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I was describing the personal tragedies that have happened because of the way in which the system has been introduced. I want to remind hon. Members who were not here eight days ago when the Secretary of State made her statement to the House that, on that occasion, I made the point that this concerns
individuals who each demand more respect from the system—and the people administering it—than they have been getting over the past few months.
In fairness to the Secretary of State, she has apologised at least three times for what has gone wrong with the system and for the distress that that has caused to those affected. One review has proposed changes that are about to be introduced, and she has also announced a further, broader review, which has been mentioned today. The shadow Secretary of State made a temperate speech today, with many good points. One of them was about the independence of that review, and the importance of all of us having confidence in its deliberations and conclusions. That is an important point for the House to make.
Meanwhile, making a success of the first review, with its guarantee that every junior doctor who applies for a post and states their first preference will have at least one interview, is placing a terrific strain on managers and consultants to deal with the extra work that they are being asked to do over the short space of time between now and August. It is fair to say that they are the hidden heroes who are solving this problem right now, and they deserve our thanks. The hon. Member for North Norfolk made that point earlier. A number of consultants wrote a letter to The Times earlier this month to say that they had been placed under a lot of pressure, at a time when they had plenty of other work to do to meet the demands of patients and the NHS. We owe them a debt of gratitude. That letter, incidentally, also called for the scrapping of MTAS and a return to the previous system, so although I said that no one in this debate had asked for that to happen, other people certainly have. We should remind ourselves, however, that the previous system had serious faults too. It did not find a specialty training place for every junior doctor either.
If the Minister listens to the shadow Secretary of State, and to my hon. Friends who have said the same thing, he will realise that there is the prospect of a win-win situation. My hon. Friend the Member for Bassetlaw (John Mann) made the point that certain areas are short-served by the NHS at the moment, and we could create a win-win situation by expanding the number of training places available for junior doctors in those areas and in specialties where there are shortages. Perhaps those shortages exist because people do not want to take on those specialties, and it would be wrong to force anyone to do something that they did not want to do, but this could give us an opportunity to ask people to look again at specialties where there are shortages, in which they might be able to do a good job. We could create a win-win situation by filling the posts that we need to fill and finding places for the people who want them. I hope that the Minister will be able to respond to that point later.
I want to put forward some points on behalf of a doctor in my constituency with whom I have had a good, spirited correspondence on his concerns about modernising medical careers. He and I agree that we are unsure about the evidence on the number of available posts and the number of people applying for them. Obviously, the more transparent Ministers can be about this, the better it will be for people who have fears—whether politically motivated or not—about
what is happening. It is clear, however, that there are fewer training places than there are people applying for them.
My doctor correspondent makes the point about the double cohort, observing that
“increased numbers of medical students are passing through their second foundation year and needing specialist training. The shortened training also has a big impact on the large number of senior house officers who also need to find a place on the new training pathway.”
The two cohorts are coming together at the same time. He also makes the point that non-EU doctors are competing for those posts. He concludes:
“The new doctors in their second foundation training year have no chance of success against the more experienced senior house officers and the non EU graduates.”
I do not know that, and I bet that most people in the House today do not know it, because we are not sure whether we have enough confidence in the system to say whether that is the case. The doctor goes on to say that
“MTAS has had to make its mark by designing an application form in which experience counts for virtually nothing. Selection is largely from the psychology questions which have no tested validity in this field. The marking of these questions is also widely variable between different markers.”
All those factors have undermined confidence in the system so far.
I shall not name the doctor without his permission, but it is important to get his views on record. His letter goes on:
“I should tell you that this whole exercise has also been an opportunity for government to reduce the ‘power’ of doctors and their representative bodies.”
Such allegations can be made, and can sound reasonable, because of the mess that we are in at the moment.
There has always been competition for posts, and some people will always find themselves in short-term posts because they cannot get the specialty training that they want. I was pleased to hear the Secretary of State say that support will be available for such people after this year, but will my hon. Friend the Minister tell me more about their prospects in future years? Can they always expect to be treading water and becoming what some people call the second lost tribe, or will they have the prospect of moving on? It is in the context of their fear that they will have nowhere to go that we hear the constant talk of people being forced to emigrate to find a job.
I shall return to the effect that all this is having on my constituents. It is demoralising for them to hear that the state is paying to train bright young people to provide a service that everyone wants and values, only to see them emigrate because they cannot be given a post in their own country. That is very harmful.
Mr. Leech: Does the hon. Gentleman acknowledge that some doctors will be left without a job, or does he agree with the Secretary of State, who seems to think that there will be a job for everyone?
