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“has lacked clear leadership from the top for a very long time.”
Others have used that quotation and I make no apology for repeating it. We have to ask what he meant by “the top”; I leave Ministers to draw their own conclusions. Professor Shelly Heard was similarly scathing as she quit as MMC national clinical adviser.
The courageous hon. Member for Wolverhampton, South-West (Rob Marris), in a thoughtful intervention on the Health Secretary on 16 April, asked who would be held to account for the debacle that we are examining today. She replied in her trademark, rather breezy fashion:
“As far as I am aware, no disciplinary or performance management steps are being taken in the Department, but no doubt that can be considered as appropriate.”—[ Official Report, 16 April 2007; Vol. 459, c. 48.]
So nobody has taken the rap for what doctors have described as the biggest crisis to hit British medicine since the start of the NHS.
The hon. Member for Bassetlaw (John Mann) suggested that Ministers should avail themselves of the services of the Cranfield or Henley school of management. Of course, those schools teach leadership, which is what is needed now. Next, my hon. Friend the Member for Gosport (Peter Viggers) underscored the seriousness of the crisis. He asked that Ministers give the House regular situation reports as the reviews go on. That is important, given the enormity of the problems facing the NHS.
Much of MMC and MTAS has been designed to remove the influence of the old boy network—I suppose that one can call it that—that Ministers believe has been responsible for the appointment of junior doctors in the past. NHS Employers is a metastasis of the Government’s cheerleader, the NHS Confederation. In its briefing note, it identifies the twin crimes of “patronage” and “bias” in the appointment of junior doctors. In its zeal for reform, it does not pause to consider at what terrible cost those sins have been purged. Many will believe that the Health Secretary’s surgery has been somewhat worse than the disease.
Apart from the drearily predictable NHS Confederation, there have been remarkably few apologists for the mess over which the Health Secretary has presided. Let us set aside for a moment the administration of MTAS, which has caused so much heartache, and focus on modernising medical careers. We can applaud the intention to move forward to a more focused, competency-based training that reflects what has been happening in other trades and professions, and in other countries. We hope that training will be more flexible and, as women make up half the medical work force, that it will facilitate a better work-life balance. It is surely right that doctors are better able to communicate with patients and colleagues, and that communication is a key element in any training or assessment process. Modernising medical careers recognises that, but we have grown an inflexible monster that forces early job choices on young doctors that will be difficult to move out of and into. Practical experience will be curtailed and all of a sudden that “second to none” training about which the Health Secretary boasted in her speech last week is beginning to look far less robust.
MTAS is truly remarkable. In place of a CV and hard data encapsulating hard-won academic qualifications and clinical experience, applicants are invited to furnish a load of soft mush. Other hon. Members have mentioned scoring, and the hon. Member for Stafford (Mr. Kidney) referred to that. The essential concern is that the influence of PhDs, for example, has, as we discussed earlier, been eclipsed by offerings in essay form that are made up at short notice and in a way that, as my hon. Friend the Member for South Cambridgeshire (Mr. Lansley) noted, is capable of being imparted in a course that costs very little.
Certainly, the current system encourages creative writing and theatricality. No doubt they are invaluable attributes, but they are hardly core competencies for aspiring consultants—even, if I may say so, for consultant surgeons. I understand from a written answer sent to me on 13 March that MTAS will cost £6.3 million over five years. Can the Minister who will wind up the debate confirm that that does not include the cost of the paraphernalia of failure—review groups, appeals, judicial reviews and so on? I assume
that it does not, because last week the Health Secretary admitted that she did not know how much the review that she had announced would cost.
On 16 April, the Health Secretary said of the extra resources required by the first—the Douglas—review that
“the service around the country will in many cases need to release consultants from their planned activities in order to make time available for the additional interviews.”—[ Official Report, 16 April 2007; Vol. 459, c. 45.]
