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DiU and Unite Podcasts

Episode 3: Work and Pensions

Today we’re joined by public health and medical sociology professor David Blane, to discuss the rise in the state pension age, the effect of work in later life on health, and the changing perceptions of key workers since the start of the coronavirus pandemic.

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COVID-19 DiU and Unite DiU's place in Unite Podcasts

The Doctors in Unite podcast: Episode 0

Over the next few weeks we’ll be sharing a new podcast with you, where we’ll discuss the coronavirus pandemic, the government’s response, and what might happen next. We’ll interview doctors and senior health figures, and try to gain some insight into this unprecedented situation.

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COVID-19 DiU and Unite Government Guidelines H&S at work Hospitals and IPC Staying safe

Doctors in Unite statement on retired health workers returning to work during the coronavirus pandemic

The UK government has asked the General Medical Council to contact doctors who have retired within the last six years and grant them temporary registration, a licence to practice and return to the GP performers list or secondary care equivalent. 

Without consulting the individuals concerned the GMC passed their details to local health services. Tens of thousands of retired doctors will be contacted, encouraging them to return to practice.

Doctors are able to opt out, but if they do choose to start working again they must be assured of protection.

They should:

  • Complete a short survey to help determine skills.
  • Complete identity checks including a declaration of honesty letter, Disclosure and Barring Service declaration, and occupational health questionnaire.
  • Have a choice in what work to be involved in.
  • Expect to be tested for SARS-Cov2.
  • Not be expected to work if they choose not to for any reason.
  • Not be expected to work if they have co-morbidities.
  • Not be expected to work in direct patient facing roles. This recognises that increasing age is most likely an independent risk factor for severity of illness. Several retired health care workers who returned to work have died. Early epidemiological data suggests that BAME health care workers may also be at increased risk.

Suitable roles include:

  • Telephone support for NHS 111.
  • Helping in out-patients or GP surgeries by telephone.
  • Backfill for clinicians in direct patient facing roles.
  • Training other clinicians.
  • Psychological support and mentorship for clinicians on the front line.
  • Support for public health and community roles e.g. contact tracing.

Employment working conditions as laid out by the four devolved governments [1], [2], [3], [4] and GMC [5] guidance includes: 

  • Suitable pay and remuneration.
  • Six month contracts of employment.
  • Annual leave.
  • Employment by one organisation.
  • Pension protection.
  • Death in service benefits.
  • Free government indemnity cover with advice and support from defence unions [6].
  • No need for revalidation.
  • Induction and suitable training including Information Technology.
  • Provision of suitable equipment including IT, laptops, mobile phones, smartcards and passwords.
  • Proper home working facilities.
  • Suitable Personal Protection Equipment (PPE).
  • The expectation to work within limits of competency and the right to leave at anytime by submitting a notice period of no more than a week.

[1]    https://www.england.nhs.uk/coronavirus/returning-clinicians/faqs-doctors/#do-i-need-to-be-included-on-the-nhs-england-medical-performers-list-the-list-to-work-as-an-emergency-registered-practitioner-erp-in-primary-care

[2]    https://gov.wales/doctors-returning-nhs-assist-covid-19-guidance-html

[3]    https://www.gov.scot/publications/coronavirus—returning-to-registered-professional-practice-guidance/

[4]    https://www.health-ni.gov.uk/Covid-19-returning-professionals

[5]    https://www.gmc-uk.org/registration-and-licensing/temporary-registration/information-for-doctors-granted-temporary-registration/returning-to-work

[6]    https://bma-mail.org.uk/JVX-6TQS5-S0FWOA-40RGIL-1/c.aspx

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COVID-19 DiU and Unite Government Guidelines H&S at work

Medical ethics during the coronavirus pandemic

Treatment without prejudice

We believe that all people are of equal value. Whether old or young, rich or poor, disabled or not disabled, we all share a common humanity. This was true before the coronavirus pandemic, and it remains true today.

Coronavirus is affecting different people in different ways. Many have a mild illness, but for some, it threatens their life. When severe disease strikes, there will be a choice about the types of treatment doctors offer. These decisions, though difficult, are made every day in hospitals and clinics across the country. Will a drug work? Will an intervention succeed? Or, will the side effects, the negative consequences, and the harms, outweigh the potential benefit to a person’s life?

