Category Archives: Staffing

Yes we need more resources in mental health but not the same old ‘diseased’ bio-psychiatric medical model of mental ‘illness’ and mechanistic Cognitive Behavioural Therapy,  but a social-social public health preventive model of mental distress/health, health workers who firstly tackle the social determinants of health and work amongst the people where the social is not forgotten.

No one is denying the reality of mental distress, also mental distress needs twenty times more resources than at present, but the question is “what type of resources and interventions?” Does anyone ever stop to analysis why mental health issues are occurring. What is the cause that causes the cause to become a cause? Is it diagnosis which is so wide e.g. DSM5, that everyone is now mentally ill?  Is it iatrogenesis? Is it the ideology of austerity? Is it the treatments with so called anti psychotics and anti – depressants? Is it coercive mental health laws?  Is it unfairness, poverty, inequalities? Is it abuse and discrimination? Is it a cruel state, poor working conditions, deregulation and privatization? is it individualising, psychiatrising, psychologising existence so that the social, political, economic, materiality and broad environmental issues conveniently disappear? Is it capitalism, society, which causes so much mental distress? Why are so many people internalising their own oppression, harming themselves? Why not externalise their distress come to voice. There are many people who would like to work in mental health but not one dominated by psychiatry and mechanistic CBT.

Psychiatry is a pseudoscience with a faulty epistemology  and wrong, very wrong, ontology. What is a human being – not just DNA or neurochemical selves. Humans are social beings and how society is socially, economically politically and environmentally (SEPE) arranged influence much including mental health and distress.

Many people who go into the psychiatric system have just normal emotions, reactions to situations, e.g. bullying, all forms of abuse, power-over, lack of autonomy and control, alienation, homelessness, trauma, unfairness and poverty. Many have been drugged (iatrogenesis doctor induced illness) into psychiatric services as Whitaker (2010), clearly and with evidence illustrates over the last sixty years people have been medicalised and damaged.  Psycho-trophic drug giving has ‘sky rocketed’ leading to an explosion of chronic mental health and physical disabling conditions.  Q if the drugs are so good why has chronic mental health conditions increased so much in the last 40 years – madness. No one is denying the reality of mental distress. People suffer suffering is not an illness. Psychiatry is a marriage of convenience with neo-liberalism, big pharm, corporations, governance (control of the populace) – a form of ideological hegemonic power.

Surely all the children in USA/UK now medicalised with toxic drugs aren’t all mad? Did the children ask for these drugs? Do all women and the poor placed in institutions by husbands, families consider themselves mad, are all the Jews exterminated by German psychiatrists in T4 camps did they consider themselves mad? Are all BME groups labelled and tortured by psychiatry would they consider themselves mad?  The Soviet dissidents tortured in Russian and sent to gulags would they consider themselves mad? Are all the people getting on in years and particularly women given electric shock at alarming increasing rates are these people mad?

When you listen to people who have experienced abuse, rape, power-over, poverty, trauma including psychiatric trauma and psychiatric rape, experienced a cruel state, would they consider themselves mad? Maybe nearly driven mad but that’s another issue.

What can be called mad is a biological and genetical, nonsense aetiology which still prevails. When in the 21 st century today’s scientists are aware of epi-genetics and that genes get switched on and off and are influenced by social economic political broad environmental  issues including poor diet. The genome studies again have found no conclusive findings for biological explanations for mental distress.  Mad is the four ideological myths of psychiatry (chemical imbalance, 1960’s marketed drug ‘illness model of drug action, pseudoscience of diagnosis, biological biomarker myth) and the reality of coercion and iatrogenic mad practices. Another madness is the invention of illness DSM and all classifications, fabrications of psychiatry. Thinking that psycho-trophic drugs will cure mental distress is another madness. Nor providing the social determinants and the prerequisites for health and wellbeing is mad also really a crime against humanity. Psychiatry is a crime an industry of death.

Some people  state it is  naïve to want to abolish psychiatry without putting something in its place  – to abolish psychiatry is a necessary prerequisite for change and it is naïve not to want to do this. Replace it with more doctors of medicine MD’s, they are trained to deal with health problems – adopt a new approach to mental health, a public health approach, adopt community preventative medicine, not dualistic but holistic including changes in SEPE – increase resources for mental distress twenty times fold – not less resources but more. Have a 100% state funded NHS, have no private provision in NHS, have a national work occupation health service in all organisations to promote health and reduce mental distress. But don’t have a national sickness service have a health service.  More up – stream public health measures preventing and enhancing health, a more just society, reduce relative income differences, introduce a universal wage. There are numerous alternatives – open dialogue, exercise, social solidarity, Hearing Voices Network, peer groups, Sorteria houses, dial house in Leeds, activity for life, retreats, safe spaces, quiet spaces, night cafes, more social engagement, better healthy workplaces promoting autonomy control and income and so on. Adopt a social model of health and mental distress tackle alienation. Just stop abuse. Maybe social transformative change has to occur before psychiatry is abolished? Just think if annoyed, angry, discontented, irritable, unhappy, grief stricken, miserable people, put upon people, people disadvantaged, ‘down depressed’ people, agitated people, traumatised people, abused people, decided to use this energy as a catalyst joining alliances to change things, demand a less abusive fairer society, that would upset the status quo.

This author acknowledges the reality of serious mental distress which needs resources but the crucial question is what type of resources. It also acknowledges that some people are happy with present day mental health services and drugs but others are not. Many people are trapped and damaged by the drug regime.

If you get rid of the ideology of psychiatry and psychiatry itself, there will be less stigma more possibilities. One can easily make a case that capitalist society  makes you mad – isn’t education mad, testing children, pressurising children, labelling children – too much I.T  and  social media pressure, too much computer time, sedentary children inducing future public health ‘time-bombs’-  isn’t this madness?