What assessment has the Minister made of the cost in front-line patient care caused by the crisis? What will be the impact in the next few weeks of the redeployment of medical staff apparently necessary to patch up MTAS? How many operating lists will be cancelled, how many clinics scratched, and how many ward rounds foregone?
The hon. Member for North Norfolk (Norman Lamb) is worried about logistics, costs and wastefulness, and rightly so. I am delighted that the Liberal Democrats will support our motion this evening.
On 19 March, the Health Secretary said that
“shroud-waving about unemployed doctors is absurd”—[ Official Report, 19 March 2007; Vol. 458, c. 582.]
On 16 April, we had more assurances from the Secretary of State when she said that she wanted to take
“the opportunity to refer to the thoroughly misleading statements made in recent weeks about the prospect of thousands of junior doctors finding themselves without work. This is complete nonsense.”—[ Official Report, 16 April 2007; Vol. 459, c. 46.]
Dr. Murrison: The Health Secretary is nodding. In contrast, however, NHS Employers has at least some grip on reality. We learn from its leaked report of how it is desperately scratching around for jobs abroad to offer doctors who it recognises will be unemployed on 1 August. The NHS Employers briefing paper talks optimistically of service posts that have been converted by employers into training posts. How many of those have there been after Lord Warner’s announcement of 13 December, and how many more does the Minister anticipate? Other hon. Members have made that point already, and it is important that we know the numbers involved.
While NHS Employers has been trawling the world to see where it can park unemployed British doctors, has it asked our EU neighbours how they might help? Given that many of the available training billets in the UK will be going to European economic area doctors, it seems reasonable to ask where the reciprocity is. The right hon. Member for Birkenhead (Mr. Field) spoke about banning European doctors, and that point may be germane here. Certainly, we recognise that the treaty obligations into which we entered—rightly or wrongly—forbid us from banning European doctors. That is simply not possible, but NHS Employers might consider Europe as it trawls around the world. Many Labour Members have been greatly exercised in the past by unpaid researchers attached to MPs’ staff. In a like manner, are they not concerned that officials are entertaining a scheme to hive unemployed junior
doctors off into voluntary service overseas? What would be the precise terms of such an arrangement?
Heaven for junior doctors will be a place on a run-through training programme. The Government are saying, “Get that and you’re well on your way to consultant status, in due course. Fail and you’re set for a grisly series of fixed-term specialist training appointments, so-called locum appointments for training, a re-run of your second foundation year”—how depressing must that be?—“Undefined academic appointments of the sort we thought MMC was designed to address, professional ‘locuming’ and a constellation of low-grade, non-training jobs. You’ll be part of your postgraduate dean’s euphemistically styled ‘talent pool’, to be fished out when something vaguely suitable turns up.”
I hope that that “something suitable” does not involve working in a supermarket, as happened to the constituent of my hon. Friend the Member for Mid-Bedfordshire (Mrs. Dorries). The lost tribe of senior house officers is set to become nomadic as they drift from hopeless job to hopeless job with little chance of breaking out, in stark contrast to the previous flawed, but far less rigid, milieu. It is little wonder that so many dedicated, expensively skilled professionals are set to quit the UK and the NHS, as my hon. Friend the Member for Croydon, Central (Mr. Pelling) pointed out, and even to quit medicine altogether.
The Health Secretary’s fulsome apology last week was indeed appropriate, but junior doctors facing the prospect of being hung out to dry want to know why she is not joining them.
6.48 pm
The Minister of State, Department of Health (Andy Burnham): The hon. Member for Westbury (Dr. Murrison) is right to say that this has been a good debate, and I shall do my best in the time available to answer some of the points that have been raised.
This matter is of fundamental importance to the country. We must ensure that patients get the best possible care from highly trained and motivated staff, but we recognise that there has been a significant impact on the lives and careers of those dedicated and hard-working staff who are applying to progress their training as doctors in the NHS. Young people and their families will be watching today’s proceedings closely, and we know that they will have gone through considerable anxiety. I know from the e-mails that I have received—and I am sure that other hon. Members of all parties have received similar messages—that there has been considerable anxiety about this matter. It is right for the Government to address that and to give people practical information so that we can map a way forward.
