Opinion: If the NHS is struggling to meet one of its core targets what is the best way forward?
If you are Tory Health Secretary Jeremy Hunt and the target is the four hour maximum waiting time in Accident and Emergency departments of NHS hospitals the answer is shift the goalposts.
In 2000 a four hour maximum waiting time target for A and E departments was introduced. Departments have to see at least 95% of their patients within four hours. The target has been repeatedly missed for many years.
Monday Jeremy Hunt has said the four-hour target should only be for urgent cases. How that will work heaven only knows.
Initially in 2000 some hospitals decided to have a "hello" nurse to ensure the target was met at all times. That was developed into a triage nurse insome hospitals who would assess whether the patient was a real emergency or could wait a little longer.
Hospitals may have tried a few ways to get around the four hour wait target but the target reduced the previously excessive waiting times often experienced in A and E departments.
With GP appointments taking much longer to come through more people now visit A and E and sometimes the visit is not a real emergency.
But who wants a return to sitting in an A and E waiting room for hours on end?
Educating people about the use of A and E departments and how an unnecessary visit could deprive a real emergency patient of appropriate treatment in a timely manner may be necessary.
But scrapping this core target should not be an option.
Without such a target standards can and will slip. The postcode lottery of NHS care will mean some patients will have excessive waiting times in some Accident and Emergency departments.
It is not rocket science. A rural hospital rarely compares at all to one in an inner city, especially a city with huge problems.
Targets are always a mixed bag but overall are a positive.
The A and E target may need tweaking or perhaps departments just need more staff and resources.
Jeremy Hunt like most of his colleagues in government can afford private healthcare. In many ways that makes them unfit to oversee the running of our NHS.
Speaking in the House of Commons Monday Jeremy Hunt talked a good talk but as always fails to walk the walk. And expert in waffle he offers the NHS no real solutions.
In July 2016 http://www.bbc.co.uk/news/health-36854557
Today Mr Hunt called for an "honest discussion with the public" about what A&E does and said the target should not include "all health problems, however minor."
Jeremy Hunt you are mishandling and have mishandled the NHS and in particular the imposition of new junior doctor working contracts.
This is not the first ministerial job that you have screwed up but your political career survives.
Could that be because you were one of those who supported Cameron in his bid to lead the Tory party?
This is what this retired NHS employee thinks:
On the back of Jeremy Hunt's announcement Thursday that he will impose new working contracts on junior doctors after failing to reach an agreement the fallout continues.
#dimposition was trending on Twitter Thursday as tweeters in England took to social media to express their anger.
Junior doctors in NHS England that means not in Scotland, Wales or Ireland will have new non-agreed working contracts forced on them in August unless Hunt is forced into a U Turn.
The Tory tactic of public letters that appear to show support from people linked to the debate are falling flat Friday.
In April 2015, days ahead of the UK General Election, #lettergate blew wide open. As we reported it was a case of "Business leaders dodgy Tory letter more mind games."
The Tories won the General Election but with a majority of just 12 seats.
But that letter included people who later distanced themselves saying they had not been asked but rather just included by Tory campaigners.
Seems this may have happened again.
Friday the Guardian reports "Health chief: letter backing 'whatever is necessary' on contracts was not agreed -NHS trust chiefs distance themselves from letter supporting plans to impose new contracts on junior doctors."
Is that down to misinterpretation of 'whatever is necessary' or something sleazier?
Either way Jeremy Hunt’s claim that he has the backing of 20 NHS bosses to impose new contracts on junior doctors quickly unravelled overnight; at least half said they had never agreed to support forcing the deal.
Health Minister Hunt joined a Tory Shadow Cabinet originally as Shadow Secretary of State for Culture, Media and Sport.
He made a pig's ear of that role and was moved on to Culture.
After a second pig's ear he was rewarded with the role of Health Minister.
The only qualification Hunt has to oversee healthcare in the UK appears to be that he co-authored a book calling for NHS to be replaced with private insurance.
How come Ministers need no qualifications? What next for Hunt - Chancellor?
That fits with the way he is handling NHS England while pretending that he is simply trying to fulfil a Tory manifesto pledge for a seven-day NHS.
The NHS of course is already a 24/7 NHS each and every day and night of the year.
Currently some services are limited at the weekend a bit like in parliament-Ministers only attend willy nilly during the week and it is closed weekends.
