Tory Leadership/Next PM Battle

[Eugene Wrayburn]

I don't think you really need to read a study to understand that when using percentages you have to compare like with like.

Edit. And I don't for a minute think you don't understand that.

Well of course I understand it, which is why i talked about stroke. I assume there isn't a study which says that emergency admissions accounts for the whole effect judging by your answer then, but if there is please do direct me to it.

[Eugene Wrayburn]

For info:

https://fullfact.org/health/ask-full-fa ... nd-deaths/

[canta_brian]

For info:

https://fullfact.org/health/ask-full-fa ... nd-deaths/

The researchers said that in particular, if patients who suffer less severe strokes tend not to come into hospital at the weekend, this might affect the result.

That’s because it would make for a more challenging ‘case mix’ at the weekend—in other words it would make the risk of death look higher at the weekend because the average patient would have been more seriously ill when they arrived:

[Eugene Wrayburn]

For info:

https://fullfact.org/health/ask-full-fa ... nd-deaths/

The researchers said that in particular, if patients who suffer less severe strokes tend not to come into hospital at the weekend, this might affect the result.

That’s because it would make for a more challenging ‘case mix’ at the weekend—in other words it would make the risk of death look higher at the weekend because the average patient would have been more seriously ill when they arrived:

That is of course possible, even if it seems somewhat unlikely that someone will decide to leave a possible stroke until Monday to investigate - leaving aside of course that the chances of death increase the longer you leave a stroke before treatment so you'd expect a spike in weekday deaths. Again there is an effect, but the reason for the effect is less clear.

[canta_brian]

For info:

https://fullfact.org/health/ask-full-fa ... nd-deaths/

The researchers said that in particular, if patients who suffer less severe strokes tend not to come into hospital at the weekend, this might affect the result.

That’s because it would make for a more challenging ‘case mix’ at the weekend—in other words it would make the risk of death look higher at the weekend because the average patient would have been more seriously ill when they arrived:

That is of course possible, even if it seems somewhat unlikely that someone will decide to leave a possible stroke until Monday to investigate - leaving aside of course that the chances of death increase the longer you leave a stroke before treatment so you'd expect a spike in weekday deaths. Again there is an effect, but the reason for the effect is less clear.

It was your study I quoted. And yet yet it is now you who is questioning it's interpretation.

[morepork]

What is the nature of the effect being debated here? Is it that terminal outcomes are more prevalent because doctors won't work weekends, or that the resources allocated will not stretch to 7 days a week? Stroke has a window of opportunity for intervention that can be defined by relatively non-invasive diagnostics that are themselves dependent on human and technical resource availability. A terminal outcome is more likely when these are not available. What is being debated as the primary determinant here? Doctors being available? Money for 7 day constancy? Both?

[Eugene Wrayburn]

What is the nature of the effect being debated here? Is it that terminal outcomes are more prevalent because doctors won't work weekends, or that the resources allocated will not stretch to 7 days a week? Stroke has a window of opportunity for intervention that can be defined by relatively non-invasive diagnostics that are themselves dependent on human and technical resource availability. A terminal outcome is more likely when these are not available. What is being debated as the primary determinant here? Doctors being available? Money for 7 day constancy? Both?

A while ago a study came out which suggested that there was increased mortality for people admitted to hospitals at weekends. The study obviously has limits. For example it deals with admissions at the weekend but the deaths may occur at some other point. The original study did not attribute a cause to this effect, merely observed that such an efect existed. Subsequent studies have tried to assess whether there is a weekend effect and most say that there is an effect in some areas but argue about the size and cause. At least one also points out that there is a variation during the week (I can't remember but I think there's a spike on Thursday's as well).

The Conservative Party ran on a manifesto in 2010 which included a commitment to a "7 day NHS". They used the original study as part of the justification for this and have in particular used it in the contractual argument with "junior" doctors. In the UK a junior doctor includes everyone who isn't a consultant which is the very top tier. There tend to be very few consultants around at weekends but there are junior doctors.

