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Finally, as I told the House yesterday in relation to the recent security breaches of the online application service, a full security review of the MTAS system has now been completed and validated, and appropriate action taken to deal with the problems. The site was, therefore, reopened last week for the use of postgraduate deaneries only, to support the next steps in the recruitment process, including continued monitoring in line with MMC principles. Because the
investigation has made it clear that criminal offences may have been committed, the full security analysis and report have been given to the police.
Mr. Lansley: I am sorry that the Secretary of State did not volunteer a statement and I am also sorry that today, in responding to my question, she said nothing more than she said in her written ministerial statement yesterday, yet many questions require answers.
The Secretary of State has effectively abandoned MTAS. It will not be used to make offers in round one and it will not be used at all for round two. In her statement, she said that there would be further substantial opportunities in round two, but junior doctors need to know what that means. She has not told usalthough she must knowhow many training posts have become available through round one. In early April, the British Medical Association said that 18,500 training posts had been advertised and the Secretary of State must know how many eligible applicants there are. Originally, there were more than 34,000. How many are there now? That figure will give us a basis for establishing how many junior doctors are likely not to have training posts after round one.
We need to know how many additional training posts there will be. The Secretary of State has still not told us how many will be created. The House will recall that on 19 March, when she responded to our first urgent question, I called for the creation of additional training posts. The Department asked NHS trusts to bid for such posts by 27 April and we are now approaching the point where those posts need to be put into the application process, yet we do not how many there are or where they are.
It is vital that junior doctors know how many of the available posts are run-through training posts that will take them all the way to specialty status and how many are fixed-term or temporary training posts. The balance between the two matters tremendously, not least because if thousands of junior doctors do not obtain training posts this year, they need to know that there will be scope for additional run-through posts for complete specialty training starting next year. If they do not know whether those posts are available, they may choose to leave the profession or the countrya decision they may be making in weeks, not months.
Will the Secretary of State tell the House why it has proved possible for the Scottish deanery to supply all the applicants with the four interviews they were originally promised, yet a guarantee of only one interview is possible in England? Will the Secretary of State understand and acknowledge that although we talk about junior doctors, they are actually people who have gone through five years of undergraduate medical education, a year of pre-registration as house officers and, in many cases, several years of academic and clinical experience? These are the people who are quite likely to be the doctors we rememberthose who treat us when we go to hospital. They are senior professionals and the way in which they are being treated is appalling.
Even at this late stage, these people do not know where they will be working on 1 August. It may be anywhere from Cromer to St. Albans in the eastern region. [ Interruption. ] Perhaps they would prefer to be in CromerI do not know. That issue is absolutely
essential. These people have families to look after and careers to pursue. They have husbands, wives, or partners who have their own careers that cannot simply be picked up and dropped somewhere else in the country at five weeks notice. That is what the Secretary of State and the system are requiring of them. When will the Secretary of State acknowledge that these people cannot be treated as numbers on a computer system, especially when the computer system crashes? They have to be treated as individuals.
Will the Secretary of State now take responsibility for all this? In a survey published in The Lancet yesterday, 95 per cent. of doctors said that they regarded the performance of the Department of Health on this issue as miserable. As she did on Channel 4 last night, the Secretary of State takes refuge in saying that the principles of MMC were agreed with the profession, but those principles included fair and effective recruitment, flexibility, and a wider career choice. Those principles have not been delivered; they have been undermined by the implementation of the MTAS process. No wonder that Sir John Tooke in his review is having to go back to ground zero to review the principles as well as the implementation of medical education and training.
Does the Secretary of State recall the document that I have in my hand? It was an internal document from her Department last July and it looked at the communications needs of MMC-MTAS. It referred to having to communicate with chief medical officers and Ministers. How did the document describe Ministers status last July? It referred to:
High awareness, low understanding of details and complexity.
That is the position that Ministers were in when they were in the midst of preparing for this shambles. The Secretary of State cannot chuck away the responsibility for this matter. She has to take responsibility for it. Will she now understand that the only way to do that is to resign?
Ms Hewitt: The hon. Gentleman has raised a number of points, some of which we have covered in the House before. I have already explained the position with MTAS. The online application system has not been abandoned. In the light of the security review and the improvements that were made last week, it was reopened to the postgraduate deaneries, which will continue to use it for the recruitment process.
The hon. Gentleman talked about the need for junior doctors to know how many training places will be available after round one. Of course they need to know, but we will not know how many training places have been filled in round one until round one is completed later in June. We know and have already discussed in the House how many posts there are. The overall total for the UK as a whole is about 23,500. That includes the general practitioner posts, which have been dealt with under a separate system. The remaining posts have been made available via MTAS. Of those posts, just under 12,000 are run-through training posts, 3,488 are fixed-term posts and 182 are academic posts. Those figures are for England. For the UK as a whole, the figures are just over 14,500 run-through training posts, 4,392 fixed-term posts and 185 academic posts.
