Ken Livingstone: not a racist but an idiot and maybe a bit racist

For anybody unaware, Ken Livingstone has been suspended from the Labour party. The Guardian timeline summarises the events leading up to this.

My Facebook feed has largely turned into Livingstone-bashing with some misunderstanding why mentioning a historically accurate fact is such a big deal. Like any good debater, I can split this into three main points, primarily using West Wing quotes.

 

  1. “I don’t care what it is, I care what it looks like.”
  2. The ‘technically not a racist’ defence
  3. “There are only a handful of anti-Semites”

OK. I used one West Wing quote.

Shut up.

1. “I don’t care what it is, I care what it looks like.”

'SlimCity - Managing Urbanization':

No doubt, praying for leniency as the party exercise Jew process

It’s both apt and unsurprising that when I looked up the exact wording of this quote from The West Wing, it’s said by CJ Cregg, the White House press secretary.

On Thursday 28th at 0850 in an interview with Vanessa Feltz on BBC Radio London, Livingstone said:

“When Hitler won his election in 1932 his policy then was that Jews should be moved to Israel. He was supporting Zionism.”

Feltz: What do you think over the top means? Over the top of what? [in reference to Naz Shah’s Facebook posts]

Livingstone: Basically to think of anti-Semitism and racism as exactly the same thing.”

He then followed this up with an interview on The Daily Politics where he said:

“I’m being questioned in an interview I answer the question. You’ve never known me not answer a question you’ve put to me.”

We know there was an agreement between Nazi Germany and some Jewish groups called the Haavara agreement. Let’s assume Ken’s description is accurate.

Let’s also ignore the fact I had no idea that Vanessa Feltz was still a broadcaster or that she was married to the singer on the 1999 single Turn Around by Phats & Small.

This still begs the question, why mention Hitler? (Livingstone’s comments, not Phats & Small who to my knowledge have never mentioned Hitler in relation to anti-Semitism in the Labour party.)

His response – that he was asked that question. Except the question he was asked was

Feltz: She [Shah] talked about relocating Israel to America. She talked about what Hitler did being legal. And she talked about the Jews rallying. And she used the words Jews, not Israelis or Israel. You didn’t find that to be anti-Semitic?”

There are a number of Naz Shah’s comments to which Feltz refers. Livingstone specifically picks out the Hitler comment and then goes on to talk about the Haavara agreement apropros of almost nothing.

Livingstone’s defence is that what he says was true. On mentioning Hitler supported Zionists, there are two possibilites:

  1. He did not realise it would have consequences.
  2. He realised it would have consequences.

Let’s examine scenario 1.

As Livingstone has said, he has spent 47 years in politics. If after 47 years you don’t know that defending the comment ‘what Hitler did was legal’ by arguing that it was technically true on the basis that ‘He [Hitler] was supporting Zionism’ is likely to get you in trouble with Jewish voters, you must be exceedingly stupid.

That it is historically accurate is neither here nor there.

It is accurate to say “there is a higher proportion of black men who commit crime than white men”.

Let’s say somebody asks: “what do you think the main causes of crime are?”
You respond: “there is a higher proportion of black men who commit crime than white men”

It’s likely you’ll get called a racist. It’s a non sequitur and in the context implies, though doesn’t technically state outright, that the problem is black men. The accusation of racism is not unjustified and we could all get round and through a liberal amount of metaphorical rocks at you. Liberal? Liberal? D’you get it? Eh? EH?

(On historical accuracy, I’m no historian. However, I understand arguing ‘Hitler supported Zionism’ is rather like arguing the National Front used the word ‘paki’ and argued for the forced deportation of South Asians in the 1970s because the NF were advocates for Pakistani sovereignty. Hitler would have happily seen Jews deported to Birmingham – he just wanted them out of the country and did not, to the best of my knowledge, support the creation of a Jewish state.)

2. The ‘technically not a racist’ defence

Let’s look at scenario 2. Indeed let’s look at worst-case scenario 2.

Ken Livingstone is an antisemite. He believes that Jews are genuinely ‘rallying’, should stop complaining about being racially abused and doesn’t think the Holocaust is relevant any more. Let’s assume he’s that bad a man. How would that look?

Now, he knows he can’t go on the radio and the TV and say ‘I hate Jews’. Not even the most ardent Livingstone supporter would advocate that unless they too were openly anti-Semitic.

What he can do however is go on the radio and say things that are arguably defensible. So he can say “well, I was just telling the truth”. And that the Labour party have suspended the handful of members who’ve made anti-Semitic comments.