Mr. Kidney:
The hon. Gentleman cannot have been listening to what I have said. Under the previous system, not everyone got the specialty post that they applied for, so they did something else. They still had a
job, however. The Secretary of State has said that nothing in the new system will change that basic fact. If someone does not get a specialty training place, they will still have a job. That is the point of my question to the Minister. What are the prospects for those people who still have a job, even though it is not the training post that they want? That is a reasonable question.
I mentioned earlier that a university in Stafford offers health training. Admittedly, it does not train junior doctors, so I will not push my luck too far in talking about issues other than modernising medical careers. I want to make the point, however, that there have been superb improvements in medical training in recent years. There have been some great developments, from foundation degrees to professional doctorates. In terms of continuing professional development, relationships between NHS employers and training providers have been much improved, including the excellent development of mentors for newly qualified doctors and other health professionals. Much better recognised training and qualifications have been developed for those in the support teams for doctors and consultants. For example, last week, at Staffordshire university, I heard about training for operating theatre staff, the pilot for primary care staff, and the current deliberations about whether help can be provided in the training of care home staff. We should celebrate all those excellent developments.
Everyone I listed at the beginning of my contribution has said that better work force planning is needed. Nobody would disagree with that. We are dealing with one of the biggest work forces in the world, not just in the country, so it is understandable if it presents more difficulty than others. Clearly, good work force planning involves listening and research, engaging those who know what is happening and have expertise to offer, piloting changes before implementing them more widely, on which I agreed with the hon. Member for North Norfolk, and, having carried out pilots, conducting proper evaluation before the final implementation. If there are lessons to be learned from today, I hope that the Minister will accept that those points cover some of them.
6.1 pm
Mrs. Nadine Dorries (Mid-Bedfordshire) (Con): I thank Remedy UK and the junior doctors for the lobby that they organised in a professional and effective way. You were not in the Chair, Mr. Deputy Speaker, when the Public Gallery erupted, rather naughtily, into spontaneous applause earlier. They managed to do something that Opposition Members rarely achieve, no matter how many hours we debate for: to make Government Members hang their heads in shame—
Mr. Deputy Speaker (Sir Alan Haselhurst): Order. I am sorry to interrupt the hon. Lady in full flow, but it is customary not to refer to anything happening outside the Chamber.
Mrs. Dorries: I apologise, Mr. Deputy Speaker.
There are 650 MPs in the House, and I do not know how many of us have three As at A-level. I would imagine, however, that the number is in single figures. Junior doctors have had to plan from childhood to become doctors—deciding that they want to do so
when they do their GCSEs and choose their A-levels—because it is incredibly hard to get the results necessary to go into medical training and pursue the career with determination for six or seven years.
The Opposition have agreed that medical careers needed to be modernised, because the system did not work as it did in the past. As a nurse, I know that. What doctors did not need, however, was a computer system that failed hopelessly and abysmally, application dates for interviews extended by days, data lost and the computer system crashing. Junior doctors did not know what was happening to their applications, when or where—or if—their interviews were being held, or whether they would have a training position.
Nor did junior doctors need uncertainty, particularly those who have families or are dependent on their jobs or salaries, as we all are. We are all dependent on knowing how much we will earn this year, particularly if we have a mortgage to pay. Thousands of junior doctors do not even know whether they will be able to make their mortgage payments, let alone whether they will be able to pay any debts that they may have brought with them out of university or medical school, or whether they will be living in a particular area with their families or working in a particular region.
Justine Greening: My hon. Friend is making some excellent points. Anyone with primary school-age children is possibly going through the process now of working out which primary school they will be starting in September.
Mrs. Dorries: I thank my hon. Friend.
Although we are not allowed to refer to what is happening outside the Chamber, I can legitimately bring some of the comments made by junior doctors to the House’s attention. There has been much speculation about how many doctors will not have jobs, and the figure seems to range between 9,000 and 11,000, so we can safely say that it will be about 10,000. We know that the Department of Health is in discussion with VSO about finding employment for our junior doctors, which is a shameful position for the fifth largest employer in the world to be in.
Mike Penning: I could not agree more with my hon. Friend. Will not that just delay the problems, because once doctors have done the wonderful work that they can do with VSO, they will come back to the country and have no jobs?
Mrs. Dorries: Absolutely. The majority will come back and look for jobs, and we will be faced with the problem later.
Moreover, were I a junior doctor, I might not want to go and work for VSO. I might want to stay in this country. I might have a family and a mortgage, and might want to continue my career in the UK. Dr. Sonia Heyer, of Harrow, Middlesex, said:
“As a junior doctor who may be unemployed this summer as a result of the present recruitment fiasco, I was delighted to learn that we may be required to seek employment with voluntary services overseas.
I would go, provided I could secure the company of the present Secretary of State for Health, in which case I would gladly accept a mapless mission to the Amazon jungle.”
