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UK Doctor Contract Row

Discussion in 'Real Life Discussion' started by TMD, Sep 26, 2015.

  1. Mordecai

    Mordecai Drunken Scotsman Prestige DLP Supporter

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    Taure, its a feedback loop though. They need a better contract in place to retain employees and get more new ones onboard, they need this in order to ensure patient safety.
     
  2. TMD

    TMD Groundskeeper DLP Supporter

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    Taure ...No.

    The strikes were because of the contract. The contract contained things which would cut doctors pay, reduce doctors quality of life even further, and compromise working patterns of doctors which WOULD impact patient safety.

    I'm not a lawyer, but it seems common sense that it is possible to strike about one thing (the contract), while also being extremely concerned about the multiple implications of that thing (including patient safety). A doctor being allowed to work 100+ hours a week on the new contract is the specific point that people went on strike for, sure. But it's rather obvious that that point also implicates patient safety.

    The health system is fucked from all those things you said, but those are not new issues. The year is just the continuation of those issues, with the big difference maker being the massive staff gaps and shortages from doctors leaving the NHS. Because. Of. The. Contract.

    And since during the entire contract saga, doctors said repeatedly "patient safety will be significantly more at risk if this contract is imposed", and individuals said "you're just talking about patient safety to win the public over, actually it's about money" - well, that is the definition of 'we told you so'.
     
    Last edited: Jan 10, 2017
  3. Taure

    Taure Magical Core Enthusiast Prestige DLP Supporter

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    Do you have any statistics for this? Every analysis I have read of the current crisis puts the blame firmly on bed shortage and due to exit block, which is itself a feature of the continued cuts in local government spending on social care. You say that's "not a new issue" but sometime doesn't need to be a new issue to get worse. It takes time for changes to government budgets to filter through to "street level" and the really harsh cuts were only really made in the last year or two (though they were planned years before).

    The new contract was mostly about trying to squeeze NHS resources even further to extend full services to the weekend.


    The concerns of doctors about lack of government investment in healthcare and the impact that has on patient safety are concerns they have as private citizens, not as doctors/employees. Their concerns qua employees are the only ones that are relevant to a strike situation - or at least, they should be, if the doctors are acting in good faith (which one assumes they are).
     
    Last edited: Jan 10, 2017
  4. TMD

    TMD Groundskeeper DLP Supporter

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    Speak to any frontline doctor who has been working in the NHS for the last couple of years. The issues of bed shortages and lack of discharge to social care has existed for a while, and I agree that it's got worse over the last 12 months as I stated in my last post. But goodwill and overtime work and effort from a fully staffed team have kept things running so far. When everything else is done, doctors and colleagues dont mind staying an extra couple of hours after their shift is finished to make phonecalls and get patient discharges sorted for those vulnerable patients who need social support.

    Now, as a direct result of the contract and the subsequent low morale, those fully staffed teams are no longer fully staffed. The goodwill and unpaid overtime is now being spent by the remaining doctors to cover the work of the missing ones. That means actual clinics/operations/ward rounds/emergencies. So the existing problems you mentioned, previously being dealt with to the best of staff ability are now not being dealt with. Hence, a backlog. Hence, reduced number of beds/discharges. Hence, reduced space for patients to be admitted from A&E. Hence, more patients needing admission waiting in A&E.

    Now in addition to that, the actual A&E doctors are in even worse shape because as mentioned previously, their speciality is one of the worst affected. They got hit hardest by the new contract, and they are the ones who were already most liable to throw in the towel due to stupid hours and difficult working conditions. So now, all this extra BS that was being kept at bay by other specialities in the hospital is now flowing downhill towards A&E. A&E itself has been gutted by the contract, and there's greatly increased pressure on A&E during this period of the year.

    Add up all those ingredients and you get this.

    • If this new contract never happened, would the NHS be under pressure this winter? Yes.
    • Would it be under more pressure than last year due to continued mismanagement/funding cuts/general shit? Yes.
    • Would the staff be able to band together, and with a bit of help, get through it with minimal issues above the norm? Yes
    • Therefore, has the contract had a massive compounding effect on the current crisis? Yes

    I think this is just semantics and not worth actually discussing. Doctors went on strike because the new contract would cause them to be treated like shit, and cause the NHS to go further to shit as a direct result. As an employee, their concerns was about their career and the future of their organisation as a whole. I don't really know what your point is here.
     
