Select Committee on Health Minutes of Evidence


Examination of Witnesses (Questions 760-765)

MS ANNE RAINSBERRY, DR MOIRA LIVINGSTON AND MS SIAN THOMAS

24 JANUARY 2008

  Q760  Dr Taylor: These sorts of posts could be a long-term worthwhile alternative if they are organised correctly?

  Dr Livingston: They need to be.

  Q761  Chairman: Earlier I quoted from what was said to us in our session last week from a post-grad dean. He said that in some parts of the country outside of the Southeast these were the best cohorts of trainees they had ever had in post-grad trainee. Could I ask you, Moira, do you have a view about that?

  Dr Livingston: Yes. We have had regular meetings with employers across the patch throughout Round 1A, Round 1B and Round 2. After Round 1A the employers were absolutely certain that they were very positive about the recruitment they had made from Round 1A. Round 1B, for them, was felt to be an add-on which was not necessary to assure them of getting the highest calibre, but we understand nationally the need for it and support the decision that the Programme Board made. We have also seen improved recruitment in areas where that has been a challenge in the past and general satisfaction with the quality of the doctors who have been appointed.

  Q762  Chairman: A marked difference from years gone by?

  Dr Livingston: I do not think I am able to say a marked difference but I would definitely say satisfaction with the quality of recruitment.

  Ms Thomas: I have already given some examples of the real case studies we have had. I will just make two points. I do agree broadly with that statement but we have also heard of very excellent doctors who have not got into their specialty. The recruitment process did generally give us high calibre people and generally some employers who have not been able to recruit are recruiting, but the real question is did we discriminate between good doctors and excellent doctors. We did get reports from consultants that they were unable to do that through some of the recruitment process. I think the general answer to that is "yes", but it is a "yes, but we may not actually have the right doctors". One example of that I would give where there is real concern is on the clinical academic recruitment. We were unable to recruit posts to the clinical academic structure in some parts of the country and we are not quite sure if we have got the really excellent clinical academic doctors we need for the furthering of scientific research. In a year where new money was injected into that programme, where we really need to give emphasis on encouraging doctors not only into clinical medicine but academic medicine and research, that is absolutely critical to get right. Broadly, yes is the answer but I do not think that fits for every single situation. A final point I would want to make about recruitment issues is you have heard a lot of evidence as a Committee about the redesign needed of this huge change programme and time is getting on. We have a process for 2008 which we think will run smoothly but is a one year local fix, if you like. We have got increasing concern from employers that we should not repeat the mistakes we have made before, if you like. Huge change needs time, it needs testing and it needs stakeholder engagement. I really do not know if we are going to have all of those things in place for 2009. We talked to John Tooke and his team about this. We may even be talking about 2010 or 2011 before we have the actual solution for the longer term and we must be courageous and stick to our guns if we think that is the right thing to do and not rush headlong into something for even 2009 which is not the right solution.

  Q763  Chairman: I was just going to give the last word on the question I asked to the Southeast.

  Ms Rainsberry: We bear out what has been said in that our fill rate in London was the lowest we have known it, so there obviously was a redistribution that was going on. The question of whether gold standard doctors, the stars, were not getting into training is probably right, but the reason for that was because they persisted in going for being a cardiothoracic surgeon and the reality is you have lots and lots of stars going for that. Despite giving lots of advice and lots of support, it is very difficult to dissuade people when they have set their heart on it. On 2009, the MMC England Programme Board has just started to consider that and will be considering it in more detail at the next meeting. Just to offer some reassurance, there are a lot of stakeholders around the table saying exactly that. We need to look at what is the change that is required and then how long it will take to implement that change properly, not to say we must do this by 2009. That is certainly the tenor of the discussion at the moment.

  Q764  Dr Naysmith: I wanted to pick up what on what Sian said. Obviously we do not want discrimination, we need to eliminate discrimination, but I have been around medical schools most of my working life and there have always been some people who were disappointed at not getting into their preferred speciality. It seems to have been highly focused this year but it is something that has always happened. The other thing is, it has always been relatively difficult to recruit into academic medicine, particularly with GPs getting the salaries they are getting now, and some of the consultants. Being an academic and spending a lot of your time doing research as well as seeing patients is not as attractive and never was as attractive to some people, unless you are obsessed with becoming a medical scientist. Both of these problems have been in the system for a long time.

  Ms Thomas: They have, absolutely.

  Q765  Dr Naysmith: It is not true to blame them, despite—

  Ms Thomas: No, but we should expect a change through MMC to deliver improvement, that would be the point to make.

  Dr Naysmith: Yes, we can always make things better.

  Chairman: Thank you for coming along and helping us with our inquiry.





 
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