Jeremy Hunt

[Chippy_boy]

Right for the last time. Work does not balance like that. There are thousands of routine procedures that happen during the week, things like cataract removals, plastic surgery, planned burns surgery to name but a few, a very few, and all that work needs to be done. Accepting if you want to do that work at weekends and smear it over seven you need to accept that you need staff up for it. Currently there are not enough doctors available, though I would again wager that of the additional cost doctors wages would probably be less than 20%. I would wager there are very few, if any Junior doctors currently work under 45-50 hours a week, probably nearer 60-65, and they are struggling to deliver the existing work - what impact is moving the work to Saturday's and Sunday's going to have? The overheads to make hospitals a 7 day a week would be phenomenal don't you get that?

I have to say the graphic you provide is extremely basic and very (too) simplistic to be worthy of comment and would be the kind of work I would expect to see from someone in their final year of primary school. Please don't take that as a personal insult, because it isn't, but it no way whatsoever gets anywhere close to addresing the point in discussion here, and I think you know that... well at least I hope you do! In your graphic you show nobody working on the Saturday and Sunday on your five day example. I have news for you there are loads of doctors working doing loads of work, oh and by the way it's not 9-5 either, it's 24 hours cover that they provide.

OF COURSE the chart is an oversimplification. I am trying to demonstrate it in a way that you might conceivably understand.

But you say "Accepting if you want to do that work at weekends and smear it over seven you need to accept that you need staff up for it." YESSS!!!!! Of course we do.

With staff that otherwise work Wednesday but not Saturday! Or Tueday but not Sunday.

Doing work at the weekend means there is less work to do in the week. You don't need an MRI scan on Tuesday if you had it done on Sunday. FFS.

In your graphic you show nobody working on the Saturday and Sunday on your five day example. I have news for you there are loads of doctors working doing loads of work, oh and by the way it's not 9-5 either, it's 24 hours cover that they provide.

Dear oh dear oh dear. Give me strength. Of course you numpty, any idiot knows that. I should have thought that was so blindly obvious as to not even need saying, but clearly not.

 

[BigJoe#1]

OF COURSE the chart is an oversimplification. I am trying to demonstrate it in a way that you might conceivably understand.

But you say "Accepting if you want to do that work at weekends and smear it over seven you need to accept that you need staff up for it." YESSS!!!!! Of course we do.

With staff that otherwise work Wednesday but not Saturday! Or Tueday but not Sunday.

Doing work at the weekend means there is less work to do in the week. You don't need an MRI scan on Tuesday if you had it done on Sunday. FFS.

Right for the last time.....

There are already NOT ENOUGH PEOPLE WORKING IN THE SERVICE AT THIS MOMENT IN TIME. There is too much work for the current staff. Increase your staffing levels across the board, including all ancillary staff then bring in 7 day working.... Please think about it before coming back with another pointless argument, unless you believe there are already enough staff in the system - which no one, even the government thinks.

 

[Chippy_boy]

Right for the last time.....

There are already NOT ENOUGH PEOPLE WORKING IN THE SERVICE AT THIS MOMENT IN TIME. There is too much work for the current staff. Increase your staffing levels across the board, including all ancillary staff then bring in 7 day working.... Please think about it before coming back with another pointless argument, unless you believe there are already enough staff in the system - which no one, even the government thinks.

For the 93rd time, 7 day working does not mean more work. So whether or not we have enough staff already is irrelevant because the changes do not mean more work or more resources needed.

(And yes, this is a simplification and in reality some extra ancilliary staff will be needed and yes it can only be brought in where there is a critical mass and enough people to cover. I really shouldn't have to say any of that because it's bleeding obvious a 4 year old would understand, but clearly you need spoon feeding.)

I've tried to explain this to you with words and graphics and you still don't get it. So now I give up. Believe what you like. It's all irrelevant banter anyway. The country wants and needs a 7 day NHS, the changes are happening, it's getting a 7 day NHS, the doctors are going to have to eat it. End of debate.

 

[Matty]

It's naïve to assume that, if during a 5 day week we conduct 70 operations, that we would conduct 70 operations in a 7 day week and, as such, we wouldn't need any more staff. Do people honestly believe that 70 is a measure of all the operations that the NHS WANTS to conduct? No, it's what they can accommodate given their staff, and scheduling, deficiencies. If you suddenly say "guess what, you can schedule operations 7 days a week now, instead of 5" what you'll see is that there will be 70 operations scheduled Mon through Friday, and then another 10/12 on the Saturday, and another 10/12 on the Sunday. So, something like 90 to 95 operations instead of the original 70. This clearly means more staff would be required, or existing staff will be expected to work longer hours. Pressure will be applied to the trusts, and by the trusts, to get more and more procedures done. The simply won't be allowed to work 7 days a week yet only complete the same amount of work as they previously did over 5 days. There will be measures put in place to ensure this isn't acceptable.