The phrase ‘dog-whistle’ has come back into vogue and would be relevant here. Unwittingly or not, Livingstone’s comments are a dog-whistle to antisemites who believe that Jews simply don’t deserve to be in Israel at all. He’s Labour so the Labour party is for them.

In form

On 24th February 2006, he was suspended from mayoral office for referring to journalist Oliver Finegold as ‘like a concentration camp guard’.

In July 2005, he was pictured embracing Yusuf Al-Qaradawi, who has supported Palestinian suicide bombing and wife-beating (albeit lightly).

Whilst these aren’t recent instances, one would think a politician would be extra careful when talking about anti-Semitism. It suggests a general lack of sympathy and sensitivity for those who are victims of anti-Semitism.

So he’s a racist?

I suspect not. Though he doesn’t help his cause by claiming that anti-Semitism isn’t thing same as racism.

After some discussion with friends, the two possibilities I’ve come to are either that:

  1. He is surrounded by people where suggesting that Hitler supported Zionism would not be considered a controversial thing to say.
  2. Whilst he doesn’t actively hate Jews, he believes that the problems of anti-Semitism are overstated and given the relative affluence of the Jewish community, does not see it as a significant problem

Probably a little from column A, a little from column B.

3. “There are only a handful of anti-Semites”

Does the Labour party in general have a problem with anti-Semitism?

That’s really beyond me to say. Besides Livingstone, the 3.5/4 instances of anti-Semitism I’m aware of are:

Some argue that 5 antisemites in a party of 388407 members does not a problem of anti-Semitism make. Ken Livingstone is an idiot and should be ignored. Wes StreetingJohn Mann and other MPs are merely disgruntled Blairites using the row as a stick with which to beat Jeremy Corbyn.

This slightly misses the point. Individuals making anti-Semitic comments do not do so in a vacuum. To normalise these sentiments even if they are the most extreme exponents of them, it’s likely (but not certain) that others around them and within the party share similar views. Racists tend not to out themselves if their friends aren’t racist too.

In the New Statesman podcast, Helen Lewis points out that there’s a problem on the left of assuming that middle-class women can’t have problems because of their affluence. That attitude, she argues, is one that also pertains to anti-Semitism.

It’s not concrete evidence and Shami Chakrabati is a good person to lead Jeremy Corbyn’s anti-Semitism inquiry. To be honest, whether Labour had a problem with anti-Semitism is now moot; it does now.

“I don’t care what it is, I care what is looks like.”

For many Jewish voters, it will feel like Labour is a party with an anti-Semitism problem. Unless there are visible signs of change, many simply won’t vote for them.

PS: here’s a video of Diane Abbott not helping.

Advertisements

MEDICINE: a complicated guide to junior doctors’ pay

UPDATE 13/2/16: NHS Employers has sent more specifics about the contract out rendering this post somewhat inaccurate. Will be adjusting it soon.

UPDATE 14/2/16: now adjusted to take into consideration the specific changes NHS Employers sent out on 13/2/16 to junior doctors.

A significant component of the current dispute between Health Secretary Jeremy Hunt and junior doctors is pay. It is not the whole dispute.

Part of the new proposals involve a hospital ‘guardian’. The ‘guardian’ would be responsible for ensuring doctors do not breach their hours. Where they do, guardians would enforce financial penalties. (It’s really hard to Google ‘guardian’ and ‘junior doctors’ strike’ without just getting articles from the Guardian.)

However, they would be employed by hospitals; the conflict of interest between an employee deciding whether to fine his or her employer is obvious. As yet, this issue has not been addressed by government. The practical effect on hours worked that having a guardian will have is unclear.

There are many other issues too. However, the question for this post is, what are the differences in pay going to be?

I’m going to use the last full-time rota I was on as an example. (NB: this is not the same rota for the whole country.)

I’m going to be using ‘old’ to represent the system at the moment and ‘new’ to represent to prospective system. Using the term ‘current’ could get a bit confusing.

If you can’t be bothered look at the maths, just go to the end. There’s a section called, The punchline, which summarises the key numbers.

The old system

This worked via something called ‘banding’. If you Google ‘NHS banding’ you get the bands for nursing and other healthcare professions.

The old banding system for doctors looked like this:

OH MY GOD WHAT EVEN IS THAT?

It looks complicated but the hospital tallies up the number of hours you’ve worked, the proportion that’s ‘antisocial’ and gives you a pay supplement based on that proportion.

Antisocial hours are considered the weekend and 1900-0700 during the week.