Sorry for the (recent) history lesson but I thought the context might be useful because I'm guessing it's hardly common knowledge in the states - it barely is in the UK. So basically the government implies that the effect can be cured by their "7 day NHS" despite the weeknesses in the data and the conclusion being no part of the study. They also suggest that the lack of a 7 day NHS is down to the lack of junior doctors, rather than consultants, or phlebotomists, or testing services etc etc.

The researchers said that in particular, if patients who suffer less severe strokes tend not to come into hospital at the weekend, this might affect the result.

That’s because it would make for a more challenging ‘case mix’ at the weekend—in other words it would make the risk of death look higher at the weekend because the average patient would have been more seriously ill when they arrived:

That is of course possible, even if it seems somewhat unlikely that someone will decide to leave a possible stroke until Monday to investigate - leaving aside of course that the chances of death increase the longer you leave a stroke before treatment so you'd expect a spike in weekday deaths. Again there is an effect, but the reason for the effect is less clear.

It was your study I quoted. And yet yet it is now you who is questioning it's interpretation.

You don't seem to understand the word "if".

[canta_brian]

If? As in "if" something is presented as fact when it is in fact not proven, it is both dishonest and stupid to base a government policy on it.

http://www.independent.co.uk/news/uk/po ... 93526.html

[Eugene Wrayburn]

If? As in "if" something is presented as fact when it is in fact not proven, it is both dishonest and stupid to base a government policy on it.

http://www.independent.co.uk/news/uk/po ... 93526.html

The government would be dishonest to state that the study proved that the weekend effect was down to staffing levels. It is not dishonest to believe that that is the case - albeit for the reasons I've stated before it may well be wrong. Absence of evidence is not evidence of absence.

[Zhivago]

If? As in "if" something is presented as fact when it is in fact not proven, it is both dishonest and stupid to base a government policy on it.

http://www.independent.co.uk/news/uk/po ... 93526.html

The government would be dishonest to state that the study proved that the weekend effect was down to staffing levels. It is not dishonest to believe that that is the case - albeit for the reasons I've stated before it may well be wrong. Absence of evidence is not evidence of absence.

The point is that the government has taken two facts - that there are more deaths when patients are admitted on the weekend, and that there are fewer junior doctors working on the weekend, and come to the conclusion that if there were more doctors on the weekend, the deaths would be reduced. There is no basis for them linking these two, and no evidence that it would help.

Don't you think that before leaping to conclusions, it's a good idea to carry out more studies so that you can make decisions based on scientifically ascertained facts instead of 'common sense' type inferences?

[Which Tyler]

I'm not 100% convince it's that way around.
I think it's more that the government wants to drive the NHS a bit further into the ground, to push more people towards private care (and ministerial retirement funds) and drive the (idealistic) privatisation of the NHS one step closer.
They also want to press a number of other public servants (eg teachers) hard in the next round of negotiations, and either pay less, or get more work out of Jr Dc.s to help "reduce the deficit".
Jr Dr's contracts were up first, and they found some stat.s to give them an excuse to push hard.

I'm utterly convinced that the desire to privatise the NHS, and to push Jr Dr contract negotiations hard was made before the "weekend effect" was ever a thing - that's the post-hoc (publicly acceptable) rationale, not the reason.

[Zhivago]

I'm not 100% convince it's that way around.
I think it's more that the government wants to drive the NHS a bit further into the ground, to push more people towards private care (and ministerial retirement funds) and drive the (idealistic) privatisation of the NHS one step closer.
They also want to press a number of other public servants (eg teachers) hard in the next round of negotiations, and either pay less, or get more work out of Jr Dc.s to help "reduce the deficit".
Jr Dr's contracts were up first, and they found some stat.s to give them an excuse to push hard.

I'm utterly convinced that the desire to privatise the NHS, and to push Jr Dr contract negotiations hard was made before the "weekend effect" was ever a thing - that's the post-hoc (publicly acceptable) rationale, not the reason.

Yes this too.

[canta_brian]

If? As in "if" something is presented as fact when it is in fact not proven, it is both dishonest and stupid to base a government policy on it.

http://www.independent.co.uk/news/uk/po ... 93526.html

The government would be dishonest to state that the study proved that the weekend effect was down to staffing levels. It is not dishonest to believe that that is the case - albeit for the reasons I've stated before it may well be wrong. Absence of evidence is not evidence of absence.

