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Schools: Ancient History

3.23 pm

Lord Faulkner of Worcester asked Her Majesty’s Government:

The Parliamentary Under-Secretary of State, Department for Education and Skills (Lord Adonis): My Lords, the Government are not content to see the withdrawal of ancient history as a free-standing A-level, and we have invited OCR and the QCA to come forward with proposals for its continuance.

Lord Faulkner of Worcester: My Lords, what a splendid Answer—gaudeamus igitur! Is my noble friend aware, and I am sure he is, that his decision will be greeted with great joy not just by the ancient historian academics who have fought so hard against this ill conceived proposal by the examinations board but by thousands of others as well, particularly the pupils in state and independent schools who are increasingly taking up ancient history because they feel it gives them an insight into the birth of democracy, the growth of Christianity and indeed the shape of modern Europe? Will he also gently remind the examinations regulator, the QCA, that it has a continuing responsibility to protect minority subjects such as ancient history which are provided by only one examination provider?

Lord Adonis: My Lords, I am grateful to my noble friend for his remarks, to which I will draw the QCA’s attention so that it can see what he said. On ancient history, which we regard as a very important A-level, the number studying at AS-level rose from 749 to 951 between 2005 and 2006, while the number of candidates for the A-level has also been increasing. I am glad to say that the number entering for Latin and ancient Greek has also been increasing. I would like to think that that had something to do with the appointment of an Adonis as Schools Minister, but I am told that it has rather more to do with successful projects such as the Cambridge classics project, outstandingly successful books such as Robert Harris’s Imperium and Tom Holland’s Rubicon, and films such as “Gladiator”.

Baroness Walmsley: My Lords, does the Minister agree that the study of the roots of our democracy through ancient history is crucial to the understanding of the importance of having a contested election rather than a coronation of the leader of the Government?

Lord Adonis: My Lords, the Romans were also quite good at dictatorship and subverting established governments, so, as ever in history, you can take your pick.

Baroness Warnock: My Lords, will the Minister also draw the attention of the examination regulators to the fact that ancient history is an extraordinarily useful subject? It is a tool subject for pupils at A-level because it teaches them in a manageable way what it is to seek and use evidence, both literary and archaeological. It is an ideal A-level subject.

Lord Adonis: My Lords, I entirely agree. I am at one with Cicero:

I assume that that is what the noble Baroness meant.

Lord Redesdale: My Lords, I declare an interest: I took ancient history A-level and did rather badly. I hope that the Minister’s comments will go into the future, because we fought the same battle over archaeology A-level. In the first round, the Government said that they were quite keen for archaeology A-level to remain, but since then it has been discontinued as an A-level subject, which is unfortunate considering the popular interest in archaeology throughout the country.

Lord Adonis: My Lords, the noble Lord is living proof that there is no such thing as grade inflation. I take his point about minority subjects, and we see it as our responsibility to safeguard them.

Lord Hamilton of Epsom: My Lords, if it was such a bad idea to drop the subject of ancient history, why did the examination board make that proposal in the beginning?

Lord Adonis: My Lords, I have no idea.

Lord Lucas: My Lords, if we are going to learn ancient history better than we ever have before, can we hope that we will learn British history in its entirety at some stage in the future?

Lord Adonis: My Lords, we are safeguarding the teaching of British history. Indeed, we have made changes to the content of British history in both GCSE and A-level that will see it given greater prominence, to meet the noble Lord’s concerns.

Medical Training Application Service

3.28 pm

The Minister of State, Department of Health (Lord Hunt of Kings Heath): My Lords, with the leave of the House, I shall repeat a Statement made by my right honourable friend the Secretary of State for Health in another place. The Statement is as follows:

