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“should at this stage fall out of the training system”.
Yet, according to the Department’s own document, between 500 and 1,300 such foundation year graduates might fall out of the system.
It is not acceptable that this shambles means that large numbers of senior house officers, many of whom have excellent clinical experience, good academic qualifications and fine references, are going to be closed out of the ability to enter specialist training. We must turn more trust grade posts into training posts. I said that to the Secretary of State on 19 March, when Ministers sat there barracking me, saying, “That is extra money; it’s going to cost.” Of course, as we now know from a document sent to hospital trusts and strategic health authorities on 5 April, that is exactly what the Department is doing. It has asked hospital trusts and SHAs to respond by 27 April. Will the Secretary of State now commit to an increase in the number of training posts available this year and the holding back of some run-through training posts for 2008 and 2009 so that, as the hon. Member for Oxford, West and Abingdon said, senior house officers—those who have a legitimate expectation of completing their specialty training—will not suffer the guillotine that cuts off the possibility of their securing the appropriate level of training this year, next year or the year after?
Dr. Evan Harris: The hon. Gentleman is absolutely right. He is also right as regards the financial cost, or otherwise, of converting staff grade posts and trust grade posts to junior doctor training posts. Clearly, some service functions may have to go with the loss of those service posts, but I think that most junior doctors will be prepared to do some supervised service as the price of having a career in training. Does he agree that if the Government plan junior doctor posts, there must be some central planning to get the consultant expansion that is needed to underpin all of this?
Mr. Lansley: On the latter point, it is fair to say that one of the essential things that John Tooke must do is to establish a new work force planning arrangement that is owned much more by the profession and the service than by the Department of Health, which has handled it so appallingly.
The hon. Member for Oxford, West and Abingdon makes an important point. As I am sure that the Secretary
of State would agree, turning trust grades to training posts is not without cost. That would have to come from the MPET—multi-profession education and training—budget in strategic health authorities. The Government have admitted that in the last financial year—2006-07—they cut £350 million from education and training budgets. Three or four weeks ago, the chief executive of the NHS said that that was for one year only. We are now at the start of the new financial year. It is clear from the SHA board papers that some SHAs are already planning to cut £136 million out of their training budgets for this financial year. We know where the money could come from for more training posts, because there is money in the training budgets, yet the Secretary of State sits there saying that the Department cannot afford them. It could afford them were it not mortgaging the future of the NHS to deal with its financial mismanagement to date.
Let me make it absolutely clear what we want. On 30 March, I sent the Secretary of State a letter with 101 e-mails that I had received from junior doctors about the many problems that they had experienced. I have had no reply. Senior house officers cannot become another new lost tribe of junior doctors in whom we, as the public, have invested not only our taxpayers’ money but an enormous amount of our emotional support in the best young people of this country who have chosen to go into medicine but who might end up never being able to fulfil their vocation or, worst of all, pursuing it overseas, so that all those investments have been lost
Justine Greening (Putney) (Con): It is not only a matter of the time and energy that junior doctors put into getting qualified but the massive student debt that they incur. Medical graduates now have an average debt of £21,000.
Mr. Lansley: It is no wonder that not only Australian medical recruiters who come to this country but the City try to recruit junior doctors. Some of them will understandably be tempted precisely because of the point that my hon. Friend makes.
Mr. Frank Field (Birkenhead) (Lab): The hon. Gentleman says that we should ensure that there are career prospects for our best young people in this country. Given the unique circumstances that give rise to the issues that we are debating—two strings of training are concluding in one year—does he believe that the Government should ban doctors from Europe from applying for jobs in this country? Given that Europe takes so long to respond to anything, the year would be over and we would be into a second one before it had caught up with what we had done.
Mr. Lansley: I am grateful to the right hon. Gentleman but I fear that, legally, his suggestion is impossible. I do not propose it because I do not believe that the Government could legally take such action.