These are not just issues of the past. They are happening now and will happen in the future if psychiatry isn’t abolished. We are drugging people and damaging them, some drug use will still be required, there is a role but use the correct drug induced model of drug action, be truthful with people and use drugs with extreme caution and only mainly short term. Electric shock, psycho-prisons, Community Treatment Orders, harmful mental health laws are still used. Human rights violations are very much still rampant. So who is mad? Surely not the people, surely not children and the poor,  not the politically constructed ‘race’ people.  It isn’t psychiatric neglect but SEPE neglect, social justice neglect, materiality, power and resources neglect and psychiatric abuse. It is also an abuse that there is very little resources for mental distress but these are decisions made by people in power with vested interests in the status quo. Just think how much money we could save without a pill for ever ill. Just think how many people could be saved from chronic disabling mental health conditions, how many children could be saved. This money could be used in mental health on alternative schemes and up –stream public health to prevent health problems.

Here is the crux many people have a vested interest in psychiatry, and the psych industry unfortunately they are also very powerful in a neo-liberal state and the ideology of individualism, a form of social control and it’s an ideal way to make profits.

One person with a similar aim and viewpoint – Bonny Burstow (2015) her latest excellent book Psychiatry the Business of Madness: an epistemological and ethical audit advocates an abolitionist approach.

Revision after consulting the public in four workshops and 14 discussion groups  have recently  come up with a manifesto for change which will be launched in 2017

Revisions Manifesto’s seven visions for change:

  1. To move from a ‘diseased’ bio-psychiatric model of ‘mental illness’ to a social model of mental distress/health. We need for a different approach ‘grounded’ in social fairness, listening, equity and social justice.
  2. To  stop using all psychiatric diagnostic and classification systems
  3. To recognise what we need to achieve good mental health :
    1.  Income, family, friendships, a safe home, opportunity, work, leisure, the arts, spirituality – plus many more which should be defined by individuals and communities themselves.
    2. Recognise oppression in all its forms and develop strategies to combat these at the individual and structural level.
  4. To understand that medication does not and cannot ‘cure’ mental distress.
  5. To work towards socially orientated and democratically accountable types of mental health service provision.
  6. To stop coercion – abolish Community Treatment Orders, ban electroconvulsive therapy  and urgently review all mental health laws.
  7. To challenge the current crude neo-liberal economic system that creates a fertile environment for ever increasing mental distress.

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Wednesday’s budget delivered grim news of poor economic growth over the next few years, compounded by even grimmer jokes. However amongst the cautiously delivered statement seemed to appear one pearl of  policy that should of set every NHS employees heart a flutter. The announcement that funding would be provided to facilitate pay rises for some staff, but this was not the monumental announcement abolishing the pay cap or a U-turn on austerity that some may have hoped for. This announcement came as more of a carrot on a very long string with a few hoops to jump through along the way and it would appear the devil was in the detail. The Chancellor confirmed that this increase in pay would be linked to productivity and pay reform, something that has been mooted before without being fully explained. So the question of whether or not there would be a pay rise has left many nurses, midwives and paramedics scratching their heads.

Union bosses criticised Mr Hammond’s announcement. Unison’s Dave Prentis showed concern that the chancellor was raising the hopes of nurses without putting any extra money on the table, where as the RCN’s Janet Davies warned that any pay rise should not be linked to staff working harder highlighting the fact that nurses have had their pay frozen for the past 7 years and that any increase would only deliver what had been lost. So what could this announcement mean for nurses ?

It is no secret that the NHS faces a funding black hole despite receiving an extra 2.8 billion this budget, with the government hoping the restructuring of services will help plug the gap. Many NHS staff are paid via an agreement called Agenda For Change which allows for universal pay across the NHS as well as providing incremental pay increases linked to progression.

2016 saw Health Secretary Jeremy Hunt embroiled in a row with doctor’s over contracts that many labeled unfair but the government said were necessary to modernise the health service. It is thought that the same will happen again with Mr Hunt setting his eyes on aspects of the Agenda For Change agreement particularly surrounding enhanced unsociable hours payments given for night shifts and weekends when he submits evidence to the NHS Pay review body in the next few weeks. It is  also felt that the Government will attempt to redefine the working day in line with their 7 day service strategy. This could see unsociable hours pay kicking in much later in the evening and being abolished at weekends. Other possible changes could include smaller incremental progression pay rises as well as getting rid of any overlapping pay structures between bands. meaning those nurses who reach the top of their band, don’t progress or rely on extra hours payments may see the long term pay drop further despite any pay increase.

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Over many years we have seen the NHS develop some really stupid ideas. To be fair realising that they were stupid may only have become obvious with hindsight – but not always. Key characteristics of stupid ideas are that they rest of dubious assertions not solid evidence; they make wildly optimistic assumptions; they lack (or refuse to publish) the details of the case; they are not independently assured; they are driven by outsiders (usually management consultancy firms); and those who decide to go ahead are never there to be accountable when everything goes wrong.

Many PFIs, a lot of the ISTC’s, much in Connecting for Health, Commissioning Support Units, Regional Procurement Hubs, outsourcing commissioning (Cambridge, Staffordshire etc), outsourcing patient transport, pay cartels, management franchises, some STPs and so on ad nauseum (literally).

You might say this is the price of being innovative and trying things and that failure is one way of learning. But evidence of any learning from failures is scant.

So, the latest wheeze is wholly owned companies – arm’s length bodies. The ideas around setting up arm’s length bodies is hardly new as it has been done for two decades in local authorities. But some parts of the NHS are determined to ignore all that has been learned.

There are examples of sensible approaches to arm’s length bodies – where the reasoning behind the venture is clear. An example would be some ALMOs set up to manage council housing. One NHS FT has set up a company to better deal with facilities management and some other services using a model that makes some sense.

But what we seeing now in the NHS is the use of such a devise simply to undermine national terms and conditions – with claims that workforce costs can be reduced by 15% (or pluck any figure you like) simply be taking the staff out of the mainstream NHS. This is just like the argument that brought us Circle managing Hinchingbrooke – that a new model of management has to be better and cheaper – which proved eventually to be nonsense.

Other reasons offered as a smokescreen are that there are tax benefits or the ability to be more “commercial” or the idea that the shiny new organisations adds new customers which then add income – these are all fanciful and risky. It’s amusing that making profits for one part of the NHS as service provider out of another part of the NHS as a customer is supposed to be sensible.