My right hon. Friend the Secretary of State began by setting out the principle of modernising medical careers. One of the interesting things about today’s debate was the degree of agreement on both sides of the House, expressed by almost every Member who spoke, about the principles behind MMC. The programme has the potential to benefit both doctors and patients in the NHS and it is important to note that its foundation stages have been successfully introduced. We believe that we can build on that success.
The difference between us and some Opposition Members is that they suggest that all the measures were hatched in secrecy in the Department of Health and that we did not involve anybody else in drawing up plans for this stage of the implementation of the MMC programme. That is not the case. We have worked closely with the Academy of Royal Medical Colleges, the BMA, NHS Employers and others over a long period. However, we are not washing our hands of the issues. We have tried to face up to them, but the important thing is to take action now to help people and to put in train a wider review of the system so that when this year’s process is over, we can ensure that lessons are learned and that, in time, we can bring in a strengthened system.
The suggestion crept into many of the comments today that there were no unfairnesses or problems in the old way of doing things. That simply is not the case. If we accept the principles of MMC, we must also accept that there were myriad unfairnesses in the old system. The difference is that those unfairnesses were not out in the open, in the transparent way that they are now— [ Laughter. ] It is because they are transparent that we can work through the issues that have been identified and create a fairer training system for doctors.
The hon. Member for North Norfolk (Norman Lamb) made a speech that was good in many ways. He, too, endorsed the principles of the programme and observed that patronage and bias had been problems in the past. Despite the laughter from the Conservative Benches, the hon. Gentleman was right to identify those problems. He suggested that the system was too inflexible—a point raised by the shadow Secretary of State in his opening remarks. I draw the attention of both Members to one of the points in Sir John Tooke’s terms of reference:
“the lack of flexibility available to trainees on run-through programmes”.
Sir John will examine that specific point in his review.
The hon. Member for North Norfolk spoke about the lack of a pilot for the scheme. In fact, the electronic portal for foundation recruitment was piloted in 2006. The application form was based on an existing form used in the London area, and the current form was piloted pre-launch in at least two deaneries. At the end of the day, we can review the programme and consider whether there was enough piloting and I shall take on board the conclusions of the review. However, it is not the case that the scheme was rushed through with no attempt to consult or to pilot.
The hon. Gentleman asked how many extra interviews would be required. Originally, 26,000 non-GP interviews were scheduled. The number of extra interviews required following the Douglas review will depend on how many junior doctors change their first preference. As the hon. Gentleman knows, that process has been going on over recent days so it is obviously too early to give him the figures. However, we estimate that guaranteeing one interview for each eligible applicant will require between 13,500 and 23,900 interviews. The number will depend on how many doctors change their preference. We shall of course need to balance the requirements of the
service—another point made by the hon. Gentleman. We believe that the provision of extra interviews in round 1 is likely to reduce the number required in round 2, but we shall work through that issue as we go further down the line.
We shall not know how much additional cost will be incurred until the end of the process. However, the proposals have been agreed with the deaneries and NHS Employers. We believe that is the right action to take, because it will bring back a degree of fairness and meet the complaints we faced—that the system was unfair and people were being denied opportunities. Like the hon. Member for Westbury, the hon. Member for North Norfolk asked about the provision of care to patients during the period of the review. We shall not relax any service standards or targets.
The hon. Member for North Norfolk asked my right hon. Friend the Secretary of State about the 700 posts that are to be added. Originally, a small number of one-year posts was held over for round 2. After the review group’s recommendation, those posts were loaded on to the system for the extended round 1, so the 700 posts will soon be available on the system. I hope that that answers his question.