Intensive care will not work for some patients. Ventilator support will sometimes not succeed. Doctors must judge who is most likely to improve with these measures, and who is not.

These decisions have previously always been made on a case-by-case basis, where the risks and benefits to an individual patient are carefully considered. The arbitrary condemnation of one group or another is inexcusable. Being old, living in a care home, or having a pre-existing disability should not lead to an automatic exclusion from possible treatment. Blanket categorisation of large groups of people in such a way is prejudice. There is no place for it in the NHS.

Rationing of care

There may come a time where our healthcare system is overwhelmed. But we have not yet reached that point. How we act now affects whether the country runs out of ventilators, oxygen, protective equipment, and medication. The single priority for all UK manufacturing must be the production of these goods. There is nothing more important. We must never reach the point where a person goes without a lifesaving treatment only because it is in too short supply. 

Secondary harms

The needs of those without coronavirus, but with other acute medical problems, remain despite the new pandemic. Their health must not be squandered while our attention is focussed elsewhere. 

Informal palliative care

Families must never be placed in the position to go without the support of either community-based, hospice, or hospital-based palliative care for a dying relative. Many already act as carers for their loved ones. They should not shoulder the further responsibility of administering palliative care that would otherwise only be conducted by a trained healthcare professional. Palliative care staff should not be routinely redeployed to other parts of the health service during the pandemic.

Telemedicine

The necessary shift to telephone and internet consultation presents a challenge in ascertaining objective measures of health. In normal times, a record of oxygen saturation would be a routine examination for a respiratory illness. It should be no different now. Pulse oximeters should be made widely available to all patients with coronavirus symptoms other than the most mild cases.

Unsafe working

It is immoral to request that a health or social care worker looks after patients without appropriate personal protective equipment. It jeopardises the health of the worker and their patients.

Volunteers and the newly unemployed

Volunteers are not a substitute for qualified staff. Their generosity is humbling, but they must only be offered jobs that maintain their safety and the safety of patients. 

The expertise of those now without work should not be squandered. Those with life support training and other transferrable experience may be utilised as key workers. Appropriate training, well-defined roles and written contracts must be always provided.

Immunity

The immune response to COVID-19 is not yet fully understood. Immunity may be relatively short lived. Any policy that relaxes social distancing and isolation measures must be based on robust understanding. Using ‘immunity passports’ without evidence will be futile. 

The improved civil liberties for those perceived to be immune would likely create social disharmony, and those still susceptible may seek out infection in order to resume their previous lives. This may well lead to many unintended harms.

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COVID-19 Defend the NHS DiU and Unite DiU Policy Statements Unite Leader statements

COVID-19: Response from Doctors in Unite

The threat posed by COVID-19 demands a united national response across the UK. As well as protecting individual and public health, the burden of maintaining public resilience must be shared equally, on a pooled basis across society.

In response to COVID-19, Doctors in Unite urges the government to:

  • Extend day-one sick pay to those on zero hours contracts, in the ‘gig-economy’ and to the self-employed.
  • Ensure that workers are not under pressure to attend work while they are unwell and may inadvertently pass on the disease, both financially and in regards to staffing.
  • Allow the NHS to requisite private health care facilities to accommodate effective COVID-19 treatment and quarantine provision if needed.

Trades Union Congress General Secretary Frances O’Grady has said:

“Employers have a duty of care to support workers affected by coronavirus. No one should have to worry about making ends meet if they have to self-isolate or if they fall ill. They should be able to focus on getting better.”

The government issued a statement on 4th March, explaining that statutory sick pay (SSP) would be available from day one, and that “there is a range of support in place for those who do not receive Statutory Sick Pay, including Universal Credit and contributory Employment and Support Allowance (ESA).”

This solution is not sufficient for the three million people in the UK on self-employment contracts plus the two million workers who do not earn enough (£94.25 per week) to claim SSP. In order to claim, these workers would need to enrol for Universal Credit which can take up to five weeks for payment. The alternative is ESA which requires claimants to have built up two to three years of National Insurance contributions.

Doctors in Unite endorses the position adopted by the Socialist Health Association which strongly supports the TUC, and urges that this scheme is extended to those workers who currently do not qualify for SSP.

Employers should make up SSP to the average pay of workers to ensure they are under absolutely no financial pressure to attend work while they are unwell and may inadvertently pass on the disease. This must apply not only when patients are ill but also when people are laid off work for public health reasons, even if they themselves are not actually unwell. 