There is no doubt that this is all about an attack on the workforce. One case set out that “flexibility” was needed, that sickness absence must be better controlled and that new kinds of jobs were necessary – all of which are perfectly possible within the mainstream NHS. Again, the echoes are there from a time when facilities management of various kinds was outsourced simply because the Trusts were unable to manage their staff properly.

Setting up new bodies that are outside the NHS, behaving like commercial companies, setting their own bargain basement terms and conditions and competing for business from other NHS bodies is surely exactly what we are all trying to get away from. The most likely scenario is that the change will cost a lot to implement, will alienate a large section of the workforce and make others fear they may be transferred later. Why not deliver all services through arm’s length arrangements? We could have commissioning Trusts that just meet once a year and place contracts – a nightmare dreamed up by some local authorities.

This is a stupid idea and those who should know better in NHS England and NHS Improvement should step in and stop it, because this kind of outsourcing does not work. Just as they should have stopped the outsourcing of commissioning debacles in Cambridge and Staffordshire or the never-ending saga of the in/out CSUs. Get a grip!

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We need better policy for the NHS. But we are not going to get it if the entire debate is a Manichean point scoring contest conducted entirely in shibboleths and lacking reasonable analysis of alternatives. Too many serious people seem to believe that everything in the NHS would be fine if we undid the Lansley act and spent a bit more money. That analysis is naive, is stopping serious discussion of what the real challenges are and is distracting people from improvement that could come right now.

I went to the recent Royal Society of Medicine event (the one where Stephen Hawking condemned Jeremy Hunt’s selective use of evidence on weekend mortality generating a flood of media commentary). There were a lot of serious, senior thinkers on stage and in the audience. I naively assumed that a debate about the past present and future of the NHS would contain some disinterested assessments of the real problems and their causes. What I found was a desire to blame all the problems on the government and/or longstanding conspiracies to destroy the system. There was a remarkable lack of serious analysis and a widespread belief that every problem would miraculously go away if we simply reversed government policy.

Once you have adopted this position, you are clearly absolved from doing any serious analysis of the state of the NHS and you don’t have to do any thinking about how to improve it. This is a catastrophic position for the NHS as it desperately needs some better thinking about how to improve.

The debate consisted of shibboleths not substance

Here are a few examples of just how futile that debate was.

Richard Murphy made some good arguments about the limits of government spending (in a sovereign currency area, he argues, we don’t need austerity at all). But he then argued that the reason why we have austerity is because of a neo-liberal conspiracy to shrink the state. Maybe some people want to do that, but this government are about as useful as a one-armed trapeze artist with an itchy bum and are not credible organisers of such a conspiracy. Assigning the blame to a deep rooted conspiracy lowers the credibility of the argument and absolves true believers from any further need to engage or analyse the difficult details of policy.

Many speakers, including Hawking, condemned any private sector involvement in the NHS as if undoing it would suddenly improve things. Nobody mentioned that the largest sector of the NHS run by the private sector (the GPs) has the highest patient satisfaction. Supposedly we must have public provision as we can’t trust the private sector’s motives. Somehow, though, the even more severe conflict of interest of working for the NHS while also running a competing profit making enterprise (as perhaps half of NHS consultants do) was raised once and then completely ignored.

Audience members heckled Nigel Edwards for pointing out that the “we must spend a higher % of GDP on health because our neighbours do” argument was undermined by the latest OECD statistics. There are good arguments for spending more but this isn’t one of them. Rather than recognise this, the audience and many commentators prefer to quote the old numbers because they bolster their argument in a way the better numbers don’t.

And a disturbing number of people advocated solutions to the current crisis that involve major legislative and organisational change. So reversing the current Lansley bill to make the Secretary of State directly responsible for the NHS and abolishing the purchaser provider split were widely supported. This is extraordinarily naive for two main reasons. Jeremy Hunt, despite not being directly responsible for NHS management according to the legislation, has been the most interfering SOS in recent history, directing individual hospitals to do what he wants in a way that would make even stalinist central managers like David Nicholson jealous. Secondly, the one thing we are certain of about major legislative and structural change is that it is extraordinarily disruptive and costly to the the NHS in the short term. We have had so many reorganisations in the last two decades that we still don’t know whether any of them have made any sustained difference to NHS performance. Despite this many are still arguing that we need another one.

Then there is the response to STPs. Simon Stevens (wisely I think) opted to try to do significant change in the NHS without new top-down structural change or legislation. But the panels and the audience broadly disliked the STP plans. Not because they are often poorly thought through or lack evidence that what they propose will work (though this is usually true) but because they are a trojan horse for American style Accountable Care Organisations which are a part of the conspiracy to privatise the system and put profits into the hands of american capitalist scumbags. Once you have a good conspiracy you don’t need to think any more about the actual content of STPs. Simon Stevens is clearly a trojan horse for United Health. Conveniently this absolves anyone from having to engage with the nasty operational details of STP plans (which would be well worth doing given how many consist of fairy-tale wish-fulfillment fantasies).

Many argued that the NHS was facing serious staff shortages. And this may well be true in many places. But Sarah Wollaston’s claim that this might be due as much to problems with retention as it was due to any lack of supply was ignored. The idea that weak operational management leading to high staff turnover might be the core problem didn’t seem to occur to anyone: it’s all about the supply of doctors and nurses and we can blame that on the government.

Again the debate ignored several relevant facts that would require actual analysis and thought. For example the biggest cause of increasing hospital deficits is the reliance of expensive agency staff to fill rotas. That’s not a staff shortage, that’s an inability to recruit or retain people on permanent contracts: a very different problem with the need for very different solutions. And it is hard to reconcile the belief that the major problems in A&E waiting times are primarily a staffing issue with the actual facts. Medical staffing in A&E has grown faster than demand for more than a decade while performance has declined. And it is hard to see how more A&E doctors can magically create more free beds (lack of free beds is the major cause of A&E delays not a lack of staff in the A&E). Anecdotes about the pressures and overwork facing front line staff point to a symptom of the problem not the cause of the problem.

