Cutting doctors hours during swine flu outbreak is unnecessary risk labour Government is warned

Cutting junior doctors hours during the swine flu outbreak will be "a sledgehammer that breaks the camel's back" medics have warned.

Implementing the European Working Time Directive next Saturday, when the NHS is already under pressure with 100,000 new cases of swine flu being diagnosed in a week, is the 'probably the worst time in living memory to do this', the junior doctors' campaign group RemedyUK said.

Junior doctors are the last group of NHS staff to come into the Directive this Saturday by cutting their working week from 56 hours to 48.

Experts have warned that the NHS is not ready for the change and there will be gaps left in rotas putting patients at risk.

John Black, president of the Royal College of Surgeons said if swine flu turns into a major crisis, the Government should show leadership and suspend the Directive.

He said: “We could have a one, two or three-stage serious pandemic. If that happens everybody of course will work whatever hours are necessary to keep the patients alive in a crisis."

“I trust that if that happens the Government will not fudge it and they will actually say that the European Working Time Directive leaves no slack at all in the system and if there is a major crisis it should be suspended.”

Richard Marks, Head of Policy at Remedy, said: “Millions have been spent on staff call-centres using non-medical staff to diagnose and prescribe (for swine flu) but at the same time they are reducing doctors’ working week by one full day.

"It’s probably the worst time in living memory to do this.”

Doctors are likely to be in short supply during a flu outbreak as they are in the frontline of exposure to the virus and are at increased risk of falling ill themselves and may also have sick children to care for during the peak of a pandemic.

RemedyUK has called for the introduction of the Directive to be delayed until the uncertainties over how the flu outbreak are resolved.

Dr Matt Jameson Evans, chairman of Remedy, said: “Unfortunately we have a camel’s back situation and swine-flu is more of a sledge hammer than a straw.

"We already know most doctors are against EWTD, we just need the leadership to do the right thing here.”

Dr Andy Thornley, Chairman of the BMA’s Junior Doctor Committee said: “Clearly pandemic flu is going to place additional pressure on an NHS that is trying to adapt to the introduction of the 48-hour week for junior doctors.

"The government need to be much clearer in communicating how it plans to deal with these additional pressures as it is unacceptable that so little information is trickling down to junior doctors.

"It is also important that the NHS works hard to reduce unnecessary bureaucracy and inappropriate work so that junior doctors can do what they do best – treat their patients.

The Directive does not allow for wholesale suspension but if individual staff work longer than the 48-hour limit the time can be balanced out over the coming months.

A report due from the House of Lords Science and Technology Committee is expected to criticise ministers for not setting up the National Pandemic Flu Service in April.

From:
Cutting-doctors-hours-during-swine-flu-outbreak-is-unnecessary-risk-Government-is-warned

Swine flu- labour ministers blamed for chaos

The labour Government will be criticised over its handling of the swine flu crisis by a powerful parliamentary committee this week.

The report will attack the labour Government's failure to keep its promise to set up a flu telephone helpline by April.

Labour Ministers will be held to account for the delay in setting up the national flu helpline and for giving confusing advice to vulnerable groups and NHS staff.

The report will be published as senior doctors hold an urgent meeting with Andy Burnham, the Health Secretary, in a last ditch attempt to persuade him to drop controversial European rules limiting the hours doctors can work, which are due to come into force on Saturday.

One doctor gave warning that the NHS was facing a “triple whammy” as it struggled with swine flu, the introduction of the European Union Working Time Directive and– four days later – the movement of more than 30,000 junior doctors between hospitals as part of the annual rotation of specialities.

Further concerns over Britain’s swine flu response are raised today by a Sunday Telegraph investigation, which has exposed major security lapses in the national flu pandemic service.

The flaws would allow fraudsters to obtain dozens of doses of Tamiflu – the main drug being issued to swine flu victims.

The Sunday Telegraph has also discovered that maternity units are planning to cancel home births and planned caesarean sections if the outbreak turns into a major epidemic.

Andrew Lansley, the shadow health secretary, said government planning failures had created a response to the pandemic that already appeared to be “riddled with problems”. He accused ministers of taking “an ad hoc approach” to a situation which needed careful planning.

This week’s report by the House of Lords science and technology select committee is the first to look into the Government’s preparedness for pandemic flu. It will attack its failure to keep its promise to set up a flu telephone helpline by April when the world was on the brink of a pandemic.

This newspaper disclosed in May that the delay was caused by the Treasury, which took seven months to sign off on the deal.

The hold-up meant the Government had to introduce a stopgap flu phoneline, introduced last week, manned by staff given just one day of training.

In the meantime, NHS Direct, which should have been running the service, has made hundreds of its highly trained staff redundant.

The Lords report will also question the adequacy of advice being issued to the public, in particular that offered to vulnerable groups such as expectant mothers. In evidence sessions, committee members described the lack of public advice for pregnant women as “extraordinary”.

The advice was only publicised last week, leading to further confusion when ministers appeared to distance themselves from recommendations they had previously endorsed.

Last night senior doctors said ministers must take urgent action to avert an impending crisis.

From Saturday, doctors will not be allowed to work more than 48 hours a week, under EU rules. The change has been fiercely resisted by many senior doctors who say it will put lives at risk.

