Manifestos, Mandates and Mendacity

[Sweep]

I totally support the junior doctors and hope they strike. They have been messed around for decades and Hunt's latest promise is simply his biggest lie to date. Hunt is responsible for the exodus of doctors overseas. This winter is going to break the NHS.

I hope they go on strike too and then people can die to prove they were right
Like it or not, the 7 day NHS was in their manifesto and that is what the majority voted for.
Whilst I don't think being a doctor can be all about a vocation, I do think that more consideration has to be given to the fact that the nation has paid to train them and given them a well paid profession for life. I had to pay for my training and progression in my career like millions of others. My job doesn't stop outside "social hours" just like millions of others. Those marching with placards stating "I am off to Oz" may want to think about that.
TBH the public sector need to get real. Constant striking just because they don't like a Tory led government isn't going to get anywhere and public opinion soon wanes. What good did the teachers strikes do? None. Because they striked on pensions that are way better than any in the private sector can ever dream of and it's the private sector that pays for everything. 2 strikes in and the public lost patience. Now, if the PRIVATE sector went on strike, you would really know about it. You wouldn't even eat.

 

[Deleted member 16999]

Maybe I'm being too simplistic, but i honestly think the majority of voters vote for who they like, were they live or their circumstances or what they see/hear in the media, regardless of what's in a manifesto, a,b and c will get x, y and z's vote.
Sad, maybe, but in my honest opinion, reality, that's why at times when people are questioned about who they vote for it's not actually based on the manifesto.

 

[SwingsitlikeHogan]

Maybe I'm being too simplistic, but i honestly think the majority of voters vote for who they like, were they live or their circumstances or what they see/hear in the media, regardless of what's in a manifesto, a,b and c will get x, y and z's vote.
Sad, maybe, but in my honest opinion, reality, that's why at times when people are questioned about who they vote for it's not actually based on the manifesto.

This is the heart of my OP. The government claims their electoral mandate means that they must implement their manifesto - as that is what the voters have asked them to do by voting for them. Really? Everything in the manifesto? I think it is disingenuous for the government to proclaim that they must implement the 7-day NHS on the grounds that it was in the manifesto. If they can give good reasons why their subsequent detailed investigations and planning shows that the concept is either flawed, unworkable or unfair, would the electorate who voted for them not understand? I think it would.

 

[Hobbit]

This is the heart of my OP. The government claims their electoral mandate means that they must implement their manifesto - as that is what the voters have asked them to do by voting for them. Really? Everything in the manifesto? I think it is disingenuous for the government to proclaim that they must implement the 7-day NHS on the grounds that it was in the manifesto. If they can give good reasons why their subsequent detailed investigations and planning shows that the concept is either flawed, unworkable or unfair, would the electorate who voted for them not understand? I think it would.

I think that if a party isn't going to follow a manifesto pledge they absolutely have to tell the electorate why. I can remember voting Labour in the Tony Blair years, only for Labour to totally renage on a major manifesto pledge. I've not voted for them since, not that they've exactly excited me either.

But, with massive investment, why can't we have a 7 day NHS?

 

[SwingsitlikeHogan]

I think that if a party isn't going to follow a manifesto pledge they absolutely have to tell the electorate why. I can remember voting Labour in the Tony Blair years, only for Labour to totally renage on a major manifesto pledge. I've not voted for them since, not that they've exactly excited me either.

But, with massive investment, why can't we have a 7 day NHS?

I agree - I think that government should feel able to walk away from implementation of a policy if the explain why.

On the 7-day NHS - some would argue that we already have it. Besides - just looking at doctors and consultants for whom weekend working is not core hours - what are mothers of young children going to do when they have to work weekends. OK - they'll have to do what mothers who work weekends have to do. But is this not going to be a distinct disincentive for females to go into that profession if they know they'll have to work weekends. And if we start losing female doctors and fewer join the profession how does that match up with having to employ MORE doctors and consultants than currently are employed to cover working weekends?

A lot of practical stuff and you do have to ask whether it is really justified. More folks die at weekends? Well maybe more folks go into hospital with life threatening conditions at weekends because it is the weekend...

It sounds great - I'm not so sure.

 

[Hobbit]

I agree - I think that government should feel able to walk away from implementation of a policy if the explain why.

On the 7-day NHS - some would argue that we already have it. Besides - just looking at doctors and consultants for whom weekend working is not core hours - what are mothers of young children going to do when they have to work weekends. OK - they'll have to do what mothers who work weekends have to do. But is this not going to be a distinct disincentive for females to go into that profession if they know they'll have to work weekends. And if we start losing female doctors and fewer join the profession how does that match up with having to employ MORE doctors and consultants than currently are employed to cover working weekends?