If and when parliament are recalled during vacations due to a national crisis the taxpayer foots the bill and it is a costly one.
If parliament wants a seven day working week that is a one pay fits all then they should lead by example but moreover they should reward staff.
Junior doctors already work far too many hours; they may get some sleep on a long night shift but if they are working on a busy hospital ward or department they may be run ragged covering more than ward across a huge site.
They already work weekends, nights, bank-holidays and more but on a shift basis; as these same doctors have to fit in lectures, study, training and more that is understandable. They also rack up debt as they undergo extensive training which lasts for years.
The conclusion has to be Mr Hunt that the new junior doctor working contracts, with the promise or is that threat of further changes in the working contracts of other staff, is only about cutting the service to the bone.
In allegedly trying to make a 24/7 NHS you are in fact wrecking the service - either so that it will be ripe, ready and cheap for your buddies when they come on the scene to privatise or undermine it completely in the minds of voters.
But either way you will fail.
The NHS has its problems but remains much loved and the pride of Britain and long may that continue.
Op-Ed: Wednesday, after failing to reach agreement over new working contracts proposed by the government, junior doctors took the next step in a series of actions and staged a 24-hour strike.
Thursday Health secretary Jeremy Hunt moved a step closer to imposing the new contracts on the doctors in a like-it-or-lump-it move.
Hunt appeared on TV news Thursday, and it has to be said he looked less like the rabbit-in-the-headlights than in recent days.
Perhaps having decided to, shall we say, call the doctors bluff he may feel more comfortable about the junior doctors' new working contracts fall out but many will not.
Thursday parliament begins a recess (February 11 to February 22 which ties nicely in with school holidays in a way most ordinary employees can only dream about) meaning Hunt and the government can disappear while watching in the wings from, in some cases, free and far flung vacations to see what happens next.
From day one Hunt has touted the new deal as better for both junior doctors and patients, claims the new contracts in effect offer a pay rise and reduces working hours but manage somehow to encompass Saturday as just another day of the week.
That would be a tough task and if you look at the fine details expect to see Hunt has failed miserably.
Other NHS staff are waiting-in-the-wings to see how this one pans out.
If Hunt can get the new junior doctor contracts done and dusted he will move on to senior doctors including consultants.
Will they get a better deal on the table from Hunt?
The new intake of junior doctors is imminent and if Hunt can impose the new contracts before they arrive in post the new recruits will have few options.
The fact that UK retail often operates a one hourly pay rate fits all these days, making sure every day of the week attracts the same hourly pay rate, does not make it fair. Neither does it make such operations work well as in many cases they are half-ass after cutting costs to the bone.
There was a time when working Sundays attracted a pay incentive of up to double time. Saturday working in the NHS attracted time and a half pay for administration staff after a set time.
Hunt is trying for a cut price NHS that operates fully seven days a week every day and night of the year but does not want to pay a fair salary to achieve this.
Previous Tory government ravaged services across the UK by mass privatisation of utilities and has its sights set on similar for the NHS. It has refused to protect the NHS from TTIP and if you look at who has money invested in privatised NHS services links to the Tory party are all too evident.
Check out a Daily Mirror report from 2014 which shows what it calls a dossier of shame.
Having experienced the NHS as an employee, a patient and the loved one of a 'customer' or two I know junior doctors save lives and they do this each and every day of the year with or without the new insulting contracts.
Hunt may hope he will be home free if he imposes the new contracts but if junior doctors and other staff decide to resign NHS England is screwed.
And yes it is England that is imposing these changes which means NHS junior doctors could get better working contracts by crossing borders into Scotland or Wales or ditching the UK altogether and choosing to work abroad.
In the end you have to decide if changes to the NHS are about improvements or handing it over bit by bit to the fatcats and their supporters.
We will fight contract imposition, says BMA, BBC News Thursday
The Independent goes for"Jeremy Hunt unilaterally imposes new contract on junior doctors without their agreement."
NHS England boss Simon Stevens favours the new contracts claims Jeremy Hunt. He was appointed in 2013; US healthcare boss to be appointed chief executive of NHS England next year wrote Pulse Today. He was the Tory choice to run NHS England and it is easy to see why.
2011 Telegraph Named: the highest NHS fat cat earners - An investigation by The Sunday Telegraph has uncovered at least 660 NHS managers who earn more than the Prime Minister.
