The NHS, a lesson in politics part IX

The NHS; a lesson in politics part IX

There’s no mistake, I smell that smell
It’s that time of year again, I can taste the air

Hello doctors, you still here? Shouldn’t you be filling in an OOP form? Or maybe an undated resignation letter? The OOP is only an offer, but if we manage to gum up the “please god get me out of this shithole” system it will raise a few eyebrows.

If you are struggling and want help writing your undated resignation letter or are planning to OOP, tell me here at I will do my best to collate and help.

Also any hunt effect cases would be very useful.

Unlike GCHQ I respect privacy, so rest assured you’ll be treated in confidence.

Why is this a repeat?

Sir David Dalton the tenth highest paid NHS manager (£232k if you’re asking) has shat out a letter saying that it’d be really awfully nice if you’d stop making a fuss and get on with working yourselves to death.

So in true secretbatcave style, I shall go through the letter, pick out key points and translate them into human.

First, a logo

Do you really expect me to trust someone so highly paid as your self, Sir David, if you can’t put a logo on a letter head with the correct dimensions? Look its not tall enough. There is a whole website detailing all the things you could want to know about putting an NHS logo on a piece of paper.

I can only hope you’ve brought the same razor sharp eye for detail to the negotiation.

Now the letter:

It is clear that there is a high degree of discontent which has been fermenting for some years and that the proposed new contract has brought this to the surface.

It turns out that actually the BMA wasn’t kidding when it said that you juniors were pissed off. Fuck we miss-judged that one. Why can’t you be like GPs and argue amongst your self? Look they are quite happy to hold conferences where they argue about points of order, and lengths of debate, to the nearest 30 seconds. Be more like GPs please.

There are almost 100 separate points which have been considered as part of the proposed contract, which illustrates the complexity we are dealing with.

Firstly its “points that” the green squiggly lines are a give away. However of these 100 points, the stock answer from the government is: ‘NOOOPE, too expensive’

There is a lot written and spoken of in news and social media and much of that gives polarised opinion about the views of trainees and NHS Employers with little consideration of the full, wider picture.

Well, yes, that’s what happens when you let spin doctors loose on a tame media isn’t it. Should have thought about that before trying to break the Junior’s resolve by publicly smearing them with shit.

Speaking of the wider picture, do you mean the increasing numbers of doctors leaving the profession permanently (set to be 20% per year by 2020)? Or perhaps the massive financial crisis the trusts are facing? or maybe the impending drop in survival rates for common diseases due to budget cuts? Or were you meaning the massive drop of nurses in training?

The wider context is an ocean of shit, almost entirely self inflicted by the last 6 years of fuckery by the government. Pro tip: if the biscuit is soggy, stop any further wanking onto said biscuit.

The complexities are most often ‘explained’ in very simple terms and single issues are frequently taken out of context adding unnecessarily to existing anxiety and uncertainty.

  • Cough 15% more likely to die at the weekends.
  • Cough just Google the rash
  • Ahem Stroke care is rubbish at the weekend

Did I miss any? The only one here damaging the NHS, and generally causing harm to patients is Mr Hunt (and his press team). How many people has Hunt’s pronouncements killed?

At what point on the Shipman scale of “Accidental Deaths” will Hunt start to feel regret? (1-100 scale, a “full shipman” is 208 deaths)

The outline of his goals:

Here are a number of bullet points that explain in nice general hand wavey terms what everyone wants: decent conditions.

However, as the national lottery said to the Grandma Its all about the details love.

Significant safeguards would be introduced to prevent excessive hours being worked and to prevent excessive consecutive days/evenings/nights to be worked;

“Would” is a rather odd, passive verb to use in this sort of letter. We’ll see later that actually “Significant” means fines going to the very trusts that were causing the breach.

it would pay trainees for both the level of responsibility and for every hour worked, including occasions when shifts overrun;

Well no. It would only do that if doctors clocked in and out of each shift, and were paid by the hour. You see Doctors are on salaries. So it doesn’t matter how many hours you actually work, you’ll still get paid for doing 48 on average. Unless you request hours monitoring, and enough of you lazy arses filled in the paper work.

for existing trainees, in three-quarters of cases, during the period of training, the level of pay would increase, and no trainee would experience a pay cut;

But yet you don’t release a sample banding/pay scale system. So we just have to swallow that ejaculate sight unseen. If it’s so good, show us the evidence young man. Also is that total pay? because the spec of negotiation says no “overall increase in pay envelope”.

