed and within 5 years is earning £150k and within 10 years £250k+. Surely much more interesting than earning £50k a year under intense pressure.
That's not helping low earners either.
Pay people what they are worth and go find the money to do it. Else you'll lose them
Paying someone 10k extra a year Ryan to keep them happy will only work short term whatever profession you are in, if the working conditions are terrible it makes no difference. Ok it may give that person a kick in the right direction but the problems don't go away and in most cases get larger.
Im not arguing that point anyway, I'm arguing the point of taxing huge swathes of the community who earn well under 44k a year and have little savings who are already on the bread line struggling to pay bills and put food on the table.
Going back to your first statement, if the working conditions were better the problem would be nowhere near as bad…surely meeting somewhere in the middle would be a start rather than throwing money at the problem?
But the appalling working conditions stem largely from understaffing which stems from people leaving the NHS. If you fill the staff roles then working conditions get better. Working on a ward with 2 doctors not on the rota can be hell and very dangerous for patients (happens all the time by the way), a day with a fully staffed rota can actually be enjoyable and you are a much better doctor as a consequence.
The ironic thing is is that these staffing holes are often filled with locums and agency staff which cost way more than the permanent staff (even if you gave them a 20-30% pay rise).
The argument about taxing struggling people doesn't really stand because it is these people that will suffer the most when the NHS becomes untenable because of... staffing.
There are other problems granted, too many managers and wasted money, sure, even with that the NHS is incredible bang for the buck.
To me, this is the biggest issue with the NHS. Management heavy, even bed movers are on above average salaries.
I've a friend whose a Trust manager and he's told me his wage is, "obscene".
The whole of the NHS needs a management shake up so that the nurses at the sharp ended get a decent wage.
The other issue is huge losses by theft.
When you refer to bed movers can I just ask who exactly do you mean...if you mean the Porters, those people who transfer patients and equipment from one place to another, which seems likely, then a quick google suggests they're on around 18K on average...iirc UK average salary is somewhere around 27 to 30K...So you would seem to be spouting nonsense...though I've an open mind if you'd like to add anything...
I don't think hospital porters are the ones being meant, unless you think they're part of the 'Management heavy' being referred too.
R
Ignorance breeds Fear. Fear breeds Hatred. Hatred breeds Ignorance. Break the chain.
He could have as likely been contradicting himself for all we know. Management usually don't move furniture/ patients or stock, and there was the diminutive '' 'even' bed movers are on above average salary''...seems confused as Management by virtue of their position are generally on above average...As observed a bit confused, contradictory seeming...hence interested in any more detail...who do you think he might've been referring to?
maybe these guys
https://www.britannia-movers.co.uk/b...pital-removals
not really important.
Last edited by Passenger; 27th November 2022 at 19:37.
regarding staffing issues and having done work in the system myself the levels of people on sick leave within the NHS is off the scale - and ive seen first hand how quickly staff get better the day after the 6 months at full pay is up at my local trust , regardless of pay levels the whole system is set up to fail no matter how much money you throw at it due to mis management.
Here here.
In NI last week we heard of another GP surgery handing back it's contract because it couldn't safely manage with it's current resources. The NHS is collapsing due to chronic underfunding, if you care about it's future, strike away, and I fully support you and your colleagues. If you don't, you're better off emigrating. It's a stark choice.
I haven't read all of this but you've got my backing to strike, as have every public sector group who've had their pay eroded under years of Govts to the point where many are substantially behind in real terms compared to years ago. This Govt have willfully mismanaged the NHS, the Police and Education to the point where recruitment is a major issue. Ryan's example ^ says it all in terms of how public sector workers are under valued and it needs to change!
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I think everyone has sympathy with the junior doctors situation and support improvement.
The solution is simple in that the government needs a root and branch reform of its various organisations.
There are people in the NHS making huge salaries, same in other civil service positions. I have a friend in Network Rail with no qualifications and is not a particularly bright bloke who earns a vast salary and is often on the golf course/working from home.
We don’t need to raise taxes to fix the problem for junior doctors, nurses, carers and many other key workers we just need to redistribute the state payroll to the right places. Starting with cutting MPs.
So has the money! Unless the basic rate of income tax goes up to 35% the NHS will become an insurance based 2 tier system where GPs and the Local A&E or Trauma centre are free and everything else is on an insurance based system. Even social care needs sorting, when carers are doing 80 hours a week and only getting 9.60 an hour and having to pay there own fuel between calls is a disgrace.
