More consultant radiologists needed to meet rising demand, say BMA doctors' leaders

Around 1,300 extra consultant radiologists are needed in England over the coming years if the NHS is to meet the increasing demand for emergency interventional treatments, diagnostic imaging and screening, the BMA warned.

Recent Department of Health projections on workforce show there is a need for a focused and planned expansion in consultant numbers to meet the increasing demand for radiological services.

Although government figures on diagnostic waiting times published show improvements in waiting, this level of activity cannot be sustained with the current workforce levels.

The demand for ultrasound, CT and MRI scans is increasing year on year, and with complex imaging now being required around the clock, more consultants are needed to ensure the service can be delivered more quickly and at the highest standard.

The Healthcare Commission’s report on its investigation into maternal deaths at Northwick Park Hospital recognised that there was a shortage of suitably trained interventional radiologists and recommended all obstetric units should have urgent access to this crucial emergency treatment at all times.

The Royal College of Radiologists (RCR) supports the need for consultant expansion. Dr Gill Markham, Vice-President of the RCR and Dean of the Faculty for Clinical Radiology, said: ‘Demand for scans and complex imaging is rising year on year and is set to increase even further in light of recent developments with extra patients being referred from the Government’s planned extension of the Breast programme and Colonic screening programme.

"We need a steady and sustained expansion in consultant numbers if we are to deliver this level of service to patients safely and to the high standards that patients deserve.”

The BMA recently launched a campaign to enhance the quality of care for patients by expanding consultant numbers across many specialities.

Dr Jonathan Fielden, chairman of the BMA’s consultants committee said: “Although waiting times for diagnostics seem to be improving; this progress cannot be sustained unless capacity is expanded to meet future rises in demand.

"Ad-hoc commissioning of poorly integrated private providers is not a long term solution. The NHS needs to build its own sustainable infrastructure to deliver for the longer term benefit of patients.

“Focused expansion of consultant numbers will not only help meet the extra demands on the NHS, but as medical leaders and innovators, this will enhance the development of local services and provision of teaching and research.”

From:
http://www.bma.org.uk/pressrel.nsf/wlu/STRE-7ENBWT?OpenDocument&vw=wfmms

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.

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.

Like most outsiders (and many insiders), I find it impossible to understand precisely what has happened, but having a daughter-in-law at the sharp end has helped. The outlines at least are clear. They also offer a classic example of how a government-run monopoly behaves.

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.

As always, reasons existed for the shift to central planning: critics complained that the traditional apprentice system was riddled with favouritism; and the European Union's working time directive sharply cut hours for junior doctors, which not only necessitated a greater number of them, but also reduced the experience each would gain from a given period of training.

Some reform was presumably necessary. But this one is an object lesson in what happens when the government introduces a "big bang" shift to a centralised, computer-driven system. A bureaucratic monster replaced what had been a moderately flexible, albeit imperfect, system.

In the old system hospitals hired senior house officers; now they are sent them like a parcel of slaves. In the old system, if doctors did not get a job first time they could keep on applying; in the new system, they were to be given just one chance a year.

In the old system, if they made a wrong choice it was relatively easy to change; in the new system, doctors must decide early and are then stuck with the consequences. In the old system, hospitals could change the mix of junior doctors relatively easily; in the new system, nobody knows what flexibility will exist.

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?

To make the computerisation manageable, the doctors were allowed only very limited choices - far too few to eliminate random factors. As the chaos mounted, people were offered just one interview each.

The result was that those most likely to fail to get a job were the best, because they made the most desirable options their first choice. To make the computerised system "fair", much of the detail of people's careers and the detailed knowledge of those they worked for were also eliminated.

Centrally planned systems always eliminate latent knowledge, ignore human motivation and destroy flexibility. It was predictable that this Gosplan for the training of doctors would end up just as it has. It could not do anything else. This is a superb example of how the combination of centralisation of power with a belief in rationalistic planning works in the real world.

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.

But bureaucrats are far too grand to be held accountable. It is doctors whose lives are disposable. Who cares that they have devoted up to a decade to the acquisition of knowledge and experience? Who cares that patients will be worse served? What matters is that the Department of Health is firmly in charge.

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.

By Martin Wolf
http://www.ft.com/cms/s/0/bb574538-5cda-11dc-9cc9-0000779fd2ac.html

Health Direct notes that the Financial Times then printed a torrent of letters in response to this considered review. Two are included below:

Bureaucratic machine that cares little for best medical practice

From Dr Angus McNair.

Sir, I would like to congratulate Martin Wolf for such an accurate summary of the feelings of junior doctors at the present (“A terrible way to treat our doctors”, September 7, 2007). I have been struggling to explain to people outside the profession exactly how bad this process has been and he has described it very eloquently.

Like the majority of doctors, I entered this profession with the main aim of looking after patients. I realised that this would involve sacrifices to many aspects of my life, but I accepted these sacrifices with this aim in mind.

When a patient you are responsible for is sick you need to be with them and have the knowledge and skills required to treat them. This is what motivates doctors to work as hard as they do, not the financial reward or apparent “social status”, but the knowledge that you make a difference when it counts.

Therefore it seems farcical that our employers would do anything but create a supportive and flexible environment for us to practise.

This process has only succeeded in making us feel undervalued and is demotivating the whole workforce.

It becomes very difficult to make these great personal sacrifices when they are in the name not of patient care but of a bureaucratic machine that seems to care little for your welfare or best medical practice.