 

[BigJoe#1]

For the 93rd time, 7 day working does not mean more work. So whether or not we have enough staff already is irrelevant because the changes do not mean more work or more resources needed.

(And yes, this is a simplification and in reality some extra ancilliary staff will be needed and yes it can only be brought in where there is a critical mass and enough people to cover. I really shouldn't have to say any of that because it's bleeding obvious a 4 year old would understand, but clearly you need spoon feeding.)

I've tried to explain this to you with words and graphics and you still don't get it. So now I give up. Believe what you like. It's all irrelevant banter anyway. The country wants and needs a 7 day NHS, the changes are happening, it's getting a 7 day NHS, the doctors are going to have to eat it. End of debate.

Correct, there is no getting through to some, so I'll leave you alone to defend the indefensible.

 

[BigJoe#1]

It's naïve to assume that, if during a 5 day week we conduct 70 operations, that we would conduct 70 operations in a 7 day week and, as such, we wouldn't need any more staff. Do people honestly believe that 70 is a measure of all the operations that the NHS WANTS to conduct? No, it's what they can accommodate given their staff, and scheduling, deficiencies. If you suddenly say "guess what, you can schedule operations 7 days a week now, instead of 5" what you'll see is that there will be 70 operations scheduled Mon through Friday, and then another 10/12 on the Saturday, and another 10/12 on the Sunday. So, something like 90 to 95 operations instead of the original 70. This clearly means more staff would be required, or existing staff will be expected to work longer hours. Pressure will be applied to the trusts, and by the trusts, to get more and more procedures done. The simply won't be allowed to work 7 days a week yet only complete the same amount of work as they previously did over 5 days. There will be measures put in place to ensure this isn't acceptable.

See chippy boys illustration clears your obvious misunderstanding up nicely. You just spread the volume of work done in 5 days across 7... We won't worry about the work that is currently done at weekends and night time. BTW, are BUPA and other private healthcare facilities a 7 day a week operation, or do they scale down at weekends?

 

[Chippy_boy]

It's naïve to assume that, if during a 5 day week we conduct 70 operations, that we would conduct 70 operations in a 7 day week and, as such, we wouldn't need any more staff. Do people honestly believe that 70 is a measure of all the operations that the NHS WANTS to conduct? No, it's what they can accommodate given their staff, and scheduling, deficiencies. If you suddenly say "guess what, you can schedule operations 7 days a week now, instead of 5" what you'll see is that there will be 70 operations scheduled Mon through Friday, and then another 10/12 on the Saturday, and another 10/12 on the Sunday. So, something like 90 to 95 operations instead of the original 70. This clearly means more staff would be required, or existing staff will be expected to work longer hours. Pressure will be applied to the trusts, and by the trusts, to get more and more procedures done. The simply won't be allowed to work 7 days a week yet only complete the same amount of work as they previously did over 5 days. There will be measures put in place to ensure this isn't acceptable.

Obviously it's not as simple as I suggested but you have to simplify things sometimes to make a point and unfortunately then the more dense readers get the wrong end of the stick (I don't mean you by the way.)

And you do have a point that the changes will put upwards pressure on the number of treatments. But I don't accept the problem is of the scale you imply. It might mean some extra procedures, but it cannot mean a huge increase.

Why? Because if it did then that would necessarily mean that there are large numbers of important treatments that need to happen today that are simply not happening. If that were true (I don't believe it is) it would be evidenced by waiting times getting longer and longer as the backlog got larger and larger, and this is not the case. The NHS' capacity right now is broadly in line with the nations need for treatments. So whilst I am not refusing to believe that we will do a little more in a 7 day timetable, it won't be much more because we are already doing the vast majority of what needs to be done, within the current 5 day timetable.

And also (as I have stated before) there are efficiency benefits to running a 7 day operation. You might need to invest less in facilities if you can get higher utilisation out of those facilities and the money thus saved can go on extra resources. In plain terms, if you have 1,000 MRI scans to do and that means you need 20 MRI scanners, maybe you can get away with 17 MRI scanners if you use them more. That's £10m saved that can be spent elsewhere. Having expensive resources like operating theatres, x-ray machines, MRI scanners, etc etc being underutlizing because no-one is there to work them, is not a very sensible plan. Car manufacturers run 24x7 and 3 shifts for a reason! Or else why not just build 2 plants and run them half the time? It's not very efficient to do that.

 

[worsleyweb]

Not ventured in for a day - is everyone in agreement now?

 

[Matty]

Obviously it's not as simple as I suggested but you have to simplify things sometimes to make a point and unfortunately then the more dense readers get the wrong end of the stick (I don't mean you by the way.)

And you do have a point that the changes will put upwards pressure on the number of treatments. But I don't accept the problem is of the scale you imply. It might mean some extra procedures, but it cannot mean a huge increase.