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As a consultant for 22 years, therefore somewhat of a dinosaur, I have looked at what my awesome junior colleagues get paid
This shows the scale
https://www.nhsemployers.org/system/...-MD-3-2022.pdf
In addition to this most doctors get a supplement called banding. Most of my colleagues are on a 1A banding, but they do have to work a lot of antisocial hours, and have a higher weekend frequency.
This is how banding works
https://www.bma.org.uk/pay-and-contr...-banding-works
I did spend an hour writing an analysis of the current issues the NHS faces, as well as my perspective on the BMA dispute, but on reflection, thought I would post pay information, for what is essentially a pay dispute.
Dave
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So on the bio front, I'm an NHS A&E consultant.
I didn't go to public school, I'm not the child of medics. I graduated 16k in debt and as a 19 year old if you'd told me that going in, I wouldn't have gone. Now unless subsidised by parents it's 100k. Oh to top if off as medics you have to pay a higher rate if interest despite the course being longer because you earn more.
From the financial crisis in 2008 the pay was cut in real terms.
Of the A&E consultants I trained with over 1/3 are no longer in the country another 1/3 are part time or have left the speciality, there is a worldwide shortage of us. I get 2-3 invites a day to go elsewhere for 3 times my salary. We are always short staffed, in A&E the locum rate is so low that we pay, we never have a full staff, especially out of hours.
Money can be found to pay the pensioners the rate of inflation, yet not the people working to support them.
On another forum someone said, "remember how people were paid to stay at home, well the countries credit card is mazed out, there is no more money". Actually I don't remember this as I was working and the covid patients who were dying but somehow still conscious will haunt me forever. I remember holding their hands and explaining what was going on, I remember having to tell their relatives but not letting them in and trying to find ways round the rules.I remember the first wave when PPE was basically a bin bag and a mask for sanding and trying to do CPR in it. I remember hearing of people I worked with dying from it.I remember the first wave with the clapping and public support and not wanting it. I remember the much worse second wave when we needed the support and didn't get it and had to deal with a resentful public who thought we were the enemy.
I come from a time when we did the crazy hours, as a house officer 1 week in 3 I did 136 hours. Went 3 days straight without sleeping, but it was better then shifts which really mess you up destroy and shorten your life.
The real question is the difference in children of medics, when I went to medical school at least 50% had one parent who was a medic, most of my colleagues advise their children against going in now.
Something is messed up when I get paid three times as much doing medico legal work or injecting botox as I do working in A&E, you can see which job I'm planning reduce my hours in.
I get the line, it's not a job its a vocation, and it was. But the Country and NHS broke that agreement first with independent review bodies who would only recommend a maximum of what the government has decided. That's not independent. All the benefits and support removed. They turned it into a job, so now a job is all it is.
The system is breaking, my department,is full of patients, if you go to a&e plan on spending a day there our wait is 4-6 hours and that's just to be seen not sorted. While there wonder if the staff are over paid.A&E as a specialty is dying, we are losing more consultants to retirement and overseas then we are training to replace them, we can't fill our training slots because the juniors like the specialty but look at our lives and say no thank you. I can't blame them.
Despite all this, I love what I do, having someone acutely unwell being rushed in and then reassuring them that you have them is a great feeling, picking up things which have been or almost have been missed, spending an extra 5 minutes to stop and explain why something is happening and seeing people understand.
My advice is to strike, do it, do it properly, hit the NHS when it is weak and can't respond. If you go on strike you have to be willing to do what it takes to win.Look at the tube drivers and rail workers. Alternate between the nurses and yourselves. Provide the cover that is provided at night only. Personally if I was organising it'd strike over the Christmas week.
If the country decides that you're not worth it, then the country can live with the consequences. They can wait for ambulances, wait in a&e, wait for an appointment in the end its their decision.
Don't trust the BMA, last time they took the legs from under you because knighthoods and quangos where offered to those who were meant to be supporting you (I had a friend on the negotiating committee)
Finally just to give you an idea how bad it is, I'm a consultant, I can talk to my colleagues direct and get looked after, I get to access almost the very best of the NHS. But I have the very very best private healthcare because despite this, I know what shape the NHS is in. I consider it a bargain as it costs me less then my identity cover.
So as someone who's been in it for 22 years it would be interesting to get your overall take on it…will throwing money at the problem make it better?
Probably not if the pension was £88,364 to £119,133 per year.
Started out with nothing. Still have most of it left.
Ok, slightly against my better judgement, this is what I think.
I’m an NHS Consultant in Emergency Med, and have been for 22 yrs. It has been sometime since I was a junior!