It could mean that the NHS is short of doctors just as pressure on hospitals caused by the swine flu outbreak intensifies.

Britain’s top surgeon has urged ministers to suspend changes to working hours. John Black, the president of the Royal College of Surgeons, accused ministers of “having their heads in the sand”.

He said: “The courageous thing to do would be to step in and suspend the 48-hour limit for the whole of the NHS, once we come under pressure, but that would require political leadership. I don’t expect it to happen.”

Mr Black said despite warnings the Government had made no useful concessions over the rules which he says will put lives at risk, and “devastate” the training of health professionals. He will restate his plea for concessions over doctors’ hours in a meeting with Mr Burnham on Wednesday.

The weekly 48-hour limit for doctors is measured over a sixth-month period, allowing doctors to work extra hours some weeks, if they then cut back on others.

Doctors can opt out of the directive on a voluntary basis, but only individually, throwing rota planning into “chaos”, according to senior doctors. They want whole departments or specialities to be allowed to suspend the rules.

Both Mr Black, and John Heyworth, the president of the College of Emergency Medicine, said they did not expect the introduction of the working directive to have an immediate impact, but they fear it could cause shortages of doctors by September, when flu cases may soar. Mr Heyworth, an A&E consultant at Southhampton General Hospital, said: “There is a triple whammy heading inexorably our way – the directive, doctor rotations, and swine flu, and the impact of all of this happening at once is unknown.”

He said doctors had explained their concerns to ministers about the changes to working hours “at great length”. Last night the Government defended the operation of its Pandemic Flu Service. It said that on the first day of the service, Thursday, it carried out more than 58,000 assessments, and almost 6,000 courses of antiviral drugs were collected in England.

From:
http://www.telegraph.co.uk/health/swine-flu/Swine-flu-ministers-blamed-for-chaos

Working hours directive will put lives at risk in hospital

The UK's top surgeon has claimed that patients lives will be put at risk and hospitals forced to close because of new European red tape that will limit the hours doctors can work.

John Black, president of the Royal College of Surgeons, said the European Working Time Directive (EWTD) would be catastrophic for the NHS.

The EWTD, which fully comes into force on August 1, limits the number of hours doctors and surgeons can work each week to 48 but doctors and especially junior doctors often work longer hours than this.

Mr Black said reducing the hours of doctors and surgeons could lead to an increase in waiting lists and even hospitals shutting.

Writing in the Mail On Sunday he said: "Unless the Government comes to its senses the result will be catastrophic for the NHS with patient safety on a knife edge, surgeons not being properly trained, waiting lists going up again and even hospitals closing.

"We have already reached the point where patients' health has been endangered. There is a serious risk of units in hospitals having to close to emergencies, with resulting chaos, not to mention the danger and inconvenience brought about by patients going long distances to a hospital that has enough staff to stay open.

"This is truly a nightmare, and I despair that the labour Government will not take action."

Earlier this week research was published revealing that junior doctors were being asked to lie about their working hours to meet new the new European rules.

A survey of 31,360 junior doctors who were compliant "on paper" with new limits on their working week, found that one in 10 had been asked to submit that data even though the hours they worked were actually longer.

Of the 3,938 junior doctors who said their hours were not compliant "on paper", 17% said they had been asked to submit hours that showed they were in line with the new rules.

From:
http://www.telegraph.co.uk/Working-hours-directive-will-put-lives-at-risk-in-hospital

Junior doctors asked to lie about working hours to meet red tape targets

Misleading data is being submitted to comply with a directive that restricts junior doctors' hours to 48 a week to meet eu targets.

Junior doctors are being asked to lie about their working hours to meet new European rules, research suggests.

A survey of 31,360 junior doctors who comply with new limits on their working week found that one in 10 had actually worked longer hours, with some asked to submit different data.

Of the 3,938 junior doctors who said in the survey by the Health Service Journal (HSJ) that their hours were not compliant, 17% said they had been asked to submit hours that showed they were in line with the new rules.

The new European Working Time Directive (EWTD), which fully comes into force on 1 August, limits the number of hours that junior doctors can work each week to 48.

Richard Marks, a consultant who is also head of policy at the campaign group Remedy UK, said the findings were interesting and should not be ignored.

But he said his own experience of talking to junior doctors had revealed that many wanted to work more than 48 hours, to ensure good patient care and maximise their training.

He said: "I've been asking lots of trainees about this question. It's true that they are being economical with the truth but it's because they think reduced hours, in line with the EWTD, is bad for patient care and it's also bad for their training.

"They want things to stay as they are – they want good training and exposure."

The Liberal Democrat health spokesman, Norman Lamb, said: "This demonstrates just how ludicrous the imposition of these rules are on the NHS.

"Doctors have been warning for months about the chaos that will happen in the summer when the rules are applied.

"The labour government must take its head out of the sand and recognise the damage that will be done to patient care if it insists on imposing these working hour restrictions. It is vital that we don't see another repeat of the farce that engulfed the recruitment of junior doctors two years ago."

From:
http://www.guardian.co.uk/society/2009/may/28/junior-doctors-working-hours

Bullying- the corrosive problem the NHS must address

Sir Ian Kennedy’s parting shots and last month’s staff survey both warn of a culture of bullying in the NHS. The HSJ analyses where and why the bullies are found.