We cannot allow investment in junior doctors to be abandoned—that appears to be a risk as a result of the Government’s policies. The vocation to serve patients in our national health service must not be lost to this country. The human needs of junior doctors—to
pursue their career and maintain their family life—must not be ignored by the way in which the process is administered. We need to return to the profession greater control over its education and training. It is vital to find a solution that wins back the profession’s confidence, which the Government have lost.
It is vital that Sir John Tooke’s review not only has the option of making immediate recommendations but can be independent, representative of the profession and the service, open in its analysis—not closed, as previous review groups have been—and strategic in its outcome.
In a briefing paper for the debate, the Royal College of Physicians described what has happened as:
“The worst episode in the history of medical training in the UK in living memory”.
The medical profession is rightly angry. Its members have been disempowered and they are demoralised. That has happened on the Secretary of State’s watch. We have brought her to account and we want a solution. The Government’s amendment makes no reference to the appointments and recruitment systems or MTAS. Worse, it contains no expression of regret. Our motion expresses on behalf of Parliament our deep regret about the distress caused to junior doctors and the loss of good will in the medical profession. We do not hear that from the Government. That is why hon. Members should reject the amendment. I commend our motion to the House.
Mr. Speaker: Before I call the Secretary of State to move the amendment, I point out that a demonstration took place in the Public Gallery. I know how seriously members of the public take the matter and I understand that things can get heated. However, I must tell the House that, if there is another demonstration, the Serjeant at Arms’ officers have the authority to clear the Public Gallery. That might be unfair to those who have travelled a long way to hear the debate.
4.23 pm
The Secretary of State for Health (Ms Patricia Hewitt): I beg to move, To leave out from “House” to the end of the Question, and to add instead thereof:
“recognises the international reputation for excellence of medical training in the UK; acknowledges the need to modernise medical careers to ensure all doctors are properly trained to nationally recognised standards, including a fairer and more transparent process for applying for specialist training; notes that Modernising Medical Careers (MMC) will deliver training to a consistently high standard which, combined with the expansion of the number of doctors, will provide high quality safe care by appropriate skilled medical staff; notes the wide consultation that took place on MMC and the strong support for the need to improve doctors’ training amongst doctors’ representatives including the medical royal colleges and the British Medical Association; welcomes the external review that is already being conducted into how MMC has worked to date and the changes made as a result; and supports the longer term review recently announced to ensure MMC works well in the future.”
Let me begin by stressing, as I did last week, that my ministerial colleagues and I are in no doubt about the distress, anxiety and uncertainty that has been caused to junior doctors by the problems with this year’s applications system. Those problems should not have arisen, but they have, and we are all—Ministers, officials in the Department, the medical royal colleges, the British Medical Association, the postgraduate
deaneries—completely focused on sorting them out so that, as I said to the House last week, we have a system for this year that is fair to junior doctors and enables the NHS to make the right appointments to all the posts involved.
In addition to the urgent questions that the hon. Member for South Cambridgeshire (Mr. Lansley) mentioned, there have already been three written ministerial statements as well as last week’s oral statement. I will, of course, continue to update the House on the work of the review group under the leadership of Professor Neil Douglas, which will remain in existence while we continue to sort out the problems that have arisen with this year’s applications system.
Before I return to the question of the applications system and look forward to Sir John Tooke’s review, I want to say a little more about the new medical training system and what it replaces. As on previous occasions, the hon. Gentleman has simply understated the very real problems of the old system that modernising medical careers replaces. That system, as the whole House would acknowledge, has always produced outstanding doctors for the NHS, many of them world leaders.
However, that system was also wasteful, inconsistent, often unfair and, indeed, as the Royal College of Surgeons said several years ago, “most unsatisfactory”. Some junior doctors had to apply for a new training post every six months. They were sending in different applications in different formats to different hospitals and different post-graduate deaneries at different times of the year. There was no proper national curriculum and no standardised assessment process. It has always been the case that, because of the intense competition for medical training posts, junior doctors who could not secure the senior house officer job that they wanted found themselves filling in time in the wrong post—from the point of view of the skills that they wanted to develop—in non-training posts or as a locum. Sometimes, as Conservative Members pointed out, they had to do so for years on end.
