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The Government have been given warnings and they have to account for why they did not accurately reflect on the problems. The hon. Member for Broxtowe
(Dr. Palmer), who asked the Whips’ question and then left the Chamber, said that this was about the number of applicants. However, I remember standing at this Dispatch Box on 20 December 2005 and making it clear to the Secretary of State that there would be a problem in August 2007 because two year cohorts of applicants would be coming together in one year, so the number of applicants for training posts would effectively double. The Secretary of State said that that issue had to be addressed. With a year and a half in hand, I was foolish enough to imagine that she would solve the problem. When, on 13 December 2006, Lord Warner said that junior doctors in England should be pretty confident about securing a training post and that additional training posts would be created, I was foolish enough to think that the Government had considered the situation and arrived at a solution.
There was a good deal of forewarning. The royal colleges rightly told the Government that the programme should be piloted, as my hon. Friend the Member for Worthing, West suggested, but that did not happen. Last year, junior doctors in the British Medical Association wanted a delay of a year. To be fair, I was not sure that that was the right thing to do because it would have harmed the circumstances of the foundation programme graduates. None the less, the BMA was rightly pointing out serious unresolved problems.
Dr. Evan Harris (Oxford, West and Abingdon) (LD): I strongly support the hon. Gentleman’s motion. Does he agree that the key point about MMC is that the number of training posts will not meet the need of the people who want to apply? The principle should be that all those who are qualified for a training post, and who are capable of being trained to consultant level and wish to be trained to that level, should have a training post; otherwise, we are wasting money by putting them through medical school and house jobs. A solution in which those people are parked in career-grade posts, so that they become fellows or hold staff grades or trust grades, is not acceptable, because then the service will be delivered not by consultants, but by a demoralised and often racially segregated group of doctors who are not fully trained and who are not specialists—and that is not the way we want our health service to go.
Mr. Lansley: The hon. Gentleman is leading me further into what I was hoping to say. Let me just respond to that point. From what I know of the interviews that are already taking place, many consultants holding the interviews are meeting well- qualified applicants; I see that the Secretary of State is nodding merrily. However, unfortunately, we know that many well-qualified applicants did not get interviews. As the hon. Member for Oxford, West and Abingdon (Dr. Harris) suggests, we need a process in which well- qualified junior doctors have progressive opportunities to enter specialty training, and that is what our motion says. It also suggests that it may not be possible for all well-qualified applicants to secure specialty training or run-through training posts this year, but we have to put a stop to the current structure, which, in effect, limits the ability of some people, particularly senior house officers, to enter specialty training next year, or the year after that, if they do not enter the run-through training process this year.
Dr. Julian Lewis (New Forest, East) (Con): Surely specialisms are to be held by the people best qualified to fill the posts, but how can that be reconciled with a situation in which people are confined to applying for posts in certain geographical areas? That means that if there are only two or three posts going in an area, and someone is the third or fourth best qualified person in the area and so does not net the post, they are unable to qualify, or even to apply, for similar posts in other parts of the country, even though they may be much better than the people who are allowed to apply for those posts.
Mr. Lansley: I am grateful to my hon. Friend, who makes an important point. He reminds us of the most important reason why we are debating the subject. I have received hundreds of e-mails on the subject, and I have met many constituents, as I am sure that colleagues from across the House have done, who are concerned for their careers, for their livelihoods, for the fulfilment of their vocation to be a doctor and care for patients, and often for their family life. I ask hon. Members from across the House to imagine how they would feel if they were junior doctors—highly motivated professionals who have gone through graduate education, and who have, in some cases, worked in the health service for several years. They are senior professionals by any measure, but the net result of the current structure, including the way in which the review group has changed things, is that there is one interview for one unit of application, and that might be for a post anywhere in the east of England, from Hemel Hempstead to Cromer. That is the sum total of their ability to exercise control over the future of their career.