Sir Ian Kennedy issued a sombre warning about the “corrosive” impact of bullying among NHS staff last month.

In a farewell interview as he stepped down from his role as Healthcare Commission chair, Sir Ian said bullying worried him “more than anything else” in the NHS and was “permeating the delivery of care”, before calling on managers to stamp it out.

His fears regarding the scale of the problem appear to be well founded if the annual staff survey, published last month, is anything to go by.

Twelve per cent of staff surveyed said they had suffered bullying, harassment or abuse at work by colleagues in the previous year and 8 per cent said this was by managers or team leaders.

At some trusts the problem is more widespread. The highest rates were at St George’s Healthcare trust in London, where 23 per cent of staff said they had been bullied, harassed or abused by their colleagues.

A spokeswoman said the figures were “of great concern” and the trust was looking at how to address the problem. A joint letter from the chief executive and a staff representative will go out with this month’s pay slips stating the trust’s commitment to tackling bullying and encouraging staff to speak out if they experience or witness bullying behaviour.

It is reassuring to see trusts taking action, but why is bullying so widespread in an institution devoted to caring?

Managers in Partnership chief executive Jon Restell says it is embedded in the culture of the NHS. “People tell themselves they do it for patients,” he says. “But to think we have to be brutal [to our colleagues] to be nice to patients - I don’t see how that works.”

To make matters worse, top doctors have had bullying “hardwired” into their training, he says. This is borne out in the 2007 survey of junior doctors by the Postgraduate Medical Education and Training Board, which found half of trainees in non-foundation posts who reported being bullied said it came from consultants.

Department of Health director general of workforce Clare Chapman says undergraduate and postgraduate medical programmes must be adapted to discourage the behaviours that lead to bullying.

However, far from being an isolated issue, many feel the problem is systemic in the medical profession.

Ms Chapman says there is a recognition that action must be taken but “the challenge is that not all trusts are tackling it”.

The Pacesetters programme is working to tackle bullying and discrimination, and the NHS constitution sets out the right to an environment free from harassment, bullying or violence.

Another barometer will be the review of the health and wellbeing of the NHS workforce, which is being led by Dr Steve Boorman and is due to report back by the end of this year.

Given the frequency with which NHS chief executives face sudden departures and complain about harsh performance management, is bullying being driven by the target culture?

There are also questions for regulators: Mr Restell asks whether they perpetuate the problem through their “tough” interactions with organisations.

While bullying occurs at all levels of the health service, close examination of the staff survey reveals stark disparities. For example, 11 per cent of white British staff complained of bullying, harassment or abuse from colleagues in the past year, compared with 19 per cent of Bangladeshi employees.

Bangladeshi staff are followed by Asian/Asian British and Pakistani staff (both 15 per cent), black African, black British, Chinese and Indian staff (14 per cent), and white Irish and black Caribbean staff (13 per cent).

In acute trusts, the proportion of workers saying they were bullied by colleagues was more than a fifth (21 per cent) among staff from white and black African backgrounds as well as employees classing themselves as “other Asian”, meaning they did not define themselves as Pakistani, Bangladeshi, Indian, Chinese or Asian British.

For white British staff the figure was 13 per cent. These statistics will fuel fears that the NHS does not always treat staff from different ethnic groups equally, backing up findings by HSJ and the NHS South East Coast black and minority ethnic network.

Evidence shows the NHS also needs to provide more support to staff with disabilities, who were almost twice as likely to say they had been bullied, harassed or abused by managers (13 per cent) than those who had no disabilities (7 per cent).

In acute trusts, one in five of the 7,486 disabled staff surveyed said they had been bullied by colleagues, compared with 13 per cent of non-disabled workers.

An Equality and Human Rights Commission spokesman said the figures were a “cause for concern”. A report by the commission last year highlighted the “profoundly different” experiences at work of people with long term illnesses or disabilities from their colleagues.

There are also clear distinctions between staff from different professional groups.

Social care managers were the group most likely to say they had suffered bullying, harassment or abuse by their managers in the past 12 months - 16 per cent compared with 4 per cent among arts therapy staff, the group with the lowest figures.

The figure was 13 per cent for midwives, who are also the occupational group most likely to say they have suffered bullying, harassment or abuse from colleagues - 17 per cent, compared with 8 per cent of physiotherapists.
Pressure cooker

Royal College of Midwives director of employment relations Jon Skewes puts this partly down to the “pressure cooker” atmosphere of busy maternity units and acute trusts in general.

However, this is no excuse for bullying, he says. “The midwifery profession has to work towards exemplary behaviour, but it’s also the responsibility of senior managers and boards.”

Investing in organisational development, bringing experts in from outside if necessary, will help tackle bullying, he says. But where will the money come from in a recession?

Mr Skewes says this is a moot point. “Last time the NHS was struggling with deficits there was no money for organisational development and training. That might be a problem again if spending gets cut.”

Before slashing budgets, finance directors may want to read an unpublished report carried out for the DH and released last year under freedom of information legislation.

It calculated that the cost of bullying and harassment to the NHS, taking account of sickness absence, replacement costs, productivity losses, litigation, service delivery, damage to employer brands, and bullying by patients and their families, was an “immense” £325m a year.