Even the revered Stephen Hawking broke his own rules not to selectively quote evidence. He was right to condemn Hunt for his selective use of data on 7-day mortality. But then he proceeded to recommend NHS policies based on a highly selective analysis of the international evidence. Private provision of services is evil (because the USA’s health system is evil). But many health systems in Europe seem to do well despite much of the provision being run by organisations other than central government. The NHS is being pushed towards private insurance and we must resist that trend. But, though I hate to agree with Hunt on anything, there is no evidence this is happening. Moreover, though private insurance for health funding is bound to be less efficient that funding from taxation (so there is no good reason to move the NHS to that model) there are plenty of systems in Europe where compulsory insurance works well and has none of the damaging effects it has in the perversely badly designed US “system.”

In short the event was not a debate but largely consisted of a bunch of people exploring shibboleths that helped them decide whether they were on the right side in the argument. The trouble with shibboleths is they are arbitrary and irrelevant and seem to form a shield that avoids any need to discuss matters of substance about what policies might actually improve the NHS. Which side you are on is all that matters: whether you have anything of substance to add is irrelevant.

The NHS needs a serious debate on how to improve.

For example, how big should the key organisation units be? Nigel Edwards pointed out that we do have evidence for this and that the best-performing systems have units that are 10 to 20 times smaller than the NHS. If the NHS is run centrally, any policy mistake will affect nearly 60m people. That means mistakes have really big consequences (it also means that there will be pressure never to admit they were mistakes greatly inhibiting the speed of learning). Imagine a system where the organisational units were maybe 2-4m people (we could call them SHAs as we haven’t used that unit name for a while or we could just call them STPs). The scale of mistakes could be limited and the effectiveness of different policies could be compared, greatly increasing the possibility of learning and improvement.

But the audience and panellists would mostly have preferred a centrally-controlled monolithic system where the SOS always magically knew the right policy for everything. The idea that variation and experimentation with policies could be used to greatly increase the amount of learning and therefore drive much faster improvement was condemned as an excuse for a “postcode lottery”. This convenient shibboleth avoided any need to engage with that important issue of how we structure of the system.

Or, consider the problem of variation in quality and efficiency across the NHS. The evidence we have suggest that there is far too much variation and that the system isn’t good at learning from it or improving. The cause of this variation isn’t top-down structures or Jeremy Hunt, it is bottom-up operational management. For example, some parts of the system are good a diagnosing and treating patients who need hip replacements and other parts are not. Most significant improvement in the NHS probably comes because people find better ways to organise and coordinate the work in some single operational area. Even some GPs, who are supposedly overwhelmed because of staff shortages and government indifference, have found that reorganising how they receive and manage patient demand can create a lower workload, faster patient access and much improved patient satisfaction. All without central government having to do anything.

But the idea that improvement are possible is essentially ignored in the current debate. Even the idea that there is too much variation across the NHS is regarded as part of the conspiracy to undermine the system rather than an important metric that can point to what needs to improve and how to improve it.

In short, the widespread belief that the current government is the source of all problems has become an excuse not to bother thinking about how the improve the NHS now. Worse, even if the current government is replaced at some point in the future, there will be no good ideas on how to make the NHS better and we will likely be faced with yet another round of disruption that will deliver no tangible improvement when the smoke has cleared.

I’m no fan of Jeremy Hunt who has been a bad SOS. But his opponents are are as bereft as he is of good ideas to make the NHS better. What a woeful place the debate on the future of the NHS has become.

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Healthcare and the National Health Service (NHS) budget were a key element of the Brexit referendum narrative: Vote Leave infamously promised that savings from paying into the EU budget could be spent on health, a pledge from which campaigners have since disassociated themselves. Indeed, the NHS is unlikely to benefit from Brexit – very much the contrary. Indeed, Brexit weakens the financial sustainability of the NHS.

According to estimates from the King’s Fund, in 2015–16 the NHS had the largest deficit in its history. NHS funding has been unable to keep pace with a growing demand for services. These financial constrains come at a time of staff shortages in most British hospitals, which have had to rely, as is common practice, on private temporary contract agencies and, more generally, on private providers who already make up 18% of the NHS spend on community health services.

Leaving the European Union in such a context creates a conundrum for English hospitals. How can they square their need for cost savings with maintaining quality? Better-quality services inevitably mean extra resources, which are not available without extra funding. So Brexit raises questions about the financial sustainability of an unreformed NHS – that is, an NHS without additional money. Leaving the EU will lead to significant restrictions on labour mobility, which can shift labour costs upwards – for example, higher wages will be required to incentivise a declining medical workforce, and more vacancies might need to be covered by temporary staff. In addition, we can expect higher transaction costs for intermediary goods. Brexit is estimated to lead to a reduction of 6.3–9.5 % of national income which will mean even less revenues to fund the NHS.

Effect on the workforce

Even before Brexit, the NHS has struggled to recruit and retain permanent staff. In 2014, there was a shortfall of 5.9%, and in social care 5.4%, rising to 7.7% in care services in the home, and about one-third of all UK nurses are due to retire in the next ten years. The problem is even more alarming when one looks at the GP workforce. A recent report of the Royal College of Physicians suggests that, in 2016, 86% of physicians experienced shortages across clinical teams.

Reducing EU immigration would increase wages on both ends of the wage distribution. In such a scenario, the options available include incentivising EU immigration or expanding health and social care spending in an attempt to transform it into a higher-wage sector, with the aim to increase its productivity. Therefore, the trade-off is between saving NHS funds by hiring health professionals from overseas, or expanding health investment further to incentivise local recruits (with some delay as they are trained).

Brexit may offer an opportunity to get rid of the contentious European Working Time Directive  which limits the maximum amount of time that employees in any sector can work to 48 hours each week. In turn, raising working time limits is likely to cause a deterioration in the quality of NHS employment and make working for the NHS less attractive.  