A lot of practical stuff and you do have to ask whether it is really justified. More folks die at weekends? Well maybe more folks go into hospital with life threatening conditions at weekends because it is the weekend...

It sounds great - I'm not so sure.

We do not have a 7 day NHS, absolutely definitely don't! Colour it whichever way you want but it doesn't exist. Go into any large hospital and have a wander around Outpatients dept on, say, a Tuesday and a Sunday. Its a ghost town on a Sunday. Go into an operating theatre block on a Sunday compared to a weekday and you'll see similar. However, unless it was fully staffed 7 days a week, its not workable. And even if those depts were staffed 7 days a week, where are the beds to support that increase in throughput?

I dare say more people do die at weekends, irrespective of what doctors say. Try and find top surgeons etc on a Saturday and a Sunday. I know of one member of staff for whom a hospital called in the top team rather than have the duty Registrar operate... anecdotal I know, but it does happen.

 

[hors limite]

:whoo:

How did I know it would turn into this standard comment from yourself before long.

Tory votes = selfish, Labour voters = saviours of humanity.

Now we've stated that, you don't have to mention it again.

 

[Deleted member 16999]

This is the heart of my OP. The government claims their electoral mandate means that they must implement their manifesto - as that is what the voters have asked them to do by voting for them. Really? Everything in the manifesto? I think it is disingenuous for the government to proclaim that they must implement the 7-day NHS on the grounds that it was in the manifesto. If they can give good reasons why their subsequent detailed investigations and planning shows that the concept is either flawed, unworkable or unfair, would the electorate who voted for them not understand? I think it would.

There is a difference between a Party in Government and an opposition, the opposition manifesto is based on what they intend to do, but can't really cost it until they see the books, if they lose, so what. If they win, blame the previous Government if the finance is not there.
Issue this time, Tories really should've produced a balanced, thought out manifesto, they had the books.

 

[SwingsitlikeHogan]

There is a difference between a Party in Government and an opposition, the opposition manifesto is based on what they intend to do, but can't really cost it until they see the books, if they lose, so what. If they win, blame the previous Government if the finance is not there.
Issue this time, Tories really should've produced a balanced, thought out manifesto, they had the books.

Which is why I am astonished that they have got into a mess over Tax Credits. How could they not have know the impact it was going to have. Unless they did and all this we are seeing, and what we will hear in the autumn statement on the 25th, is all part of the plan...

 

[HomerJSimpson]

I may be cynical or just plain deluded but I'm voting at an election knowing full well whoever gets in isn't going to deliver on everything in the manifesto. These days I just hope the party in power leave the country in a better state than when they took over. Not always convinced this is the case either. What's the alternative? No one will stick to their promises and frequently move the goal posts

 

[SwingsitlikeHogan]

I may be cynical or just plain deluded but I'm voting at an election knowing full well whoever gets in isn't going to deliver on everything in the manifesto. These days I just hope the party in power leave the country in a better state than when they took over. Not always convinced this is the case either. What's the alternative? No one will stick to their promises and frequently move the goal posts

Quite - all governments implement the aspects of their manifesto that they want to - not because they have to. Hunt is being disingenuous to suggest he has to implement a 7-day NHS because it is in the manifesto. He is pushing it through because the government wants it. Which is fine, just don't pretend otherwise.

 

[Sweep]

I agree - I think that government should feel able to walk away from implementation of a policy if the explain why.

On the 7-day NHS - some would argue that we already have it. Besides - just looking at doctors and consultants for whom weekend working is not core hours - what are mothers of young children going to do when they have to work weekends. OK - they'll have to do what mothers who work weekends have to do. But is this not going to be a distinct disincentive for females to go into that profession if they know they'll have to work weekends. And if we start losing female doctors and fewer join the profession how does that match up with having to employ MORE doctors and consultants than currently are employed to cover working weekends?

A lot of practical stuff and you do have to ask whether it is really justified. More folks die at weekends? Well maybe more folks go into hospital with life threatening conditions at weekends because it is the weekend...

It sounds great - I'm not so sure.

We don't have a 7 day NHS. At my local surgery you can't get an appointment within the next 3 weeks! Seriously, what do you do if you are ill? Just wait 3 weeks?
I am all for a 7 day NHS and I will tell you why. I pay for it. I pay a lot for it, like every other tax payer in this country. I am sorry doctors don't want to work on Saturdays, but then neither do I. I don't get paid any more for it and I don't get another day off in lieu if I do. It shouldn't be 7 day. It should be 24 hours a day, 7 days a week. With a rising population we can't have anything else other than a 24/7 service.
Just imagine if it worked. The Tories doing better with the NHS than Labour, after all the accusations of them killing it off!
Maybe you think the government should walk away from this particular manifesto policy because you don't like it?