From:
http://www.hsj.co.uk/5000577.article

EU Cuts to trainee surgeons' hours threaten patient safety: Royal College of Surgeons

Trainee surgeons are under pressure to falsify their working hours and are operating on days off as hospitals struggle to comply with cuts to working hours, the Royal College of Surgeons has said.

Junior doctors should be allowed to opt out of the European Working Time Directive that limits them to a 48-hour working week from August because the effects on patient care will be ‘disastrous’, John Black, president of the College said.

Patients are being put at risk and the quality of their care is under threat as many hospitals are covering up failures to implement new rotas that comply with the directive, the Royal College has warned.

The College is calling for the Government to agree an opt out to safeguard patient safety and highlighted that in America juniors work an 80-hour week and in Germany a 61-hour week has been agreed.

The College also wants the on-call rule to change so sleeping at hospital does not count towards the working hours as it does currently.

Concerns were raised over junior doctors hours as many were working up to 100 hours a week and were making mistakes because they were so tired. Now the working time directive threatens to cut juniors hours so much that they cannot get enough experience to practice safely, it has been argued.

A survey of over a thousand surgeons by the Association of Surgeons in Training (ASiT) found more than half of trainees felt under pressure to falsify their hours.

Nine in ten were regularly exceeding their rostered hours, 85 per cent were coming in on days off to carry out operations and seven out of ten said the reduction of their hours so far has not improved their worklife balance.

ASiT believe 65 hours a week is required to gain the necessary training opportunities and 80 per cent of respondents would support an opt-out of the European Working Time Regulation to protect training.

Only a quarter of junior surgeons felt that the records of their working hours held by their trust’s human resources department accurately reflected their actual hours.

A further survey of almost 500 surgeons found unsafe levels of staffing because there are not enough surgeons available to fill rotas and gaps are appearing.

Over half of those questioned had experienced gaps on their rota. NHS Trusts are now routinely re-employing their own trainee surgeons out of hours as “internal locums” to cover gaps in shifts – with over two thirds of rota gaps filled in this way.

Two thirds of trainees working with rota gaps feel that patient care has suffered as a result.

“This is a worry for today and tomorrow,” said John Black, President of the Royal College of Surgeons. “On the one hand, the immediate effects on patient care in the NHS are potentially disastrous.

“There are simply not the surgeons in the UK to fill the gaps when every doctor’s hours are cut to a 48 hour per week maximum. On the other, trainees are telling the college they cannot gain enough experience to progress on the shortened hours.

The choice for the nation is clear – do we want patients of the future to be treated by a group of highly skilled and experienced surgeons; or be passed around a wider group of lower skilled surgeons with less experience?”

Alastair Henderson, joint director, NHS Employers, said: “Increasing junior surgeons’ hours would be a backward step.

“NHS employers have worked hard to implement the directive and have made good progress. More than half of junior doctors are already compliant and employers are still committed to ensuring that the maximum number of doctors are compliant by August 2009.

"We recognise, however, that there are a small number of services for which compliance may not be possible by August 2009. In those circumstances arrangements which offer a derogation of up to 52 hours work per week for a limited time are being considered, subject to EU approval. In these circumstances there would be rigorous scrutiny of the services affected and these would include plans to achieve compliance as soon as possible.

“We are not aware of any evidence that junior doctors are being asked to falsify their hours. If any doctor is being pressurised or bullied into falsifying their monitoring returns they should raise the issue with their HR department or trade union so that this can be investigated.”

From:
http://www.telegraph.co.uk/health/healthnews/4315105/Cuts-to-trainee-surgeons-hours-threaten-patient-safety-Royal-College-of-Surgeons.html

Labour ministers ignored junior doctor recruitment warnings

Thousands of junior doctors had their careers thrown into chaos last summer because of "inept" decisions at the highest levels, according to a report by MPs.

Warnings over a new recruitment system and possible job shortages were ignored by the Department of Health, says the Commons health committee.

The labour government's failure to restrict the access of overseas doctors to training posts in Britain was also "inexcusable", it says.

The report also singles out Sir Liam Donaldson, the Chief Medical Officer for England, saying that confidence in his abilities among the medical profession has been "seriously damaged" by the debacle.

Doctors' groups said the report was a "damning indictment" of the Government's failure to listen to warnings from the medical profession.

Thousands of junior doctors found themselves in limbo last year when a combination of factors, including a new computerised recruitment process, left their search for jobs in disarray.

Hundreds marched in protest, which prompted an apology from Patricia Hewitt, the former health secretary.

From:
http://www.telegraph.co.uk/news/1936349/Ministers-%27ignored%27--junior-doctor-warnings.html

Junior doctors in jobs scramble as MMC lurches to new crisis

Junior doctors will face even tougher competition for jobs this year with close to three applications expected for each position, National Health Service managers have warned.

NHS Employers, the agency responsible for staffing the health service, has warned that a Court of Appeal ruling means doctors trained in Britain will need to compete for posts to train as consultants alongside doctors from around the world who want to practise in the UK.

If the juniors do not obtain a training post, they will not be able to become hospital consultants or GPs.

Sian Thomas of NHS Employers said: “There are about 9,000 posts for around 23,000 estimated applicants - that’s what the Department of Health has told us.

“One could argue that the more competition you have, the better quality you will get. It is a good thing for patients that there is competition for jobs - it should mean they get the best doctors wherever they live.”