Before the issue of pay / strike, it might be helpful to think about the state of the NHS, what might fix it, and where junior doctors pay and conditions have come from.
From my perspective, which is solely Emergency Dept based, the NHS has never been so pressurised, or so dysfunctional. Up to 4-5 years ago, it was a winter phenomenon, but it’s now all the time.
It isn’t a simple matter of resource. When I was appointed in 2003 (second cons job), I was number 5, which was 4.5 whole time equivalents. We now have 16 consultants and this expansion has been mirrored across all grades of doctor and nurse clinician. Our main issue is a hospital that has over 100% bed occupancy, with an explosion of demand from frail elderly that almost always need an in-patient bed, as they are sick. Our walk in stream of the less sick has also increased massively, and part of this is driven by difficulties in primary care access. There is nowhere to see patients, they queue on corridors and up to 18 have to be looked after by paramedics. Doctors and nurse clinicians can’t be effective or productive in that environment. It isn’t safe, it isn’t dignified. Ambulance response times are now hours, as the paramedics are stuck in hospitals.
I don’t deal with elective work, but pressure from emergency patients constantly pressurises this, and this includes vital cancer work.
Junior doctors pay and conditions
Obviously I’m out of this. In some ways they are much better than when I was a junior. I used to work 1:3 weekends, which meant Friday 8am to Monday 6pm without a break, the bulk of my hours being paid at 1/3 of time, I don’t mean time and a third.
Todays doctors do have a lot of antisocial hours and weekends as it’s a 168h a week service. There are enforced rest days, 4h education a week and personal development time. I think the hardest thing for my colleagues is having to consult in cubby holes and corridors. They are amazing young people, but the structural impediments to them working the way they feel they should must be hard. They are relatively protected now from high risk decisions, as much of the clinical risk is transferred to consultants. My juniors can’t discharge a feverish infant, an adult with chest pain, someone who reattends with the same issue, or admit anyone lest we ok it.
What about juniors pay?
I don’t really know these days, so I’ve had a look.
Take the example of a Specialty Trainee in year 3, ST3, so 5 years after graduation with another 3-5 years until completing training.
What do they get paid, assuming a 48h working week with a weekend frequency of 1:4 or greater?
Basic £51107
1A banding is another 50%, so £25553
Total £76600
There is also a fairly decent pension scheme which relates to final salary. At this level a 13.5% contribution from pensionable pay is £4140 net, yet that is worth 1/54 of final consultant pensionable pay CPI linked.
Is the grass greener elsewhere?
When I was responsible for Foundation training, half of our doctors used to go to Australia or New Zealand , and a chunk never returned. This ceased close to 10 years ago, as Auz / NZ had enough locally trained doctors. Since then we have seen them do a bit of travel, a couple of years of locums before returning to training in the UK. If not sure the antipodes have the capacity to soak up a lot of UK graduates.
What about the commercial sector?
I’ve never worked in industry, but to get an equivalent salary in the long term, I suspect it’s going to need long hours and productivity or you are out. The NHS doesn’t get rid of people easily. There are significant numbers of trainees needing extra support who are looked after by the NHS in a way that contrasts sharply with what I think a commercial organisation would do.
The NHS is failing, but it isn’t as simple as just funding.
I don’t have the answers, but I think it needs a total structural rethink, not pouring cash into the current structure.
Separating elective and emergency hospitals, so the most complex work could be done in an elective unit, not just the usual low-acuity activity might be a start. It needs protecting from a unscheduled emergencies
There needs to be a massive expansion in social care beds, and medical support to avoid hospital. When the elderly fall, or become unwell, a care assistant on a low wage is going to call an ambulance and then you are in hospital. You can’t blame them for that decision.
A lot more clinicians, not just doctors but also nurses, and paramedics,in ENP and ACP roles. Nurse clinicians are amazing, and I’m sure there is a role for Physicians Associates too.
We have recruited lot of doctors from Nigeria, they are amazing, and the best that the country produces. I’m conflicted, as Nigeria needs their skills.
Should doctors go on strike? I don’t know, but if they do I would be honest about the issue being pay. I would be clear about banded pay, job security, career progression, guaranteed pension. Conflating pay with other issues such as patient safety, crowding, delays to be seen, cancelled activity isn’t correct.
Dave
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That's a very interesting summing up, and quite different to the usual things I hear.
Started out with nothing. Still have most of it left.
Honest question. Do you think that's a lot of money for the amount of study they have to do, the responsibility they have and the entrance criteria in the first place? Especially compared to what people of a similar ilk earn in the corporate sector?
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