“Mr Speaker, following the recommendations of the review group chaired by Professor Neil Douglas, an extended round 1 of recruitment to postgraduate medical training is now taking place. As the House knows, every eligible applicant for postgraduate medical training has now been guaranteed at least one interview for their first preference post, regardless of the outcome of the earlier shortlisting process, although many trainees of course will have more than one interview. An additional 15,500 interviews have therefore been arranged as part of round 1, and are now taking place. I am extremely grateful to the consultants who have made themselves available for these additional interviews, and to hospitals for making the time available. “The review group agreed that offers for the current round will be managed locally by individual deaneries on the basis of published MMC guidance. Subject to the outcome of the current judicial review, the first offers for hospital specialists in England will be made on or after 21 May, with all initial offers made by early June and round 1 completed by late June. Given the continuing concerns of junior doctors about MTAS, the system will not be used for matching candidates to training posts, but will continue to be used by the deaneries.“As we have stressed before, not all training posts will be filled in round 1, and there will therefore be further substantial opportunities for those who are not successful initially, including the new training posts that are now being agreed by the NHS and the Postgraduate Medical Education and Training Board. “We have accepted the review group’s recommendation that this further recruitment will be locally planned and managed by the postgraduate deaneries. Because most trainee doctors’ contracts are due to end before the further recruitment has been completed, we will be agreeing with the review group, deaneries and hospitals the necessary measures to ensure that all those trainees are properly supported and that patients continue to be properly cared for. “Finally, as I told the House yesterday, in relation to the recent security breaches of the online application service, a full security review of the MTAS system has now been completed and validated, and appropriate action taken to deal with the problem. The site was therefore reopened last week, for the use of postgraduate deaneries only, to support the next steps in the recruitment process, including continued monitoring in line with the principles of modernising medical careers. Because the investigation has made it clear that criminal offences may have been committed, the security analysis and report have been given to the police”.

My Lords, that concludes the Statement.

3.31 pm

Earl Howe: My Lords, I thank the Minister for repeating the Statement. It is almost impossible to exaggerate the extent of the disaster that Ministers in the Department of Health have presided over in relation to postgraduate medical training. The Statement represents a complete abandonment of the system of recruitment that they have been doggedly defending over the past few weeks. Yet in defending MTAS, Ministers have simultaneously left junior doctors bereft of any further information. MTAS itself has been shut down; we have seen important developments leaked to the media without any accompanying government comment. The whole process, over many months, has been characterised by poor planning, insufficient consultation and absolutely catastrophic implementation. Morale among junior doctors has been hit badly and the credibility of Ministers on this issue is now at a nadir.

Nevertheless, we are where we are and Ministers must now sort matters out. It will be helpful if the noble Lord, Lord Hunt, can answer a few central questions. Apart from the failure of MTAS, which has effectively been abandoned, one of the main concerns among junior doctors applying for posts is how round 2 of the recruitment process will work. The concerned voice from many quarters over many months has been that, in planning the number of training posts to be made available, the Government have failed to make allowance for the number of trainees coming through the foundation years in addition to those coming through the senior house officer route and that there will therefore be a bubble of applicants chasing a much smaller number of jobs. How many extra training places will there be and what proportion of the total number of such places is likely to be filled by the end of round 1B? How many training posts filled this year will be temporary or fixed term? And, in passing, why can the Scottish deanery offer four interviews and England only one?

There is an obvious dilemma for doctors who do not get posts in round 1. They need to know what other jobs will be available and where they are, and they will have to apply for these jobs before 1 August. They also need to know what happens if they do not succeed in round 2. Therefore, will these available posts in round 2 be advertised in a timely way, and to what extent will opportunities be available for entry to speciality training next year for those not appointed this year?

Alongside the uncertainty for doctors, what about the uncertainty for NHS trusts? How are trusts supposed to fill their service grade posts between the end of June and 1 August if the available pool of doctors is in the course of applying for postgraduate training posts? What contingency plans are in place to ensure continuity of patient care when the changeover of doctors’ posts occurs on 1 August?

The Minister will be all too aware that a great deal of good will is being drawn on in getting the recruitment process on to some kind of stable basis, not least the extent to which senior doctors who are having to cancel their lists are devoting large amounts of their time to conducting interviews. For their sake, as well as that of junior doctors, I hope that the Minister will appreciate the need to provide full and detailed answers to the many questions that the medical profession as a whole is asking.