Unless there is real evidence, with detailed payscales that we can all see, we’ll have to file that claim under “Anus-smoke induced injury”

supplementary payments would be made to trainees working weekends, evenings and nights

Apart from Saturdays, because they are not weekends. Oh and day shifts are anything up to 01:59 AM and from 04:01 onwards. OTHER PEOPLE WORK THEM, WHY WONT YOU? YOU UNGRATEFUL SHITS. IN T’MILL WE’D WORK ALL THE HOURS THAT T’MASTER GAVE US. IF WE LOST T’HAND WE WERE GRATEFUL.

availability payments would be made to those providing non-resident on-call;

Yeah, we’re going to make sure that you have to stay at home, pay for a child minder, live within 20 minutes of work for the 3 days ‘off’ you get a month. Don’t worry we’ll give you something, but not enough to cover your child care/divorce costs.

The Safety section

This is the bit where Sir David says that everything is better. Its where fines going back to the trusts for illegal working practices so that they can be used for funding “training improvements”

These include: that no doctor will ever be rostered consecutive weekends; the maximum number of consecutive nights will be reduced from 7 to 4; the maximum number of consecutive long days will be reduced from 7 to 5; and the maximum number of consecutive days will be reduced from 12 to 8. We also agreed a limit of 48 hours worked on average over 26 weeks,

After all of those semi colons insert the phrase “unless you are at home on call”. Sorry but simple maths here: if we are understaffed already, and doctors are really working fewer hours, how are you proposing to fill the gaps? Have a system of rolling “off days” for each hospital? Aligned so that everyone has an open hospital within 50miles?

Simple logic says that this is utter bollocks. You can’t have fewer worked hours and still provide decent quality care.

Now this paragraph about the power of the guardian to impose fines is a real “humdinger” as Ned Flanders would say:

if a doctor is found to be working more than 48 hours on average. The level of the fine to the Guardian will be based on the excess hours worked x 400% These fines will be invested in educational resources and facilities for trainees and these will be over and above monies already allocated to those areas. The doctor will be paid for the excess hours worked at a rate over and above the prevailing rate and this amount will be deducted from the 400% fine held by the guardian. We have not been able to agree the level of the payment to the doctor.

Just read that through a couple of times. The first thing that jumps out is: unlike now, you won’t be bumped up a band if you are working more hours than you should. You’ll be paid pro-rata for the hours worked. Not even overtime, just your above normal hourly rate. Is that with “banding”? without? DETAILS MOTHERFUCKER.

Second the rest of the “fine” will be used to “improve education resources and facilities”. That’s nice, it’ll allow trusts to cut back on the teaching budget and use fines to fund libraries.

The other engorged cock in the ear is this: no mention of preventative or corrective powers. Sure they can fine the trust, but only if they have proof right? What is the level of proof required? Can the Guardian act on their own? or do they need lawyers? If you’re not going to get paid anything to report overtime no one’s going to fill in the hours monitoring.

We have also discussed the shortcomings in training support for trainee doctors.

Turns out there aren’t enough hours in the week to do this. Plus we don’t have any cash to provide the teaching facilities. Also we need the teaching space to hire refrigerated lorries to put the victims of the hunt effect in.


This section is about how best to replace the banding system. Using an hourly rate plus an evening/weekend/night multiplier which almost every other industry uses is seen as too complex and not transparent enough.

The BMA and NHS Employers agree that the inequality, created by the current banding system, should be addressed. Currently it allows doctors on the same banding to be paid the same for different levels of unsocial hours working.

But paying a flat rate, plus a “this is a fucking awful time to be working” multiplier is too hard, because paying doctors for work done is too expensive.