Effects on patients

The balance of payments associated with free patient mobility seems to have traditionally benefited the UK, given that British expats (who stop using the NHS) tend, overall, to be older than EU residents in the UK – who are on average younger, healthier and more highly skilled. After Brexit, UK citizens are unlikely to have the right to travel to the EU for treatment and therefore will enjoy less control over their healthcare. Furthermore, British tourists might be excluded from the European Health Insurance Card  programme. The only advantage, from a welfare perspective, of restricting mobility is that discouraging it reduces competition between health systems. Hence it could be argued that mobility deters a ‘race to the bottom’ in healthcare investment.

Brexit almost certainly means higher costs for the NHS, especially labour, as I argue in more detail in a recent article in the Journal of Social Policy. As a consequence of Brexit, it will become more difficult to attract qualified staff and other inputs affected by non-tariff barriers (e.g. rules of origin checks, regulatory barriers, border controls etc.), and procurement will become more expensive. Certainly, Brexit does bring some opportunities too – including the possibility of redefining the NHS in new directions. Nonetheless, it takes place in the midst of a process of fiscal consolidation (leading to longer waiting lists, waiting times etc) and will create additional and unnecessary financial pressures.

This was first published on the  British Politics and Policy blog

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High paying health care careers

The medical field is one of the most rewarding fields of all time. Like it or not, some people associated with this field are earning big both by good and bad means. Although it is not an easy job as the responsibilities in this area is big. With the proper knowledge and the right skills, one can easily make a decent bit of income. But the question here is about the jobs that can pay you big. If you don’t particularly know the jobs, you are less likely to opt for one. You may have a medical degree, but that’s not the only way to make yourself to money land. So, what are the jobs that can serve you a promising career in the medical field? Let’s find out.

  1. Physicians and surgeons: Standing on top of the list are the physicians and the surgeons. They are the primary role player and the cycle mostly originates from them. They are the most important entity in the medical world as they generate the entire business. What are the things that they do, let’s find out?
  • They diagnose and treat patients and prescribe the necessary medications accordingly.
  • They conduct medical surgeries and special therapies in case the patient is going through some extensive form of medical condition.
  • They conduct a routine checkup and make sure that they treated a patient is in a right guided path.
  • Special cases such as bone damage, muscle or nervous damage etc. are also treated by the specialists of this field.
  • They also take care of life-threatening circumstances, such as Jaundice, TB, and Cancer etc.

The job is one of the most respectable jobs and also the most profiting in the entire medical ground. They are counted among the most influential individuals in the entire society.

With a payout of more than $185k, they bag the highest available package with a good and genuine surety that their career will go above the charts and not below.

  1. Dentists: Similar to physicians and surgeons, they are also one of the most influential personalities of the society who bags the tag of a doctor. While others may consider their job to be less complex, dentists have to have a complete knowledge of all the treatments and medications accordingly. They also are the specialists of any other mouth issues along with teeth. What do they do? Let’s find out.
  • They treat patients with teeth issues and diseases.
  • They treat gum and other oral issues.
  • They need to have a considerable knowledge in medical science.
  • They also need to have knowledge of chemicals and spirits for cleaning and other purposes.
  • They may need to design a new set of artificial teeth for a patient on demand.

Equivalent to the job of any other medical practitioner, dentists are most likely to get the same treatment in matters of respect in the society. They are actually the oral medical specialist and will solve any issues related to mouth better than any other doctor.

They have a $150k salary package which concludes that they are well decorated in matters of financial status as well.

  1. Pharmacists: Now this is a very promising field to consider. You can go solo as an entrepreneur or take a job in a medical facility. In both the cases, you will see some promising financial upliftment in your career. It is best suited if you take this position as an owner. That way, you can see all the ups and downs and change your approach to the situation accordingly. What are the things that you need in order for you to be a pharmacist, let’s find out?
  • They deliver the medications with respect to the prescription.
  • They guide the procedures needed to complete the entire course accordingly.
  • They check whether the medicine prescribed can be replaced with an equivalent product if not available.
  • They provide the medications to the patients from the dealers in case the medicine is an exclusive one.

The best way to gain success in this field is to go solo and have your own store. This is a line of business where you may make more money than you can ever imagine. But your social life may have a contributing effect due to the amount of time needed to invest.

If you are under any medical facility then you can bag a payout of $120k. If you are running solo and have a business of your own, you can have as much profit as you want to depend on your business tactics.

  1. Podiatrist: The main job of a podiatrist is to provide with the medical and surgical assistance to issues that occurs in legs, ankle feet etc. This is also a very promising profession as it can also have a great influential boost in your career. If you are good at what you do, you are likely to get famous as specialists are more preferred than general physicians. Let’s see what the things that this job requires are.
  • They treat the leg section as specialists.
  • They recommend you to special clinics where the treatment is exclusive.
  • They will supervise the medicinal preference if you are a regular practitioner.
  • They will assist you in critical and chronic anxieties related to legs.

This is also a field which grabs the title of a doctor. So, the social influence can be considered to be high. You may also get a special recommendation from a hospital that can influence your career to some new extent.

This job has a decent payout of almost $120k.

  1. Nursing in charge or midwives: This is one of the most needed services after a doctor. Their main job is to provide well-advised suggestions in matters of family planning and kids. They also play a contributing role for a pregnant lady who needs some special care and attention. The main duties of a nurse are:
  • They provide you with parental suggestions to the family.
  • They will tell you the correct time and circumstances of conceiving.
  • They will also tell you how to treat a female during pregnancy.
  • They will help you to understand the risks of any issues that may hamper the maternity situation of a lady.

This is a very noble and highly recommended social duty. This is done more from a passion’s point of view rather than professional aspects. That doesn’t mean that the payout is bad.

With a payout of $100k, this is the 5th best medical ground job to opt for.

  1. Optometrists: They are the eye doctors in a simpler language. If you have any issues related to the eye, you must consider giving them a try. They are specialized in treating eye and they belong to the class f doctors nonetheless. The main duties of the people of this profession are:
  • To examine the conditions of your eyes.
  • Provide you with routine check-ups in case your eyes had gone through an injury.
  • Treat you to recover from an injury in your eye.
  • Prefer you spectacles if needed. They will do that after conducting a power check on your eyes.
  • Provide you with nutrition and medications for your eyes if needed.