She admitted, however, that taxpayers’ money would be wasted if junior doctors trained in Britain decide to take consultant posts overseas.

The British Medical Association blames the health department for continuing to recruit medics from overseas at the same time as increasing the number of medical graduates from British universities.

Meanwhile, patients are suffering from a postcode lottery of drug prescription eight years after the labour government set up a body to get rid of the problem, a report by a parliamentary committee will say this week.

The health select committee is expected to say that the National Institute for Health and Clinical Excellence (Nice) has failed to ensure that medicines available in one area are not denied in neighbouring districts.

An inquiry by the committee of MPs is also expected to say that the NHS, which spends about £90 billion a year, should not need to withhold life-saving medicines. It is likely to say that restrictions on drugs to treat cancer or Alzheimer’s could be avoided. The MPs are expected to recommend that Nice gets greater powers to force NHS trusts to make drugs it has approved available to all patients.

From:
http://www.timesonline.co.uk/tol/news/uk/health/article3137490.ece

Health Direct continues to wonder whether the labour government realises what devastation is being caused to the lives of our future doctors by this news

These are people with lives and families not just numbers or a resource to be allocated.

Give them a system that considers their needs as well as the needs of the NHS.

New doctor training body needed by BMA in stinging rebuke

The labour government should be stripped of its responsibility for training junior doctors in England, a report says.

Professor Sir John Tooke was asked to look at the system after the chaos of last year when 30,000 doctors were competing for 20,000 NHS training jobs.

Thousands of medics protested on the streets, complaining about the system and the application process.

Sir John has called for a new body, NHS Medical Education England to manage postgraduate medical training.

The body should also have responsibility for liaising with the devolved administrations in Scotland, Wales and Northern Ireland to ensure cohesion across the UK.

And it should have its budget ring-fenced - in recent years training funds have been raided to plug deficits.

Sir John's report also warned measures need to be taken to ensure that junior doctor training did not suffer when the European Working Time Directive - limiting doctors to 48 hours a week - fully comes into force next year.

The inquiry into Modernising Medical Careers (MMC) was set up by then health secretary Patricia Hewitt last May as she faced calls to quit over the new system.

MMC was designed to cut the number of years it takes for junior doctors to reach consultant level from about 14 years to 11.

But medics complained that application forms under the online Medical Training Application Service were badly worded and resulted in many of the best candidates not being granted interviews.

The disparity between the number of training posts and applicants was caused by the streamlining of the system, an increase in graduates from the investment in medical schools since Labour came to power and a large pool of foreign doctors.

Only about 14,000 of the doctors looking for specialist posts were UK trained and the overwhelming majority of these got jobs.

On top of the training posts, there were also thousands of service posts, but these do not count towards a doctor becoming a consultant.

The situation has prompted calls for UK medical graduates to be given a priority.

However, junior doctors have been warned that competition for posts in the coming year could be even more intense.

Sir John said the issue needed to be looked at as it costs the taxpayer £250,000 to put graduates through medical school, but he did not make any direct recommendations.

The final report comes after an interim version published in October found the government's reform of the system in 2005 was "rushed and poorly communicated".

"It is a serious blow for the government and essentially a vote of no confidence" said Dr Chris McCullough, of the Remedy pressure group

It also said the present system was unlikely to encourage or reward "striving for excellence" or offer trainees flexibility.

Sir John, who is dean of the Peninsula Medical School in Exeter, said: "Although the original principles of MMC were well conceived, they were lost in translation.

"We have ended up with an inflexible structure that does not encourage excellence."

This year deaneries are being left to organise their own recruitment at a local level after the government suspended the centrally-run arrangements.

The Department of Health will now spend the next few months assessing the report, before setting out how it will proceed for 2009.

Dr Hamish Meldrum, British Medical Association chairman, said: "This report charts a path that can lead us out of the current mess the government has made of doctors' training.

"While there are some areas of detail that need further, careful consideration, action on the key recommendations will deliver better education and training for doctors, for the NHS, and for the public."

Dr Chris McCullough, of the junior doctor pressure group Remedy, said: "We warmly welcome the report. It is a serious blow for the government and essentially a vote of no confidence."

Professor Dame Carol Black, of the Academy of Royal Colleges added: "The recommendations command the support of the profession and the task that now lies ahead is to ensure they are implemented as a matter of urgency."

Professor Morris Brown, chair of the Fidelio group set up to campaign against the new arrangements, described the findings as a "truly damning indictment of the evangelical ramblings and chaotic incompetence which caused last year's disaster."

http://news.bbc.co.uk/1/hi/health/7176356.stm

Health Direct also notes the stinging rebuke by the BMA at:
http://www.bma.org.uk/pressrel.nsf/wlu/STRE-7ANGP5?OpenDocument

Housing blow for junior doctors in new recruitment fiasco

Junior doctors beginning their training in hospitals will no longer have their accommodation found or paid for, it emerged today.

The Conservatives accused ministers of "robbing junior doctors of a roof over their heads" just months after mishandling their recruitment to speciality training places under the Modernising Medical Careers (MMC) system.

Just under 4,000 UK trained junior doctors have so far not got a training post.

Under the system in place before the introduction of MMC this year, employers were required to offer Pre-Registration House Officers accommodation on site for their first year's training.