    Last edited: Jan 10, 2017
  5. Taure

    Taure Magical Core Enthusiast Prestige DLP Supporter

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    My point is that the NHS going to shit doesn't mean doctors get to say they were right about the contract. The contract is unrelated to issues of investment etc. The contract relates to work conditions and pay. Those have not caused the crisis. The NHS would have gone to shit new contract or no.

    Your argument for how the contract dispute has led to the current situation is completely anecdotal and runs contrary to most analysis of the situation. Staff shortages - and I'm not persuaded that the NHS has lost a significant number of staff off of your stories -- are not anywhere near the top of the list of causes of the current crisis. Saying that it is is trying to force a narrative that there is no real evidence for.

    The NHS is dealing with a surge in demand, not a restriction in its ability to supply. Such a surge in demand happens every winter, and this year it has been made significantly worse than last year (which was itself significantly worse than the year before) because social care is much less than it was a year ago.

    The ultimate cause of the problem is the huge backlog of patients which hospitals cannot discharge for a lack of social care in the community to take over their care. This causes hospitals to literally overflow with patients, and thus demand for care shoots up as the should-be-discharged patients still need attention as well as the new arrivals. The same number of staff are being asked to cover a significantly greater number of patients.

    Edit for your edit:

    I think this displays a certain ignorance of the unprecedented scale of the disparity between demand and supply that has hit the NHS in quite a sudden way. The NHS simply does not have the capacity to cope with current patient numbers. No amount of pulling extra shifts would solve that. Every single hospital in the country would need something like 20% more capacity than it has to be able to operate smoothly right now, that's how bad the exit block is.
     
    Last edited: Jan 10, 2017
  6. Innomine

    Innomine Auror Prestige DLP Supporter

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    While it may not be the leading cause, Taure, surely it's a contributing factor? Reducing the crisis of the NHS down to one cause in a black and white manner seems to be simplifying the complexity of the situation. From what I've read of TMD's posts, the new contracts have exacerbated the situation the NHS is in, to the extent where it sounds like it's facing collapse. The straw that broke the camels back so to speak. Especially when it results in the lowering of staffing levels, combined with the increasing number of patients that you point out.

    In that sense, yes, the Doctors do get to say that they were right about the contract. Especially because, as you so clearly pointed out, they are unable to strike over political matters, so they are striking over what they can. If we follow your logic chain and lay the entire problem, and the solution to that problem, at the feet of lack of political funding (social care etc), then there's nothing the doctors can do about the situation. So they are doing what they can, within the realm of the law.

    It comes down to a matter of perspective.
     
    Last edited: Jan 11, 2017
  7. TMD

    TMD Groundskeeper DLP Supporter

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    Innomine is completely correct.

    Incorrect. NHS is already underfunded, and will remain underfunded. Therefore, to try and keep things running despite massive lack of funding, impose a new contract that makes it cheaper and easier to have doctors in the hospital. That is directly related to investment levels.

    Correct

    Correct. Work conditions and pay have not caused the crisis, merely exacerbated it severely.

    Correct. It would have indeed done so eventually unless funding and management massively improved.

    Because the wankers doing the 'analysis' are sitting in an office somewhere posting on the junior doctor's facebook group asking for quotes and information about the situation on the ground. The people who are seeing what is happening with their own sleep-deprived eyes are at this very moment still working in their hospitals doing the best they can. They don't have time to write lengthy analyses on the situation, so all they can do in their little free time is post their 'anecdotes' to above 'analysts' and hope something gets fixed.

    Quotes from frontline A&E doctors in the last week:

    "We have a brilliant team, but are devastated by underemployment and underinvestment. We have two permanent registrars on a rota of seven places." - 71.4% of the required doctors do not exist, 2 doctors doing the work of 7.