How do you figure out whether you’re moderately, most or least antisocial? You can use the following helpful chart:

SERIOUSLY THEY ARE JUST TAKING THE MICHAEL NOW!

Suffice it to say, it’s fairly complicated. I say this with some trepidation but most first- and second-year doctors (F1 and F2 or Foundation Year 1 & 2) will be on 1A or 1B. I think.

This means, for the number of antisocial hours they work, they get a pay supplement of 40% of their basic salary.

The F1 year is usually split into 3 x 4-month placements. Assuming that all of these jobs have a fairly standard on-call rota for medicine or surgery, an F1 will receive a 40% supplement on the basic salary of £22,636

They’re paid 22636 x 1.4 = £31690 pa.

Placements vary. F1s often do jobs like medical microbiology or general practice which many only require social hours work – they do not receive a supplement for these jobs.

They may also work in emergency medicine (A&E) where they would receive an even bigger supplement but the shifts are largely antisocial.

The same applies to any hospital medic. They have a basic salary. The hospital calculates the proportion of antisocial hours; determines what band they’re in; and gives them the requisite pay supplement.

The key misunderstanding is that you get a percentage supplement on total hours under the old system, not just on the out-of-hours work as some of the press have suggested.

Now, I hope you enjoyed the arithmetic – there’s loads more to come.

The rise in basic pay 

When I originally wrote this post, the government had been suggesting a 13.5% pay rise. Subsequently, NHS Employers have sent out this pay letter which has more specifics about the new pay scale. The old pay scale can be found here on the BMA website.

I’ve summarised them in this table:

Comparative hours table

Pay and percentage increases relative to year

F1 and F2 refer to the first and second year of the foundation programme. If you look at the old pay scale, these consider pay for up to three years in each of these posts. These are relevant to part-time doctors which I’ve ignored, largely because it’s something I don’t have a lot of experience of.

CT/ST (core/specialty training) year refers to years in specialist training (surgery, internal medicine, pathology etc.). From the point of view of pay, the difference between core and specialty training posts is a technical one, not relevant here.

Otherwise, there are two changes. The first is simply there is an increase in basic salary across the board (though this doesn’t necessarily lead to a final salary increase).

Secondly, you’ll note the new ‘nodes’. Previously, there was a year -on-year increase in salary. Now doctors will have the same salary during certain blocks of training, particularly ST3-7.

Government argues that the responsibility of these doctors is the same regardless of grade. For anaesthetics and critical care, this is true when looking purely at on-call responsibility. However, it doesn’t consider the assessments and exams one has to pass to progress from year to year.

Most doctors require revalidation every 5 years. Junior doctors go through an equivalent process every year which is more onerous that revalidation.

How the new system’s supplements work

Oh, the fun I’ve had with this. My last job was as a CT2 anaesthetist. Looking at the table above, that means I would be paid 7.5% extra basic pay. I’ve also calculated my comparative pay as a CT1 anaesthetist which involves a 16.21% increase.

You can download the spreadsheet here but I’m going to use a couple of screenshots.

I’m not sure how well this will show up on whatever device you’re using. The top row is hours. 0700 means 0700-0800. I’ve put a ‘1’ for every hour I’ve worked and also to make the spreadsheet work.

Hours 1

As a CT2, under the new contract:

  • Basic hours, 0700-2100, Mon-Fri, +7.55% from the old system, dark green
  • Saturday and Sunday, 0700-2100, +30% (on top of the 7.55%), middle green
  • Antisocial hours, 2100-0700 Mon-Sun, +50% (on top of the 7.55%),  light green (this says light green though you probably can’t see it)

(NB: if I were to work fewer the 1 in 4 Saturdays – I work 2 in 7 – I would get no supplement 0700-1700 on a Saturday which would further complicated payment. Also, it’s possible that because one of those shifts is day and one night, that they would be considered different shifts and I would not get a Saturday supplement. That would be pretty shifty.)

So you can see, the arithmetic gets a little complicated.

Broadly my job consists of three different types of shift:

  • Normal day – 0800-1800
  • Long day – 0800-2100
  • Night – 2000-0900

There’s an hour overlap in the morning and evenings between the person coming and the person leaving. This is to facilitate handover. It doesn’t happen in every hospital but we got paid for it.

Hours 2

This is the bottom half of that spreadsheet. I was on a 1 in 7 rota. That means that there were 7 anaesthetists on the rota. Whilst I was on week 1, another was on week 2, another week 3 etc. This works out at 48.14 hours/week.