My hon. Friend the Member for Bassetlaw (John Mann) made an interesting point, which again goes back to the principles of the MMC programme. He asked about the needs of communities such as his, where traditionally there have been problems in the recruitment of both hospital-based staff and GPs. My area is in a similar position. My hon. Friend the Member for Houghton and Washington, East (Mr. Kemp) pointed out that in his area, too, there were real difficulties in recruiting more GPs. MMC is being introduced to ensure that we can address those recruitment problems, especially for shortages such as that of GPs in the north of England. In principle, the scheme enables people to move from over-subscribed to under-subscribed specialties and we believe that the review group’s proposals for early announcement of recruitment for GP training will encourage applications in that field, which has traditionally been under-subscribed.
The hon. Member for Gosport (Peter Viggers) asked about double cohorts and why we could not guarantee everybody a place. May I give him a snapshot of the situation? At present, about 3,000 senior house officers are training in surgical specialties, feeding into about 500 specialist training opportunities for surgery. It is the case, as it always has been, that not everybody can be a consultant surgeon. The difference is that under the old system people hung around trying to progress their careers, but could not obtain opportunities to do so.
Mr. Lansley: Will the Minister give way?
Andy Burnham: I have very little time and I want to do justice to the Members who spoke in the debate, if the hon. Gentleman will forgive me.
Like other Members, the hon. Member for Gosport spoke about the double cohort—[Hon. Members: “Give way.”] When I have answered the hon. Gentleman’s point I will give way. There has never been any restriction on applications for sought-after training posts—it is not a feature of the new system. Indeed, I
am sure that the hon. Gentleman would be the first to agree that it would be wrong if the Government imposed restrictions on people in staff grades applying for those posts, so I am not sure that he was raising a valid point.
Mr. Lansley: Our motion calls for SHOs who are not able to obtain entry to specialist training this year to have opportunities to do so next year and the year after. Will the Minister confirm that the Government will ensure that that is the case?
Andy Burnham: I was coming to that point, but first I wanted to do justice to the excellent and thoughtful speech made by my hon. Friend the Member for Stafford (Mr. Kidney), as well as to other points that were raised. The shadow Secretary of State makes an important point—that we must do what we can to ensure that help and support is available for doctors displaced this year. Of course, they will be able to apply in future rounds in future years, even if they are applying from a non-training or staff grade post.
There is much more we can do this year. We are working with the service to maximise the number of job opportunities available in and leading up to the end of the 2007 recruitment round. We will invite any displaced doctors to register on NHS Jobs and NHS Professionals so that they can quickly and efficiently be matched to the vacancies that will continue to emerge, to training posts and to locum appointments, as was always the case. Posts will become available in any normal year.
We will work with the postgraduate deaneries to maximise the number of training opportunities available within the overall number of job opportunities. In particular, we will undertake urgent work with the medical royal colleges and the service to establish the need for additional training posts. We will ensure that doctors who take up jobs in service grade posts continue to have support to ensure that the training and development opportunities in those posts are maximised. Those unsuccessful this year will be able to reapply next year. They will also be able to apply for posts that emerge, as they always have, through the course of the year. I am glad that the shadow Secretary of State raised that issue because I am pleased to put that point on the record.
I fear that I cannot do justice to all the sensible points that were made in the debate in the time that I have left. I conclude by saying that we recognise the anxiety that this year’s round has caused. We have not sought to dismiss it; we have sought to engage with it and come up with solutions to give people real answers to the difficulties in which they find themselves. Implementing quickly the recommendations of the review group will further help the position that people find themselves in and, crucially, will give support to people who have been displaced by the process and will help to enable them to progress their careers as they had hoped to do.
I am grateful to colleagues for their contributions to the debate. I hope that we can agree a measure of consensus that will provide a good, workable training system for the NHS that will stand us in good stead for many years to come.
Question put, That the original words stand part of the Question:—
The House proceeded to a Division.
Mr. Deputy Speaker: I ask the Serjeant at Arms to investigate the delay in the Aye Lobby.
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