    "being in charge of the emergency department [ED] overnight with rota gaps;"

    "There are not enough staff and 12 ambulances regularly sitting in the corridor. "

    "On Thursday, there were 75 patients in a department that has 18 majors’ beds. Thirty-five of those were medical patients awaiting beds, 20 hadn’t been seen as there was nowhere to see them or no staff to triage them."

    "The mess in ED is the symptom not the disease...they should speak to doctors trying to discharge vulnerable elderly inpatients back into the community, and rota co-ordinators across inpatient specialities who will tell all about the staffing black holes appearing all over the place..."


    Correct.

    Incorrect for previously stated reasons. Both are true, increased demand and decreased supply.

    Correct.

    I said this in my previous post, you're agreeing with me here. Except that even the backlog of patients isn't the baseline cause, but a symptom of, as you said, social care cuts AND lack of primary care physicians AND overall NHS underfunding AND hospital staff shortages. You've never discharged a patient so it's unreasonable to expect you to know this, but you'd be seriously surprised as to how long it takes and how much paperwork is involved in a single discharge. Again, the contract has added another factor into the existing mix of factors putting massive pressure on the system.

    Less staff.

    I was there yesterday, I was there today and i'll be there tomorrow. I can see the disparity with my own eyes.

    Correct. Too many patients are coming in, and too few are getting discharged per unit time. You have highlighted the major issues and factors that have led to this problem, with exception of admitting that the contract has a significant part to play in this mess. To say the contract, and the effects stemming from the massive loss of workforce morale and staffing numbers has nothing to do with this crisis is blatantly untrue.

    Edit to clarify my position since I think we're at risk of going in circles:

    The main causes of this crisis are chronic under-funding of the NHS and cuts to social care. Poor social care leads to inability of doctors to smoothly discharge patients from hospital into the community*. Increased pressure in winter on A&E, combined with more patients going to A&E because of an overwhelmed primary care service*, combined with staff shortages in A&E* increase the pressure at the other end of the patient journey.

    The contract dispute which led to reduction in staffing levels and massive workforce morale reduction is not the main cause of this crisis. However, every * in the above paragraph highlights a portion of the main factors behind the crisis which is made worse than it otherwise would have been as a direct result of the contract dispute. If that A&E department had the 7 A&E doctors it's supposed to rather than 2, do you honestly think things wouldn't improve massively?
     
    Last edited: Jan 11, 2017
  8. Invictus

    Invictus Heir

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    You're being pedantic for the sake of being pedantic. I know, I know, not your intention. But that's what you are doing. You're trying to apply an artificial division that the law uses to help them define things in doctrinaire terms, to a real life situation that just doesn't allow for that division.

    Private and professional worries blend in, because that's how human being works. There's no separate part of the brain specific taking care of this worry and the other worry.

    TMDs entire point is that this is not an unrelated situation. All problems have the same source. Budget cut/freezing that simply doesn't accompany the growth of the demand. Thus actions to squeeze at maximum to compensate the growth leaders to more attrition both to the staff and equipment. Which leads to quittings, a dimishment of interest staff, more trianings, more replacement equipment, etc. That's the loop.

    I do agree however, that TMD is both using anedoctal evidence heavily, panic tone that imies a much worse situation than it actually is and is conflagrating different issues, such as lack of ambulances to the contract row.

    It is, however, a proven fact that the UK is seeing massive drainage of doctors. So much so that Australia doesn't want more British doctors.
     
    Last edited: Jan 11, 2017
  9. Taure

    Taure Magical Core Enthusiast Prestige DLP Supporter

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    I think there's no point carrying this on any further, as you seem to simply lack the kind of evidence that I require to believe you. No amount of personal experience or quotes from doctors will be persuasive for me, especially as they are the experiences of people who are personally invested in the situation and therefore unreliable.

    If you can produce statistics which demonstrate that staffing levels have fallen significantly following the contract row, I will concede that you are correct. In the meantime, however, I have seen no evidence of a fall in staff and therefore no evidence of a restriction in supply. Your argument that the contract row is a contributing cause of the current crisis is based entirely on that proposition, which I can't accept without evidence. Especially when there are good reasons to think that it's not the cause - namely that the problem is one of physical capacity, not man-hours. You talked about how long it takes to discharge a patient, but that's a handwave - it doesn't matter how long it takes to discharge a patient if the problem is that you can't discharge them at all because they have nowhere to go. The NHS could have a doctor for every patient and it still wouldn't conjure new beds out of thin air. Patients would still be waiting in corridors, laundry rooms and ambulances for beds.

