NHS

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Another big change to the NHS, from STPs, which are not off the ground yet, to Accountable Care Organisations.

I agree with GillT57 anyone whose training is paid by the tax payer should give back 7 years full time or equivalent. If they don't do this they should have to repay their loan. Also more medics need to be trained. There is fierce competition for places and sometimes students with four A grades at A level do not get a place for medicine. It is madness when we have a shortage of doctors. We don't train enough medics then try to entice medics from overseas some of whom struggle with speaking English and are badly needed in their own countries, who paid for their training then lose them almost immediately.

Our town is so short of GPs that the surgery has amalgamated with one 6 miles away.
Almost all the doctors choose to work part time, which is nice for working parents but not possible in most other professions.
In 23 years I’ve rarely seen the same doctor twice and the appointment system has been changed recently, apparently with the intention of diverting most patients to A and E, 12 miles away.

I think we need to differentiate between those who work in a hospital and those who work in general practice.

I go to a large practice which is essentially a small business and a lot of the nurses and doctors are part time. But from what I can gather when they don't work at the surgery, they can be working elsewhere. At least one of our doctors teaches at a hospital and others have private practices. The other thing is the length of the days they work can be very long. I'm not aware of any doctor working school hours, but some do work half days. The doctor who teaches a a hospital told me years ago that only a small number of his students intend to go in to general practice. I wonder if those who choose general practice these days do so on their own terms and the work life balance is definitely part of that decision.

In hospitals HR is involved in the recruitment process and for equal opportunity reasons each post is supposed to be offered on a part-time or full-time basis. There has to be a good reason why role must be full time. HR departments have long been used to looking at staffing on a 'whole unit' basis, so the number of bums on seats is always much higher than the number of jobs. The problem the NHS has is finding the money for staff.

GillT57, teachers, doctors, nurses (social workers too) pay for their degrees and subsequent further training. Doctors will earn enough to pay back their student loans but nurses, teachers and social workers are unlikely to earn large salaries unless they go into management

I'm not concerned about GP's working part time. This enables young parents to be more involved in bringing up their own children and older GP's to ease off a bit as their energy levels drop. I am concerned about the difficulties surgeries are having in recruiting GP's. Ours is a teaching practice in an area that has been a good place to bring up children so in the 50 years I've been with them, there has never been a problem recruiting. There is now. Young doctors don't want the bureaucracy and long hours that go with being in general practice. Our GP's work 10 hour days or longer, regularly.
The same issues arise in other areas of public service, where staff accept they are accountable and must comply with expectations. The difficulty is in the box ticking culture, the constant on line forms to complete that mean more time is spent on that than with service users/client/patients (or victims of crime)

My DiL is not a GP but is in specialist training at our local hospital and has been studying medicine for 13 years.
At 30 she and DS are hoping to start a family soon. She'll take 6 months maternity leave and return to work, hoping to be a registrar in 4/5 years.
Surely no-one would question her commitment.

It depends how you define ‘gone down’. If inflation is greater than the amount by which the budget has increased then spending has gone down

The taxpayer funds many types of training. Should lawyers, vets, engineers, musicians, economists and so on also be obliged to work for the state?

The 'work experience' of trainee doctors & nurses is cheap labour for the NHS. Students in England are in fact paying £9000pa for that WE.

It's not that our expectations that have gone up, but that spending has gone down, quite dramatically.

I don't think you've read the chart.
It shows the average increase in spending.
Each year in positive.
This means, each year, the spending is increasing.
Some years it's increased more than others.
But every single year it has increased.
That means it has never gone down.

I think all of our GPs in the local surgery, bar one, are part time. At Christmas they are all on leave and so there are locums to cover. It is hopeless to request a specific doctor. My husband needed to see a consultant urgently and was told the wait was 4 months. Went private and saw the same guy the same week. Go figure.

Do the independent sector really scoop up many of the newly qualified in any sector. Some of course, but more than 10%?

When I graduated in the mid 1960s everyone was getting their knickers in a twist over the brain drain of new graduates to the USA, and demanding that new graduates do so many years work in the UK before they could emigrate, but I only knew of one person doing that and other people did not know any, including several in medicine and engineering.

Never thought of that ,Gill. You are right.
Can't imagine why anyone becomes a nurse/teacher these days. It must be most demoralising. I presume doctors eventually get back to what the profession used to be. Still disheartening.
Why does the government want to do everything on the cheap?

I know DJ both of mine have those debts ( and interest at 6.1 usury rates, but that is a different topic ). But, the work experience part of these medical and teaching qualifications are provided by state/tax payer funded institutions.

I am sure when my husband was given day release to go to college to train to be an architect he had to sign a contract which said he would have to work there for the same number of years afterwards; otherwise he would have to repay pro-rata.

The difference now is that they pay their own fees, and end up coming out of university with a debt of up to £50,000.

All people who have their training paid by the taxpayer ( teachers, doctors, nurses, medical professionals of all areas)should be obliged to undertake a certain amount of time working for NHS/LA funded schools etc. It is grossly unfair and immoral that the independent sector, be it medicine or education, should be able to scoop up people without the expense and commitment of training.

It is regularly being suggested that the way to get more employment, not just in the numbers of people working, but also in the hours worked and pay they get, is to cut down to a four day working week. I've always thought it a good idea to have more part time work.

I am very happy with the part-timers. They are often women with families and they bring a grounded approach and understanding to family problems. It also means that they are not so over stretched that they burn out, as my OH did, working in full time general practice. The spouses and families get to see them and they get some normal life from which to take strength and come to their work refreshed.

He wasn't talking about nursing either, which is becoming a more professional environment.
That was never male- dominated.

There is less part time working in the NHS than there used to be. There used to be lots of part time jobs which suited working mothers but most are now full time. Some experienced professionals, especially in specialist areas, are still able to negotiate reduced hours return to work after maternity leave as the other option is that they leave altogether. I think Prof Cumming is talking nonsense.

An interesting chart here on health spending in the NHS.

It's not that our expectations that have gone up, but that spending has gone down, quite dramatically.

SueDonim I agree that we ought to rethink our expectations of the GP service, saying "I want to see my own GP, nobody else" is not realistic.

I also think that the the Govt would like to privatise, but wont dare to until they have run the service down to the bone.

I very much dislike the idea of rationing treatment in a sort of deserving and undeserving ill people way. That is against the whole ethos of the welfare state.
We are already having that sort of attitude as regards poverty, let's not start doing it with illness.

The government want to privatise the NHS. That's why we have these problems.
Nothing to do with whether we pay more into it or not.

People have always worked part time in the Health Service, its not new it happened in the 60s and 70s so people could raise a family and work. Life changes, there is huge progress in the conditions that can be treated, it is not the people working in the system who are the problem it is the system. There has to be a better way so people do not spend hours on trolleys in corridors, but politicians never commit to what is really needed, money to properly modernise and most people seem reluctant to pay more, personally if I thought it could sort out the Health and Social care systems I would pay more.

Its always been the norm in care work that you're obliged to stay for so long after doing training, or else pay back some or all of the costs. Obviously, just a few hundred pounds for nvqs, maybe a thousand.