More at Big Up the NHS
[A previous Labour government implemented an NHS Agenda for Change which offered fair pay-there were some winners and some losers but overall it worked-the Tories are slowly but surely stripping that away]
Many people would now say both men are currently making pig's ears of their current posts.
The junior doctor's strike was put on hold in December following vague political promises but a month later it could go ahead.
Little has changed to persuade junior doctors to pull the plug on industrial action.
The delay helped the Tory government over the Christmas period which is a traditionally busy time for the NHS. It gave the government a breathing space and allowed them to tootle off for the Christmas parliamentary recess but it solved nothing in real terms.
Even though the strike in December was halted some operations were cancelled and services hit as it was too late to reschedule; that does nothing to help the junior doctors case.
A series of strikes could now begin next week with the first action planned for January 12.
The government denies allegations that they had a hand in sexing up the strike threat but Sky News reports:
A dirty tricks row has broken out in the junior doctors' dispute over claims that a warning of the impact of a strike in the event of a terror attack was sexed up in Whitehall.
Medical professionals are just that - professionals. They do not hold the country to ransom and probably never will.
They have been backed into a corner and industrial action will happen unless there is arbitration and it works.
The players need to be independent of government and there must be transparency.
In the event of a major incident in any part of the UK medical professionals respond whether they are on duty or not. They are not small-minded; if they were they would not be working in their roles.
In the event of a major incident, terror related or not, junior doctors will abandon strike action and respond-that is a certainty.
But should they be pushed into such a corner?
NEWTEKWORLDNEWS earlier reports:
Jeremy Hunt offers junior doctors 11 per cent
Junior doctors vote to strike
An arbitration request by NHS staff to Jeremy Hunt
Junior doctors 24 hour strike called off
The Tories along with Lib Dem coalition partners helped draw up new working contracts for junior doctors; the government describes "the current arrangements as "outdated" and "unfair", pointing out they were introduced in the 1990s." Talks on the new contracts stalled in 2012 and have been going nowhere.
The doctors looked set to take a pay cut as reclassifying unsocial hours came into force; 'normal hours' will be reclassified as being from "7am to 10pm, Monday to Saturday. Extra payments for unsociable working will be earned only outside of these times, rather than the current arrangements of 7am to 7pm Monday to Friday."
Working hours of 48 hours a week will remain and Hunt is promising the top limit of 91 hours will reduce to 72.
But can junior doctors trust the Tories? According to the Daily Mirror "Doctors threatening to strike say it's 'spin' and there are plenty of reasons it's nowhere near 11% . For some people it'll actually be a cut."
The government is trying to slowly but surely erase any positives accredited to former Labour governments; they were responsible for many previous N.H.S. pay and working hour improvements.
The doctors are not about to take new contracts lying down and "the junior doctors committee of the British Medical Association (BMA) is preparing to ballot its members about potential walkouts." With the government threatening to impose the new contracts on junior doctors in 2016 if agreement could not be reached battle lines were drawn.
But it seems the government has had a change of heart; offering an additional 10% pay rise on top of the restricted 1% or less for other N.H.S. staff could do the trick but what about those other staff members? How will they feel when they receive 1% or less knowing junior doctors are getting a whopping 11%?
The problem is all staff who work for the N.H.S. except for some managers, are essential to the best care of patients.
But some of the lower grade staff earn paltry wages and yes some are also on zero hours contracts.
There was a time when junior doctors worked crippling shifts that must have endangered patient and their own, health and safety; that was improved and under a previous Labour government when 'Agenda for Change' was implemented to correct an imbalance between private sector and public sector health care workers pay.
Working for the N.H.S. for around 13 years pre-retirement this writer experienced the good the bad and the ugly. Staff would say work here long enough and you will see any changes come around at least twice and that was a fact.
A succession of well paid 'project managers' appeared in an endless stream; in some cases it was difficult to know exactly what they did. Many may have only been on temporary contracts but were paid exceptionally well, often had already worked for the N.H.S. and retired and usually were handed another post without a problem when the role ended.
Can Hunt afford to give junior doctors 11%? Will it be a no strings attached offer? Will the government abide by any promises it makes?
Will Hunt have to rob Peter to pay Paul?
All N.H.S. staff deserve a decent working contract but can that be achieved under a Tory government that is hoping to privatise the service?
Sources and more information at:
BMA refuses to re-enter contract talks