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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