    I will address one thing, though:

    What I obviously meant is that the contract isn't the cause of investment issues. It's the result of them.

    It's not pedantic, it's the fundamental factor which determines whether or not I support the doctors. If they are striking for better pay and conditions I support them, because their pay and conditions are shit. If they are striking to force change at the political level to improve the NHS I do not support them, because it's illegitimate use of political pressure which subverts democratic systems of representation.
     
  10. Invictus

    Invictus Heir

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    It's being pedantic. Again, the basic reason isn't pedantic. It's completely valid to worry about abuse of power given to essential services in exchange for political concessions, but this case isn't a clear cut problem. It is, at essence, a political problem brought by a policy, cutting spending.

    All issues derivate from this policy. From the conditions to the contract row. The contract row is just one symptom, as mentioned before, but solving it won't solve the other issues that TMD mentioned, and you too, including lack of beds, better equipment, etc. Thus the doctors have no choice but to organize pressure against all of this. As public workers, as medical professionals and people they have their rights to protest against attacks on what they see as fundamental needs by a harmful policy.

    All points are connected. You are claiming that there's a clear divide in motivation, when there isn't nor there will be I this issue. You're insisting on an artificial division merely to fit your pre conceived ideas on strikes and pressures. That's why it's pedantic. You're demanding something that is obviously unrealistic for anyone but a Law Theorist to be able to do, while sitting in his chair.
     
  11. TMD

    TMD Groundskeeper DLP Supporter

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    I don't really understand this. The people generally responsible for such statistics and evidence (i.e. the DoH) are the same people who went to war with doctors, lied repeatedly in the press and in parliament and ran a long term smear campaign against the profession in order to impose an unfair and politically-motivated contract. Why you think the same people would then do a 180, and start publishing statistics of how bad the fallout from their own actions is, is beyond me.

    I understand that in general, 'the plural of anecdotes isn't evidence', but in this instance its a case of every person on the front line saying the same thing. If all the formula one drivers next season come out and say "the new tyres feel shit because of X", I would tend to believe them even before the teams go ahead and do a detailed engineering analysis to get the data - since they're the experts on the front line of the situation. I wouldn't go ahead and say 'the formula one drivers are personally invested in the situation and therefore unreliable.'.

    A total of 57 per cent of doctors said they had thought about pursuing a career in private healthcare, according to the research.

    The same number have considered leaving the UK or had already left to work abroad.

    One in 10 said they planned to leave the profession for a new career.

    And 63 per cent of doctors said they have considered or started locum work to ease some of the pressures of the job.


    Source

    The number of doctors who applied for documentation to work abroad surged by over 1000 per cent the day Jeremy Hunt announced he would force a new contract on them, new figures show.

    300 doctors applied for Certificates of Good Standing on Thursday 11 February – up from an average of 26 a day in February before the announcement.

    The surge of doctors thinking about leaving has continued since the announcement, with 109 doctors requesting certificate the day after it, and figures on the weekend over double the previous weekend.

    The certificates are required to get a doctors’ job abroad and can only be sent directly to another appropriate body overseas – meaning some level of contact must have already established with employers aboard.


    The number of doctors applying to go abroad before the announcement already represented a significantly higher level than under Mr Hunt’s predecessors.

    In 2015, when the industrial dispute began, 8,627 certificates were issued to doctors – up from 4,925 in 2014 and around 5,000 in the previous three years to that. The annual increase amounts to additional doctors with over a billion pounds in training looking to leave a year.

    An unweighted survey reported by the Independent last week recorded around 90 per cent of junior doctors having misgivings about remaining working in the UK.