I would be perfectly happy with this statement if it wasn't for the fact that the beliefs they have decided to come to appear to be politically motivated rather than medically. They put the statistics in the public domain in a way that suggests they are indeed proven facts.

I you believe that something is the case, but don't have the hard facts to back them up, and yet choose to present them as such I think there is a significant case to say that you have been dishonest.

It is the same technique used by the leave campaign to put an extreme case across in the public domain in full knowlege that id didn't bear scrutiny.

[morepork]

So increased hours for junior doctors is seen as the most cost effective "7-day NHS" then? It's battle hardened veterans you want in the trenches for acute trauma. If you want comprehensive care, you enact it. Seems a bit of a red herring to me. Money is the real end point being targeted, yes?

[Donny osmond]

I'm not 100% convince it's that way around.
I think it's more that the government wants to drive the NHS a bit further into the ground, to push more people towards private care (and ministerial retirement funds) and drive the (idealistic) privatisation of the NHS one step closer.
They also want to press a number of other public servants (eg teachers) hard in the next round of negotiations, and either pay less, or get more work out of Jr Dc.s to help "reduce the deficit".
Jr Dr's contracts were up first, and they found some stat.s to give them an excuse to push hard.

I'm utterly convinced that the desire to privatise the NHS, and to push Jr Dr contract negotiations hard was made before the "weekend effect" was ever a thing - that's the post-hoc (publicly acceptable) rationale, not the reason.

Exactly 100% this

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[Eugene Wrayburn]

So increased hours for junior doctors is seen as the most cost effective "7-day NHS" then? It's battle hardened veterans you want in the trenches for acute trauma. If you want comprehensive care, you enact it. Seems a bit of a red herring to me. Money is the real end point being targeted, yes?

If you mean total money spent then no, because spending on the NHS goes up in real terms every year - which incidentally is a funny way of driving it into the ground. However they certainly want to bring down the cost of getting staff working at weekends by normalising it in their contracts. It seems to me, having spent a lot of time in hospitals recently, that they are trying to sweat the physical assets. There's a lot of very expensive equipment sitting around idle rather more than is ideal from a financial point of view.

[Eugene Wrayburn]

I'm not 100% convince it's that way around.
I think it's more that the government wants to drive the NHS a bit further into the ground, to push more people towards private care (and ministerial retirement funds) and drive the (idealistic) privatisation of the NHS one step closer.
They also want to press a number of other public servants (eg teachers) hard in the next round of negotiations, and either pay less, or get more work out of Jr Dc.s to help "reduce the deficit".
Jr Dr's contracts were up first, and they found some stat.s to give them an excuse to push hard.

I'm utterly convinced that the desire to privatise the NHS, and to push Jr Dr contract negotiations hard was made before the "weekend effect" was ever a thing - that's the post-hoc (publicly acceptable) rationale, not the reason.

You'll probably find a dozen, max 2 dozen mps who want to privatise the bits of the NHS that aren't already basically privatised - GPs have always been basically private contractors. I think that the widespread desire to sell off the bulk of the service and make it insurance based is a myth.

[morepork]

So increased hours for junior doctors is seen as the most cost effective "7-day NHS" then? It's battle hardened veterans you want in the trenches for acute trauma. If you want comprehensive care, you enact it. Seems a bit of a red herring to me. Money is the real end point being targeted, yes?

If you mean total money spent then no, because spending on the NHS goes up in real terms every year - which incidentally is a funny way of driving it into the ground. However they certainly want to bring down the cost of getting staff working at weekends by normalising it in their contracts. It seems to me, having spent a lot of time in hospitals recently, that they are trying to sweat the physical assets. There's a lot of very expensive equipment sitting around idle rather more than is ideal from a financial point of view.

