"Posts unfilled are not jobs lost"??

Good old British "fudging"

The one certainty is that jobs have been lost. But in the publicity fog surrounding the NHS, it is unclear how many. Take the Mid Yorkshire Hospitals NHS Trust. Health Service Journal (Oct 19) quotes its chief executive: "We thought we would have to place just over 200 staff at risk of redundancy." In fact, just ten have taken voluntary redundancy and only four have been made redundant. But 200 is more likely to make headlines than four.

Another trust, in Worcestershire, identified more than 750 jobs at risk. In fact, says a trust spokesperson, only 11 have actually been lost. But pessimists can be forgiven for having expected worse. NHS Employers estimated that 20,000 posts were threatened. HSJ says that the reality is just 766 redundancies so far.

The important distinction is, it seems, between jobs lost and posts unfilled. Kevin Barron, the chair of the Commons Health Select Committee, says that he is "hoarse" from talking to organisations such as the Royal College of Nursing (RCN) which he says tell the media that thousands of jobs are being lost. "In my view, posts unfilled are not jobs lost," Barron says.

But that's little comfort to those who have been made redundant or who have completed their healthcare training and then found that they cannot get work. Commenting on a survey which found that barely half of student nurses expect to have jobs on qualifying, Susan Watts, the RCN's student adviser, says that new staff should be guaranteed a one-year contract. Failure to do so risks nursing shortages in a few years' time, she predicts.

Therapy Weekly (Oct 19) suggests that newly qualified physiotherapists are in a similar position. It says that a "staggering" 93 per cent of this year's graduates have still not found an NHS post.

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Australia: Working hours for young doctors still insane

Young doctors are still being compelled to work far more hours than are good for either them or patients, the Australian Medical Association said today. Despite the best efforts of the AMA over recent years, the latest safety audit of doctors found some still worked more than 100 hours a week, AMA president Dr Mukesh Haikerwal said. In one case, a doctor reported working 63 hours continuously.

The audit covered more than 15,000 doctors from hospitals around the country. Details will be released today. Dr Haikerwal said it showed 62 per cent of hospital doctors still were working unsafe hours and were classified as working at high or significant risk. "It used to be part of the folklore and it continues to be part of the myth and the myth is that you need to work long hours non-stop continuously to gain the experience," he told ABC radio. "At the end of the day, you can't actually learn anything if you are dead beat on your feet. "People who are seeing a doctor would expect them to be sharp and aware and alert when they are being treated and they certainly wouldn't want to be seeing them on their 80th or 39th or so hour on the trot."

Dr Haikerwal said he had been working in this issues since his days as a student and as a young doctor. The situation had improved, "but it is still not acceptable for people to be working 39 hours non-stop and it's not acceptable for people to be working up to 100 hours on average a week," he said.

Dr Alex Markwell, from the AMA council of doctors in training, said there was still an element of older doctors who trained under the old regime who felt their junior colleagues should undergo similar experience. "We need to start putting in place strict guidelines that actually enable safe rostering, enable doctors to say 'hold on, it's 16 hours, I am tired, someone else needs to come on and take over'," she told ABC radio. "We just need to stop expecting our doctors to keep going until something tragic happens which we have unfortunately seen in some states."

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For greatest efficiency, lowest cost and maximum choice, ALL hospitals and health insurance schemes should be privately owned and run -- with government-paid vouchers for the very poor and minimal regulation. Both Australia and Sweden have large private sector health systems with government reimbursement for privately-provided services so can a purely private system with some level of government reimbursement or insurance for the poor be so hard to do?

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