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24 Apr 2007 : Column 813

Rob Marris (Wolverhampton, South-West) (Lab): A couple of years ago, the province of Ontario in Canada abolished grade 13, which led to a double cohort going to university, for which steps had to be taken. My right hon. Friend talks of posts for medical graduates, but the difficulty is that no steps appear to have been taken to plan for the inherent and entirely foreseeable problem of the double cohort of SHOs at one end and recent medical graduates at the other. SHOs who started under the old system are competing with recent medical graduates for an insufficient number of training posts—I stress the word “training” to my right hon. Friend. As I understand it, a lot of those people will be redundant from 1 August. Will she assure me that a sufficient number of training posts will be available for those doctors?

Ms Hewitt: The number of posts must be based on the needs of patients and the service as well as the needs and wishes of trainees. As I have tried to stress, it has always been the case that some doctors in training have either had to change their specialties or been unable to progress in their training to consultant grade. The new system does not change those realities.

Mr. Andrew Pelling (Croydon, Central) (Con) rose—

Ms Hewitt: I want to make a little more progress before I give way again.

I fully recognise that it would be quite wrong to leave a junior doctor part-way through his or her training with no clear prospects. Until the whole process of interviewing and job placement is completed in a few months time, we will not know which trainees—whether they are just completing the foundation programme or are more senior—have obtained specialist training posts. However, I assure my hon. Friend and the House that we will give them proper support.

As part of the review, we are working urgently with the royal medical colleges and the NHS to establish the need for additional training posts—which will of course have to be approved by PMETB, the Postgraduate Medical Education and Training Board—including one-year placements and more senior posts. We are also considering how we can provide more effective training support for doctors in service posts—that is, non-training posts—to maximise their development opportunities. That is the issue on which Professor Douglas’s review group is now focusing, having dealt with earlier problems involving the application process, and it will make a full statement—as will I, to the House—on the support that will be available very shortly.

Mr. Pelling rose—

Mr. Bellingham rose—

John Bercow rose—

Ms Hewitt: I will give way to the hon. Member for Buckingham (John Bercow).

John Bercow: The right hon. Lady referred to the needs of patients. When we envisage circumstances in which every junior doctor in every grade and in every specialty changes job on the same day, the spectre is
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inevitably raised, and was articulated to me only this morning, of wards either empty or massively understaffed, potentially thereby—I choose my words carefully—imperilling public and patient safety. The right hon. Lady shakes her head, and she is entitled to do so, but can she assure me that there will be no such scenario anywhere in the country? If she is confident that she can, will she say precisely what contingency planning is being done to enable her confidently to make that prediction?

Ms Hewitt: As I have just said, the great majority of applicants who are already in non-training staff posts, trust posts and a variety of other non-training posts will still have those jobs because they will still be needed in the NHS. Each hospital trust, and the board of each trust, has a responsibility to its patients to ensure that on 1 August, or any other day, the right number of the right staff are available to provide safe, high-quality care.

Mr. Bellingham: Further to the point made so eloquently by my hon. Friend the Member for Buckingham (John Bercow), is the Secretary of State aware that in my constituency Queen Elizabeth hospital has made it clear that because of the changeover date of 1 August, no elective work will be done during the first week of that month? All day surgery will be cancelled for a week, which will mean the cancellation or postponement of probably 100 operations and a consequent increase in waiting lists. Will that happen throughout the country, and why will it happen in my constituency?

Ms Hewitt: The issue of the changeover date is nothing new. Trusts have to plan for it very year, and that is what they are doing this year. It is not exactly unpredictable or novel. As I have said, it is up to individual trusts to decide how to organise staff in order to meet their patients’ needs.

Mr. Pelling rose—

Ms Hewitt: I want to make a little more progress before I give way again. I have been quite generous in taking interventions.

We hear from Conservative Members and others demands for the creation of an unlimited number of training posts to meet the needs and wishes of junior doctors. We must recognise that it is necessary to balance fairness to doctors in training with the needs of patients and the NHS. It would be completely wrong to create a specialist training post for everybody who wants to become a consultant in a particular specialty, including for people who have in the past applied for training posts year after year, as some have done, and have not been able to progress in their training, or to create posts regardless of whether the NHS actually needs so many consultants in a particular specialty.

Cardiothoracic surgery is an example of such a specialty. Because technology and medical practice have transformed how cardiothoracic patients are treated, the NHS already has far more fully trained cardiothoracic surgeons than it needs. This year alone we have 300 applications for five speciality cardiothoracic posts. It would not be right for the NHS
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to create another large number of cardiothoracic training posts simply so that there are enough for every applicant who would like to specialise in that field. Equally, however, those applicants who have that field as their first choice and who are disappointed must have the opportunity and support that they need to progress in another specialty. That is an important point, because what we need in terms of training—and I believe that we will get this with modernising medical careers—is a system that not only gives dedicated and excellent junior doctors the chance to progress in their careers, but enables the NHS to have the right number of people with the right skills at a time when medical practice and technology are changing faster than ever before.