Those figures are all in the public domain and have been for some time, but the number of training posts that will be filled in round one and therefore the number that will be available for the next recruitment round will depend entirely on the decisions of interviewing panels. Those decisions will be taken only as the interviews are completed for each group of posts. The interviews are still taking place this week, although we expect them to finish early next week. The interviewing panels will then decide how many job offers to make to the candidates they have rated as appointable, and the candidates will then decide which of those job offers to accept. That process for round one will be completed towards the end of June. The expectation of the postgraduate deaneries is that the majority of posts will be filled in round one, before the end of June, but that there will remain a substantial number of training posts available to enable further recruitment to take place, including the extra training posts that we will announce shortly.
The reason why we have not yet been able to announce the number of additional training posts is that it was not possible to begin to decide where those additional posts should be placed until we knew exactly how many candidates there were for different specialties. We did not know that until the candidates had exercised their right, as a result of the review groups excellent deliberations, to change their first preference. I realise that this is complicated and that Opposition Members might not be interested in the detail, but understanding and sorting out the detail is essential, so that is precisely what we are doing.
As the candidates have now all reprioritised their applications, we know how many candidates there are for each specialty, and that information has been published. The Department, the review group, the royal colleges, the deaneries and the hospitals are now deciding where the additional training posts should be made available in such a way as to meet the needs of the service and patients. I am afraid that there is no point in creating large numbers of additional training posts if the service itself has decided that it does not need that number of jobs.
The hon. Gentleman said that Scotland has offered all candidates four interviews. It has indeed done so, and the review group examined whether that would be possible in England, where, of course, the numbers are a great deal larger. There were certainly junior doctors who were pressing for that to happen. The review groupin other words the royal colleges and the British Medical Associationdecided, quite rightly, that it would be impossible to give every applicant four interviews for the simple reason that consultants would have to abandon patients completely to carry out four interviews for every candidate, regardless of whether those candidates were initially shortlisted. Every candidate is getting at least one interview, while manyprobably mostwill get more than that.
It is a great pity that the hon. Gentleman has made no recognition at all of the admirable work and dedication of people such as Carol Black, the chairman of the Academy of Medical Royal Colleges, Jim Johnson, the chairman of the BMA, and their junior doctor colleagues who, through the review group, have helped us to put in place the necessary arrangements for this yeara difficult year in which problems have
arisento ensure that this years system will be as fair as possible to junior doctors and will continue to meet the needs of patients. Those are our priorities, and I will continue to deliver on them.
Barbara Keeley (Worsley) (Lab): When I wrote to my right hon. Friend a few months ago to outline the comments and concerns of the daughter of one of my constituents, who is training in the Leicester area, she gave me a helpful response. Does my right hon. Friend agree that to support my constituents daughter to move through the process, it is right that we persist and work through any difficulties, rather than heeding any calls to abandon the recruitment process? My constituents daughter and the consultant with whom she was working have put in thousands of hours on this across the piece, and it would be wrong to change and abandon the process at this point.
Ms Hewitt: My hon. Friend is absolutely right. The BMA and the royal colleges made precisely that point at the end of last week and again yesterday. If the process was abandoned, as is being sought through the judicial review, it would mean simply throwing away the enormous amount of work that has been done by consultants in the current interview round and junior doctors themselves. That would be the wrong thing to do, which is why we are not going to do it.
Norman Lamb (North Norfolk) (LD): Is not the real scandal that the Secretary of State has ploughed on regardless with a fatally flawed system that has caused massive strain to junior doctors and potentially compromised patient care? Does she not concede that it would have been better if she had listened to clinicians and junior doctors right at the startwhen the chaos first emergedand suspended MTAS at that point, rather than having everyone go through such a costly exercise over the past few weeks?
I have asked previously about cost. What is the cost of the MTAS system, and what is the cost of remedying and handling the crisis that has occurred? The Secretary of State previously referred to a breach of contract that she believes has taken place. Is legal action being taken, and is she considering terminating the contract with Methods, the supplier? Despite her announcement, the selection system for interviews remains unfair. Is she considering the proposal that we make the posts temporary training posts until a fairer system can be introduced? Also, the 1 August problem remains. Is she listening to the concerns raised by senior consultants, who think that there will be chaos on 1 August, as everyone will start their new job on that date?