John Bercow (Buckingham) (Con): Dr. Mary Weisters and Dr. Tracy Graves practise general surgery and neurology respectively. Between them, they have 25 years’ experience, which includes education, training and hands-on practice in the national health service. According to the figures, they have a one in 30 chance and a one in 13 chance respectively of securing a job at a time of rising demand for medical services. Does my hon. Friend not agree that it would be a scandal bordering on criminal irresponsibility if they were shunted out of the national health service or, as happens at present, patronisingly encouraged to go abroad—something that they do not have the slightest desire to do?
Mr. Lansley: I am grateful to my hon. Friend, because he further reinforces my point. I have often met married junior doctors who are wrestling with the issue of how they can both secure posts in a way that is consistent with maintaining their family life. That is intensely difficult. My hon. Friend’s point is a fair one; the British Medical Association is today warning that literally thousands of junior doctors could end up going overseas. What is the Government’s response? Well, we saw the document produced in the Department of Health last week. It was not published, but it found its way out. The Government are “volunteering” junior doctors to join Voluntary Service Overseas, so that they go abroad. [ Interruption. ] Well, it struck me that VSO is about volunteering—not the distressed reallocation of doctors from the United Kingdom to overseas, which is outrageous.
Tony Baldry (Banbury) (Con): Further to the point made by our hon. Friend the Member for Buckingham (John Bercow), how do I explain to my constituents at the Horton hospital that we are likely to lose 24/7 consultant-led paediatrics, consultant-led obstetrics and a special care baby unit in the near future, because we have been told that there are insufficient doctors? How is a community like north Oxfordshire to accept on the one hand that there is a substantial downgrading of NHS services in Banbury and the surrounding area in a way that has never taken place before, while on the other it can see that junior doctors are being thrown on to the scrapheap?
Mr. Lansley: There is only one way for my hon. Friend to explain that to his constituents: it is chronic mismanagement of the national health service by the Government. It was the Government’s intention to continue the expansion of consultant posts, but that has been torpedoed by the mismanagement of finances and deficits in the health service so that across the NHS posts have been frozen, consultant posts have disappeared and specialist consultants in some specialties cannot find posts. The consequence is seen not only in the impact on Horton hospital in my hon. Friend’s constituency, but across the country. The increase in medical school output or in the number of junior doctors coming through would have been consistent in due course with a larger throughput into consultant posts, but the Government’s attitude is that those consultant posts have been lost for financial reasons and they are cutting back on the hospital sector, so they want to maintain a tight bottleneck at the point at which junior doctors enter the further reaches of specialty training. They are stopping the flow, and they are literally forcing large numbers of doctors to leave the country.
The Government may believe that the doctors who will leave this country will be those who came from overseas in the first place, but that is not how it is working out. It is an arbitrary system. The scoring system, recruitment and application system have been made “objective” in a way that has become virtually arbitrary. Those who are selecting candidates for posts across the country were unable in the initial process to see anything like sufficient of the clinical experience, the academic achievements and the character of the candidates presented to them. It turned into a scoring system in which someone could literally—I have evidence in my file—pay £129, go on a course, and be told how to answer the questions to be selected for interview. That is utterly outrageous.
Mr. Michael Jack (Fylde) (Con): Following my hon. Friend’s extensive research for this debate, can he explain why there is such a misfit between the 30,000 junior doctors who started out with an aspiration to reach those higher posts and the 22,000 opportunities that exist? Who created that over-supply of 8,000 junior doctors, and has he worked out the cost to the economy, never mind the human cost, of that enormous waste of unplaced talent?
Mr. Lansley:
My right hon. Friend may be aware that we are constantly searching for accurate figures as to precisely how many applications and run-through training posts there are. Of the 18,500 posts in England—I think that the Department would
acknowledge that figure—we have not even been told how many are run-through training posts and how many are fixed-term posts. The disparity between the figure of 18,500 and anything up to 34,000 posts is principally the result of the combination of two annual cohorts coming together because the new MMC process is shorter than the old training process, the right of European economic area nationals to apply without legal restrictions in this country, and a large number of overseas doctors who, for example, have highly skilled migrant programme visas.