The Government is all about the real economy, unless it involves paying people civil servants market rates. Then it’s a bad thing. You are bad for wanting money. YOU SHOULD FEEL SHAME DOCTORS. Everyone should feel a sense of duty to tighten their belts and do what they can to support the UK. Unless you are a big business, then you can do what you want. Pay only 2% tax? OK GOOGLE.

Following an improved offer made on 16 January, the proposed new contract allows every doctor to be paid for every hour worked with supplements for Saturday evening (from 5pm), night (from 9pm) and Sunday working – and for those who work for Saturdays more frequently (those working 1:3 or more), to receive additional payment for all the time they work on Saturdays.

CLOCKING IN AND OUT IS TOOO HAAAARRDDD. TIME AND A HALF ON WEEKENDS, BANK HOLIDAYS AND 7PM-7AM IS TOO MUCH FOR YOUR LITTLE TINY MINDS TO COMPREHEND. Or words to that effect, seriously every. other. fucking. company. does it like this. Its really not that hard, unless you are trying to get people to work more and get paid less….

The substantive outstanding area of disagreement is about payment for evening and Saturday working. […] I remain disappointed that the BMA has refused to negotiate on this issue. It seems to me that an inability by the BMA to find any room for manoeuvre on this outstanding issue is not helpful, if both sides are to reach a fair settlement.

Listen dicksplash: go and talk to a junior doctor, go on pick a few and ask them: “Will you work on Saturday for no extra cash?” You get a range of responses ranging from “no”, to “NO” all the way up to “GET TAI FUK LADDIE, DO YA WANT A PUNCH?” its not the BMA who are being obstinate, it’s the people they represent.

If you were truly in the business of healing wounds, you’d stop all this redefining night-time and weekends, and generally behaving like a Dickensian mill owner. You’d say alrighty kids: Everyone gets x an hour, depending on skill.

  • After 8 hours you get time and quarter, any time day or night.
  • nights are 7pm-7am you get 50% extra an hour.
  • Weekends are and extra 50% as well

That means if you are on your 9th hour on a Sunday you’ll be getting 225% of your hourly rate.

Fucking simple. Job done. Now go and find the extra money to hire the nurses that we need to stop the NHS from imploding.

Oh wait, yeah, lets not mention that.

Payments for non-resident on call have also not been agreed. These staff are not required to be at their place of work for the period of on call duty unless they are required to attend, in which case they are paid full rates for the hours that they work. Our offer of a 10% maximum is less than the BMA would have liked at 20%, but it is more than that paid to consultants (or staff, associate specialist & specialist doctors), and is more than our original offer. Again it is unfortunate that we have not been able to reach agreement in negotiation with the BMA on what that rate should be.

You know why there has been no agreement? Because Non-resident on call is a great way to plug rota gaps. That means you’ll be working a full 48 hours a week, but you can’t go out to the park, or visit friends because you have to be available to drop everything to go into work. All your “off” days become property of the NHS.

Oh, and don’t think about leaving that crash bleep at work, you’re taking that home my friend. That’s right bitches, you’re on call during the night. Its like all the fun of young children (the shit, the tears and vomit) but none of the pension, organ donation and shitty artwork that it entails.


It is clear that what is needed is a commitment on both sides to continue to talk on the key remaining issues and to find the room for settlement. Failure to do this will mean that no agreement can be reached.

It’d also mean a mass exodus of staff, but you don’t quite realise that yet. Sir Dave, if I may call you that. You really need to understand, Its not the BMA that’s making this stuff up, they are one and the same as junior doctors. There is only so far you can push these people. Unlike the miners, Steel workers, Tube drivers, junior doctors are highly middle class, highly mobile, sought after people. Remember, middle class people are the ones that vote tory.

Given the high level of unhappiness, I have recommended that the government, the Academy of Royal Colleges, Health Education England and NHS Employers commission a review of the long-standing concerns with recommendations to all parties for action which can improve the welfare and morale of trainees.

Stop acting like imperious cunts then and put some fucking funding into the NHS. If you want a productivity revolution you need a healthy happy workforce.