Sunday, May 1, 2016


What next is pretty much the question on everyone's lips. Many theories, many conjectures, many thoughts…but to be honest, when you are in uncharted territories, all bets are off. So all guesses, including mine, are all, at best, guesses- some tinged with reality, some in hope, some in despair- and some as ever with an agenda lurking in the background. Many blogs have appeared where patients feel left out of the discussion- as far as the government is concerned, they did have a discussion- it was in their manifesto- to have 7 day services. That discussion went quite well actually- it was called the General Elections.

So what will happen next? The strikes have happened- the seniors moved things around, cancelled stuff, stood by their juniors and to, what appears, the utter incredulity of some, no major safety issues cropped up. The scaremongering was anyway a bit silly- most seniors on the ground knew it would be ok- and to be fair, as did most NHS managers. All it needed was a bit of planning, cancellation of some activity, teaching etc- and there were enough personnel around to cover what was needed. I have no idea what happens next- more strikes, more the mix of that the Euro referendum - all of that makes this all pretty unpredictable- who knows- maybe both sides may have an epiphany and decide to go have a beer…though to be honest, the chance of that happening and Lance Armstrong coming back to competitive cycling appears to be at par-at the moment.

But heck, everyone's having a go at conjecturing- so why not me! Trusts are not stupid- they know, beyond everything, they do need their staff to run things safely. Given a choice- most executives will choose patient safety above fiscal discipline (aka being tight with money)- the reason? They rarely do their job to balance books- they do want to make a difference. Want an example? Pretty simple- the reason the NHS is still running reasonably well in spite of all pressures is because its happened at the expense of the money side…the billion dollar question is how long that is sustainable.
Anyway. so Trusts won't be stupid- and they will find loopholes in the contract to ensure their juniors find it reasonably acceptable. Roy Lilley's suggestion of "local negotiations" will happen- but not publicly- and variations will emerge- but by using the new contract.
That will result in gaps- which will need filling. The locum caps will be breached- has to be - in fact there exists a clause of breaching it for patient safety- and it will continue to happen at pace. If Trust X decides to hold to the cap, a neighbouring one will breach it…all about who wants patient safety above the issue of money. Tricksy eh?

What will that do for 7 day service? Nothing to pretty much nothing- why? Because the whole 7/7 had nothing to do with juniors but heck, who cares about technicalities. All that aggro, fights will result in little for patient safety, the finances will continue to take a hammering - so we are stuck where we are. And then comes the most important bit…to keep the NHS going, what you do need is a lot of "extra"…"extra" bits that are not paid for, bits that come from vocation- and angry disgruntled people don't give you that. Thats not special for a  medic, but is the same for the chap seeing you drinks at a bar too…he will stay on a bit extra because his boss made an extra effort to make him feel valued

So how would that happen? Well- it will require the medical leaders to do so…the question is whether they have the trust to do so? Would the juniors trust those who have either stayed quiet or openly forced the contract? Would those seen as, rightly or wrongly, furthering their career be trusted to put an arm around their shoulders…or will it need a new generation of leaders to do that? Tricksy indeed. How would Dalton fare when he stands up to speak to juniors and regain their trust- who knows indeed?

So, in short, a forced contract, achievement of bits of government manifesto,more financial troubles, need for new leaders to rejuvenate the workforce…that's my prediction for next 6-12 months
Or I could be completely wrong- and it could all be sorted by that one single beer between Johann and Jeremy.  Or the next battle with consultants will erupt with further embitterment, angst…and all those attempts at "working together"? Take one further hit.

Imagine…all of this potentially avoided by an open honest discussion with the public…something along the lines of "We genuinely want to improve 7 day service- however, we don't have enough money for it- so lets discuss what needs to stop or reduce"

Now…THAT wasn't so tricksy..was it?

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