Sauce for the Goose?

The Guardian reports today that despite all of the private sector bleating about public sector pensions those at the top have been doing quite well thank you. Whilst labour MP's suggest that public sector pensions should be capped at £50k directors of the FTSE 100 have increased their pension payouts by 23%. This gives a mean pension payout of £248,000 per year. Yet again the public sector are simply not worthy. Only heroes like Fred the Shred deserve £342,000 per year and a tax free lump sum of £2,800,000 after all.

Nurses, doctors, managers, what were you thinking?

Cut 10% of the NHS Workforce?

What a good idea. As a nation we are broke.

Does the McKinsey plan stack up? We are training too many doctors. At the current rate we are likely to have 10's of thousands of trained, unemployed consultants in the future. Do we really need every minor complaint to be treated within 18 weeks, does it make sense? Try ordering a sofa and see how long to takes to arrive. Urgent conditions should be treated immediately, semi urgent within a couple of weeks and everything else should wait its turn.

Can we lose 130,000 jobs in the NHS and continue? You bet. The NHS is stuffed to the gills with Workforce Transformation Directors (£100k), HR Business Partners(?), Service Improvement Facilitators, Diversity Coordinators, Safe-guarding Leads, Deputy Heads of Car Parking and a whole slew of hopeless managers. Management numbers could be halved with most of the duties taken on by nurses, physios, doctors etc, for themselves. It would probably not make a jot of difference.

Cut medical student numbers, sack lots of management posts. Good idea.

Sack lots of nurses or front line doctors? Quite clearly they have never been admitted to a general medical ward on a busy take in the era of the EWTD!

90% of Trainee Surgeons Feel EWTD is Harming Patient Care

Surgeons are keen on working. They like the work, they like to make people better some even like the money. It therefore comes as no surprise that a survey of 70 surgeons on the EWTD suggests that 91% thought it would have a negative impact on their training, with 90% feeling that patient care would suffer. Seventy three percent wanted to opt out, with 74% wanting either standard pay or time and a half.

The initial survey was a small sample with only 70 doctors involved but ASiT and BOTA are planning a bigger study for the early autumn. Should be interesting!

DoH letter on EWTD

The DoH on Thursday wrote to wrote to Medical Directors and Chief Execs spelling out the EWTD. Specifically

• Hours must balance over a 26 week period (e.g. if a ward round runs over then that is fine)
• Extra hours (e.g. that ward round) should be paid back in compensatory rest
• NHSLA indemnifies juniors even if outside hours limits
• Junior docs hours shouldn't be more than 56 including locums
• All training should be contained within 48 hours
• Opt outs must be in writing and cannot include rest periods or leave

The full letter is available here

Now PwC Wants Our Pension

In my little neck of the woods we all had a visit from Price Waterhouse Coppers. This was about 2 years ago. Some clever men and women with clipboards came and asked us what we do, how we might improve things. They wrote it down into a Word Macro and then charged the hospital a fortune. I went to a regional meeting and it turned out that PwC had been into every hospital in the region. Word on the street (no doubt partly wrong) was that some hospitals had paid up to £1 million pounds to get someone else to talk to their own employees!

Now they have waded into the 'we're having a miserable time in the private sector so you can loose your pension too' debate, reported here by the BBC.

When I was 25 I attended a course at King's on the Strand. It had cost me £1500 and was every night and every Saturday for 4 months. I was taking home £950 per month working as a doctor and lecturer. I was working about 80 hours a week and my rent was £850 per month.

Every night at 7pm I walked past the then Arthur Anderson Consulting, I watched countless men the same age as me drive out of the garage in brand new TVR's and Porsches going home as I was about to attend my course until 10pm.

Now, I wasn't bitter because I realised that I would have shit pay and conditions until I was about 38 and then my life would become reasonable, I would be paid more and I could anyway look forward to a good retirement income if I made it that far.

But it seems I was wrong.

Now I'm not saying that the private sector puts in any less effort. But the average doctor would have had an excellent chance of going to Oxbridge, turning out a good degree and getting a job in the City. I work with quite a few medical students who did just that, saved a few million after tax and are now studying medicine as a hobby.

If I was looking at the pay, conditions and pension arrangements that PwC and the rest of the private sector would like visited on the NHS then there is no way that I would have chosen medicine. I would have picked business or the City. I'm sure many others would think the same way.

What needs to therefore be considered is just what sort of people will be recruited into medicine. In Russia doctors pay and conditions have been very poor for many years. The Russian health service has some of the lowest outcomes on the planet. In America the ludicrously expensive health service has the best paid doctors in the world. It's outcomes are also the best. I don't suppose these facts are entirely unrelated.

It may be worth noting that in 2006, Keiran Poynter, the last Chairman of PwC took home £2.5 million. The 793 partners earned an average of £716,000 each. Of course pay and conditions are vital tools in recruitment.

Oddly enough PwC has 16,000 employees in the UK so their partners represent 5% of the work force. The NHS has 1 million employees and 40,000 consultants or 4% of the workforce. If senior management are included too it comes to less than 5% of employees. Yet our pay and conditions are far too good. Even if our pension contributions are 35% above the private sector their salary is 716% higher. I know which I'd settle for.

Bean counters. They simply can't see beyond the numbers.

Pensions Put Out To Pasture

The Great News! The recession is nearly over and it's only needed public borrowing and printing enough money to account for 21% of GDP.

The Bad News. We're broke and you've got to pay it back.

The Result. Pensions are even less affordable than ever and yours is going to be cut.

In a story in today's Times plans are announced to cut council workers pensions. One of the plans is to swap to career related average earnings (as tried a couple of years ago for the NHS). It seems likely that all further pensions accruals (not just new starters) will only continue to build benefits on this basis. For council workers at the upper end of the salary range (a bit like consultants) this will mean cuts in pensions of 10's of thousands per year.

A senior local government official who has been briefed on some of the proposals said that doctors, nurses and teachers were likely to face similar changes as the public sector burden becomes unaffordable.

Wave goodbye to that last minute Bronze award impacting your pension. On a career average basis it'll make not a jot of difference. The pension changes are likely to be brought in with the sweetener of a pay increase. This will of course be eroded over the course of a couple of years DDRB pay awards.

Gird up your loins for a battle!

Was Jackson Killed by Dr Conrad Murray?

Goodness only knows what Dr Murray was doing giving Jackson a combination of Propofol, Lorazepam and Diazepam. Giving people an anaesthetic in their bedroom is only going to lead to trouble, especially when Bubbles the chimp is known to be a reasonably poor ODP.

Murray, one might argue, must have been barking mad.

Not quite as mad however as his employer seemed. Occasionally I have trouble sleeping but it seems unlikely I could get my local GP to come round to Spratt Towers to give me a domestic anaesthetic.

Jackson had a bit of form. I wonder, if it is just possible, that what killed Michael Jackson was his seriously wierd life?

Coming next, Porsche charged with killing James Dean, National Trust charged with Killing Sir Donald Campbell, Columbian farmer charged with killing River Pheonix.

Trainees quit resus when shift ends

Sources tell LS that there are reports of trainees knocking of from CPR when a shift comes to and end.

I'm endlessly impressed by most of the trainees attitudes but clearly this kind of behaviour is out of place in any profession.

Treat people like simple employees and it's what you get.

American doctors looking like doctors

British doctors looking like nurses