They are a class of doctors and thus receive the same status. They are specialists of eyes and can have a good promising career if they have a clinic of their own.

With a job taken, they can grab a salary of $100k and with their own clinic; they can just have as much money as they wish to work for.

  1. Physical therapists: They are the people with a great command over the body massage and other relief techniques. They are mostly recommended by doctors so you have to have a great social life in the medical field. The main duties of physical therapists are:
  • They will provide you with messages for chronic and hereditary pains and blockages.
  • They will help you to recover from an injury that may have caused immobility.
  • They may help you recover from partial paralysis or full-time paralysis.
  • They may help you to get cured from a repeating pain that happens to you at a certain period of time.

They are someone with a good sense of practical knowledge and they have a good influence as a helper on the society. They don’t need to focus on getting patients as they are mostly recommended by doctors.

They are good with the payment factor with a $80k payout. The more someone practices, the more experience he gains, the pricier his service becomes.

So, if you are one of the above and don’t know where to start with and how to have a heading, the above things will help you to start. Just make sure you stay honest with your professions as this is something that is better suited for the helping kind.

We hope you like this article. Let us know what you think with your comments in the comment section. If you think that this article is informative and worth sharing, please share and help someone else in need. Thank you for reading.

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The NHS is involved in a standoff with many of its locum staff -doctors, nursing and non clinical staff such as IT contractors.

There has been a change to tax rules, -IR 35 -which means that staff who are not regularly employed but are contracted with “off payroll” , -have to now pay the same tax and national insurance contributions as employed workers. This means their take home pay will drop -though most will still be paid a far higher hourly rate than regular salaried staff. for that job. The NHS didn’t make the tax rules but is having to deal with the consequences.

A number of staff, notably doctors, have abruptly withdrawn their availability for shifts, some at very short notice -less than 24 hours -unless the employer pays an increased rate to make up for the tax changes. This has meant that hospitals have had great difficulty in covering those rota gaps at short notice. And some departments such as A and E have been threatened with closure. In my own Trust, we have a heavy reliance on locum doctors to staff A and E as we have not been able to recruit permanent staff, so our A and E has been badly affected.
It was hoped that all NHS employers would” hold the line,” but some Trusts have agreed to pay the higher rate. So staff have moved to work with them, rather than the employer to which they had committed.

So, is this reasonable action by locum staff , who can sell their services to the highest bidder? The law of supply and demand is working well, one could say.
However, the medical regulator makes it clear that reasonable notice should be given if doctors are not available for agreed shifts.

The General Medical Council has warned that any locum doctors engaging in “unreasonable withdrawal” from work could exacerbate pressure on health services and potentially risk patient safety. This is against the professional code of conduct.

It remains to be seen if the action of some doctors will be judged to be “unprofessional. It depends on what you think is” reasonable notice”. It is worth noting that some of these doctors have a long term relationship with certain Trusts -they may be employed on an ongoing basis. What price loyalty?
And since when did we all expect our employers to increase our salaries, when there is a tax rise??

My hunch is that the Trusts will cave in and pay the higher rates, as they have to have continuity of safe services (the result being more strain on the budgets). But it is an unedifying tale.

“Unprofessional behaviour” seems about right to me…

www. drlindasays.wordpress.com

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Responding to a report published today (Wednesday) by the House of Lords select committee that criticises the ‘short-sightedness’ of successive governments for failing to plan effectively for the long-term future of the health service and adult social care, Dr Mark Porter, BMA council chair, said:

“This report highlights what we have been saying – that the NHS desperately needs a long-term strategy to deal with the funding and staffing problems threatening the delivery of high-quality care. For too long successive governments have based health policy on short-term measures that do not benefit patients or staff in the long term. This is especially evident in cuts to funding for public health which this report identifies as short-sighted and counter-productive. The NHS is at breaking point and this can only be relieved through increasing investment based on a realistic assessment of what is needed to meet the health and social care needs of current and future generations. We need politicians of all parties to come together to agree a long-term approach and put an end to political game-playing with the NHS.

“The committee is right to identify the serious and ongoing problems in recruiting and retaining NHS staff, and the morale damage of years of ongoing pay restraint. Only last week, doctors got yet another real-terms cut in pay despite working harder than ever before. At a time when GPs are unable to keep up with the number of patients coming through the surgery door and hospital doctors are working under impossible conditions, our government should heed the committee’s recommendation and allocate the investment needed to match the promises made.

“It is important that general practice continues to evolve to meet the changing demands of patients, especially those who need more intensive, complex and flexible care in the community. Many GP practices are, with the BMA’s support and leadership, exploring new ways of working, including forming federations or networks to pool resources and plan care for their local populations. A “one size fits all” model won’t do this. General practice’s great strength is its flexibility, and smaller practices can work just as well as larger units in providing services that their patients want. The biggest threat to smaller practices is not their organisational form, but the pressure that all parts of the NHS are under from rising demand, unnecessary bureaucracy, stagnating budgets and staff shortages. It is this wider challenge that the government must urgently address.

We spend less on healthcare than other leading European economies and the NHS cannot continue to do more, with less. We need to end the chronic underfunding of our health service and address inadequate staffing and funding for the health and social care system as a whole.

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The triggering of article 50 starts a period of uncertainty in our NHS. The decision is momentous, but after seven years of neglect from successive Tory governments the prime minister and health secretary must finally give the NHS and patients the certainty needed through the Brexit process.

So far the complacency in government is astounding. Last week, Jeremy Hunt published the department of health’s “mandate to NHS England” to set “the government’s objectives and any requirements for NHS England”. Amazingly the 24 page document made no mention of Brexit whatsoever.

And during the prime minister’s statement yesterday confirming the triggering of article 50, she failed to mention the NHS even once. Neglecting our health and social care system during the most significant period of political and economic uncertainty in decades is completely unacceptable.

The prime minister has already turned her back on the clear promise of £350 million a week for our NHS, but perhaps it shouldn’t come as much of a surprise that the NHS isn’t taken seriously as a Brexit priority for the government. Indeed, the health secretary isn’t even a member of the relevant cabinet committees managing the exit strategy.