    Source

    These articles were published around the time of the actual contract imposition itself. That is to say, the quotes above are regarding doctors who left during the contract row and just as imposition was being confirmed. Clearly, more have left in the months since then as the situation on the ground has worsened - but I suppose that's anecdotal again. I don't think the kind of statistics you're hoping for are going to available for a while, if ever. It's not in the government's interest to release them, and doctors can see the reality with their own eyes so they are not in need of figures.
     
  12. Taure

    Taure Magical Core Enthusiast Prestige DLP Supporter

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    Lots of Americans say they'll leave for Canada too, it doesn't mean they do. The stats you present show discontent but not that actual staff numbers have fallen significantly enough to affect services in such a substantial way. The NHS is one of the largest organisations in the world and a turnover of staff in the thousands every year would be normal for it. The key isn't to show that people are leaving, it's to show they're not being replaced, and in very large numbers.
     
  13. GiantMonkeyMan

    GiantMonkeyMan High Inquisitor

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    In August a report went out that there was a shortage of A&E doctors leading to slow and dangerous response times for emergency patients. Today, a report went out that just this week 23 hospitals had to declare a 'black alert' or that due to their inability to treat emergency patients fast enough because of a shortage of staff, the hospital was no longer safe for those emergency patients. This indicates that ensuring that the numbers of hospital staff on call at any time has been unstable for at least half a year. Doctors have repeatedly talked about conditions in the workplace and talked about both their pay reflecting the work effort they put in as well as the lack of support they have received, they've gone on strike over these issues, and they've been ignored by the government who control NHS trust policies and so some decide to leave. That they are replaced is irrelevant - it's just plugging the gaps. The NHS doesn't need replacement of staff, it needs a growth of staff to handle an increasingly ageing population and the increasing demand on A&E services.

    What better things to convince doctors to stay with the NHS and remain motivated within the NHS than giving them better pay and conditions, something the government refused to do when they forced new contracts upon them, and to increase the available budget, something that the government has also refused to do. If you want the NHS to succeed in its job, which the vast majority of the population of the UK do whatever party they belong to, then it needs the correct resources.
     
  14. Blorcyn

    Blorcyn Professor DLP Supporter

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    Even though he's gone about it in a nobbish way, I do find myself agreeing with Taure. The contract and conditions dispute is (was) not much to do with the crisis the NHS finds itself in. And winning wouldn't have prevented it.

    However, just because he's characteristically semantic, doesn't mean the 'I told you so' part isn't valid, even if it is in poor taste: Experiencing this hell really does sap away the urge to gloat or rage at the DoH. Mostly I despair for those caught in the middle, even as they shout at us for a systemic failure they don't understand.

    Anyway, regardless of the doctor's motives, the government as a political entity has with this contract not achieved its political aims for the NHS. That's certainly true. And it's certainly valid that they had political aims with a public contract.

    As a doctor (anecdote time: maybe of more interest to others than Taure :p ), the new contract we find imposed on us has made weekend staffing more difficult. Just today our rota co-ordination was complaining because the new rules make it very difficult for her to obtain weekend cover in a way that fits the arbitrary new precepts. The inability to now essentially swap on call shifts means we can't sort things out amongst ourselves. And most importantly, there's no difference in the number of doctors staffing the wards anyway.

    I work at one of the busiest hospitals in the UK. It's ridiculous how much it has stepped up since Christmas and we were already operating at a monstrous rate. I've seen well over thirty ambulances queuing outside my wards Windows. I've heard about deaths.

    An 'all clinical staff' email was sent from a senior manager recently, stating we must discharge people at a higher level of risk than we may be comfortable with because there's so many people coming through the door. Woe betide the doctor that actually listens to that thinking the manager will be supporting them when they discharge someone with a possible perf or STEMI. Bah.

    Still. With all non-emergency ops cancelled at least I'm not having to do the shitty pre-op assessments. Silver linings.
     
    Last edited: Jan 11, 2017
  15. Taure

    Taure Magical Core Enthusiast Prestige DLP Supporter

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    @GMM

    No one is disputing that there's a shortage of doctors. You're simply restating the point of agreement: that demand exceeds supply. The point of dispute is the cause. The article you linked specifically states that the cause is overcrowding i.e. too many patients, not a sudden increase in the rate the NHS loses staff:

    The second article you link says nothing about doctors leaving the NHS causing the shortage, but rather a failure to grow the number of doctors to keep pace with increasing demand. Again, exactly my point.

