Select Committee on Health Minutes of Evidence


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 life—I am not saying that at all—but 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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