 

[Hobbit]

Quite - all governments implement the aspects of their manifesto that they want to - not because they have to. Hunt is being disingenuous to suggest he has to implement a 7-day NHS because it is in the manifesto. He is pushing it through because the government wants it. Which is fine, just don't pretend otherwise.

Not sure I 100% agree with you there. Yes they implement what they want to. But, equally, if they don't implement something in their manifesto they run the risk of being disingenuous unless they can genuinely show their original manifesto promise was flawed. Sorry, but I really feel you're playing with words to suit your own feelings/agenda on the issue.

 

[Deleted member 16999]

Not sure I 100% agree with you there. Yes they implement what they want to. But, equally, if they don't implement something in their manifesto they run the risk of being disingenuous unless they can genuinely show their original manifesto promise was flawed. Sorry, but I really feel you're playing with words to suit your own feelings/agenda on the issue.

But doesn't Homers post sum up voter apathy, those that took the time or interest in manifesto's are few and far between.

 

[Hobbit]

But doesn't Homers post sum up voter apathy, those that took the time or interest in manifesto's are few and far between.

That's a tough one. Voter numbers have dropped off massively in the last xx elections. Maybe the hardcore that do vote take a bigger interest than some give them credit for...?

 

[Deleted member 16999]

That's a tough one. Voter numbers have dropped off massively in the last xx elections. Maybe the hardcore that do vote take a bigger interest than some give them credit for...?

But the hardcore are also probably the diehard party supporters, the floating voter are, imo, influenced by short term goals, selfishness and the media.

 

[Ethan]

Hahahahahaha - having had my appendix out on a Friday night, I think I have a pretty good idea about provision. Having been called in many times to theatres or ICU I know that in an emergency, pretty much all of the facilities needed are available. What isn't available is Outpatients clinics, and at weekends how many theatres are running lists. Nice idea to have more up-time but...

7 day working, without at least a 40% increase in budgets, is pie in the sky. Extra clinic time would mean extra theatre time would mean extra ward time. All of which would need extra staff. It isn't going to happen anywhere near the level of sound bite JH has been spouting.

As for this winter is going to break the NHS... have you taken to writing the headlines for the Express?

The Express is more concerned about the tropical cyclones about to hit Essex.

The NHS is in such a parlous state that a bad winter will be unsustainable. The problem is that this crisis is more or less designed. Hunt knows exactly the pressure the NHS is under but he is gambling that eventually the public will accept a switch to private companies running it. It is the old model. Run public services down until almost anything else is acceptable.

But there is plenty of money going into the NHS. It is just a pity so much is wasted on PFI payments, the apparatus of pseudo-market structures and the like.

As for weekend clinics, there really isn't much public appetite for them. Likewise GP surgeries on Sundays, which have a lower booking rate and a higher DNA rate than weekdays. The problem is that these weekend clinics displace staff from the week, even if they are sitting around twiddling their thumbs. If Hunt is correct that the so-called weekend effect is due to staffing reduction at the weekend, then he is proposing a similar reduction during the week by moving staffing to the weekend. There is ample evidence that the weekend effect is not due to staffing but to higher levels of morbidity instead, so called case-mix, but Hunt prefers a political soundbite. There is therefore no guarantee that greater staffing at the weekend will make a difference, but a risk it would worsen outcomes during the week. So the possibility exists that this Don Quixote strategy will worsen matters and do so at massive cost.

Of course we know that 7 day working is driven by private healthcare companies who have indicated that their level of interest in buying franchises in the NHS would be increased if they saw a flexible workforce capable of being deployed as they saw fit. it is a kern version of the old breaking of what they see a restrictive working practices.

 

[Ethan]

We don't have a 7 day NHS. At my local surgery you can't get an appointment within the next 3 weeks! Seriously, what do you do if you are ill? Just wait 3 weeks?
I am all for a 7 day NHS and I will tell you why. I pay for it. I pay a lot for it, like every other tax payer in this country. I am sorry doctors don't want to work on Saturdays, but then neither do I. I don't get paid any more for it and I don't get another day off in lieu if I do. It shouldn't be 7 day. It should be 24 hours a day, 7 days a week. With a rising population we can't have anything else other than a 24/7 service.
Just imagine if it worked. The Tories doing better with the NHS than Labour, after all the accusations of them killing it off!
Maybe you think the government should walk away from this particular manifesto policy because you don't like it?

You don't pay a lot for it. You pay one of the lowest amounts in the civilised world, actually, and if you are not a high earner, you get a bargain. So you are happy with fewer doctors around during the week and therefore, if Hunt is correct, a higher death rate for weekday admissions? And also happy to pay more tax to fund it?

