Select Committee on Health Third Report


1  Introduction

1. In March 2007, thousands of junior doctors took part in public demonstrations in London and Glasgow. Their protests were followed over the next few weeks by the resignation of several leaders of the medical profession, a legal challenge to the Secretary of State for Health, and a series of emergency statements in parliament. The source of this acrimony was a new recruitment system for selecting junior doctors for training places, the Medical Training Application Service (MTAS). The introduction of MTAS was part of a wider reform programme known as Modernising Medical Careers (MMC).

2. MMC, established in 2003, was a set of changes aimed at addressing long-standing problems with the UK medical education system and the wider medical workforce. MMC aimed to address the uncertain career prospects of the "lost tribe" of Senior House Officers and to make medical training more flexible and more streamlined. The implementation of the initial phase of change was relatively successful, with a new Foundation Programme established in 2005 for medical graduates.

3. The subsequent introduction of new arrangements for hospital specialty training in 2007, however, ran into serious difficulties. The MTAS national selection system was seen as unfair by many applicants and suffered serious operational problems. Large numbers of overseas doctors were allowed to apply freely for UK training posts, creating intense competition in many areas. The rigidity of the new "run-through" training system and the lack of planning for transition left many UK doctors facing the apparent prospect of long-term unemployment.

4. The Department of Health acknowledged problems with the recruitment system and established a Review Group to consider the future of the selection process. The Review Group decided not to scrap the MTAS system altogether, but made repeated changes to recruitment, heightening uncertainty. A legal challenge by the pressure group RemedyUK called for the recruitment process to be abandoned; the challenge was unsuccessful but the High Court verdict described the new recruitment system as "disastrous". Following serious security problems, the on-line recruitment system was subsequently discarded anyway. The majority of training posts were eventually filled in advance of the 1 August deadline, but many doctors were left with uncertain future prospects and bitterness and resentment of the new selection system remained rife.

5. The 2007 crisis was the subject of intense media coverage and caused a breakdown of relations between the Department of Health and the medical profession, as well as considerable strife within the profession itself. In response, the Department established an independent inquiry led by Professor Sir John Tooke to look at the causes of the 2007 problems and the changes required to restore confidence in the MMC programme. At the end of July 2007, the Committee agreed to hold an inquiry to examine MMC and to consider the findings of the independent Tooke Inquiry. We announced an inquiry with the following terms of reference:

  • What are the principles underlying MMC and are they sound;
  • To what extent the practical implementation of MMC has been consistent with the programme's underlying principles;
  • The strengths and weaknesses of the MTAS process;
  • What lessons about project management should the Department of Health learn from the failings in the implementation of MMC;
  • The extent to which MMC has taken account of the supply and demand of junior doctors and the number of international medical graduates eligible for training in the UK;
  • The degree to which current plans for MMC will help to increase the flexibility of the medical workforce; and
  • The roles of the Department of Health, Strategic Health Authorities, the Deaneries, the Royal Colleges and the Postgraduate Medical Education and Training Board in designing and implementing MMC.

6. We received more than 60 written memoranda from wide range of organisations and individuals and held six oral evidence sessions between November 2007 and February 2008. We took evidence from a range of groups involved with medical training, including Royal Colleges, Postgraduate Deaneries, the Postgraduate Medical Education and Training Board (PMETB), the BMA and RemedyUK. We also heard from officials from the Department of Health, the Home Office and the Foreign and Commonwealth Office, and from the Secretary of State.

7. The first three chapters of our report describe the complex events which surrounded the high-profile crisis of 2007. We look in turn at:

  • The background and early stages of the MMC programme (Chapter 2);
  • The 2007 crisis itself (Chapter 3); and
  • The initial response to the crisis and the outcome of the independent inquiry (Chapter 4).

8. In the final four chapters we look thematically at the key issues raised by the 2007 crisis and by the Tooke Inquiry. We build on the fine analysis provided by the Tooke Review but do not cover all of the same ground. We also discuss many of the Review's recommendations, particularly for changes to the structure and organisations of postgraduate training. We examine in particular:

  • The medical workforce, including debates about the structure of the training system and of the wider medical workforce (Chapter 5);
  • The supply of doctors to the UK, focussing particularly on the role of overseas doctors (Chapter 6);
  • The management of the MMC programme by the Department of Health (Chapter 7);
  • The roles of other organisations involved with medical training, such as the Postgraduate Deaneries and PMETB (Chapter 8).

9. The Committee would like to thank everybody that gave evidence. We are particularly grateful for the expert advice which we received from our specialist advisors: Professor Charles Easmon, Dr Fiona Moss and Professor Morris Brown.


 
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