Will the Secretary of State clarify what progress is being made on the 15,500 extra interviews? How on earth can there be sufficient time, after those interviews, for families and individuals to relocate for their new job before 1 August? She mentioned that criminal offences are alleged to have been committed. Will she give more details on what criminal offences are being investigated? Finally, is not the truth of the matter that the capitulation was simply the result of the legal action being taken by Remedy UK, or is it just a coincidence that the statement was made yesterdayjust one day before the judicial review application was
due to be heard in the High Court? Is it any wonder that a survey published yesterday shows that 90 per cent. of consultants have lost confidence in the Secretary of State?
Ms Hewitt: The hon. Gentleman says, once again, that we should have just abandoned the whole system at the outset. That was the first possibility that we and the review group considered. Far from ignoring the views of doctors and consultants, we listened to them by working directly with the royal colleges and the British Medical Association, including its junior doctor representatives, through the review group. I remind him that on 4 April the review group said that it had looked seriously at
all of the options available, including a full and detailed analysis of pulling out of the current selection process completely. In the end
it was simply not a credible option. It would be impossible to place the best candidates in posts and fulfil the service needs in time for August using the old system of recruitment. We believe we have come up with the best available solution for England.
The group believed that at the time. I endorsed its view and I continue to do so, and that is why we will certainly not abandon the present system. I am surprised that the hon. Gentleman is continuing on that track. As I just said to him, if we did abandon it, we would be throwing away the thousands of hours of work and effort that junior doctors and consultants have put into the tens of thousands of interviews that have taken place, and that are still taking place. Those interviews will lead to job offers being made from next week, and to posts being filled.
The hon. Gentleman asked about the cost. The cost in 2006-07 of the online MTAS system, including set-up costs, is £1.9 million. That is for the UK as a whole, and it was therefore funded by all four UK Health Departments in proportion. In each subsequent financial year of the contract, the costs will be less than that, although we will, of course, want to take account of any recommendations made by the review led by Sir John Tooke on the use of MTAS for future recruitment rounds. As for the costs of the changes that had to be made this year, it is not yet possible to estimate them; we will do so in due course.
The hon. Gentleman asked about temporary posts and the changeover date of 1 August. As I have said before, that changeover date of 1 August has always applied to most junior and trainee doctor rotations, so it is not a new challenge for NHS hospitals to ensure that they have the necessary staff in place, and that the care of patients is properly maintained. Perhaps I could draw his attention to what Dame Carol Black has said on the subject:
It isn't true to say that patient care will be put at risk. Delivering patient care is a team effort and all consultants who conduct interviews will have ensured that their services are covered.
A much greater risk to patient safety would be not to have doctors in place on the 1st August.
We are now working with the service, as I have said, to ensure that the doctors are in place to care for patients,
and that trainees who have not accepted or been made a job offer in round one are properly supported and are not left high and dry; of course, we will not allow that. Finally, the hon. Gentleman asked about details of potential criminal offences. Of course, I am not in a position to say anything more on that subject, and I am surprised that he asked.
Dr. Alasdair McDonnell (Belfast, South) (SDLP): Would the Secretary of State care to expand on her comments on proper support? That is the crux of how we take the issue forward. It is fine for the people who get a job in round onehopefully, they will know whether they have got a job sooner, rather than laterbut my concern is about the other people involved. Often, a couple of trainee doctors will live together. They may be married, or they may not, and they might have children. They may get jobs at different ends of the country, and the children would have to be uprooted from their schools. That is the human dimension of the problem. It is important that proper support measures are put in place, and that all the junior doctors who are not successful in round one know that those measures are in place, so that we can ensure that people continue to have the talent and skills to provide for the health service. Will the Secretary of State expand on the subject of proper support, and tell us how the people affected will be properly supported and provided with jobs?
Ms Hewitt: My hon. Friend raises an extremely important point, and it is precisely on those issues that the review group, the Department of Health and Ministers are currently concentrating. First, the important point to stress is that junior doctors, in making their applications and choosing their first preference, will have taken account of where they, their families and sometimes their partners will want to be, and that of course will guide not only the offers that may be made, but also the acceptance of those offers. As I have already indicated, we anticipate that those offers will start being made next week, and the round one process, in which offers are made and junior doctors accept them, should be completed before the end of June.
Of course, as I have said before, we need, value and want the skills and dedication of junior doctors in the NHS, and we want them to continue to care for patients in the way that they already do. That is why we will ensure that they get proper support, are not left high and dry, and can continue in appropriate employment while they apply for further training opportunities, which, as I have said, will be available beyond round one. We will also ensure that the service continues to have all the doctors available to it that it needs if it is to continue to care for patients in the excellent way that has led, as my right hon. Friend the Deputy Prime Minister just said, to more than nine out of 10 patients rating their care in hospital as good, very good or excellent in an independent survey. That is a tribute to all the doctors and other professionals in the health service, including our junior doctors.
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