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

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

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.

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.

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

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 f
uture 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?

Speaking on BBC Radio 4’s Today programme, Ms Hewitt said she regretted the failures in implementation of the Modernising Medical Careers (MMC) reforms. “The new system of MMC I think everybody supports but the actual implementation in this first year of transition was nowhere near what it should have been.”

But she still didn’t accept that there were faults with the system. even though she said “The shortlisting process didn’t work. We are in the process of sorting it out and we are now guaranteeing every junior doctor an interview for the speciality of their choice.”

The head of MMC, Professor Alan Crockard, resigned at the weekend over the chaos caused by the introduction of the Medical Training Application Service.

“We really don’t want highly qualified medical staff to be forced to leave the NHS, but if they can’t complete their training in this country, it could be their only option.” Dr Jo Hilborne
BMA Junior Doctors Committee.

It was designed to speed up the process for placing doctors in specialist jobs, but a catalogue of complaints have emerged. Doctors say the forms are badly worded, do not ask pertinent questions, do not allow them to set out relevant qualifications and experience, and have no facility for attaching a CV.

The result, they say, is that the best candidates are not being selected for the right jobs and has left thousands without any interview at all.

Junior doctors abandoned talks with the government’s review group, saying it was “unacceptable” for more than 11,000 doctors who offered two or more interviews to now settle for just one.

Dr Tom Dolphin, deputy chairman of the British Medical Association’s Junior Doctors Committee, said: “It’s long overdue, but at last the government is acknowledging the huge anxiety that this shambles of a system has created.

“However, an apology isn’t enough. We need a way out of this mess for the 32,000 junior doctors who currently don’t know if they have posts to go to in August.”

‘Fewer jobs available’

A BMA analysis has suggested that 18,518 specialist training posts are available under the new system – not 22,000-23,000 indicated by the government.

It is warning that large numbers of doctors will have no training post in August.

Dr Jo Hilborne, chairman of the BMA Junior Doctors Committee, said: “Not only has the government failed to design a fair recruitment process, they’ve also misled everyone on the number of jobs available.

“Even if the application system improves, thousands of doctors are going to find themselves without a training post in August.

“We really don’t want highly qualified medical staff to be forced to leave the NHS, but if they can’t complete their training in this country, it could be their only option.”

From:
http://news.bbc.co.uk/1/hi/health/6521095.stm

Health Direct first warned over a year ago (6 Mar 06) that the MMC’s computerised application was in meltdon in Junior Doctors’ new IT MMC MTAS recruitment system is a disaster.

As it has therefore taken the labour govt a year to wake up to the IT disaster that it created, how can we be confident that it will be sorted quickly?

About as likely as John “not fit for purpose” Reid’s recent spin about sending text messages to illegal immigrants asking them to kindly leave the country. How can anyone have any confidence when the labour govt doesn’t know how many people there are, what their names and addresses are let alone their correct phone numbers. Pathetic.

The depth of feeling at labour’s incompetence was highlighted by Health Direct on March 19, 2007 in Junior doctors recruitment MMC- this is a fight we cannot afford to lose when 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.

Earlier on March 08, 2007 Health Direct posted : Labour 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.

Patricia Hewitt, the Health Secretary, has come under increasing pressure from within the medical profession to review the new, online system, the selection methods and the questions candidates had to answer. In some hospitals half of junior doctors did not even get interviews for posts at the next level of their training.

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.

Concerns about the Medical Training Application Service, (MTAS), which was introduced in January, came to a head at the weekend after The Daily Telegraph gave a voice to angry and dismayed junior and senior doctors.

On Monday night Mrs Hewitt met members of the powerful Academy of Medical Royal Colleges. She agreed that the review should take place and that the academy, which represents 14 royal colleges, would lead it.

The decision gives back to the royal colleges powers they lost over regulation of specialist medical training when Modernising Medical Careers, the new training scheme for hospital registrars, was introduced.

Prof Dame Carol Black, the academy president, said: “The academy welcomes the decision to carry out an immediate review of the Medical Training

“Shortcomings in this critical element of the Modernising Medical Careers have caused dismay and much distress. We will work with the department to ensure action is taken to remedy faults and to restore confidence.”