Later this week health bosses will publish the updated five year forward view. NHS chief executive, Simon Stevens, must ensure it includes the NHS’s plan for Brexit and not duck its responsibility to staff and patients.

After all, Britain’s health and social care system is dependent for its success on tens of thousands of European staff. Many of them have settled and built lives here while caring for our sick and elderly: safeguarding their futures should be an absolute priority in the Brexit negotiations.

So our first test of the government plans will be whether they deliver a right of remain for the 140,000 European Union nationals working in the NHS and social care system.

Secondly, on funding we know that the EU’s horizon 2020 scheme is due to invest £7.5 billion in health research across the EU over the next five years, and Britain will be by far the largest recipient of those funds. This long-term funding is crucial for our medical institutions and universities planning major research projects. So we need to know whether access to these funding streams will continue after Brexit, and if not, how does the government propose to make up the shortfall?

Our third test is on reciprocal healthcare arrangements. It is a key principle that British citizens can obtain free healthcare elsewhere in Europe, just as they would here at home from the NHS. Therefore, we want a guarantee that British citizens travelling and living abroad in Europe will continue to receive healthcare.

Finally, our fourth test is on EU healthcare collaboration. Effective joint working with our European partners has been vital for the NHS over recent years on everything from infectious disease control and the licensing, sale and regulation of medicines. The government must clarify whether the UK will continue to participate in the centralised marketing authorisation procedure for medicines governed by the European Medicines Agency. And how will Brexit will affect the UK pharmaceutical industry when exporting medicines to other member states in future?

These are of course difficult and complex questions to answer, but they are all of absolute importance to the future of our health service and of our medical research sectors.

The NHS is already in crisis over funding and staffing. But without a proper plan Brexit has the potential to tip those crises into unprecedented disasters. Patients and NHS staff should not be bargaining chips, and, at the very least, the public deserves clarify and certainty from the government.

First published on Labour List

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Everyone knows that after seven years of neglect from the Conservative government, the NHS is undergoing a serious crisis of funding and staffing. The last thing needed is more uncertainty. That is exactly what the NHS faces with Brexit.

On Wednesday Theresa May will trigger article 50 and later this week health bosses publish the updated Five Year Forward View. It is time for the prime minister and the health secretary, Jeremy Hunt, to give the NHS and its patients the certainty needed through the Brexit process. May has already turned her back on the promise of £350m a week for our NHS and now she is walking away from her responsibilities to protect the health service through a turbulent Brexit process that will hit it hard.

The complacency in government is astounding. Last week Hunt published the department of health’s Mandate to NHS England to set “the government’s objectives and any requirements for NHS England”. Amazingly, the 24-page document made no mention of Brexit whatsoever.

Will health professionals from other EU countries be able to come to work in our NHS after Brexit, or will there be a cap on their numbers? As long as the issue is left unclear, more and more EU workers are voting with their feet and leaving on their own terms. In a recent survey, 42% of European health staff working here said they are now thinking of leaving the UK. Almost 5,500 have left since the Brexit vote according to NHS Digital, a 25% increase on the 2015 figures. And others are being put off from coming here at all: only 96 European nurses registered to work in the UK in December – that figure was 1,304 for last July.

So our first test of the government plans will be whether they deliver a right of remain for the 140,000 EU nationals working in the NHS and social care system. Secondly, on funding, we know that the EU’s Horizon 2020 scheme is due to invest £7.5bn in health research across the EU over the next five years, and the UK will be by far the largest recipient of those funds. We also receive EU funding from the Innovative Medicines Initiative, the European Cooperation in Science and Technology programme, and the Active and Assisted Living programme for older people.

This long-term funding is vital in giving security to those medical institutions and universities planning major research projects. They cannot just wait and see what will happen after 2019. So we need to know whether access to these funding streams will continue after Brexit. If not, how do the government propose to make up the shortfall?

Our third test is on reciprocal healthcare arrangements. It is a key principle that British citizens can obtain free healthcare elsewhere in Europe, just as they would at home. That is an important safety net for British holidaymakers, and for UK citizens living elsewhere in Europe. Does the government intend to maintain those arrangements? If not, how will it address the increased insurance costs for UK holidaymakers?

These are difficult and detailed questions, but they are all of absolute importance to the future of our health service and of our medical research sectors. There is no reason why May should refuse to give us the answers. That will allow us to understand with greater clarity what the impact of Brexit will be on the NHS – and most importantly, it will allow patients and staff the opportunity to scrutinise the government’s plans closely over the next two years.

The NHS is already in crisis over funding and staffing. But Brexit has the potential to tip those crises into disasters. Patients and NHS staff should not be bargaining chips in May’s hard Brexit negotiations. They want a world-class NHS delivering the best quality healthcare. As article 50 is triggered, the very least the public deserves is clarity and certainty from its government.

First published by The Guardian

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 The future of the optical professions

The General Optical Council – the national regulator for the optical professions – has recently published research carried out with optometrists and dispensing opticians to explore the challenges they face at work and how they see the professions developing over the next few years. The research provides some interesting insights into the future of a sector operating in a highly competitive retail market whilst contending with the need to change rapidly to meet the needs of patients and the wider health system.

An evolving sector

As is the case across the NHS, there has been increased focus on providing eyecare services within community settings to help ease the pressure on hospitals and secondary care. For example, one study estimated around four in ten acute patient episodes managed in secondary care could instead be provided in community settings.

For optical professionals, this presents an exciting opportunity to gain additional qualifications and expand their clinical skills enabling them to play a greater role in the provision of eye health care – for example, providing low vision services and glaucoma management.

And there is overwhelming support in the professions for this change of role with nearly nine in ten of those surveyed saying they were supportive of these plans, and many were enthused by the prospect of carrying out more varied and interesting work. Some 64 per cent of optometrists have considered gaining additional qualifications, which would allow them to deliver these enhanced services. Already in the last year a significant number of optometrists in England have gained additional training in treating minor eyecare conditions, whilst almost all optometrists in Scotland and Wales are trained to this level.