I should note, rota coordinators get a lot of stick in hospital but trying to design one of these things is hard. This one doesn’t show how, in order to be EWTD compliant (ie <48 hours/week), I have to get days off after weekend days and nights. Booking annual leave on top of that makes these things a nightmare.

In the ‘CT2’ column for Mon-Fri, I’ve used the following formula:

=1.0755*SUM(C2:P2)+1.5*1.0755*SUM(Q2:Z2)

That’s 1.0755 x the number of basic hours (to calculate the 7.55% pay rise) + 1.5 x 1.135 x the number of antisocial hours (to calculate the 7.55% pay rise and 50% antisocial hours supplement).

In the ‘CT2’ column for Saturday and Sunday I’ve used the following formula:

=1.3*1.0755*SUM(C7:P7)+1.5*1.0755*SUM(Q7:Z7)

That’s 1.3 x 1.0755 x the number of weekend day hours (to calculate the 30% supplement for weekend day hours and the 7.5% pay rise) + 1.5 x 1.0755 x the number of antisocial hours (to calculate the 50% antisocial hours supplement and 7.5% pay rise).

Phew!

In the bottom right, in box AA51, there is a number calculated from the formula

=SUM(AC2:AC50)

which is the sum of all the ‘CT2’ hours. I’ve done the same for CT1 except I’ve used the 1.1621 instead of 1.0755 (to indicate the 16.21% basic salary pay rise). This gives total equivalent hours of 443.51 and 410.411 respectively which I will explain shortly.

The old system – calculations

The ‘Old’column is a lot simpler because the supplement is added at the end. Every cell in the ‘Old’ column has the formula:

=1.5*SUM(C2:Z2)

which is 1.5 x the number hours worked that day (for the 50% banding supplement).

Then I’ve used:

=SUM(AD2:AD50)

to add up all the ‘old’ hours.

There is also an ‘hours’ column using:

=SUM(C2:Z2)

for each cell. This is simply to calculate the raw number of hours I worked without any supplementation. These are summed at the bottom of the column with:

=SUM(AA2:AA50)

How have I got more hours under the new system but I’m also working the same hours?

What I’ve calculated is my pay equivalent to basic hours under the old system. It is not the actual hours I worked but is way of comparing the different rates of pay.

The punchline

  • I worked 337 hours in 7 weeks
  • That’s 48.14 hours/week
  • Under the old system, I was paid the equivalent of 505.5 old system basic hours with my 50% banding supplement
  • Under the new system,
    • At CT2 I was paid the equivalent of 410.411 old system basic hours with the plethora of supplement
    • At CT1 I was paid the equivalent of 443.5 old system basic hours with the plethora of supplement
  • That’s an 18% pay cut for CT2 and a 12.27% pay cut CT1

Now, you can’t just average the two pay cuts to get my total pay cut over two years. My pay was different for the two years under the old pay scale but hopefully this gives you an idea of the sort of cuts in pay we’re looking at.

There are caveats. There is a large variation between hospitals and an even bigger one between specialties. Surgeons’ rotas are different to anaesthetists’ rotas are different to medics’ rotas which are all different to the rota of a chemical pathologist.

Further, rotas will change. Given the new obligations, it is highly likely many hospitals will adjust their rotas meaning any sort of calculation based on new or old systems will be rendered irrelevant. That said, I doubt this particular anaesthetic rota will change very much. It already adheres to the new guidelines and it would be considerable hassle to change it.

This post isn’t making a judgement about whether it’s wrong. However, given the number of antisocial hours worked, I cannot fathom a situation where the acute specialties end up getting paid more unless the premiums are quite significant.

What I will say is I’m not sure how the new system is any simpler than the old system. Whatever. Maybe I’ll just go to Canada.

MEDICINE: Why you’ll be safe in hospital during a strike

Thousands of junior doctors will go on strike on Wednesday 10th February from 8am for 24 hours. I used to be one and may be one again. How, if juniors are so important, will a hospital run without them?

Broadly speaking, juniors hold a couple of roles. Firstly, it involves seeing patients every day with a senior doctor, ensuring they have been well since they were last seen and making plans for that patient. This usually takes most of the morning and occasionally into the afternoon.

After the ward round, these plans are put into place. Ordering scans, making referrals, organising discharges, taking bloods, prescribing drugs for discharge.

The more senior ‘juniors’ (for want of a better term) will do other things. A respiratory registrar may be involved in a bronchoscopy list or a clinic; a surgical registrar may have to do a day case list; or an elderly care registrar who needs to see referrals to his team.

If consultant take over this work, who’s going to do their job?