This is an area where the government must step in, as many sectors (e.g. retail, hospitality, or care providers) which interact most with the public may not have the financial resilience to weather the storm created by COVID-19.

Should the coronavirus outbreak spread significantly everyone will be expected to respond by putting the interests of the community first. Undoubtedly workers will volunteer long hours and take on exceptional responsibilities. This will increase the risk of errors, which will need to be balanced against the risk of failure to treat patients in a mass outbreak. We urge professional bodies to be aware of this.

Our NHS must be in a position to requisition private health care facilities where it will increase local health capacity or facilitate quarantine provision.

As the trade union for medical doctors, Doctors in Unite congratulates our colleague trade unions and Labour leaders for engaging with the government and employers, to ensure that these steps are taken as a matter of urgency in the national interest.

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DiU and Unite

University strike action – their fight is our fight

The junior doctors strikes of 2015 were in response to an unprecedented attack on doctorsʼ working conditions, unequal pay and unsafe demands by then Health Secretary Jeremy Hunt. Now, Doctors in Unite stands in proud solidarity with the striking educators, lecturers and researchers in the University and College Union, who have stood shivering on picket lines around the country to protest the unfair working environment they are being asked to endure.

UCU members have been forced to take industrial action following years of stagnating wages, and insecure, zero-hours contract arrangements which leave staff overworked, underpaid, and with no job security.

One striking university researcher explained how workers were simply not getting paid for hours worked. “Many of us are on part time hourly paid contracts. Weʼre paid to lecture, but only the one hour of the lecture. It can take up to two days to properly prepare. So you can either prep a poor quality lecture quickly, or take the necessary time to put the work in – but thatʼs unpaid labour.”

Staff pay has fallen by 20% in real terms in the last decade, with women and BAME workers suffering disproportionately. UCU calls the workloads staff experience “unsafe”, criticising the entrenched culture of casual contracts, while staff are being pressured to work longer hours than ever before.

“I was contracted to work month by month,” said one UCU member. “I didnʼt know how much I would get paid. Itʼs highly unpredictable, very difficult to budget, and incredibly stressful.”

All industries rely on the training that happens in universities. Doctors would not have their jobs without the dedicated enthusiasm of their medical school lecturers and teachers. Educators are passionate about their work, and often conflicted about taking time out from crucial research and teaching. But theyʼve been backed into a corner by an unsustainable culture of casual, insecure work. UCU states that without the threat of strike action, “the employers would not have entered talks and that without the threat of further action, no more progress will be made.”

Doctors in Unite recognises the struggle of all workers to gain proper, fair recognition for their labour. There is no excuse when employers exploit their workforce. We urge all trade unionists and all workers to contribute to the UCU strike fund if they can. Their fight is everyoneʼs fight.

Donate to the strike fund on the UCU website

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Defend the NHS DiU and Unite KONP and other campaigns

Joint campaigning to defend the NHS

The annual NHS winter crisis is now a continuous crisis. The latest performance figures for emergency departments are the worst ever and waiting lists continue to increase. The government has promised much, but there is little hope this will translate into real improvement.  The situation continues to worsen due to chronic underfunding of health and social care, cuts, closures and huge staff shortages. Brexit and the looming threat of a US Trade Deal are also on the horizon.

We must stand together with other campaigning groups to speak out and take action to defend the NHS. Dr Jackie Grunsell’s motion at the Doctors in Unite AGM commits the union to this coordinated effort.

Our starting point will be on February 15th, the Winter Crisis Day of Action, arranged by Health Campaigns Together and Keep our NHS Public. Other national and local events are running around the country.

We are stronger when we work together. Doctors in Unite resolves to do all in our power to join with other campaign groups and trade unions for the organised resistance now required.

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DiU and Unite

Doctors condemn escalation of Middle East tensions

The UK’s oldest medical trade union has denounced the assassination of Iranian General Qassem Soleimani. Doctors in Unite chair Dr Jackie Applebee said she was “appaled” by the killing, citing fears that this would “further destabilise the Middle East” and “set off a chain of tit for tat actions that will lead to the deaths of countless innocent people”. 

Our union stands with anti-war movements across the world in the condemnation of the killing of General Soleimani. At our 2020 conference, we committed to building and attending anti-war demonstrations, and participation in lobbying efforts to prevent worsening conflict.