United We Stand

Alex Ashman ponders the need for a united left movement.

There are too few houses, because the government don’t build them any more. There are too few jobs, because government austerity is preventing economic growth. The NHS is suffering, because the government refuse to fund it properly.

But with the current system, it is hard to fight back against the government. The 51% win for Brexit looks slim when you consider the 63% who voted against the Tories last year. There was a huge protest vote, with a swing towards the Greens, SNP and UKIP, and yet the Tories remained.

And then people were given another outlet for their discontent. Some of those voting Leave will have done so in protest of the lack of housing, jobs and healthcare, thinking the EU was to blame for their woes. But once more, the government remains the same, and so nothing will change. Who will people blame next, once they realise that the problems are still there? Nationalism is on the rise, and populist right-wingers will continue to blame migrant workers and benefit frauds for all our woes. Just because Farage has won his precious Brexit doesn’t mean he’ll retire and go home. Quite the opposite, in fact.

If ever there were a pressing need for a united left movement, now is the time. Voters protesting against the government need to be offered an alternative narrative. A narrative that recognises that the real villain lies in Westminster, not Calais. A narrative in which austerity is rejected and public services are properly supported. A narrative in which Britain is great because we support each another, instead of blaming one another. Until the left unites, though, the Tories will continue unchecked. Action is needed, and soon.

Open Letter from Dr Clive Peedell to Jeremy Hunt regarding the legality of the latest top-down NHS reorganisation

To the Rt Hon Jeremy Hunt, MP, Secretary of State for Health

Dear Mr Hunt

I am writing to you on a subject of great urgency regarding the changes to the NHS proposed on 19th May 2016, by Simon Stevens, CEO of NHS England.

Mr Stevens has suggested that the health service could create a form of ‘combined authorities’. He talks of spanning hospitals and commissioners and consolidating CCGs.

These proposals appear to run contrary to the provisions of the Health & Social Care Act (2012) and contrary to the stated objective of the Act of a locally driven commissioning service provided by GPs, who have an intimate knowledge of their local community needs.

Whether or not the CCGs have fulfilled this function satisfactorily, they are, nonetheless, a legal creation. I am, therefore, asking for clarification of the legal status of the changes being made under the Sustainability and Transformation Plans.

Mr Stevens has also referred to removing veto powers. Does that mean, in effect, that no-one will be able to object to changes as they will be imposed? Could you clarify which powers are being removed, under what statute were those powers granted, and what legislation been passed to allow their removal?

This announcement was paired with the publication of the funding allocations expected for 2020-2021. Mr Stevens said that these numbers would give a better focus than the funding ‘gap’ numbers people try to come up with. His predicted figures are shockingly low.

I do not write as a legal expert, but as a doctor with great concern for the impact of these extensive changes on my patients. I ask that you clarify with urgency the law that is being used for these changes which are happening on a large scale with great speed.

My specific concerns are about transparency, responsibility and accountability. There does not appear to be adequate time to prepare proper risk or equality impact assessments.

I look forward to hearing your response on these serious matters.

Yours sincerely

Dr Clive Peedell
cc Rt Hon David Cameron MP, the Prime Minister
cc Rt Hon Jeremy Corbyn, Leader of Her Majesty’s Opposition
cc Hon Heidi Alexander, Shadow Secretary of State for Health

#PublicDuty Twitterstorm

Last January, we organised a mass-whistleblowing. NHS campaigners and staff united to send 30,000 tweets exposing the Tories, with the hashtag #PublicDuty trending UK-wide on Twitter that day. The catalyst was this tweet from Dr Clive Peedell:

clivetweet

Now we’re calling for a repeat performance. The Tories have done nothing in the last year but anger and upset thousands of NHS staff, patients, and members of the public. We want to take that energy and focus it, exposing the Tories with a coordinated action on the eve of the next doctors’ strike.

Here’s how you can help:

  1. Sign up to our Thunderclap campaign, which will schedule an automatic tweet for you at the start of the Twitterstorm.
  2. Join us on Twitter at 7pm, Tuesday 8th March and tweet with #PublicDuty. We suggest tweets along the lines of “As a (job) with (number) years NHS experience, it’s my #PublicDuty to inform you that the Tories are dismantling and privatising the NHS“.
  3. Use the Twitter search box to find and retweet other #PublicDuty tweets.

Thank you in advance for your support. Together we can cut through the spin and send a clear message to the public.

An All-Out Strike?

On Thursday 11th February, Jeremy Hunt announced that he would be unilaterally imposing a new contract on front-line doctors. In his infamous imposition letter, Hunt claimed he had the support of a whole raft of NHS CEOs. In fact, most of them had never seen the letter and did not agree with the imposition.