I get your point, but the idle equipment should be being used as much as possible, regardless of cost. Healthy people are employable people. Expensive equipment generally needs an experienced eye to be useful and so more experienced eyeballs should be the long term aim. The benefits of biomedical research will never be realised unless the will to implement it exists. I do appreciate there is a lot of marketing of technology that gets less than efficient use, but targeting wages for junior physicians seems an insane way of balancing that book. In this day and age there really is no excuse for a universally more efficient technological standard not being invested in. But I'm here, you're there, so I am not directly plugged in. I will say that the closer you sail towards privatisation, the greater that gap between technology and application will become for most people. This is a problem that needs to be addressed on a large scale.... equitable access to education being a vital part of the long term plan.

[Len]

http://www.independent.co.uk/news/uk/po ... 14841.html

Errrrrr.

Lol.

[Digby]

The Tories are working hard on ensuring expensive equipment isn't going unused in the NHS by funding a tiny spend on acquiring new equipment. Their notion they shouldn't invest is depressingly familiar.

[Eugene Wrayburn]

So increased hours for junior doctors is seen as the most cost effective "7-day NHS" then? It's battle hardened veterans you want in the trenches for acute trauma. If you want comprehensive care, you enact it. Seems a bit of a red herring to me. Money is the real end point being targeted, yes?

If you mean total money spent then no, because spending on the NHS goes up in real terms every year - which incidentally is a funny way of driving it into the ground. However they certainly want to bring down the cost of getting staff working at weekends by normalising it in their contracts. It seems to me, having spent a lot of time in hospitals recently, that they are trying to sweat the physical assets. There's a lot of very expensive equipment sitting around idle rather more than is ideal from a financial point of view.

I get your point, but the idle equipment should be being used as much as possible, regardless of cost. Healthy people are employable people. Expensive equipment generally needs an experienced eye to be useful and so more experienced eyeballs should be the long term aim. The benefits of biomedical research will never be realised unless the will to implement it exists. I do appreciate there is a lot of marketing of technology that gets less than efficient use, but targeting wages for junior physicians seems an insane way of balancing that book. In this day and age there really is no excuse for a universally more efficient technological standard not being invested in. But I'm here, you're there, so I am not directly plugged in. I will say that the closer you sail towards privatisation, the greater that gap between technology and application will become for most people. This is a problem that needs to be addressed on a large scale.... equitable access to education being a vital part of the long term plan.

I absolutely agree that the equiment should be being used as much as possible. Currently we get the personnel part completely wrong. The NHS uses an awful lot of agency staff - particularly nurses - who cost a fortune and are transient making it more difficult to build expertise. They are trying to remedy that but it's slow work when every nursing graduate knows they can still make a lot more money for a lot less hassle and responsibility by going contracting. We had taken our usual approach to this problem by nivking staff from elsewhere - Zimbabwe, Southern Europe etc - which was devastating to those countries but has basically kept the NHS afloat. However post-Brexit and immigration clampdown the NHS is going to be in serious trouble. I suspect the junior doctors pay wrangle is a hangover from the GP contract which HMG got badly wrong and ended up paying way more than they expected. They're also currently shit-scared about the mounting costs of old age and chonic conditions which they have little idea how to fund. Combine that with the general distrust of the tories - and the current health secretary in particular - amongst medical staff and you have a combustible recipe for industrial strife.

[UGagain]

If you mean total money spent then no, because spending on the NHS goes up in real terms every year - which incidentally is a funny way of driving it into the ground. However they certainly want to bring down the cost of getting staff working at weekends by normalising it in their contracts. It seems to me, having spent a lot of time in hospitals recently, that they are trying to sweat the physical assets. There's a lot of very expensive equipment sitting around idle rather more than is ideal from a financial point of view.

I get your point, but the idle equipment should be being used as much as possible, regardless of cost. Healthy people are employable people. Expensive equipment generally needs an experienced eye to be useful and so more experienced eyeballs should be the long term aim. The benefits of biomedical research will never be realised unless the will to implement it exists. I do appreciate there is a lot of marketing of technology that gets less than efficient use, but targeting wages for junior physicians seems an insane way of balancing that book. In this day and age there really is no excuse for a universally more efficient technological standard not being invested in. But I'm here, you're there, so I am not directly plugged in. I will say that the closer you sail towards privatisation, the greater that gap between technology and application will become for most people. This is a problem that needs to be addressed on a large scale.... equitable access to education being a vital part of the long term plan.