Remedy UK, the newly formed group that has been so critical—understandably so—of this year’s problems says in its briefing paper on MMC that many of those in the old senior house officer job were in short-term or non-training posts or endured poorly planned training with no clearly defined end points. There were certainly deficiencies in the selection and appointment procedures, along with inadequate supervision, assessment and career advice. It was precisely because of those problems that, following the leadership of the chief medical officer, the Department of Health sat down with the medical royal colleges, with the British Medical Association, with the postgraduate deaneries and others—including, of course, representatives of the junior doctors—to devise modernising medical careers, which almost everybody agrees is the right way forward. Indeed, Professor Douglas’s review group has confirmed that.
Mr. Desmond Swayne (New Forest, West) (Con): The right hon. Lady is setting up a straw man. Absolutely no one here is trying to suggest that we should have stuck with the original system. Her job here today should be to explain the shambles that we are now in and how we are going to get out of it, rather than to review what might have been the case in the past.
Ms Hewitt: I have to tell the hon. Gentleman that in a debate titled “Modernising Medical Careers”, it makes sense to remind the House of how it came about, why we committed to it in the NHS plan of 2000 and why its underlying principles and direction of reform for medical training are absolutely right.
Dr. Evan Harris: I share the right hon. Lady’s view that the problem with the old system was that too many doctors at senior house officer level had nowhere to go to get into training, so they had to mark time, go into career grade posts or SHO posts that were not really training posts. Does she accept that the test of the new system will be how many fewer people in that situation either have to leave training against their will when they are capable of being trained to be consultants or have to go unwillingly into career grade posts below specialist training level? Does she accept that that will be the test of the success of her new system?
Ms Hewitt: What I accept in response to the hon. Gentleman’s question is that it has never been possible for every junior doctor who wants to pursue training through to a consultant post to do so, particularly in the specialty that they originally wanted to follow. I will come back to that point in a moment.
Mrs. Nadine Dorries (Mid-Bedfordshire) (Con): Will the Secretary of State give way?
Ms Hewitt: I want to make a little more progress before I give way again.
The first part of the new system—the two-year foundation programme—was successfully introduced in 2005. In line with the principles that will operate throughout modernising medical careers, that will give every medical graduate a series of properly supervised placements in medicine, surgery and a range of other specialties and settings, with formal training based on a national curriculum developed following wide consultation with the profession, including the medical royal colleges, and approved by the Postgraduate Medical Education and Training Board. It will also provide our medical graduates with regular workplace-based assessments of competence, a national learning portfolio and formal access to careers advice, all of which were missing from the old system.
Ms Hewitt: If Opposition Members support all that, I shall be delighted. I shall give way to the hon. Lady.
Mrs. Dorries: As my hon. Friend the Member for South Cambridgeshire (Mr. Lansley) has said, there is no argument about the fact that doctors’ careers and training processes needed modernising. The issue is that the process has been a complete, unmitigated disaster, yet the Secretary of State is not accepting responsibility for that.
Ms Hewitt:
I am sure that the hon. Lady will not accept my word for it, but if she just looks at the several statements made by the review group under Professor Neil Douglas, she will see that it has not been a complete, unmitigated disaster. The applications system has actually been working well in many places,
particularly for GP posts. Many problems have arisen that I have acknowledged since the scale of the problem became clear and taken action on, particularly by the appointment through the Academy of Medical Royal Colleges of Professor Neil Douglas to lead the review group and to sort out the problems. Just as I am acknowledging the problems, I wish that the hon. Lady and her hon. Friends would acknowledge that we are taking this matter seriously. We have apologised for the fact that the problems arose, and we are now seeking to correct them and to sort this out.
Lynne Jones (Birmingham, Selly Oak) (Lab): A serious problem exists today, but the review group will not report for some time. I listened carefully to the hon. Member for South Cambridgeshire (Mr. Lansley), and there was nothing in his speech that I could disagree with. My right hon. Friend cites Remedy UK; I met one of my constituents this morning, and they are calling for more training posts to be created. There is nothing in the Government’s amendment today to tell us how we are going to get out of this situation, and I hope that my right hon. Friend will address that problem.