But changes introduced without parliamentary debate mean that the trainees are no longer automatically entitled to rooms.

The change came into force in August, but hospitals were asked to delay it until 2008, as jobs had already been advertised with accommodation.

The Conservatives said that the Department of Health had "added insult to injury" by making free or subsidised accommodation offered to junior doctors after August 2008 taxable as a benefit in kind.

Stephen O'Brien, the Tory health spokesman, said the change would cause problems for many junior doctors, who have to move between hospitals as many as four times in their first year, making it difficult to secure private rented accommodation.

From:
http://www.telegraph.co.uk/news/main.jhtml?xml=/news/2007/11/15/ndoctors115.xml

On Sept 13, 2007 Health Direct posted A terrible way to treat our doctors- Financial Times Comment

Modernising Medical Careers (MMC) is a suitably Orwellian name for a Stalinist new system for training doctors in the National Health Service. The phrase is a perfect example of newspeak. To oppose a "modern" system is to be a conservative, if not a reactionary.

Yet, like all systems of centralised planning, this one has proved inefficient, inflexible and inhumane. It is an object lesson in the dangers of the ever growing capture of hitherto autonomous professions and institutions by the state.

First, the department resolved on seizing control over medical training from the professional colleges and consultants, who happen to know what doctors can (and should be able to) do.

Second, the bureaucrats made a mess of manpower planning: in England, for example, 29,200 doctors have been competing for the 15,600 training places they arbitrarily decided to create.

Third, they chose this moment of upheaval to introduce an inflexible and characteristically defective computerised system (the Medical Training and Application System) to allocate doctors across the country.

To put the point bluntly, these highly trained professionals, on whom you may depend for your lives or those of your loved ones, are being treated with contempt. Do you want to be looked after by someone so treated?

And now Labour is suggesting that after shunting doctors off to all points of the compass they have to struggle to find their own accommodation. The disaster that is labour's incompetent stewardship of the NHS continues to lurch to new levels of incredulity.

Junior doctors' training still under fire over MTAS disaster

The Department of Health yesterday reverted to more standard recruitment practices for junior doctors seeking training posts for next year after the chaos that surrounded applications this year.

But more fundamental reforms are needed and will take at least two to three years to implement, according to Sir John Tooke, who headed an independent inquiry into what proved the biggest administrative fiasco in NHS history.

Sir John said there was still no consensus on the educational principles guiding the reform of medical careers and postgraduate training was still hampered "by unclear principles, a weak contractual base, a lack of cohesion, a fragmented structure and, in England, deficient relationships with academia and the service".

The "sorry episode" had caused great distress, he said, as the health department said the national IT system for applications will not be used next year and junior doctors will switch posts on up to three dates in the year rather than just one.

From:
http://www.ft.com/cms/s/0/f7776594-7601-11dc-b7cb-0000779fd2ac.html

On Sept 13, 2007 Health Direct posted: A terrible way to treat our doctors- Financial Times Comment on MMC's MTAS recruitment disaster

Modernising Medical Careers (MMC) is a suitably Orwellian name for a Stalinist new system for training doctors in the National Health Service. The phrase is a perfect example of newspeak. To oppose a "modern" system is to be a conservative, if not a reactionary.

Yet, like all systems of centralised planning, this one has proved inefficient, inflexible and inhumane. It is an object lesson in the dangers of the ever-growing capture of hitherto autonomous professions and institutions by the state.

What, then, lay behind the fiasco that Modernising Medical Careers has become? There appear to be three causes.

First, the department resolved on seizing control over medical training from the professional colleges and consultants, who happen to know what doctors can (and should be able to) do.

Second, the bureaucrats made a mess of manpower planning: in England, for example, 29,200 doctors have been competing for the 15,600 training places they arbitrarily decided to create.

Third, they chose this moment of upheaval to introduce an inflexible and characteristically defective computerised system (the Medical Training and Application System) to allocate doctors across the country.

Allocations to training posts are within huge geographical areas. But doctors are dispatched, like so much meat, to one hospital. Do they live hours away? That is tough luck. Do they have a partner, or even children? That is just tougher luck. Do they wish to switch hospital or sub-speciality? They must be joking. Do they wish to know the terms and conditions of their employment before arriving? They must reallybe joking.

To put the point bluntly, these highly trained professionals, on whom you may depend for your lives or those of your loved ones, are being treated with contempt. Do you want to be looked after by someone so treated?

No less predictable is the fact that those who made these blunders are still in place. One might have expected resignations, starting with Sir Liam Donaldson, chief medical officer.

So is the NHS suffering from an excess of free market zeal, as many on the left believe? Hardly. Where it matters, the planners are in charge. As always, they are making a big mess and, as almost always, they look likely to get away with it unscathed.

It is not just in this year that failures in labour's centralised, computerised doctor's recruitment emerged. The Department of Health has been aware for over a year that it's incompetence is leading to a road crash.

Eighteen months ago Health Direct posted on March 06, 2006 Junior Doctors' new IT MMC MTAS recruitment system is a disaster

It is an irony that many of the questions junior doctors must answer when they fill in the new form to apply for hospital jobs relate to their leadership skills and ability to work as part of a team. The form is part of a new applications procedure, called Modernising Medical Careers (MMC), which involves no human interaction whatsoever.