Much of what consultants do is elective work. It’s essential but non-urgent. It’s inconvenient for patients and unfortunately that’s the price of this strike.

Further, the cover that juniors will provide is the same as weekends, Christmas and Easter.

Let me reiterate this – it’s the same cover as every weekend, every bank holiday, Christmas, Easter, New Year. If this is dangerous, it’s dangerous all year round but it demonstrates the problem with the 7-day plan.

edinburghroyalinfirmary

What does 7 day NHS really mean?

Much has been written about the strike. The difficulty is that solving the issue of increased weekend mortality – which many dispute – involves changes to emergency cover. The 7 day plan is not a change to emergency cover. Rather it spreads the juniors covering the day-to-day tasks during the week over the weekend. It’s unclear how increasing elective work over the weekend would improve emergency care.

In other words – how do patients getting bunions removed on a Sunday improve your care if you have a heart attack?

The bottom line: government’s solution doesn’t solve government’s problem.

MEDICINE: the CEX life of junior doctors

“…not everything that can be counted counts, and not everything that counts can be counted.” – 1957, William Bruce Cameron, Informal Sociology

2000px-star_of_life2-svg

It’s been a year since I passed the FRCA Primary (I’ll explain what this is shortly). As such, I thought this topic was a good one to start the medical component of this blog.

For doctors, assessment doesn’t stop at medical school. The various Colleges (e.g the Royal College of Physicians, Royal College of Surgeons) are responsible for setting standards within their respective specialties

To that end, a variety of acronyms are used to test trainees. ‘Trainee’ means a fully qualified doctor on a training scheme to be a consultant. (It is not a medical student.)

Firstly, there are exams:

  • SOE (Structured Oral Examination) – a short semi-structured viva.
  • OSCE (Observed Structured Clinical Examination) – a multi-station practical exam on anything from procedures on dummies to communication to anatomy
  • SAQ (Short Answer Question) – short essays
  • MCQ (Multiple-Choice Questions)

Then there are workplace-based assessments (WBAs):

  • CBD (case-based discussion) – the trainee has a structured discussion with an assessor around a case in which they were involved.
  • Mini-CEX (mini clinical examination) – assessor watched the trainee take a history and/or perform an examination and then provides feedback.
  • DOPS (direct observation of procedural skill) – assessor watches the trainee perform a procedure.
  • MSF (multi-source feedback) – the doctor is assessed by 15-20 peers of varying disciplines who comment on competence and professionalism.

Tired of the acronyms yet? This is not exhaustive.

First, let’s talk exams.

You can’t revise at 5am

These exams are hard. Referred to as Fellowship or Membership exams depending on College, failure rates of 40-50% are commonplace in many (possibly most) specialties. They are mandatory to become a consultant.

They’re expensive. Anaesthetists pay £1935 (320 + 590 + 470 + 555) and GPs £2131 (489 + 1642) but this doesn’t include revision courses and retakes.

There is debate about the relevance of some content. (Do I really need to know how a horse hair hygrometer works to be a competent anaesthetist?) But this is not the full story.

Simply, doctors are allocated little or no time to study. As such, one ends up revising on night shifts and at weekends. As an example, the FRCA (Fellowship of the Royal College of Anaesthetists) examinations are split into two sets – Primary and Final.

The general advice is to set aside 6 months for each component. Not 6 months off work – 6 months of your social life on top of a rota working 2 in 7 weekends.

Organise your own exam room

Doctors also need to complete WBAs (including the CEX in the title). There is some issue as to the validity of these. They’re designed to be formative (to aid learning) not summative (to assess competence) but are used for the latter nonetheless.

Rather than being organised by supervising consultants, junior doctors arrange assessments themselves. To my mind, this is akin to asking an A-level students to administer their own exam.

Arguably, it’s an assessment of the ability to find a willing consultant, rather than ability as a clinician.

The sheer volume of WBAs has grown. Anaesthetists need an assessment every other day on top of exams. This doesn’t include reflection, supervisor meetings, personal development plans, probity statements…

The electronic or e-portfolio should make this easier. It doesn’t. Each assessment has to be linked to the correct part of the syllabus in order to pass an appraisal. Doctors have failed to progress due to clerical rather than clinical errors.

Oh, just stop being so whiny

On top of the issues leading to the junior doctor strikes, the number of these assessments is slowly increasing. Assessment does need to happen but the attitude of ‘more, more’, of ignoring the time required to pass exams and a lack of engagement from some consultants adds to what is already a stressful job.

Anaesthetics might be oversubscribed but the last thing we need is another reason for doctors avoid general practice or leave emergency medicine.