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Mr. Pelling: Notwithstanding the bold statement that the process is fair, it can only mean that people who have invested not only years of training, but before that many years securing the necessary qualifications to begin that training, are being given a most unreasonable deal. I would not be at all surprised if the junior doctors whom I met today said, This is the last straw, and took up those job offers abroad, which are better than anything that the NHS can provide.
The new system involves a great deal of uncertainty. Others have spoken of the danger of court action. There are questions to be asked about the quality of the curricula to be provided, and also about the standing of the medical training that our country provides. That standing is important not only to junior doctors but to the United Kingdom as a whole, but the gold standard is in danger of being compromised.
It is always difficult for politicians to recognise that they have made mistakes, and we are grateful that the Secretary of State has been able to apologise. However, as the hon. Member for Bassetlaw observed, it takes leadership to be able to recognise that it is time to cut ones losses. If junior doctors are to be given the confidence that will enable them to stay in this country, they must be offered the prospect of jobs in the NHS through the provision of training jobs in the first place. If we are not to lose a quarter of a million pounds worth of training for all the junior doctors who will depart these shores within the next few months, we must accept what the Opposition motion says. Jobstraining jobsmust be given to people who have invested so much of their time to become junior doctors and serve the people of this country.
It seems that whatever topic is raised, it is possible to choose witnesses and evidence. The briefing from NHS Employers glosses over all the difficulties. The date of 1 August has always been a nightmare, because junior house officers have always changed over on that date. The fact that senior house officers and registrars did not do so in the past has made it slightly easier, but I fear that there will now be a disaster. NHS Employers says:
Employers are working with their consultants and junior doctors now to ensure that services for patients are not adversely affected by the change in timing. This is vital as employers need to be confident that well qualified doctors are in place to deliver safe and high quality patient care from August 1 when the new training programmes are available.
Sadly, as the House knows, there are no junior doctors in training in my patch, but as one of the few ex-hospital doctors in the House I have had a great many letters from such doctors. To obtain an accurate assessment of the position outside, I wrote to Hospital Doctor asking for comments from senior consultants involved in training. I invited comments in support of MTAS and comments in condemnation of it. I received
exactly 40 letters: one expressing support, one expressing qualified support and the remaining 38 expressing tremendous worry. These are not whingeing letters from consultants. In contrast to the opinion of many Members, consultants work very hard for their patients, and the relationship between a consultant and his junior staff wasI hope that it still is in some waysthat of a father and their family. I remember consultants whom I worked for who were father figures, and I hope that I, too, was such a figure to my juniors. Therefore, I take seriously the comments of consultants.
I cannot express those comments except by reading some quotations, so I have selected brief passages from four of the letters, which I want the Minister to hear. A correspondent from the north-east wrote:
It is almost beyond belief that the MTAS online application form, which ignored qualifications and previous experience and relied on answers to fatuous questions, was introduced nationally without validation or piloting. Widespread scepticism and concern was expressed by a large majority of colleagues who attended MMC Recruitment and Selection Training courses with us, which was ignored.
I have personally witnessed the devastating effects this process has had and is having on our highly trained junior doctors
I have personally seen weak candidates being offered 4 interviews and very strong, able candidates being offered only one.
If the madness continues, then in August there will be many unfilled junior hospital jobs and many junior doctors without jobs...this will be dangerous for patients...and the effect on junior doctors cannot be overestimated.
We will have contrived a situation where many English trained graduates leave the country and we import doctors to fill the places.
I have been dismayed by the unfolding disaster that is the Medical Training Application Process. I have discussed these problems with many senior and junior colleagues and know that their views are much the same as mine,
We have let down all these young doctors, as well as damaging the present and future health care of patients. Equally important we have lost our reputation for medical training. This is true nationally and abroad. I have just returned from a trip to Malaysia where I spoke to doctors, university educators and other professionals and the common views expressed were amazement at how the UK got itself into this mess and secondly that they would no longer consider it wise to send their bright young people to the UK to train in medicine.
Other problems include the stupidities in the scoring systemsuch as applicants getting two points for having a PhD and four points for their 150-word description of their personal qualities. There are also problems to do with the time involved for consultants drawing up the shortlists, let alone interviewing, and the fact that the interviewers do not know whether applicants have put their institution as their first
choice. Also, to interview all applicants who put a particular training option first would be impossible without cancelling clinics and operations. The knock-on effect on spouses and families has been referred to; such families will now face uncertainty, and there might be splits between partners and between parents. The short time that is available to relocate is also a problem, as are the costs to the NHS of relocating.
Although some of our leaders are still trying to find a compromise...the bare minimum to restore confidence in our medical students and junior trainees would be disbanding PMETB and MTAS.
I regard the British parliament as the most democratic institution in the world.
I hope that the House will listen to the voice of grass-roots hospital doctors, and realise that when something is deeply unfair and wrong there is not a compromise to be had, and that instead there must be a restart.
Justine Greening (Putney) (Con): I am pleased to be able to contribute to the debate because, like other Members, I have received many letters from constituents, many of whom are directly involved in the process or who have brothers or sisters or more distant relatives who are directly involved in it. Many of them have been extremely concerned about what has happened. I wish to take this opportunity briefly to express some of their concerns in their own words.
One wonders why they bothered to commit so much time and energy to a profession to have their ambitions potentially shattered in a flawed process. Many of our junior doctors at my hospital are in a worse position and have no interviews and nothing to hope for at all.
process is spectacularly breaking down.
A series of 8 tree-hugging questions with 150 word answers
replaced any common sense when it came to qualifications, aptitude, and professionalism in order to assess the candidate. Any idiot could have answered those questions well.
I took along my portfolio and my cv and offered to show it to the interview panel and they told me that it would not be necessary.