Hospitals are banned from holding interviews, having to rely instead upon a computer "dating" system that supposedly matches the applicant to the job.

As 80 eminent doctors have been moved to protest to the Department of Health, the results have been disastrous. Sixty junior doctors recruited in this way have failed to demonstrate a basic level of medical competence, while many others have had to be retrained at huge expense.

MTAS disaster- Labour's botched NHS plan

The Medical Training Application System (MTAS) junior doctors appointment fiasco still produces fury in the medical profession. Why? And how did labour's defective system get passed in the first place?

When Sir Liam Donaldson, the chief medical officer, published his annual report last week, he found himself having to justify not resigning over the bungled junior doctors' appointments system. "The implementation in some respects went wrong," he conceded. "But the responsibility was very widely distributed."

His justification, coupled with an apology, followed widespread denunciation of the system by delegates at the British Medical Association's (BMA) annual conference last month. A motion calling for his resignation was overwhelmingly passed, while the BMA's then acting chairman, Sam Everington, condemned the "scandal" of thousands of doctors contemplating leaving medicine or going abroad.

The sustained level of anger may surprise those outside the profession who thought the Medical Training Application System MTAS fiasco was resolved in March, when the then health secretary, Patricia Hewitt, announced that it was being abandoned in its current form and promised every junior doctor an interview in their first-choice area.

MTAS had been problematic because the unpiloted computer system, which aimed to appoint junior doctors centrally, was deeply flawed, with problems such as application forms giving too much weight to Labour's caring sharing touchy feely "creative writing" and too little to academic achievements and clinical experience, and too little consistency to the shortlisting process.

But junior doctors, and their senior colleagues, remain angry and unhappy about the debacle. One in five juniors affected is feeling increasingly suicidal and 94% have felt higher stress levels during the six months covering the application and interview process, according to research published in the British Medical Journal online. Hospitals have been told to be on suicide alert.

Much of this fury is due to the mismatch between training posts and applicants, and the uncertainty this is causing. Department of Health (DH) figures reveal that doctors are chasing 18,391 training posts - with 29,193 applying for 15,600 in England.

A total of 2,320 posts will be on offer in a second round of applications, but at least 12,000 eligible junior doctors will remain without posts and will instead have to seek work abroad, leave medicine, or remain in staff-grade jobs, which will not allow them to become consultants and are often seen as career dead-ends.

The problem is most intense for the more senior doctors in the most competitive areas of surgery: figures released by the DH earlier this month show that 713 orthopaedic surgeons, 885 general surgeons, and 206 plastic surgeons were without training posts at the end of round one. For would-be surgeons, the chances of getting a training post are as slim as one in five for general surgery, or one in six for orthopaedics.

Doctors are also angry that, with most jobs supposed to start on August 1, they face a scramble to apply for the remaining training posts available in round two, or for vacant non-career jobs.

The second round of interviews has been extended to the end of October, and every junior doctor still applying is supposed to be guaranteed employment until that deadline. But there are no promises that this will be in their existing hospital, or even in their existing trust.

Huge uncertainty has surrounded even those who have received jobs, with successful applicants only recently being told in which hospitals they would start. With deaneries such as London covering all of Greater London, Kent, Surrey and Sussex, and the East of England deanery covering Essex, Suffolk, Cambridgeshire and Norfolk, huge logistical problems have been arisen in terms of arranging accommodation and childcare.

Childcare problems

The profession wants to retain women, who now account for 60% of those entering the profession, but they are being forced to abandon their careers to keep their families together or because of childcare problems.

Andrea Siggers, a GP with a one-year-old son, has had to give up her job because her husband was unable to gain a training post in emergency medicine in Wessex, but gained one in the south-west. And Katharine Augustine is having to move to Southampton, with her 19-month-old son, to pursue a training post in radiology, while her husband takes up his cardiology post in Bristol.

With a second baby due in January, she says: "There are no other job options, and I need to be in continuous employment to get maternity pay. This process is forcing apart many families."

Crucially, the ongoing fiasco will affect not just junior doctors but also patients. Morris Brown, professor of clinical pharmacology at Cambridge University, says it is unlikely hospitals will become "chaotic" at the start of August, but warns that clinics and elective surgery will be cancelled - with an obvious impact on waiting lists.

Brown, a leading critic of MTAS, is more concerned about the long-term impact on the quality of medical care and clinical research. A poll he is conducting suggests that the system, which gives the same weight to a PhD and to a two-day course that can be attended by paramedics, disadvantages the most academically able.

The relative absence of posts for the more senior junior doctors also means the experienced will be shunted into non-career posts, while inexperienced colleagues entering at a lower level will become the consultants of the future. That is compounded by the shortened training offered under modernising medical careers (MMC), the new system to which MTAS relates - and by the European working time directive, which, from 2009, will reduce junior doctors' hours to 48 a week.

Then there is the long-term impact on the NHS of a demoralised group of doctors, stuck in dead-end jobs, and no longer feeling a strong sense of vocation.

So how did this catastrophe in workforce planning happen? In part, because, with all applications for training under the old system drying up last autumn, an unprecedented number of doctors applied under MTAS. As Donaldson, the original architect of MMC, admits in his report: "The number of doctors ... was larger than anticipated."