Mr. David Heath (Somerton and Frome) (LD): It is instructive that the right hon. Lady chose the small specialty of cardiothoracic work, which has always been oversubscribed, and it would be interesting to find out whether she can give any other such examples. However, may I return her to a question that she has still not addressed, despite having been asked it at least three times this afternoon? There was an entirely predictable consequence of the double cohort. What planning did the Department do to deal with the double cohort issue?

Ms Hewitt: The hon. Gentleman is ignoring the fact that, because of how the old system worked—with junior doctors applying for jobs all over the country, and with different application systems and things happening at different times of the year—there was no national system. Therefore, we had no statistics in respect of the number of people who had been applying unsuccessfully for training posts. I agree that it is clear, with the benefit of hindsight, that it would have been better if we had predicted that almost everybody in a non-training post would take the opportunity of this year—the first year of a system that is much fairer and much more transparent, with more training posts available than ever before—to make an application. Of course it would have been better if we had predicted that. We failed to do so, and I have apologised for the problems and distress that that has caused. More importantly, however, we are now putting that right.

Mr. Pelling: I am grateful to the Secretary of State for giving way. What would her advice be to the four junior doctors from my constituency who visited me today, all of whom have been offered training posts, in Brisbane, Toronto and Singapore, bearing in mind that the offer being made by the Secretary of State is that they can have some kind of job in the NHS, even perhaps as a rural GP in Scotland—an example of “Dr. Finlay’s Casebook”, if ever there was such an example? Would her advice be that it would be best if, despite the £250,000 that has been spent on the training of each of them, they accepted those job offers outside the United Kingdom?

Ms Hewitt: I am unsure whether the hon. Gentleman is prejudiced against general practitioners, or those working in country areas, or those working in Scotland. The job he mentions is in my view an
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excellent post, and I am sure that someone will fill it admirably. He also ignores the fact that 23,000 postgraduate medical training places will be available across the whole of the United Kingdom, which is more than ever before.

Let me deal with the issue of doctors going abroad, which the hon. Member for Croydon, Central (Mr. Pelling) just raised. At the weekend, there was some quite disgraceful reporting in some sections of the press. On the one hand, they were busy saying how disgraceful it is that doctors have had to suffer the distress and added uncertainty of this year’s difficulties, while on the other they ran a headline saying that they were all going to be shipped abroad to do voluntary service overseas. That is absolute rubbish. It has always been the case that some British junior doctors have chosen to go abroad at some stage in their training to get extra experience to further that training. Some do voluntary work in, or are on secondment in, the developing world—an issue on which the noble Lord Crisp recently produced an excellent report. However, there is no question of junior doctors being forced into those options or being shipped abroad.

We all need to focus on the interviews that are taking place and that will continue over the coming month, the first round of job offers that will then be made, and the enormous effort that will go in—thanks to the work not just of the review group, but of consultants and the postgraduate deaneries around the country—to matching, as far as is possible, junior doctors with their first preference application, and to match, wherever possible, medical couples with their combined preferences through the medical training application system, which is an issue that was specifically raised. Of course, there will then be a second round of interviews and job offers. Once all that has been done, we will then ensure proper support, as I indicated a moment ago, for those trainee doctors who have not secured the training post that they wanted.

Rob Marris: I am very grateful to my right hon. Friend for patiently explaining the issues and for being generous in giving way. She talks about focus, and what I am focusing on is the figures that she has given this afternoon, which I have perhaps misunderstood. She mentioned 23,000 training opportunities and 32,000 applicants. I am focusing not on the MTAS system—good or bad as it may be in terms of the computer system and the lack of CVs—but on the fact that apparently and entirely predictably, 9,000 doctors, whom it costs £250,000 a throw to train and who have been in the system for a minimum of six years, will be redundant. That will be a great loss to the taxpayer, to the NHS and to them personally.

Ms Hewitt: I am afraid that on that point my hon. Friend is absolutely wrong. Well in excess of 9,000 of those 30,000 applicants working in the NHS are working in non-training jobs that the service will continue to need. They are the so-called “trust” jobs—the service jobs—but they also include some of the senior house officer jobs, which are not training posts, despite their name. Those jobs, as well as the 23,000 training places, will continue to be needed and to be filled by junior doctors. That is why the headlines about 10,000 unemployed or redundant doctors are simply wrong.