I absolutely agree that the equiment should be being used as much as possible. Currently we get the personnel part completely wrong. The NHS uses an awful lot of agency staff - particularly nurses - who cost a fortune and are transient making it more difficult to build expertise. They are trying to remedy that but it's slow work when every nursing graduate knows they can still make a lot more money for a lot less hassle and responsibility by going contracting. We had taken our usual approach to this problem by nivking staff from elsewhere - Zimbabwe, Southern Europe etc - which was devastating to those countries but has basically kept the NHS afloat. However post-Brexit and immigration clampdown the NHS is going to be in serious trouble. I suspect the junior doctors pay wrangle is a hangover from the GP contract which HMG got badly wrong and ended up paying way more than they expected. They're also currently shit-scared about the mounting costs of old age and chonic conditions which they have little idea how to fund. Combine that with the general distrust of the tories - and the current health secretary in particular - amongst medical staff and you have a combustible recipe for industrial strife.

Not at all. They're just frightening a gullible and misinformed electorate with scare stories that are just flat out lies to fool the public into accepting less.

They know what you don't. The government has unlimited financial resources. There will never be a funding problem.

The notion is absurd on its face.

[Digby]

If you mean total money spent then no, because spending on the NHS goes up in real terms every year - which incidentally is a funny way of driving it into the ground. However they certainly want to bring down the cost of getting staff working at weekends by normalising it in their contracts. It seems to me, having spent a lot of time in hospitals recently, that they are trying to sweat the physical assets. There's a lot of very expensive equipment sitting around idle rather more than is ideal from a financial point of view.

I get your point, but the idle equipment should be being used as much as possible, regardless of cost. Healthy people are employable people. Expensive equipment generally needs an experienced eye to be useful and so more experienced eyeballs should be the long term aim. The benefits of biomedical research will never be realised unless the will to implement it exists. I do appreciate there is a lot of marketing of technology that gets less than efficient use, but targeting wages for junior physicians seems an insane way of balancing that book. In this day and age there really is no excuse for a universally more efficient technological standard not being invested in. But I'm here, you're there, so I am not directly plugged in. I will say that the closer you sail towards privatisation, the greater that gap between technology and application will become for most people. This is a problem that needs to be addressed on a large scale.... equitable access to education being a vital part of the long term plan.

I absolutely agree that the equiment should be being used as much as possible. Currently we get the personnel part completely wrong. The NHS uses an awful lot of agency staff - particularly nurses - who cost a fortune and are transient making it more difficult to build expertise. They are trying to remedy that but it's slow work when every nursing graduate knows they can still make a lot more money for a lot less hassle and responsibility by going contracting. We had taken our usual approach to this problem by nivking staff from elsewhere - Zimbabwe, Southern Europe etc - which was devastating to those countries but has basically kept the NHS afloat. However post-Brexit and immigration clampdown the NHS is going to be in serious trouble. I suspect the junior doctors pay wrangle is a hangover from the GP contract which HMG got badly wrong and ended up paying way more than they expected. They're also currently shit-scared about the mounting costs of old age and chonic conditions which they have little idea how to fund. Combine that with the general distrust of the tories - and the current health secretary in particular - amongst medical staff and you have a combustible recipe for industrial strife.

The nurses know they can get more by going the agency route on the back of various governments trying to drive down costs and make less appealing the life of nurses with permanent contracts. I can only suppose this hasn't been changed as the cost to correct salaries overall dwarfs agency costs.

[Eugene Wrayburn]

I get your point, but the idle equipment should be being used as much as possible, regardless of cost. Healthy people are employable people. Expensive equipment generally needs an experienced eye to be useful and so more experienced eyeballs should be the long term aim. The benefits of biomedical research will never be realised unless the will to implement it exists. I do appreciate there is a lot of marketing of technology that gets less than efficient use, but targeting wages for junior physicians seems an insane way of balancing that book. In this day and age there really is no excuse for a universally more efficient technological standard not being invested in. But I'm here, you're there, so I am not directly plugged in. I will say that the closer you sail towards privatisation, the greater that gap between technology and application will become for most people. This is a problem that needs to be addressed on a large scale.... equitable access to education being a vital part of the long term plan.