Ms Hewitt: That is precisely the point that I am coming to, but I wanted first to make the rather important points about why we are changing to modernising medical careers.
Mr. Jack: Will the Secretary of State give way?
Ms Hewitt: No, I want to make some more progress before I give way again.
As I told the House last week, Professor Douglas’s review group has already agreed on significant changes to the system. They have been announced to the House and to junior doctors, and they are now being implemented. The review group decided, after careful discussion, that it would be wrong to abandon the process of interviews that is now under way. It concentrated instead on how to change the process so that it would be fair to junior doctors and meet their needs and the needs of the NHS as a whole. In particular, every eligible applicant was invited to reaffirm or revise the order of their application preferences and was guaranteed at least one interview for their revised first preference specialty. That is now happening and, over the past few days, more than 25,000 applicants have taken the opportunity to revise the order of their preferences and have done so successfully on the much-maligned medical training application system—MTAS. Those interviews are now under way, and they will continue right through next month.
Mr. Jack: I am grateful to the Secretary of State for her courtesy in giving way. Will she put on record for the benefit of the House the fact that, while receiving submissions from her officials when the new training methods were being devised, she never received any message at all from any official or from anyone concerned with medical training or medical manpower planning that there would be a problem with two streams of trained doctors arriving at the same time and chasing the same posts? Did she ever receive such advice?
Ms Hewitt: Last year, the main focus of the discussions, particularly with the British Medical Association, was on the number of training posts that would be available. That is not dictated by Ministers or the Department of Health; it is determined by the individual trusts and postgraduate deaneries on the basis of what is needed by the service. We spent several months and a great deal of work establishing the number of training posts that would be available. The noble Lord Warner, then the Minister responsible, made a statement on that subject towards the end of last year— [Interruption.] If I may remind the right hon. Member for Fylde (Mr. Jack), Lord Warner said in that statement that we did not and could not know how many other applicants there would be, particularly from overseas.
Mr. Frank Field: The junior doctors who have been in contact with me are not now so concerned about the process, which they find rather academic, but they are desperately worried about their jobs. When the crisis began to unfold, the Prime Minister said that he expected that the vast majority of doctors coming up for appointment would gain appointments. Will my right hon. Friend have an opportunity this afternoon to outline the measures that she has directed to ensure that that pledge is fulfilled?
Ms Hewitt: First, in response to my right hon. Friend the Member for Birkenhead (Mr. Field), and to other questions, I want to clarify the total number of training places available: about 23,000 postgraduate medical training appointments are available across the UK this year, which is more than ever before. Of those, 3,000 are being filled by recruitment to general practice, and just over 19,000 places are available on MTAS at the moment, with a further 700 to be added to the system. We all know very well that there are more applicants than training posts. That has always been the case, but it does not mean, as headlines and some press reports claimed at the weekend, that there will be 10,000 unemployed doctors.
Of the 32,000 or so eligible applicants for those training posts, about 30,000 are already working in the NHS, about 6,000 of whom are completing their foundation programme, and about 8,000 of whom state on their applications that they are working in non-training posts—trust jobs, staff jobs, locum posts and so on. About 16,000 say that they are working as senior house officers, but because of the deficiencies in the present system, many of those posts are not proper training posts either. Regardless of the outcome of applications for the new training posts, the NHS will continue to need all those jobs and possibly more in the future, because the number of patients is increasing, and so is the number of doctors—the NHS now has over 30,000 more doctors than 10 years ago.
Someone who is currently working in the NHS in a non-training post, whatever it is called, who does not get the training post for which they applied this year, will be disappointed, just as many were last year, the year before and every other previous year. They will still, however, have their job. Those who do succeed in getting a training post will leave a vacancy that can be filled by a doctor—with appropriate experience, of course—who has failed to get the training post that they sought this year.
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