    The fact that he specifically states that the problem is a failure to grow at a rapid enough pace indicates that in fact staff numbers are still increasing, not decreasing. It's just that they're not increasing enough.

    Edit:

    Y'all need to learn what the word "semantic" means. You're using it incorrectly. And yes, that one is a semantic argument. That is: relating to the meanings of words.

    Please note that saying "I would support doctors if they're striking for pay and conditions, but not if they're striking as a political movement" is very much not a semantic argument. Collective bargaining of employees and political movements are very much different things. Calling that a semantic difference - i.e. saying it's wordplay - amounts to the proposition that there's no difference between public and private spheres. Which is a) a substantial political proposition, very much not semantic in turn and b) a really hard sell.

    Not all logical distinctions are semantic ones. In fact, most are not.
     
    Last edited: Jan 11, 2017
  16. Invictus

    Invictus Heir

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    Except that Americans going to Canadians Universities doubled this year.

    It's not semantics. Still pedantic. It's an artificial division you created in a situation where it's not really applicable except for legal theory matters. The doctors interests as people and profesisonals aren't divisible, the policy mstter that affects their contracts and their conditions is the same that is refunding the NHS. You can't try to take a part of the argument sand say protesting about it is okay, but about the rest isn't. In practice is the same goddamn issue. The contract is just a more direct example.

    It's like damages and losses in a case where a cargo ship lost its cargo. It doesn't fucking matter what is loss and what is damage, for no one. It's the same fucking thing for everyone except for a smug Law teacher.
     
  17. Taure

    Taure Magical Core Enthusiast Prestige DLP Supporter

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    Sorry but you're just completely wrong. There's nothing pedantic about outlining acceptable mediums through which various grievances can be aired. We have a democratic political system within which there are various ways you can exert legitimate political pressure: by voting, by campaigning, by writing to your MP, by staging protests. But there are also certain forms of political pressure that are considered illegitimate within our political system. Strike action is one of those. Another is the use of violence.

    That's not pedantic, it's crucial to the correct running of our political system. The distinction exists precisely because in the 70s political strikes led to the entire country shutting down, with a 3 day working week due to electricity shortages.

    The difference between a lawful and an unlawful strike isn't something trivial or pure legal theory. It has massive real world consequences on our political system and day to day life.

    Doctors are pretty smart people. You say they can't tell the difference between striking for better pay and conditions and striking to change the government's fiscal policy. I think that doctors are plenty smart enough to comprehend that distinction.

    A) Same point as above: without knowing the base rate, and knowing that rate in the context of total applications in general, the fact that it has doubled is pretty meaningless.

    B) Source? All I can see are various stories about internet traffic to Canadian universities' websites.
     
    Last edited: Jan 12, 2017
  18. JoJo23

    JoJo23 Auror

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    Skeptical of claims that this is linked to the new contract. NHS Scotland and NHS Northern Ireland are having the same issue.

    It likely has its source in other cuts.
     
  19. Invictus

    Invictus Heir

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    ... the NHS contracts and these problems have the same source. Funding. Which according to Taure means you can't protest one, but not the other, even if it's direcrly affecting their professional and personal levies. There must be a separation. Stage three different protests and strikes I guess.
     
  20. Chengar Qordath

    Chengar Qordath The Final Pony Prestige

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    Yeah, the contracts are clearly just another symptom of the NHS's general funding problems. Big shock, the NHS not having enough money means they can't pay doctors enough to keep them on-staff. It's hard to disentangle contracts from NHS funding when NHS funding is why the contracts happen.

    I don't think there's much room to dispute Britain's ongoing brain drain when it comes to medical professionals. Those doctors are leaving because they can get better pay/conditions elsewhere. It's not exactly crazy to think that when the government responded by giving the remaining doctors lower pay and worse conditions, they encouraged the ongoing brain drain.

    It's not hard to connect "We don't have enough doctors" with "Doctors keep leaving the country to go abroad and get paid more."
     
    Last edited: Jan 12, 2017