There is no reason, as far as I am aware, why the Department should not have anticipated all those components. As little as four months ago, the Department, in the guise of the former health Minister, Norman Warner, was about a third out on the number of potential applicants. It is not good enough for Ministers to say, “There were more applicants than we expected so it all went wrong.” They were responsible for the process. They are responsible for the number of junior doctors who have access to training in this country. They should have known the likely outcome and dealt with it.
Time and again we have told Ministers that thousands of junior doctors would be left without training posts. The response of the Secretary of State is always to misinterpret that and say, “You’re saying that they are all going to be unemployed, and that’s shroud-waving.” She said on 19 March that
“the shroud-waving about unemployed doctors is absurd.”—[ Official Report, 19 March 2007; Vol. 458, c. 582.]
In a letter to me on 27 March she stated:
“It is wrong to conclude . . . that there is a danger that these doctors will be unemployed”—
The Secretary of State says that is right, but in her own Department a document is being circulated, the purpose of which is to try to deal with the fact that up to 10,000 junior doctors will be unemployed. That is what it says—unemployed or without training posts. It was not absurd. We were not shroud-waving. It was a fact and the Government knew it, but they would not admit it.
The Secretary of State has been in appalling denial about all this. I shall try to avoid a long quote, but I want the House to listen to the words of one consultant who wrote to me describing the process from the interviewer’s point of view. We are hearing from junior doctors about how appalling the process has been. The consultant wrote:
“Today was the first occasion in 20 years that I was asked to make important decisions on the careers of our future colleagues, with no CV or application form to review in preparation for the face-to-face. The only information I received was a list of candidates—in no particular order—and a start time and venue. Each candidate arrived armed with a brief one-page summary, hand-written immediately prior to interview and a portfolio the size of one or two telephone directories. Three colleagues and I were supposed to review these in 30 minutes flat, at the same time as we conducted a structured interview, marked each domain individually, and finally came to an agreed score for each domain that will be forwarded to MTAS . . . I never saw any references and there was no opportunity to review our decisions. This process is the antithesis of fair employment and equal opportunities.”
That is from the consultant’s point of view. Imagine how it seems from a junior doctor’s point of view. I have a quote from a junior doctor who describes his experience. He states:
“I have a first-class degree in medicine/neuroscience, medical degrees with distinction, two research doctorates . . . in behavioural neuroscience, nearly 30 scientific publications including text books and commercialized research software, research prizes, three years’ experience as a lecturer in neuroscience at the University of Cambridge, and two years’ experience as a medical SHO at teaching hospitals . . . whilst I was short-listed for an ST2 medical position I failed to be shortlisted for ST1 psychiatry, which requires no previous psychiatry experience. Presumably, in some way my answers to the ‘anecdote’ questions didn’t fit the psychiatry scoring system, whatever that was”.
That reflects precisely the point made by my hon. Friend the Member for Worthing, West. A candidate can end up with all those qualifications but fail to be shortlisted because of the scoring system, under which a PhD was worth one point and 150 words on how one copes with stress was worth four points.
Peter Bottomley: Perhaps one should ask whether the Prime Minister would appoint the Front-Bench health team on the same kind of system. Will my hon. Friend join me in posing a question to the Secretary of State for answer at the end of the debate? Is it true that the review group has said that each candidate will get one interview in their primary area? Is it true that under the MTAS system people who are to be interviewed this weekend are being told that there are no jobs available—that all were filled on the first round, so they cannot select their first choice? The advice is that they contact the deanery directly. The Secretary of State shakes her head. Will my hon. Friend join me in asking her to get that checked by the end of the debate and tell the House what applicants are being told under the system today?
Mr. Lansley: I am grateful to my hon. Friend. I am sure that the Secretary of State heard what he said, and I hope she will respond. On interviews, I suspect that she is not looking forward to the one with the next Prime Minister.