The number of junior doctors had burgeoned since the NHS Plan enabled a rapid expansion to allow the NHS to meet new targets. But, with NHS deficits being felt from 2005, hospital trusts then began to cut back jobs and training posts.

Andrew Rowland, of the BMA's junior doctors committee, says that, when it came to MMC and MTAS, there was a lack of engagement between the bodies involved in workforce planning - individual trusts, deaneries, regions and individual specialities on a national level.

Richard Marks, programme director in anaesthetics for north-central London, says programme directors - the people with experience of the actual numbers needed for each region - were left out of the loop.

"The hierarchy seemed to be that Lord [Norman] Warner [the health minister, who retired in December] wrote to the deaneries for numbers required, the deaneries asked the trusts, and trusts then told the programme directors - without anyone asking the departments what was needed." Strategists were planning 10 years ahead, but were not sufficiently engaged with the number of doctors currently in the system, he adds.

Meanwhile, it is these doctors, and their future patients, who will suffer.

From:
http://society.guardian.co.uk/health/story/0,,2133622,00.html

On 30 Apr 07- Health Direct wondered whether amongst all of thier fiascos the
Conntender for the greatest of all Labour's NHS failures- the Junior Doctor application system
The crisis that is leading highly qualified junior doctors to head abroad is the result of one of the National Health Service's all-time great administrative cock-ups. It is has left 30,000 junior doctors bitterly disillusioned and angry. But it also has big potential implications for patient care.

Do you feel happy to entrust this shower to keep all of your personal medical information- let alone the ID cards safe?

Junior doctors recruitment- this is a fight we cannot afford to lose

Some 12,000 people took part in Saturday's march through central London. That represents more than one in three junior doctors in Britain. Consider that another one in three or four was working or asleep between nightshifts, and that most doctors have not been on a march before, and you will understand the scale of the anger.

The disastrous overhaul of the way in which junior doctors are selected and trained to become consultants is the most serious threat to the patient care and the health service that we have witnessed, and the ramifications are frightening in scope.

Junior medics and surgeons carried banners, chatted and caught up with old friends. Placards were heartfelt: "Our training, your health care, their mistake" and "Don't dumb down doctors".

I met people I hadn't seen since medical school, doctors I had worked with in A&E, and friends who have been locked away in hospitals all around the country. Everywhere, the stories were the same: no interviews offered, or one perhaps - in Wales.

One friend from university summed up her feelings after being informed, by a computer program, that she had not been successful. "You just think, all those years, all those degrees..."

The mood overall was one of determination: this is a fight that is too important - to us and to our patients - to contemplate losing.

We are protesting against an ill-conceived, centralised attack on the integrity and quality of the medical profession. As a leaked Department of Health memo revealed at the beginning of the year, medical unemployment is seen by the Government as useful to create a downward pressure on wages.

In the context of New Labour's ideological commitment to introducing market principles and corporate provision into the NHS, this makes sense. In the context of providing safe, high quality health care to Britain's patients, it does not.

Excellent physicians and surgeons are not readily replaceable. They have to be trained well, for a long time and to exacting requirements. I started at medical school in the year that Tony Bliar took office.

Ten years ago, my colleagues and I were among the brightest and most idealistic school leavers in the country; for the past four, we have worked tirelessly in dreadful conditions. For those of you unfortunate enough to have required our services, we are the doctors who treat you in casualty in the middle of the night, carry the crash bleeps, thrombolyse you when you have a heart attack, resuscitate you, and treat your life-threatening injuries after a car accident.

We routinely work for longer than our contracted hours because medicine is a vocation rather than a job and to leave on time would be dangerous.

This is the situation, with full medical employment.

A deliberate attempt to destabilise the profession, in the hope that it will lessen our power to insist on working to clinical priorities, rather than political and commercial ones, is what the Americans would call a deal-breaker.

As we walked toward Russell Square past the British Medical Association, I was reminded of the London bombs 18 months ago during which my friends and I worked treating the injured. How quickly people forget.

This labour government knows the price of everything and the value of nothing. A downgraded, under-trained, biddable medical workforce might be a cheaper way to meet flashy paper targets, but if we don't put a stop to this, every one of us will know the true cost.

By Sarah McMahon, a junior doctor, in:
http://www.telegraph.co.uk/news/main.jhtml?xml=/news/2007/03/19/ndocs319.xml

The plight of junior doctors is terrible, as the above shows. Health Direct have been watching this labour created fiasco and have recently posted a couple of posts in:

8 Mar 07- Climb down over junior doctor fiasco MMC MTAS IT system The Labour govt backed down yesterday and agreed to an immediate review of a flawed selection system that has left thousands of able young doctors without the prospect of a job and many threatening to leave the NHS. The independent review will start today and may recommend changes to the system before the current interview round has been completed.

7 Mar 07- Doctors who face the dole as MMC's application IT system remains as fiasco given all the emphasis on investing in and improving the NHS, the idea of a wave of doctor unemployment seems a nonsense.

Alarmingly, however, it is very much a reality. Last week, the fears of thousands of junior doctors were realised when they failed to secure interviews for trainee consultant posts under a new fast-track system called Modernising Medical Careers. The doctors who missed out are left
wondering whether to try to retrain in another speciality, emigrate, or leave medicine altogether.