Do you work 60 hours a week already performing tasks for which 100% concentration and wakefulness are needed? Not sure that many normal weekend jobs require the focus needed to perform surgery or diagnose a tricky chest pain.

So you want 24/7 NHS. What does that mean, exactly? Diabetic clinics at 2 in the morning? Please explain what you understand by a 7 day NHS. If you can, you will be one up on Jeremy Hunt because he hasn't.

 

[Hobbit]

The Express is more concerned about the tropical cyclones about to hit Essex.

The NHS is in such a parlous state that a bad winter will be unsustainable. The problem is that this crisis is more or less designed. Hunt knows exactly the pressure the NHS is under but he is gambling that eventually the public will accept a switch to private companies running it. It is the old model. Run public services down until almost anything else is acceptable.

But there is plenty of money going into the NHS. It is just a pity so much is wasted on PFI payments, the apparatus of pseudo-market structures and the like.

As for weekend clinics, there really isn't much public appetite for them. Likewise GP surgeries on Sundays, which have a lower booking rate and a higher DNA rate than weekdays. The problem is that these weekend clinics displace staff from the week, even if they are sitting around twiddling their thumbs. If Hunt is correct that the so-called weekend effect is due to staffing reduction at the weekend, then he is proposing a similar reduction during the week by moving staffing to the weekend. There is ample evidence that the weekend effect is not due to staffing but to higher levels of morbidity instead, so called case-mix, but Hunt prefers a political soundbite. There is therefore no guarantee that greater staffing at the weekend will make a difference, but a risk it would worsen outcomes during the week. So the possibility exists that this Don Quixote strategy will worsen matters and do so at massive cost.

Of course we know that 7 day working is driven by private healthcare companies who have indicated that their level of interest in buying franchises in the NHS would be increased if they saw a flexible workforce capable of being deployed as they saw fit. it is a kern version of the old breaking of what they see a restrictive working practices.

Why isn't there much public appetite for weekend appointments in Outpatients? At a more base level, a mid week appointment means some people get a (legitimate) day off work. And from a business/Govt perspective its a day of lost production. Personally, do I want to miss my 9:30am tee time or appointment at Outpatients? I guess it depends on how ill I am.

I'm not sure I understand the reasoning for an increased morbidity rate at weekends. I can't see death, like illnesses in general, having a particular bio-clock. Do you have anything to back up the why...

Unless JH has got some massive funding pot stashed away, I can't see a 7 day NHS being worthwhile. Yes if it increases facilities/infrastructure and staff, but no if it only means moving some staff from mid-week to weekends. Having 5+0=5, and moving it to weekends might see the equation reading 3+2=5... no benefit, but a lot of stressed staff because they are thinner on the ground on any given day.

 

[Sweep]

You don't pay a lot for it. You pay one of the lowest amounts in the civilised world, actually, and if you are not a high earner, you get a bargain. So you are happy with fewer doctors around during the week and therefore, if Hunt is correct, a higher death rate for weekday admissions? And also happy to pay more tax to fund it?

Do you work 60 hours a week already performing tasks for which 100% concentration and wakefulness are needed? Not sure that many normal weekend jobs require the focus needed to perform surgery or diagnose a tricky chest pain.

So you want 24/7 NHS. What does that mean, exactly? Diabetic clinics at 2 in the morning? Please explain what you understand by a 7 day NHS. If you can, you will be one up on Jeremy Hunt because he hasn't.

Yes, I do work 60 hours a week -and more when needed and you will find that a lot of people do. As I understand it, the doctors are not expected to work more hours, just different hours on different days and they get an 11% pay increase into the bargain. The need for more doctors is a seperate issue. If more are needed to operate a 7 day service then more should be recruited. I do believe that the money that the NHS receives could be used more efficiently.
The amount I pay into the NHS in my taxes is the biggest "policy" I have, by far, so I do pay a lot for it. On top of that, it is getting harder and harder to access its services. As I say, a 3 week and counting wait for an appointment at my surgery, but it's closed at weekends and before 8am and after 6pm in the week. Can you imagine any business in the private sector that would only open those hours if they were so busy?
A 7 day NHS is exactly what it says on the tin. 24/7/365. That is what would happen if the private sector actually did run the NHS. And you cannot ignore the point that with a rapidly expanding population, we cannot keep this service going with anything less. There simply is not the time and it's all part of understanding that more people does not simply mean more tax. Every single person needs investment in amenities, like education, transport, water services etc etc and yes, the NHS.
Lets look at it another way. Would you be happy with a reduction of hours? No? So do we have it about right then? If that is the case, why are people dying on waiting lists and others can't even get to see their GP within the next 3 weeks?