Angus McNair,
Bristol BS8 4BG

http://www.ft.com/cms/s/0/b4b6eed2-6008-11dc-b0fe-0000779fd2ac.html

Ministers were warned but insisted on the ‘big bang’ approach to change

From Dr Andrew Rowland.

Sir, Martin Wolf is absolutely right that the implementation of the Modernising Medical Careers applications process has left us with an inflexible system that threatens professional standards in the NHS.

Thousands of junior doctors are now in posts for which they are massively overqualified, in areas where they do not want to be or specialities they would not have not chosen. Many are being underpaid by their new employers, who claim that they have had insufficient time to identify the hours their new trainees are working.

But, as Mr Wolf quite rightly points out, ultimate responsibility for this whole mess lies not with NHS trusts but with the ministers and civil servants who insisted on a "big bang" approach to change.

There was little engagement with the medical profession, which repeatedly warned that disaster was looming. Even when 10,000 doctors took part in a public protest calling for the plans to be delayed, the government ploughed ahead.

Doctors are understandably concerned that their professionalism is being undermined and that standards of care could be eroded. A recent survey of British Medical Association members showed that nine in 10 believe MMC, in combination with working time reductions, represents a threat to the "gold standard" of consultant training for which the NHS used to be famous.

Those who call for trainee doctors to show more flexibility should be aware that they are at the mercy of a monopoly employer, and that within such a rigid appointments system it is verging on the impossible to change posts. Insofar as it is possible for the government to address the bitterness of junior doctors, a relaxation of the rules on job transfers would be a step in the right direction.

Andrew Rowland,

Vice-Chairman,
Junior Doctors Committee,
British Medical Association

http://www.ft.com/cms/s/0/7a2aee9a-6007-11dc-b0fe-0000779fd2ac.html

New nurses left jobless by labours NHS budget squeeze

Thousands of newly qualified nurses are facing unemployment because of labour's NHS hospital cutbacks, with vacancies at their lowest for 10 years. New National Health Service figures have revealed how difficult it is for nurses, physiotherapists, scientists and doctors to find jobs.

The highest vacancy rate was among consultants, with 1.2 per cent of jobs empty compared with 0.4 in trainee nursing. There are currently 5,000 newly qualified nurses who cannot find a job and half of the 2,413 newly qualified physiotherapists have not found permanent posts.

More than 20,000 jobs have been cut in recent years as managers struggle to bring NHS finances back into balance.

Vacancy rates across the medical professions have dropped, showing the boom and bust nature of current workforce planning in the health service.

Places at medical school and nursing colleges were expanded and the NHS has now almost reached a point where it is self-sufficient in staff.

But experts are predicting shortages again in the medium to long-term because large numbers of nurses, GPs and consultants are nearing retirement age. In the meantime, newly qualified staff are struggling to find work and many are considering retraining or working abroad.


Dr Peter Carter, the general secretary of the Royal College of Nursing, said: "This is not a 'good news' story for nurses.

''Vacancy rates appear to have reached their lowest levels for years but we fear that has been achieved only by widespread freezing and deleting of posts by NHS trusts desperate to balance the books.

"Thousands of newly qualified nurses - costing taxpayers millions of pounds to train - cannot find jobs this year yet at the same time the workload on the wards and in the community remains high.

"It's time for the Government to put in place a long-term workforce strategy that prevents the feast or famine characteristic of the NHS job market in recent years."

The NHS Vacancy Survey also found that:
- In March 2007 there were 1,695 vacancies for qualified nurses and 391 for trainees.
- There were 364 consultant posts available and 73 jobs for other doctors in non-training posts.
- The vacancy rate for GPs has dropped from 2.4 per cent in March 2005 to 0.8 per cent this year.
- There were just 63 vacancies for physiotherapists in March this year compared with 464 in 2005.
- The highest vacancy rates are in the South East Coast area, followed by the North East, with the lowest in the West Midlands.

From:
http://www.telegraph.co.uk/news/main.jhtml?xml=/news/2007/08/21/nhospital821.xml

Health Direct points out that Labour's complete and utter incompetence in attempting to "save the NHS" is exposed by these latest figures. It's a waste of taxpayers money for us to subsidise medical training and then throw the highly skilled new staff out onto the dole queues.

On March 22, 07 Health Direct posted: MPs expose lack of control over NHS billions

A devastating insight into financial mismanagement at all levels of the NHS- from Labour ministers down to hospital bureaucrats- is provided by a committee of MPs. The report by the all party Public Accounts Committee exposes how billions of pounds of taxpayers' money is being poured into a health system with inadequate financial controls and low levels of accounting expertise.

The MPs conclude that NHS structures are so inadequate that the Department of Health has no idea what the effect of last year's total deficit of £570 million is having on patient care.

In no less than one in three NHS organisations, auditors had raised concerns "about the financial management capabilities of general management".

The committee said that while the Department of Health had no "overall picture" of the effect of deficits on services to patients, it was clear they were adversely affecting the level and quality of care.

Dr Peter Carter, the general secretary of the Royal College of Nurses, said it was very disturbing that the department had no clue about the effect of deficits on services and jobs. "It's time for the Government to come clean.

Ministers need their advisers to tell them just how damaging the deficits crisis has become and acknowledge the Government's responsibility to work with front line staff to find a long term solution."