The Secretary of State has been in denial. She has told the House about the outcome of the review group. In a letter to me on 27 March she stated:
“The Review Group is independent and responsibility for membership rests with Professor Neil Douglas”.
But a freedom of information request to the Department secured the answer:
“I can confirm that Clare Chapman, Director General of Workforce at the Department of Health, had overall responsibility for considering who was appropriate to sit on the review group.”
It was not independent at all. It is no wonder, given the lack of a strategic solution from the review group led by Professor Douglas, that the Secretary of State has had to announce a new and a second review.
Professor Crockard, who was responsible for the modernising medical careers process, resigned, and in a letter to Liam Donaldson, the chief medical officer, said:
“I have become increasingly concerned that the well intentioned attempts to keep the recruitment and selection process running have been accompanied by mixed messages for the most important people in the whole process—the young doctor applicants.”
It is basically unfair to advertise the possibility of four interviews and then suggest that these might not be honoured. Shelley Heard, the clinical medical adviser to the MMC process, said:
“The Review Group has not done this strategically or with an eye to the future.”
This is why we are here this afternoon. The Secretary of State and the Government are in denial about the scale of the process and the many difficulties and problems with the scoring system and the recruitment process, which I have not had time to go through, and are not coming forward with viable solutions for the future.
David Taylor (North-West Leicestershire) (Lab/Co-op): The hon. Gentleman makes a fair point about the lack of independence of the first review group, on which the great majority had close involvement with the creation of the MTAS and the modernising medical careers project. Does he hope that Professor Sir John Tooke, in agreeing the complement of his review group, will not include anyone who has played any part in any of the processes that have had so many problems during the past few months and years?
Mr. Lansley: I am grateful to the hon. Gentleman for that. The Secretary of State will no doubt tell us more in a moment, but she has this afternoon announced the terms of reference for Sir John Tooke’s review: that it will be independent of the four health departments—good; and that it will have an independent secretariat—good. But there are two problems. First, she has not announced the membership, and I entirely endorse what the hon. Gentleman said. It is essential for the confidence of the medical profession that Sir John Tooke’s review is conducted by people who are in no sense, whether positively or negatively, associated with the decisions that have hitherto been made about the MMC and MTAS processes.
The other problem with what the Secretary of State has announced this afternoon is that she is asking Sir John Tooke to report on an interim basis in September. Hon. Members will know that the problems that we are encountering now with the outcome of the second review group will come to a head in August, so she appears to be precluding the possibility of Sir John Tooke and his colleagues, whoever they may be, intervening more or less immediately to say that steps need to be taken.
The Opposition motion includes essential measures. The review still has serious problems and it will be subject to legal challenge. There is a good argument that legitimate expectations of junior doctors in the application process have been completely failed, and there are still problems in trying to manage the application process. People cannot obtain interviews and are being logged out and obstructed, and there is scope for gaming for those who have already had interviews. To that extent there is an uneven playing field between those who had first round interviews and those who are in round 1B. It is astonishing that in England junior doctors are being restricted to one interview, whereas in Scotland and Northern Ireland all four original interviews are being offered.
It is far from clear that consultants throughout the country will be prepared to participate in what they regard as an unfair recruitment process. The
consultants at Addenbrookes in my constituency sent me the results of a consultant survey that they had recently undertaken, and three quarters of those consultants said that they would refuse to take part in further interviews. Ninety-seven per cent. of them wanted to see the previous system of appointments restored for this year. I do not necessarily agree with that. However, there is something that we can and must do between now and August. It is not good enough to wait for Sir John Tooke’s review in order to produce a report in September. We must consider foundation programme graduates who should, in all cases, be able to access specialty training. If they are not getting access to that training, posts will need to be created to enable that to happen. That was clear from the original principles of MMC, as stated in April 2004 in “Modernising medical careers: the next steps”:
“It is not acceptable that they”—
that, is foundation programme graduates—
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