I absolutely agree that the equiment should be being used as much as possible. Currently we get the personnel part completely wrong. The NHS uses an awful lot of agency staff - particularly nurses - who cost a fortune and are transient making it more difficult to build expertise. They are trying to remedy that but it's slow work when every nursing graduate knows they can still make a lot more money for a lot less hassle and responsibility by going contracting. We had taken our usual approach to this problem by nivking staff from elsewhere - Zimbabwe, Southern Europe etc - which was devastating to those countries but has basically kept the NHS afloat. However post-Brexit and immigration clampdown the NHS is going to be in serious trouble. I suspect the junior doctors pay wrangle is a hangover from the GP contract which HMG got badly wrong and ended up paying way more than they expected. They're also currently shit-scared about the mounting costs of old age and chonic conditions which they have little idea how to fund. Combine that with the general distrust of the tories - and the current health secretary in particular - amongst medical staff and you have a combustible recipe for industrial strife.

The nurses know they can get more by going the agency route on the back of various governments trying to drive down costs and make less appealing the life of nurses with permanent contracts. I can only suppose this hasn't been changed as the cost to correct salaries overall dwarfs agency costs.

Actually it's much much cheaper to hire permanent staff, to the extent that some Trusts have been giving joining bonuses and providing accommodation for nurses from southern Europe. I think some have been paying over the odds as well. I can't say precisely what the reason for the growth in the use of agency nurses was. It is of course a quick fix when you are understaffed and provides some extra flexibility but it clearly got well out of hand. My experience in my field is that once an agency budget has been created it is always used so as to justify the budget existing for the next year, even if that means getting lawyers to sit on their hands whilst agents come in and present cases.

[Digby]

I absolutely agree that the equiment should be being used as much as possible. Currently we get the personnel part completely wrong. The NHS uses an awful lot of agency staff - particularly nurses - who cost a fortune and are transient making it more difficult to build expertise. They are trying to remedy that but it's slow work when every nursing graduate knows they can still make a lot more money for a lot less hassle and responsibility by going contracting. We had taken our usual approach to this problem by nivking staff from elsewhere - Zimbabwe, Southern Europe etc - which was devastating to those countries but has basically kept the NHS afloat. However post-Brexit and immigration clampdown the NHS is going to be in serious trouble. I suspect the junior doctors pay wrangle is a hangover from the GP contract which HMG got badly wrong and ended up paying way more than they expected. They're also currently shit-scared about the mounting costs of old age and chonic conditions which they have little idea how to fund. Combine that with the general distrust of the tories - and the current health secretary in particular - amongst medical staff and you have a combustible recipe for industrial strife.

The nurses know they can get more by going the agency route on the back of various governments trying to drive down costs and make less appealing the life of nurses with permanent contracts. I can only suppose this hasn't been changed as the cost to correct salaries overall dwarfs agency costs.

Actually it's much much cheaper to hire permanent staff, to the extent that some Trusts have been giving joining bonuses and providing accommodation for nurses from southern Europe. I think some have been paying over the odds as well. I can't say precisely what the reason for the growth in the use of agency nurses was. It is of course a quick fix when you are understaffed and provides some extra flexibility but it clearly got well out of hand. My experience in my field is that once an agency budget has been created it is always used so as to justify the budget existing for the next year, even if that means getting lawyers to sit on their hands whilst agents come in and present cases.

Around 16 years ago the girl I was seeing was staying in nurses accommodation, and I nearly fell off my chair when some of her friends also staying there told me what they could/did earn going the agency route. At the time I was faffing around doing some temp/contracting work on about £16-17/hour and they had me beat, albeit they didn't always have 40 hours a week from 9-5. To me it not only seems hugely wasteful to have temp work that never know the routines of a given job it must also hugely annoy those doing the same work, and indeed be covering for the naturally slower agency staff, to be getting paid much less.