She is a braver woman than I—I would not want to go with the Secretary of State for Health. Junior doctors, however, are facing no employment during the summer, or perhaps going to work abroad with VSO, which is not what they want.
The Secretary of State has largely chosen to ignore the problem that she knew, as my hon. Friend the Member for Gosport (Peter Viggers) described, was a train wreck in slow motion. As the Chancellor was warned of the pensions fiasco, I am sure that the Secretary of State was warned of what would happen with a double cohort. Another doctor, Dr. Judith Secker, described the process as follows:
“It was the equivalent of taking a decision for all children to leave school at the age of 17 instead of 18. In the year when the change came into effect, all the 17-year-olds and all the 18-year-olds would be seeking university places (or employment)”
at the same time. We all know that that would be a complete shambles, and that is what we are faced with today.
I am sure that the Secretary of State was warned about what was going to happen, but what was put in place to deal with it? Absolutely nothing. We have two cohorts of junior doctors looking for placements all at the same time, which has caused unnecessary competitiveness between them, indecisiveness, uncertainty and worry. One doctor, a junior orthopaedic surgeon, has said that three junior doctors in the past two months have burst into tears on his ward because they do not know whether they will have a job from 1 August.
The fact is that our doctors do not know whether they will be earning a salary. If they do not want to work for VSO, where will they go? A junior doctor in my constituency, as a midwife in my constituency has done, has applied for summer work at Waitrose. That doctor has done seven years’ training and 12 months in a hospital. What kind of Government tell our junior doctors to spend their summers working in Waitrose?
I do not want to take up too much time, and I want to allow other Members to speak, but I have some questions that I want to ask the Secretary of State. Will she let us know what will happen to the 10,000 doctors who will not be in employment? Will they be offered compensation? Will they be found work somewhere other than abroad? Will she leave 10,000 doctors without jobs? We need an answer. What will happen to those doctors? If they are unemployed, she will hear a lot more about it. Actually, I am not so sure about that, because the matter will come to fruition and hit the headlines in August, and I am sure that she will not be in her current position by that date.
6.9 pm
Mr. Andrew Pelling (Croydon, Central) (Con):
I greatly enjoyed the engaging speech of the hon. Member for Bassetlaw (John Mann), who stressed the importance of proper allocation of public resources. However, it cannot constitute the best application of public resources to spend a quarter of a million pounds on the training of every junior doctor, and then to face
the prospect of so many leaving the country to be employed elsewhere in the English-speaking world.
This afternoon I met four junior doctors, all of whom have had job offers within a very short period—in Brisbane, Singapore and Toronto. Almost all are at the specialist training stage, and they could be described as emblematic of the problems created by MMC. Often those who have made the most progress in their training are most affected. It is a great shame to see £1 million of investment and training going elsewhere, as I did when I met those doctors today. The hon. Member for Bassetlaw would think it a great shame as well if he recognised that this misallocation of resources will make it difficult for his constituents’ needs to be met.
Mr. Kemp: The hon. Gentleman has rightly raised the allocation of public resources. Many innovative health authorities, including those in my area, are paying GPs salaries rather than giving money to their practices and giving doctors a quasi-self-employed status. Does the hon. Gentleman support the move towards salaried GPs?
Mr. Pelling: It is certainly worthy of debate, but I want to concentrate on the Secretary of State’s approach and what it means to my constituents who came here today. Apparently they will have jobs in the NHS, but not necessarily in their particular specialties. It is rather like telling a promising young libel lawyer that he or she can have a job as a conveyancing solicitor. What those doctors heard from the Secretary of State today was not about jobs for GPs; she seemed to be saying that they might as well emigrate, and with great immediacy take the training jobs that are being offered to them elsewhere in the English-speaking world.
I have seen the Department’s leaked document revealing the desperate measures that will be taken to try to find jobs for doctors somewhere in the NHS. The suggestion that somehow jobs can be found in accordance with the model in the highlands and islands of Scotland shows how desperate the situation has become for the Government. Junior doctors cannot retain much confidence in the system when—as my hon. Friend the Member for South Cambridgeshire (Mr. Lansley) pointed out—they see such a demonstration of the arbitrary nature of the selection process. I know of a consultant who had to deal with 650 applications in four hours. The 150 that were not dealt with went straight into round two.
As others have said today, a large number of applicants are not sure whether their applications were even considered. They cannot judge whether they were rejected on grounds of merit or whether their applications were simply neglected. Many junior doctors will look at the MMC site, which states boldly:
“Progress through each stage of training will be through open and fair competition using nationally standardised application forms and guidelines.”
However, the oblique standardised forms that replace CVs mean that junior doctors can have no confidence that they have been able to give full expression to their talents or suitability for a post.
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