Why? Because if it did then that would necessarily mean that there are large numbers of important treatments that need to happen today that are simply not happening. If that were true (I don't believe it is) it would be evidenced by waiting times getting longer and longer as the backlog got larger and larger, and this is not the case. The NHS' capacity right now is broadly in line with the nations need for treatments. So whilst I am not refusing to believe that we will do a little more in a 7 day timetable, it won't be much more because we are already doing the vast majority of what needs to be done, within the current 5 day timetable.

And also (as I have stated before) there are efficiency benefits to running a 7 day operation. You might need to invest less in facilities if you can get higher utilisation out of those facilities and the money thus saved can go on extra resources. In plain terms, if you have 1,000 MRI scans to do and that means you need 20 MRI scanners, maybe you can get away with 17 MRI scanners if you use them more. That's £10m saved that can be spent elsewhere. Having expensive resources like operating theatres, x-ray machines, MRI scanners, etc etc being underutlizing because no-one is there to work them, is not a very sensible plan. Car manufacturers run 24x7 and 3 shifts for a reason! Or else why not just build 2 plants and run them half the time? It's not very efficient to do that.

It's not just urgent, "important" procedures that will be scheduled at weekends if 7 day working is implemented though. I broke my right arm pretty badly around 10 months ago, had to have an operation to pin it back together. I had a few issues with the NHS and it's ability to resource. I broke the arm on a Sunday morning, it was decided straight away by A&E that it needed an operation, yet I wasn't operated on until the Friday afternoon. I was in pretty serious pain, completely unable to use the arm (as my radius was in 3 pieces and my wrist had been dislocated and I had zero movement in any of my fingers) yet they simply couldn't find an available slot until the Friday, and even then I suspect them bumped someone else to fit me in.

The next issue I had was post op treatment. The plaster was removed after 5 weeks, and I still had zero movement in the wrist or fingers. I was told I needed urgent physio as I ran the risk of permanently losing a fair amount of wrist and hand movement. I was then told it was a 6 to 8 week wait to get any NHS physio appointment!! So, needed urgent treatment, but had to wait 2 months for it! Obviously I couldn't wait so had to pay for private physio at a cost of hundreds of pounds to myself. With 7 day working, and an additional 40% availability of staff, are we really saying people won't be pressured to reduce waiting times like the one I had to deal with? I've a friend who needs to see a consultant about an issue which, at it's worst, could be a tumour. They've been referred by their GP, and been told it will be 6 to 8 weeks before they find out when their appointment is, not until they get to be seen you understand, until they find out how much longer they have to wait!! Again, they can't so have gone private through their employer. Waiting periods such as the ones I've mentioned really aren't acceptable, as they could lead to increased risk to the patient, or permanent health issues. These are the things that 7 day working will be aimed at fixing. From a patient's perspective it's great, less wait, less worrying, quicker treatment. From a staffing perspective however it'll either mean more staff, or longer hours for those already in place. It's likely to be the later, as that's the cheaper option.

 

[worsleyweb]

It's not just urgent, "important" procedures that will be scheduled at weekends if 7 day working is implemented though. I broke my right arm pretty badly around 10 months ago, had to have an operation to pin it back together. I had a few issues with the NHS and it's ability to resource. I broke the arm on a Sunday morning, it was decided straight away by A&E that it needed an operation, yet I wasn't operated on until the Friday afternoon. I was in pretty serious pain, completely unable to use the arm (as my radius was in 3 pieces and my wrist had been dislocated and I had zero movement in any of my fingers) yet they simply couldn't find an available slot until the Friday, and even then I suspect them bumped someone else to fit me in.

The next issue I had was post op treatment. The plaster was removed after 5 weeks, and I still had zero movement in the wrist or fingers. I was told I needed urgent physio as I ran the risk of permanently losing a fair amount of wrist and hand movement. I was then told it was a 6 to 8 week wait to get any NHS physio appointment!! So, needed urgent treatment, but had to wait 2 months for it! Obviously I couldn't wait so had to pay for private physio at a cost of hundreds of pounds to myself. With 7 day working, and an additional 40% availability of staff, are we really saying people won't be pressured to reduce waiting times like the one I had to deal with? I've a friend who needs to see a consultant about an issue which, at it's worst, could be a tumour. They've been referred by their GP, and been told it will be 6 to 8 weeks before they find out when their appointment is, not until they get to be seen you understand, until they find out how much longer they have to wait!! Again, they can't so have gone private through their employer. Waiting periods such as the ones I've mentioned really aren't acceptable, as they could lead to increased risk to the patient, or permanent health issues. These are the things that 7 day working will be aimed at fixing. From a patient's perspective it's great, less wait, less worrying, quicker treatment. From a staffing perspective however it'll either mean more staff, or longer hours for those already in place. It's likely to be the later, as that's the cheaper option.

Was it your wanking arm?