The BMA had proposed an alternative contract that was ‘cost-neutral’ (no more expensive than the existing deal) but kept Saturday as a weekend day with appropriate pay. Hunt couldn’t accept this because of his obsession with a ‘7-day NHS’, which we all know already exists. He therefore vetoed all such deals offered by the BMA, preventing any settlement that might scupper his plans to force doctors to work extra weekends for no extra pay. To add insult to injury, Hunt claimed that no doctor would work consecutive weekends, and then published ‘example rotas’ that had doctors working three weekends straight.

The BMA has now asserted that, by failing to provide “appropriate funding for the required level of workforce needed to deliver safe services and adequate training”, the government has broken the original ‘heads of terms‘ agreed during the initial negotiations in 2013. There will be no more talks based on ‘cost neutrality’ – that horse has now bolted, and the BMA will settle for nothing less than a fully-funded workforce. As Dr Johann Malawana of the BMA puts it, “We also know – and the public understand this – that if the Government wants junior doctors to take the brunt of delivering more services across seven days, they need to put their money where their mouth is.”

So will we be seeing an all-out strike in the coming weeks and months? The BMA have made it clear that they do not take such action lightly, and have done all they can to avoid harming patient care. But with the Conservative government working to impose an unacceptable contract that is based upon flawed ideology rather than evidence-based medicine, full strike action may be the only option left.

Analysis: BMA Suspends Strike Action

Junior doctor Alex Ashman updates us on junior doctors’ contracts.

This afternoon, the British Medical Association (BMA) announced that they were suspending the 48 hour strike, which was due next week. Hospital management across the country are sure to have cheered at that news. But why would the BMA want to avoid industrial action? What are they asking for? And what are the government doing?

Why Did The BMA Suspend The Strike?

The threat of industrial action before Christmas was enough to force Health Secretary Jeremy Hunt into talks at the eleventh hour. Hunt had previously refused to negotiate, so this ceasefire was a small victory for the BMA.

Last week’s strike action was triggered by a lack of progress, and the need for the BMA to retain the mandate provided by the 97% of members who voted for action. The strike revealed a great deal of public support for junior doctors, and was said to have ‘landed a hit’ on Hunt.

Conciliatory talks at ACAS have now resumed, with Hunt sidelined. The BMA are obviously keen to aid the talks by suspending strike action, whilst keeping the ace in their hand – the 10th February walkout – as an incentive for the government to make a deal. Avoiding excessive strike action keeps the public on the doctors’ side, and thus keeps pressure up on the government.

Why Are The BMA Still Threatening Action?

There are several aspects of the new contract that the BMA find unfair, including:

  • Removal of safeguards that prevent unpaid overtime.
  • Classification of late evenings and Saturdays as ‘normal hours’.
  • Removal of pay for unsocial hours.
  • Removal of annual pay rises.
  • Removal of pay protection for academics and pregnant women.

Last week, the BMA stated that they still disagreed with the government on around 20 out of the 44  points being discussed.

What Are The Government Doing?

Outside of the talks, the government continue to bully junior doctors. Jeremy Hunt and David Cameron openly blame junior doctors for an imagined lack of 7-day NHS cover. Despite Hunt being criticised for misrepresenting stroke mortality figures, Cameron still repeated his misleading figures on national radio. Both the Health Secretary and the PM have gone on the record threatening the ‘nuclear option’ of forcing the contract upon junior doctors. Whispers in Whitehall are that the government are certain they will win the dispute through sheer brute force. Perhaps they have forgotten that, as with any nuclear option, they are courting mutually assured destruction.

 

No More ‘Shock and Awe’

Dr Guy Baily gives a personal view on Syria.

There is no doubt that all types of warfare have catastrophic effects on public health. The bar, for military interventions to be acceptable, must always be a very high one. In my view it has not been reached for the Syrian bombing campaign. The recent history of Western military interventions is of a series of calamities.  The reasons why they are so liable to go wrong have been well rehearsed and it should be possible to learn from them.  I suggest that before becoming violently embroiled in other people’s countries, a few conditions have to be met:

1) There must be a humanitarian crisis which cannot be resolved by other means. There are plenty of humanitarian crises about but force is not often the obvious solution.

2) There must be a clear and realistic political and diplomatic strategy that has a probability of returning the recipients of our bombs to stable government. In Syria there is a complete absence of such a strategy.  The local fighters are fully engaged with fighting Assad in their own backyards, while being bombed by the Russians, and have little interest in wandering off into the Eastern desert to take on ISIS. Many of them are radical Sunnis closely allied to Al Qaeda, who we recently invaded two countries to attack.  Where these forces have achieved local power they have shown more interest in feuding than in tolerating other groups or religious minorities. The Kurds, who are well organised and have a coherent government, are very sensibly not interested in trying to control large areas inhabited exclusively by Arabs. Who is going to govern Raqqa after it has been flattened? This needs serious diplomatic peace-brokering.