Barriers to development

However, there are a number of barriers which the sector needs to overcome before the high street optician is seen as the first port of call for the management of routine eyecare problems. Not least of these is the perception amongst the public that GPs – not the high street optician – remain the place people would go if they woke up with an eye problem. Furthermore, as our research also shows, only around one in three members of the public view opticians purely as a healthcare service, and only one in five viewed themselves solely as a patient when they received optical services.

Anecdotal evidence has also suggested that the tension within a high street practice between delivering a healthcare service and being a profitable retail business can impact on patient care. Our independent study of over 4,000 optometrists shows that four in ten said they had felt under pressure at some point to meet commercial targets at the expense of patient care and a further four in ten had felt under pressure at some point to sell a product or provide a service that was not needed by a patient.

opticians

Spectacles and teeth

The opticians who took part in focus groups on the subject explained that this pressure could include a requirement to deliver a certain amount of sight tests in one day in order to meet company targets. This in turn meant that they sometimes did not spend as much time with patients as they would have liked. Others explained the pressure they were under to achieve targets to sell glasses or contact lenses to patients who come in for a sight test.

In the focus groups and interviews which were conducted for our research, some respondents felt that this pressure often came from non-clinical managers who were primarily concerned with meeting sales targets. Others felt that targets and commercial pressures were simply part and parcel of working in a high street opticians.

There was a feeling from those who took part in the focus groups that commercial pressures have increased over the last few years and that this trend will continue. For a small number of the respondents interviewed in the research, this has led to them to leave jobs and in some cases to leave the profession. There was also concern about whether universities and training providers were preparing students for the types of pressures that occur in daily practice.

Despite the pervasiveness of pressures, many respondents were keen to stress that they did not let the need to meet targets affect the quality of care they provided. They considered their professional integrity and duty of care towards their patient more important than meeting targets. Our research also shows that public satisfaction levels with opticians remains very high – at well over 90 per cent – and that patients themselves didn’t feel under pressure from opticians to purchase services or products that they didn’t want or need.

Next steps

These research findings pose a challenge to the sector to adapt their ways of working so that they are in a position to take on greater healthcare responsibilities. Whilst commercial pressures are an inevitable part of working for a business which is highly dependent on the sale of glasses and contact lenses to subsidise the loss often made by providing sight tests, a balance needs to be struck between the needs of patients and the needs of the business.

If the public and the wider NHS are to see opticians first and foremost as healthcare professionals, optical businesses will need to address the impact of the commercial environment on how they are perceived, as well as to raise awareness of the broader role of opticians in treating eye health problems, prescribing medication, and making referrals.

As the regulator of the optical sector, our primary concern is the protection of the public and so these findings, which show the extent of commercial pressures on optical professionals, are naturally of interest to us. We intend to look into this issue further as part of our review of how optical businesses are regulated and the standards that we set for them.

But we also want to make sure that we enable opticians to play a greater role in providing community based eyecare services to address the burden on eye hospitals. To do this, we are working with the optical sector to ensure that optical professionals have the skills, knowledge and behaviours to deliver care safely and with the trust of the public and the wider healthcare sector.

First published on the British Politics and Policy blog

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When you don’t speak English very well, visiting the emergency room or a doctor’s office can be confusing and even scary when you’re trying to grasp vital medical information. Particularly if you feel discomfort or pain. For the millions of people living in the United Kingdom who speak English with limited proficiency, the potential for mistakes in medical care is considerable.

An interpreter sent from a professional medical translation services agency provides a vital role for the patient and physician. Obviously, because he or she serves as the communication bridge between the two parties. Often, hospitals and other medical environments provide inadequate medical interpreters services.

In such cases, the patient’s family often doesn’t think to hire a professional interpreter, or doesn’t think it necessary, opting instead to have a family member serve as the interpreter. At other times, medical staff members who speak the patient’s language at varying fluency levels step in as the interpreter.

A 2012 study published by the Annals of Emergency Medicine in the United States found that amateur interpreters made almost twice as many clinically important interpreting mistakes as professional interpreters. An example of a standard clinically important mistake amounts to the interpreter communicating a wrong medication dose.

The study evaluated 57 interpreting scenarios at two sizable pediatric emergency departments in New England. The patients observed by the study’s researchers were Spanish speakers and had problems speaking in English. Twenty families were assisted by a professional interpreter while 27 had an amateur interpreter. Ten families received no assistance from an interpreter.

The implementers of the study evaluated recorded videos of the interactions, and looked for mistakes such as additions, substitutions, omissions besides false language terms — which is when a term is made up, calling an eye an “eye-o” instead of the Spanish word “ojo”.

Altogether, the team detected 1,884 mistakes, of which 18 per cent were of vitally important clinical information.

Professional interpreters with a minimum of 100 hours of training, in turn, made mistakes connected to vitally important clinical information only 2 per cent of the total interpreted time. Professional interpreters with fewer hours of training committed mistakes 12 percent of the time. Critical medical information mistakes made by amateurs amounted to 22 percent of the total interpreted time. The number dropped slightly — to 20 percent — for patients who lacked an interpreter.

“The findings document that interpreter errors of potential clinical consequence are significantly more likely to occur when there is an ‘ad hoc’ or no interpreter, compared with a professional interpreter,” said Glenn Flores, a general pediatrics professor and director at the University of Texas Southwestern Medical Center and Dallas Children’s Medical Center, who directed the study.

The fact that trained medical interpreters, particularly those with experience, make fewer mistakes makes sense, said Flores. Seasoned interpreters “know the medical terminology, ethics, and have experience in key situations where you need a knowledge base to draw on,” he pointed out.

Studies have concluded that patients prefer having a translator help them. Moreover, accurate medical interpreters improve care and whittle down costs, by avoiding unnecessary medical tests, for instance.

Flores stated plenty of questions remain about medical interpreters services at hospitals.

For example, studies need to be undertaken on the effectiveness and cost-effectiveness of in-person professional interpreters versus that of video or phone interpretation services.

Flores’ findings indicate that ensuring patients are served by interpreters who have been trained for 100-plus hours “might have a major impact” on significantly reducing interpretation mistakes. The fewer the mistakes, the better for the health of patients.

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