Examination of Witnesses (Questions 680-690)
PROFESSOR PETER
RUBIN, PROFESSOR
NEIL DOUGLAS
AND PROFESSOR
SIR NICK
WRIGHT
24 JANUARY 2008
Q680 Dr Stoate: I am asking you for
your opinion of what you think is a reasonable level of over-demand
for posts compared with supply.
Professor Douglas: My basic stance
would be that people who have trained in the UK, who are highly
competent, should have a reasonable chance of getting a job. That
does not translate into a competition ratio.
Q681 Dr Stoate: Your position is
there ought to be a job for every applicant.
Professor Douglas: Not necessarily
in the area in which they wish to work.
Q682 Dr Stoate: No, but a job.
Professor Douglas: A job. I do
believe we need more doctors in the country and I do believe that
we have a lot of very, very talented people who have been grossly
disadvantaged by MTAS.
Professor Rubin: Your question
shows why we need effective management workforce planning. I do
not know what the right competition ratio should be. I do know
that nearly 60% of medical graduates now are female. I know that
medical graduates male or female want a life of the sort that
we did not have when we were young doctors. We do not know what
the impact of these changes will be and we need to get a handle
on this. I do not want to be misinterpreted as saying that every
doctor is guaranteed a job for lifeI am not saying that
at allbut I think we have to be sensible about workforce
planning in this country and we have to decide whether we really
do want to be self-sufficient in doctors or not. If we do, that
has implications well beyond the Department of Health. We really
have to get our head around the changing patterns of the workforce
in the future. That is not being done at the moment.
Professor Sir Nick Wright: Speaking
as a medical school head, I think Dr Marshall said to this Committee,
"T'was thus ever so". There has always been stringent
competition but never at this level. If you think about the aspirations
of my students and the aspirations of people coming towards medicine
in the next five years, they want a reasonable chance of fulfilling
their career ambitions. That is where I am coming from. We certainly
do not want to disenfranchise a whole generation of medical students
and prospective medical students by "gold medallists",
for example, who want to do cardiology, having to do psychiatry
because they cannot get a job in cardiology. By all means, let
us have competition, but let us have a reasonable level of competition
and let us try to solve this current level by increasing the number
of junior training positions. You could argue very cogently for
a longer training because of the European Working Time Directive,
certainly in the craft specialities, and that would help solve
this problem, and, also, de-linking the number of junior staff
with the number of consultant positions.
Q683 Dr Stoate: The GPs are calling
for a five-year training programme. Would you broadly think that
is a good idea?
Professor Sir Nick Wright: Yes,
I do.
Q684 Dr Naysmith: Why is it always
that people end up talking about psychiatry when they want to
indicate that if you want to be a brain surgeon
Professor Sir Nick Wright: That
was just an example.
Q685 Dr Naysmith: I know it was just
an example but it is amazing how often it comes up, and yet, if
one third of the population need treatment for mental disorders,
should we not be providing more doctors in this area and better
training?
Professor Sir Nick Wright: Let
me give you two examples from the last round of MTAS where there
were two candidates for psychiatry positions who both had MB PhD
degrees from the University of Cambridge who were not short-listed
for any psychiatry jobs in the country.
Q686 Dr Naysmith: That in itself
is a bad thing. I am just pointing out that it could well be that
the country needs more psychiatrists, highly qualified, well trained
ones, than brain surgeons at the moment.
Professor Sir Nick Wright: Absolutely;
as I would want try to make sure that the people who want to do
psychiatry are able to do psychiatry.
Professor Douglas: It is one of
the findings of our review group that there were very few UK graduates
who wanted to go into psychiatry, obs and gynae and paeds, and
we need to rectify that.
Q687 Mr Bone: This is not a party
political point because I am well out of tune with my own party
on this issue, but is it not strange that this unique state-run
health system that we have cannot match the number of people it
puts in with the number of people it wants? If you are like me
and think there should be a great expansion in the number of doctors,
et cetera, are we not being held back by the state plan. Presumably
in other countries they do not get these imbalances, or do they?
Professor Rubin: It varies from
country to country. In the USA, for example, they take a very
pragmatic approach, in that they under-produce doctors and then
buy them in. You can argue about the ethics of that very seriously,
but that is how they do it. It comes back to having to have a
serious, mature debate at the national level of what sort of health
service we are looking for and how many doctors do we need in
this country and, having decided that, are we going to produce
them all ourselves or are we going to have a mixture of home-produced
and abroad. We need absolutely clarity and honesty about that.
Dr Stoate: Could I just say that there
is a massive imbalance across Europe. For example, Spain, Italy
and Germany produce quite a lot more doctors than they need, who
often have to come to this country for further training because
they cannot get posts abroad. It is not an issue that just is
facing us.
Q688 Chairman: From the evidence
session of the postgraduate deans last week, I am going to leave
you with a couple of quotes I would like you to comment on. David
Sowden said, "There are elements of success in the sense
that DGHs, which historically outside the South East in particular
have had real difficulty in recruiting good quality staff, are
singing the praises of the people they have recently appointed.
Speaking to my specialty training committees, many say that this
is the best cohort of trainees they have ever had in postgraduate
training ... " Professor Thomas, from my area of the UK,
said, "In particular, Hull has said it has the best doctors
that it has ever seen and many others have said the same, particularly
DGHs across Yorkshire and the Humber which have had difficulties
in recruiting doctors. This year they have had much better recruits."
Would you agree with those comments or do you have any knowledge
of that?
Professor Douglas: I think those
are perfectly reasonable comments. Some places have benefited
from people looking beyond their normal horizons as to where they
should be applying. My understanding for this current year is
that there are going to be areas where there are relatively few
applicants, still, and areas where there will be a vast surplus,
so we have not solved the balance, but I am sure there are other
areas that will benefit.
Professor Rubin: I am not surprised
to hear this. A personal view with regard to MTAS is that just
because it was implemented badly this time does not mean that
MTAS is bad in principle. UCAS works well and has been respected
for many years. UCAS results in good applicants, through clearing
or whatever, going to universities they may not otherwise have
gone to, but if MTAS is properly implemented then there is no
reason why it could not work as well as UCAS with the benefits
to which you are alluding, which is that very able doctors go
where they might not want to go.
Professor Sir Nick Wright: I would
agree with that. UCAS, as far as medical school admissions goes,
is extremely well implemented. Most medical schools will, after
short-listing from UCAS, form interviews for themselves. We know
a structured interview is just about the only thing that does
correlate with success in medicine, so it is a well-trodden path.
If MTAS was implemented correctly, with CVs and appropriate interviews,
then we would have much more confidence in it.
Q689 Chairman: The picture we have
painted about what happened last year is one of complete disaster.
I am saying that my constituents are benefiting by what happened
last year, in so far as, when they go to Rotherham District General
Hospital, the doctors they have there now are a better cohort
of doctors than they have had in years gone by.
Professor Sir Nick Wright: That
may well be true. At the same time, if you have individuals who
are going into specialities they did not want to get into and
they are having to do a speciality which they had no plans to
do ... Of course they will do it to the best of their ability
but then we have stories of people stuck in specialist training
without the ability to change because of lack of flexibility.
I am sure that this is a success story so far as DGHs in the provinces
are saying but, if you think about the personal aspirations of
those doctors, then we have to consider this, because of successive
generations of students who may find that their ambitions are
not going to be realised.
Q690 Chairman: My personal aspirations
are a bit clouded with the needs of my constituents in relation
to healthcare, Professor Wright.
Professor Sir Nick Wright: I am
speaking as head of a medical school.
Chairman: Could I thank you all very
much indeed for coming along here this morning and giving us evidence.
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