3) The use of military power must clearly and directly enable the political strategy. As there is no credible political strategy in Syria, this is going to be a hard one to fulfil. Air power can be an effective tool when used in close support of a well organised ground force, such as the Kurdish Peshmerga in Iraq, but otherwise what can be achieved by bombing is limited and the collateral damage to people and infrastructure is huge.  Conflicts can ultimately only be resolved by winning over hearts and minds.  Killing all the bad people – presumably so only good people are left – appears to be the infantile level of military reasoning we have sunk to.  Similarly ‘fighting Islamic fascism’ has a fine rhetorical ring to it but in reality, bombing is more likely to boost recruitment to Islamic fascism than destroy the idea. Their ideology actually requires that we attack them, they desperately need it. And remember it was the excesses of the Iraq campaign that gave rise to IS in the first place.

4) The use of military violence should be the absolute minimum required for number 3. No more ‘shock and awe’.

The argument of self-defence is entirely bogus. Dropping bombs on Syria is not an effective means to prevent attacks on London and is more likely to be counterproductive. Too often, a bombing campaign fulfils an atavistic urge to lash out at the bad guys without any further real strategy. The problem in Syria is not a lack of sufficient high explosives.  Nor is it a lack of different players with different agendas getting involved.  Britain could be so much more useful as a non-belligerent broker between all the competing interests that must be reconciled to bring about the diplomatic deal that ultimately will have to emerge. And we could use the money otherwise spent on those fantastically pricey smart bombs to support the refugees.  But that would not allow David Cameron to feel like one of the cool kids when Western leaders meet.

Junior Doctors’ Pay – The Facts

Junior doctor Alex Ashman has the inside story on what junior doctors are actually paid.

A new ‘investigation’ by the Daily Mail has apparently revealed that fifty thousand NHS staff earn more than £100k. The timing of this announcement is somewhat suspicious, coming as it does during a dispute over junior doctors’ pay. But how much do junior doctors actually earn?

Basic Pay

A first year doctor (F1), having completed five/six years in medical school, receives a basic salary of £22,636. Thanks to below-inflation pay rises under the coalition government, today’s F1s are as much as £6,300 worse off compared to F1s in 2010.1

F1s are paid poorly because they traditionally received free onsite hospital accommodation. This was taken away in 2010, but there was no compensatory pay increase.

After one year, F1s become F2s, and their basic pay rises to £28,076. Further progression is rewarded with smaller increases thus:

Year of Service Typical Title Basic Pay Minimum Age
 First House Officer / F1  £22,636  23
 Second Senior House Officer / F2  £28,076  24
 Third Senior House Officer / CT1  £30,002  25
 Fourth Senior House Officer / CT2  £31,838  26
 Fifth Registrar / ST3  £34,402  27
 Sixth  Registrar / ST4  £35,952  28
 Seventh  Registrar / ST5  £37,822  29
 Eighth  Registrar / ST6  £39,693  30
 Ninth  Registrar / ST7  £41,564  31
 Tenth  Registrar / ST8  £43,434  32
 Eleventh  Registrar / ST9  £45,304  33

Banding Supplements

For many junior doctors, basic pay is funded by their regional deanery. The hospital they work for then pays a banding supplement based on the unsocial nature of the hours they work (nights/weekends/long shifts).

Banding supplements were introduced to punish hospitals for overworking their junior doctors. Doctors working traditional 80-hour weeks were given up to 100% extra pay, ending the 80-hour week pretty damned quickly!

Today’s junior doctors seldom receive the higher banding rates. A few receive a 0% rate and are ‘unbanded’, meaning they work 36 hour weeks. Most junior doctors work up to 48 or 56 hours a week, meaning they work 30-55% additional hours. For this they receive 20, 40 or 50% more pay, depending on just how many long shifts, nights, weekends and bank holidays they work.

How Many Junior Doctors Earn 100k?

None of them. Not unless they have a side job that pays more than their work as a doctor! As demonstrated above, doctors can easily reach their mid-thirties without ever getting anywhere near such a salary. Even a junior doctor in their tenth year earns less than an newly-elected MP.2

Footnotes

1 – In 2010 an F1 earned £22,412 basic pay, which would be £26,840 in today’s money. Assuming they work in a post with 50% banding pay, today’s F1s are £6,300 worse off compared with their 2010 colleagues.

2 – MPs currently receive an annual salary of £74,000 plus expenses. Compare this with an ST8 on 50% banding, who will earn £65,151 but have to pay their own professional expenses.