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Mr. Frank Field rose—

Ms Hewitt: I give way a second time to my right hon. Friend.

Mr. Field: I am very grateful for the chance to make a second intervention. I ask my right hon. Friend not to answer the Liberal Democrats’ endless plea for a post mortem. [Interruption.] Yes, the Liberal Democrats did ask for a post mortem to find out what went wrong. We all know that something has gone wrong—even the Liberal Democrats should understand that simple point—but young doctors in Birkenhead want to focus on the future. In answer to my previous intervention, my right hon. Friend said that, at some stage, she and others would consider the creation of new training posts. Will she please say a word or two about that before the end of the debate?

Ms Hewitt: I did indeed say that as part of sorting out the difficulties that have arisen this year we are already working with the royal colleges, the NHS and postgraduate deaneries to see whether additional training posts can be made available to start, of course, alongside the other ones later this year. We are looking at that issue.

Dr. Evan Harris: Will the Secretary of State give way?

Ms Hewitt: No. I am not going to take further interventions, as I am very conscious of the time.

We are also looking at what additional training and support should be given to those who take the non-training posts—the staff jobs and so on—so that they can continue their development. In some cases, they will be in a position to apply successfully for a training post next year.

We are doing two things. First, through Professor Douglas’ review and with the close involvement of the medical royal colleges, the BMA and other bodies, we are sorting out the problems that have arisen this year. Secondly, we are looking further into the future. As I announced last week, we are to set up a wider review of the modernising medical careers programme. It will be led by Sir John Tooke, and the House will know that I published the review’s full terms of reference today.

The principal task facing Sir John and his review group will be to examine the framework and processes underlying modernising medical careers to inform improvements for 2008 and beyond. Therefore, the existing group led by Professor Douglas will continue to make sure that we sort out the difficulties for this year, and Sir John Tooke’s review will look ahead to next year.

As hon. Members will see from its terms of reference, Sir John Tooke’s review will look at questions such as whether the system is flexible enough—one of the main principles of modernising medical careers—or whether the scoring system devised through a very full consultation with the professions is now, on reflection, thought to be inappropriate and in need of revision. I am extremely grateful to Sir John for undertaking the review, and I stress once again that it will be completely independent. Sir John is identifying the members of his review panel and I shall make an
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announcement about that with him in due course. He will recruit his own secretariat and have a budget for that purpose. He has kindly offered to produce an interim report in September, as that will assist us in planning and making improvements for next year. That interim report will be published, of course, and Sir John has also undertaken to inform us of preliminary findings earlier. I know that Sir John will do everything that needs to be done to involve junior doctors, the medical profession more broadly and the NHS in the review. I have full confidence in him, and I hope that that confidence is shared across the House.

As I noted earlier in this important debate, we have more than 30,000 more doctors in the NHS than we had 10 years ago. We have more trainees and more training places than ever before. We are establishing a new training system that will build on the excellence that British doctors have always achieved. However, it will also give us a much better, fit-for-purpose medical training system.

We are sorting out the problems that have arisen this year, and we are learning lessons to ensure that we can make further changes and improvements next year. It would have been much better, of course, if the problems with this year’s transitional year had not arisen. We all regret—I most of all—that they have arisen, but the new system that we are putting in place with modernising medical careers will be fair to doctors and right for the NHS. Above all, it will be best for patients.

I commend the amendment to the House.

4.58 pm

Norman Lamb (North Norfolk) (LD): I want to start by speaking about the Government amendment that the Secretary of State has asked the House to support. It is remarkable for the fact that it makes no reference at all to the extent of the shambles in the medical training system. I assume that the amendment will win the day this evening, but anyone reading it would not have any understanding of the scale of the discontent in the medical profession resulting from what has happened.

All those involved are left in a state of some despair, because the problem was so avoidable and because the damage that has been done—and the likely disruption still to be faced—have had such a negative impact on the NHS and the morale of the doctors on whom we all rely. Today, the Secretary of State repeated her apology to junior doctors. She was right to do so, because of the stress and anxiety caused to so many young professionals who have committed themselves to the NHS.

Although the impact has been most severe on junior doctors, who feel that their careers are hanging in the balance, consultants too have been left completely frustrated and angered by the utter incompetence that they now have to remedy. They are faced with having to try to clear up the mess by undertaking a vast number of extra interviews in a short space of time.

Of greatest concern, however, is the impact on patients. When doctors have rock-bottom morale, it is not good news for patients. What about the impact on patient care of the recovery programme—all the extra interviews that must take place during May? What will happen on 1 August? I shall return to those questions.

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