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7.18 pm
The Minister for Public Health (Ms Tessa Jowell): I have listened with great interest to the points raised by the hon. Member for Oxford, West and Abingdon (Dr. Harris). He is right to say that there is a serious mismatch between the number of fully trained specialists in obstetrics and gynaecology and the number of consultant jobs available. We are rightly concerned about that.
I should like to set out the background. By the end of April, there were 117 doctors who had completed their specialist training in obstetrics and gynaecology but had not found suitable posts. We expect that, over the next three years, the number of specialists completing their training will be 137, 185 and 100 respectively. Between 1992 and 1997, consultant expansion in the specialty grew by around 4.5 per cent. a year. To absorb all those doctors completing their training into consultant posts over the next three years the consultant expansion will have to increase to approximately 10 per cent. a year.
This difficult and complex situation needs to be handled sensitively and carefully. There has clearly been a failure to appreciate fully the supply and demand position for the specialty and in particular the pace of change in relation to consultant expansion.
We have already acknowledged the need to look more closely at work force planning processes--locally, regionally and nationally--so as to ensure a better match in the future between those trained and the jobs available in all specialties and professions. We will be undertaking work over the next few months with that in mind.
In the short term, we accept the need to deal with the immediate problem of career prospects for those currently training in obstetrics and gynaecology, including the current surplus of fully trained higher specialists. For that reason, we set up a small working group last autumn including representatives from the Royal College of Obstetricians and Gynaecologists, the Royal College of Midwives, the joint consultants committee, the junior doctors committee and NHS management. The group reviewed the position and proposed a way forward.
The working group recognised that there were strong arguments on quality grounds--to which the hon. Gentleman referred--for balancing an increased emphasis on midwifery-led services with access to the best-quality medical advice and expertise to deal with emergencies and difficulties. It noted that, in practice, the ratio of consultants to juniors was lower in obstetrics than in most other specialties. It also expressed concern about the numbers of appointments that were continuing to be made to non-consultant career grade posts.
The working group noted the joint report from the RCOG and RCM, "Setting Standards for improving Women's Health; Safer Childbirth", which dealt specifically with staffing and organisational issues. The
report recommended greater consultant cover on labour wards in all but the smallest obstetric units. The RCOG has sent a copy to all NHS chief executives. The group also considered another report from the joint consultants committee which discussed issues about consultants' job plans in obstetrics and gynaecology. The JCC proposed changes to consultants' working patterns in future to provide for a consultant-based service.
The working group agreed that a combination of short, medium and long-term action was needed to address the situation. In the short term, it was agreed that it was imperative to engage the NHS in discussions about staffing and grade mix in obstetrics and gynaecology.
My officials have taken action to ensure that that happens quickly. A series of workshops is about to be arranged by each regional office to address that specific issue. They will not only look at the urgent and immediate problems of current surplus specialists without appointments, but address issues connected with those currently in specialist training and their career prospects. It is important not only to look at our current problems, but to consider the numbers in training.
We want two main outcomes from the workshops: first, to discover ways to find employment quickly for current surplus holders of the certificate of completion of specialist training, and in so doing improve the quality of current obstetric services, and secondly, to secure agreement from a number of trusts to act as pilot sites to evaluate different ways of working and staffing profiles which have less reliance on juniors and more input from qualified staff--midwives and fully qualified specialists.
My officials met representatives of each regional office at the end of April, and workshops are now being set up. We expect the first one to take place in July, probably in the west midlands. In the workshops, we will be working jointly with the profession, as was agreed by the working group.
Dr. Harris:
The Minister is hinting at consultant-only units with no junior doctors; something that has been suggested in other specialties, including by researchers in my area in Oxford. However, that will cost money, as it will take a lot of consultants to give that on-call cover. Will there be new funding as part of the short-term and long-term solution?
Ms Jowell:
I am setting out the stages by which we intend to address the problem. The first stage is to engage in joint discussions with the colleges, the working group and the NHS to address the short-term problem in the context of the need for clarity about the long-term position.
In the meantime, there will be continuing local action aimed at discussion with the postgraduate medical deans, who are continuing to extend the training period of all newly qualified specialists for as long as 18 months to give them time to secure a post. They will also continue to offer advice and help to all specialist trainees in obstetrics and gynaecology, and give particular support to CCST holders experiencing difficulties in securing a post.
Postgraduate deans will also explore ideas and opportunities aimed at improving the career prospects of all specialist trainees in obstetrics and gynaecology, including the feasibility of switching to another specialty where career prospects are better. I understand that the
RCOG is having discussions with the Royal College of Surgeons to consider the feasibility of whether specialist trainees could, at an early stage of training, switch to a surgical specialty. Similar discussions with the Royal College of General Practitioners will also be held. We are fully supportive of the RCOG in its efforts to find solutions in this way. We want to work with the college and support it.
We are encouraging regional directors--through local workshops, and action by deans, consortiums or local medical work force advisory groups--to persuade trusts to offer temporary appointments of 12 months to CCST holders on fixed-term contracts. Such posts would be distinct from career-grade posts, and would be open to competition. Essentially, these would be developmental posts, with particular emphasis on new ways of working; possibly in the context of the pilot studies that I have already mentioned.
As I have said, the problem of surplus specialists in this specialty is multi-factorial and complex. Equally, solutions likely to improve the career prospects of those currently engaged in specialist training, or those who have recently completed training, are likely to vary. Such solutions will be thoroughly explored with local NHS management, by the profession and by my officials, as appropriate.
We have already taken steps this year to reduce higher specialist training opportunities in this specialty to ease the situation. In the light of advice from the specialist work force advisory group, which considers future investment in training across all medical specialties, we have reduced training opportunities by 76 places during this year. This will have the effect of restricting entry to the specialty to 65 places nationally. This decision was taken to avoid the detrimental effect of closing entry to the specialty altogether, given the knock-on effect that that would have on senior house officers and their career intentions.
Dr. Harris:
Before she finishes, can the Minister guarantee that none of these doctors--who have cost us at least £300,000 to train--will be made redundant this year? Will she address the question of bringing back manpower controls?
Ms Jowell:
Every possible effort will be made to ensure that those 117 people are found jobs. That cannot be a guarantee, but I have set out the steps that the Department intends to take to address a completely unacceptable situation. The remedy lies in immediate action--which we are taking--and a sustained, long-term assessment of the need for consultant posts and the deployment of consultant posts in the specialty.
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