How can we expect good recruitment decisions to be taken when CVs are not even looked at? Another person who got in touch with me was a candidate in a Birmingham interview session which was cancelled at the last minute. Another described the system as a
vastly unfair, harsh, draconian punitive selection procedure
on all junior doctors within the UK. Lives are being destroyed as we speak and the UK will lose its brightest and best doctors of a generation if it is not stopped.
nothing short of a disgrace. The future loyalty to the NHS of these young people on whom we shall depend will have been lost. They have absolutely no confidence that they will be fairly treated now or in the future.
Many Members have been made aware of similar cases involving people who had spent many years training to become doctors and who had almost got to the final hurdle only to find that it had been taken away; they were not even allowed to jump over it at the beginning of this unfolding shambles. The situation is depressing. Getting the Government to take action has been like pulling teethto use a medical simile. Over a period of several months, the Minister and the Secretary of State have had to come back to the House to continue to explain what is happening in respect of this unfolding disaster.
One clear way that we can tackle this matter and give some genuine confidence to the junior doctors who are listening to the debate, and to those who will read about it tomorrow in Hansard, is to vote for the motion before the House. That will give them the confidence that the necessary training posts will be in place over the next few years to help us work through this crisis in a measured way, which is what we need to do.
I want to ask the Secretary of State about the Tooke review. It is obviously easierand, given the judgment calls already made by the Department, more appropriateto get out of this mess by subcontracting it out to Sir John Tooke. However, in her opening speech the Secretary of State said that Sir John might make recommendations to the House earlier than August if he considers it appropriate to do so. Why is that not her decision? Surely it is appropriate for junior doctors to know much sooner what is going to be done about this problem, rather than having to wait until the end of the summer. By that time, many will have already taken alternative decisions about their careers. People cannot just put their lives on hold until this Government manage to talk their way out of this shambles.
I have another question for the Secretary of State and for the ministerial team who have been involved in this process. What will happen if Sir John Tookes review uncovers further problems, if the shambles develops in an even more dramatic way and, as my hon. Friends have suggested, we get to August and many junior doctors are left redundant? What will it take for the Secretary of State to say that enough is enough regarding her and her teams role, and to take voluntary redundancy, which many people in her Department have done? Whose career prospects are being damaged morethe
Secretary of States, or those of the many junior doctors who will not get a second bite of the cherry, once they have lived through this shambles?
This is not good enough, and it certainly is not the best year ever for the NHS and the doctors whom we have been discussing today. The NHS has been fundamentally financially mismanaged in the past decade. As an accountant, I was astonished to see financial boom in the NHS followed by bust. Such boom and bust is largely responsible for the destabilisation of recruitment in the NHSan issue far broader than the catastrophe that MTAS has created. How many more shambles have to occur before the Secretary of State takes genuine responsibility, instead of continually subcontracting Government policy out to other people and putting off taking decisions?
The situation is urgent for those involved; they have not got until August to wait for answers. If the motion before the House is accepted, that would at least provide them with some certainty about their roles and what will happen in the coming years. It would give us the chance to take a thorough look at what has gone wrong, and to consider in detail what needs to be done. As I have said before, as someone who has been in business I know that when many different issues unravel over time one needs to take a step back and to look at the fundamentals of what is going wrong. However, our junior doctors cannot wait for an holistic review process. We need to give them some certainty by voting for the motion before us.
Having read this debate in tomorrows Hansard, not many people will have much confidence in this Government and their ability to deliver and work their way through these dramatic problems. It is not just doctors who are concerned about the recruitment process. I have no doubt that many nurses throughout the country who are finishing their training courses will be shuddering at the prospect of the process that they will have to go through to find a job over the summer months. It is not good enough to be told that we are having a review, and that there will be no answers before August.
The Secretary of State referred in her opening speech to creating some additional training posts. It is incumbent on her to give the House a sense tonight of the number of such posts. What is the approximate number? What is too low, and what is unrealistically high? That is what we and junior doctors need to know. I doubt whether many of us have much confidence in the management team at the very top of the Department of Health. Frankly, the sooner that that team is changed and we have people who can run professionally an organisation that so many of us depend onwhether we work in it or are treated by itthe better.
I start by declaring my interest as a registered medical practitioner, although mercifully I am not one of those caught up directly in the shambles that we have been discussing, or one of those involved in events
outside this place today. A number of us went outside to speak to the representatives of Remedy UK and to listen to what they had to say. I recommend that Ministers listen to what they have to say to them, too, because they have done a wonderful job in highlighting this issue to Members.
The whole concept of MMC had some merit but the way it has been planned and carried out is nothing short of scandalous.
That is a pretty good way of epitomising what many of us feel about this issue. The hon. Member for Wyre Forest (Dr. Taylor) gave a series of worrying accounts in a similar vein from other consultants throughout the country. My hon. Friend the Member for Putney (Justine Greening) gave further evidence from junior doctors who had written to her with personal stories of how this catastrophe has affected them in a direct way. In her excellent contribution, she was right to askas a number of other Members didthat the second, Tooke, review be truly independent. That means that when Sir John Tooke chooses his team, its membership should not include those previously involved in this process, because they would inevitably bring to the debate preconceived ideas. It is important that this issue be approached with fresh eyes.
We Conservatives have always supported the evolution of a consultant-led, increasingly consultant-delivered service, and we support the principles of MMC that underpin it. We can, of course, debate points of detail such as the removal of the influence of the medical royal colleges and their replacement by the expensive training quango PMETB in 2005. It is salutary to remember that those are the same UK royal colleges whose supervision of medical education and training was described by the Health Secretary on 16 April as second to none.
However, having agreed with the Government in principle, we turn to implementation. At the heart of this, of course, lies MTAS. As he threw in the towel as MMCs national director, Professor Alan Crockard said that MTAS
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