The review will be led by Prof Neil Douglas, the vice-president of the academy and president of the Royal College of Physicians of Edinburgh.

The senior doctors have been given the power to identify what action is needed and when it should be taken – either before the end of the current round or before the start of the next round of job applications at the end of next month.

The British Medical Association said Mrs Hewitt had not gone far enough.

“The Government has finally been forced to address the appalling problems with this system,” said Dr Jo Hilborne, the BMA junior doctors’ committee chairman.

“We have been warning since last summer that these reforms were being rushed through too quickly. From the point of view of the thousands of doctors who’ve been messed around, given incorrect information, or denied job opportunities that they deserved, it’s a shame the Government didn’t listen then.

“Not only is this response too late, it also does not go far enough. While we welcome a review, the only fair solution now is for the interview process to be suspended until it can be clearly shown that no doctor has been disadvantaged as a result of the Government’s mistakes”.

Dr Hilborne said they were disappointed that they had not been invited to take part in the review panel.

Prof Gus McGrouther, professor of plastic and reconstructive surgery at the University of Manchester, has described the new system as the “biggest crises to hit British medicine since the start of the NHS”.

He said the process should be stopped altogether.

“How can we carry on interviewing in a system that they now admit is flawed? It is likely that this first round of interviews will fill most of the jobs up but it may be excluding some doctors who are better. This is unfair,” he said.

On Monday senior surgeons on an interview panel in Birmingham refused to interview 80 candidates because they said the system was not fit for purpose and they could not be confident they would be choosing the right doctors for the jobs.

The Government has promised that there will be enough jobs for British-trained graduates but there were 30,000 applications for 22,000 posts.

From:
http://www.telegraph.co.uk/news/main.jhtml?xml=/news/2007/03/07/ndocs07.xml

Health Direct first warned over a year ago (6 Mar 06) that the MMC’s computerised application was in meltdon in Junior Doctors’ new IT MMC MTAS recruitment system is a disaster.
http://www.healthdirect.co.uk/2006/03/junior-doctors-new-it-mmc-recruitment.html

As it has therefore taken the labour govt a year to wake up to the IT disaster that it created, how can we be confident that it will be sorted quickly?

About as likely as John “not fit for purpose” Reid’s spin yesterday about sending text messages to illegal immigrants asking them to leave. How can anyone have any confidence when the labour govt doesn’t know how many people there are, what their names and addresses are let alone their correct phone numbers. Pathetic.

From:
Sarah Hall is the Guardian’s health correspondent:
http://www.guardian.co.uk/comment/story/0,,2027287,00.html

I know this because it is the conversation that has been going on in my home. My husband, an orthopaedic registrar, is trying to assess whether he has any hope of becoming a fully trained surgeon, or whether, after committing 12 years – five as a student and seven as a doctor – he should leave medicine altogether.

He hasn’t cried – he is too numb for that – but I have never seen him so ashen. A registrar with seven-and-a-half years’ experience, a period of research, a regional prize and a list of academic publications, he had been told by his boss – who shortlists – that his application was sufficiently strong. Sure, the glitch-ridden online application form was repetitive, vague and confusing. True, the whole process seemed geared towards the most junior doctors. But he couldn’t believe that his commitment and skill would not show through.

Now it is clear that it hasn’t – and that this system has scuppered the chances of thousands. No one knows how many of the 30,000 junior doctors are affected – Department of Health officials, who will meet the British Medical Association today, are still collating that information.

But Remedy UK, a grassroots doctors organisation set up two months ago, now has 8,000 members – with 250 applying daily and 3,000 planning to march in protest.

The situation has arisen in part because the government has failed to match the number of training posts – 22,000 – to the 30,000 junior doctors. The most junior, who started on the new system two years ago when they left medical school, have had 5,000 posts ring-fenced for them. But those who began under the old system haven’t received such preferential treatment.

Ministers are right to say no one has the right to a trainee post, but the lack of interviews appears to have been compounded by flaws in the selection process. The online application system felt rushed and botched. Results were due on February 24. On the 28th – the day interviews were meant to start – they had still not been completed.

