Select Committee on Health Minutes of Evidence


Examination of Witnesses (Questions 691-699)

MS ANNE RAINSBERRY, DR MOIRA LIVINGSTON AND MS SIAN THOMAS

24 JANUARY 2008

  Q691 Chairman: Good morning. Could I welcome you to what is our fifth evidence session in relation to our inquiry into MMC. I wonder if, for the record, I could ask you to introduce yourselves and give the position that you hold. Can I start with you, Anne?

  Ms Rainsberry: Anne Rainsberry, Director of People Organisation and Development, NHS and I am a Member of the new MMC England Programme Board.

  Dr Livingston: Moira Livingston, Head of Workforce, NHS North East and Deputy Medical Director; previously a Member of the Modernising Medical Careers team on the staff grade area of work.

  Ms Thomas: I am Sian Thomas and I am here representing NHS employers. We are the employers organisation for the NHS supporting and helping employers implement best practice around employment.

  Q692  Chairman: Thank you and welcome. A question to all of you. Do you accept that the 2007 MTAS process was a disastrous experiment in workforce planning?

  Ms Rainsberry: I do not think it was absolutely disastrous in workforce planning, no. I would agree, actually, with the evidence that the CMO gave to the Committee. I think there was one particular variable, which was the late decision on IMGs, which changed the projections quite substantially. If that had not been the case, in effect, the projections, in terms of demand and supply, would have been pretty much aligned.

  Dr Livingston: I would agree with Anne. I think the issue was the difficulty in predicting the number of doctors who would apply for the posts available. In terms of workforce planning, looking at the number of training posts and how that fits with future service delivery, that was well in place. I think with the increased number in specialty training posts, there was effort to target those in terms of workforce planning needs according to locality and capacity to train. I think, where possible, attempts were made to align the developments that were needed, but it is very difficult to predict the number of applicants at that point.

  Ms Thomas: We believe that evidence from employers shows there were many good things about MMC, and we welcome the opportunity in this session to tell the panel about that. There are two issues that we think did affect the failures around MMC. One was the high volume of applicants, which has already been commented on, and the second was the failure to take into account a transition period and a big bang approach to, effectively, a large cohort of doctors, and that led to a sense for them of a last chance attempt to get into specialty training. So, it was those two factors: the high volume of applicants and no transition.

  Q693  Chairman: You were a member of the Douglas Review.

  Ms Thomas: I was.

  Q694  Chairman: Which recommended a single interview for English candidates last year. Did the NHS Employers put pressure on the professional members to ensure the jobs were filled by the 1 August deadline and do you accept some responsibility for the way that many of your employees were treated during the subsequent months?

  Ms Thomas: I endorse many of the things that you have heard Professor Douglas say this morning. In fact, his transcript would pretty much reflect our view. The review group, at the beginning, was in a very difficult situation, but all partners agreed that to carry on was the best thing. The 1 August date was critical because we only had weeks to go to ensure the service had these doctors in place to deliver Save Patient Care, which the service was relying on, so employers fully supported those decisions; and behind every representative's evidence that I gave, we had over 150 employer views backing that. Increasingly, we based our decisions on evidence. It is always easy in hindsight to go over those decisions, but I think, on the whole, the review group did the right thing and tried to base its proportionate decisions to make a good outcome for the August service delivery pressure.

  Q695  Chairman: Could I ask Anne and the Moira: by how much were medical education budgets cut in your areas in the lead up to the implementation in 2007. Do you accept that budget cuts were a major cause of the failure of the MTAS system?

  Dr Livingston: I think in the north east there were, in fact, no budget cuts to the deanery. We receive a deanery investment plan every year and we met the requirements of the deanery. If we look at the increase in training numbers, since 2005, 2006, when the deaneries became the responsibility of the SHA in the North East, there has been an increase in training numbers, overall 58%, and if we look at the specialty training, training numbers, they went up by 71%, with general practice being less, at 22%. So that commitment to training, in terms of the number of trainees in the system, I think, is evident. At no point have we had any sense from the deanery that they were under-resourced. If we look at this year and our commitment to delivering the MTAS process as efficiently and effectively as we could, then I think that we can demonstrate from the SHAs perspective that we invested a further £1.6 million in the delivery of the MTAS process, which included additional posts as part of transition as well as meeting the Secretary of State's commitment to on-going employment from 1 August and the transition arrangements for doctors to help them become more competitive for next year.

  Q696  Chairman: So no cuts as far as you are concerned?

  Dr Livingston: No.

  Q697  Chairman: Anne?

  Ms Rainsberry: It is a similar picture to the North East. There were cuts in 2006-07, and I gave evidence to this Committee last time we talked about workforce planning. The majority of those cuts came from non-medical education. Because of the nature of the way the contracts are set up with medical education, it makes it very difficult to do that. In London, since 2005, the numbers of specialty training posts have increased by 65% and, therefore, we have had to invest in the infrastructure to support that. I think it needs more investment, and we have just gone through a process with our own deanery of looking at their three-year strategy to look at how we would tailor that investment, but certainly, in relation to your question, I do not think there was a relationship between the problems that were experienced in the recruitment to specialty training in the last year and the degree of investment, and, indeed, as Moira has alluded to, SHAs used their flexibility quite substantially in order to smooth the bulge of trainees in their unit of application to help transition. That was funded by SHAs.

  Q698  Dr Naysmith: Before I go on to ask the question I was going to ask, can I ask Anne and Moira: you have both said there were no cuts in postgraduate training, but are you not just talking about the salaries, paying the salaries? Is there not a separate little budget that is supposed to be used for courses and that sort of thing? Lots of people tell us that the budget was cut.

  Ms Rainsberry: Let me clarify my answer. I said the majority that came from non-medical education. The financial position in London last year was really quite serious, and as an SHA we had to create the right platform in order to take the service forward, like other parts of the country, and therefore there were some reductions, temporary reductions.

  Q699  Dr Naysmith: For that year?

  Ms Rainsberry: For that year, which have been restored.


 
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