We are used to problematic government IT systems – and the minister initially in charge, Lord Warner, also oversaw the NHS IT system – but it is hard not to fear careers are being ruined because of such flaws.

At a press conference last year, the same minister dismissed the idea of junior doctors’ unemployment as “absolute rubbish”. Doctors just had to be flexible – change speciality or move. “Instead of working in the south-east,” he explained, “they might have to go to Aberdeen.” Despite having a wife, daughter and mortgage in London, my husband would jump at that option, were it available. Instead, he is asking if he should retrain, move abroad, or try his luck “in the City”, where they apparently value the dedication, coolness and decisiveness of trainee surgeons.

Each option seems bleak. His confidence has been shattered and yet he knows it would be a massive waste, not only of public money – £250,000 just to get him through medical school – but of his talent and experience if he has to hand back his scrubs. “I know what I’m good at,” he says, “and I just want to be able to do it.”

Health Direct warned last year (6 Mar 06) that the MMC’s computerised application was in meltdonw in Junior Doctors’ new IT MMC 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.

Some successful east European recruits turned out not to speak English, while 600 well-qualified British students have been left without jobs at all, leaving them unable to complete their training.

No checks have been made, so it seems, on the information that applicants put on the forms. Moreover, in the absence of an interview, there is no way hospitals can be sure whether the applicant is a genuine, qualified medical student or whether they are an impostor who paid someone to fill in their form for them.

And the consequencies of the Dept of Health’s incompetence? On June 15, 06 Health Direct posted: NHS faces brain drain, BMA doctors warn

Doctors’ leaders said yesterday that the profession faced a potential brain drain because of a shortage of posts being made available under controversial labour government reforms. The British Medical Association said that up to 11,500 doctors could be left disappointed because there were only 9,500 training posts being competed for by more than 21,000 doctors.

But the BMA junior doctors’ committee – which will meet officials to lobby for more posts tomorrow – warned the remaining 11,500 would face options including leaving the NHS and working abroad. “There will be a brain drain,” said Dr Jo Hilborne, chair of the junior doctors’ committee.

“Huge numbers of people will choose to go abroad and significant numbers will choose to leave medicine altogether if they can’t get a job in the UK.” With each doctor costing £237,000 to get through medical school, such an exodus would constitute a huge waste of money for British taxpayers, she said.

“The alternative – pushing doctors into dead-end jobs so they never get essential skills that would benefit their patients – is
unacceptable and won’t work. Doctors are simply going to leave the NHS instead,” she added.

The warning came a week after the president of the Royal College of Surgeons, Bernard Ribeiro, told the Guardian there was “a real danger” the medical reforms could lead to a brain drain similar to that in the 1960s, when doctors went to the US.

The shortfall has arisen because the government increased the number of medical students – from just over 4,000 in 2001 to 7,380 last year – while hospital trusts and deaneries failed to match this with an increase in training posts.

Last week Professor Shelley Heard, the MMC’s national clinical adviser, said junior doctors needed to accept that not all would receive training. But critics, including Mr Ribeiro, said doctors who had already committed at least seven years to training were reluctant to settle for jobs which will not lead to consultant status.

A BMA survey shows 61% of doctors would opt to continue their training overseas, and 35% to leave medicine altogether, rather than resign themselves to a career path with no possibility of training. Australian authorities have already visited the UK to recruit doctors.

Dr Hilborne, who will meet MMC officials tomorrow, blamed the government for ignoring doctors’ concerns and forging ahead with MMC. “We asked the government to delay this but it’s part of their wholesale reform of the NHS, which they’re insistent on taking forward” she said. “Meanwhile, these poor guys who by an accident of fate happen to be at this point in their careers are caught in the middle.”

Dr Crippen’s blog also raises the disgraceful fiasco that is the MMC.

Because this Labour Government and its bureaucrats only see people as a mass, they fail to recognise the power and potential of the individual. Yet it is the individual – significantly so in education and medicine – who can inspire and transform the lives of those with whom they deal.

Throughout history, when the rights of the individual have been denied for the “good of the masses”, disaster and misery have quickly followed.

If Labour and the Dept of Health can’t run a small database of doctors what hope is there for their white elephant of a database for 60 million patients?