3.35 pm

Baroness Barker: My Lords, when we discussed this matter two weeks ago, it was commonly recognised that something had gone badly wrong, but quite how seriously was not then obvious; it is becoming so now. Given that, the Minister would do well by the NHS if he were able to provide answers to a number of detailed questions.

The Minister has announced that the system is to be subject to a review led by Sir John Tooke. Can he assure the House that that review will be wholly and thoroughly independent of the Department of Health? Can he explain the extent of the involvement of the Chief Medical Officer in the design of the MTAS system? The Chief Medical Officer is, after all, the doctors’ doctor in government, so there is a serious concern shared by all doctors about the CMO’s role.

In the Statement, the Minister referred to criminal offences. I do not expect him to speak in detail about particular offences, but can he give us the order of seriousness of the offences that have been notified to the police?

What is the cost to the NHS of the MTAS system and the handling of this crisis? The noble Earl, Lord Howe, spoke of consultants being taken away from patient care in order to conduct interviews. Has the Department of Health made an estimate of quite how much this affair has cost the NHS? Further, what is the position of the contractor for MTAS and what is the status of its contract with the department, given the appalling level of service provided?

This year, we are going to subject doctors to a system that is patently unfair. We will have doctors who have been recruited using a system that is now widely recognised as fundamentally flawed. Does the Minister agree that there is a case for making all the appointments to posts this year for one year only, and next year introducing a system that is full, open and fair, and in which all doctors are appointed on an equal footing?

Finally, a problem at the heart of all this, one which has been ignored, is that there are not enough training places. Over 30,000 doctors are chasing 23,000 jobs. In all the four Statements that the Minister in another place has made, she has not addressed that central issue.

3.38 pm

Lord Hunt of Kings Heath: My Lords, I say in response to the noble Earl, Lord Howe, that it is clear that there have been visible problems with the MTAS system. But I stress that the Modernising Medical Careers programme came about because doctors and medical bodies found the old system unacceptable. Applicants often had to make dozens of applications, the training was patchy and it had elements of the old-boy network about it. Those very same organisations were all involved in the planning, strategy and development of the new system. It is important to keep in mind that there has always been strong support for the principles behind Modernising Medical Careers.

The noble Earl has asked me some specific questions that I am afraid I am simply not in a position to answer. That is because round 1 has not yet been completed. It is still going on; interviews are still taking place. As was repeated in the Statement, we are very grateful to the NHS trusts and to the senior consultants who have given up time to take part in these further interviews. Only when the first round is fully completed and the offers have been made—as will happen in June—shall we know how many places have been filled and, therefore, how many places will then fall to be filled in the second round.

I understand completely the point that the noble Earl makes about the need for junior doctors to have as much information as possible as early as possible. I absolutely accept that, but we are not in a position to give that information at the moment because it simply is not available. Of course, when the information becomes available, we shall want to ensure that it is put in the public domain and, more specifically, communicated with junior doctors as soon as possible.

Scotland has taken a different approach, but some of the logistics are different. In England, some of the deaneries have a huge number of appointments to deal with. After consideration by the review group, which consists of representatives of very distinguished medical bodies, it was decided to take the approach in England that was considered the most practical. It has ensured that applicants who were not shortlisted at all in round 1A were all given the opportunity to have an interview for at least their first preference in round 1B. We think that that is a pragmatic and sensible solution. It was taken after we had received advice from the review group established under the chairmanship of Professor Douglas.

I fully accept the noble Earl’s point that decisions made in relation to specialty training have a knock-on impact on NHS trusts. Again, I pay tribute to the way in which NHS trusts collaborated with the department and ensured that consultants were released to conduct interviews. He referred to a potential gap as regards some applicants moving to round 2. The relevant interviews will take place and we will set out a timeframe. The noble Earl is concerned that that will lead to uncertainty among NHS trusts. Work is going on with those trusts to ensure that there is continuity of employment and that services do not suffer as a result. That is also my answer in relation to the 1 August date and the issues raised about that.

I say to the noble Baroness, Lady Barker, that I cannot go into the details of the report that is being made to the police. However, the security breaches were very serious indeed and are to be deplored. That is why we took the action that we did. We have now passed that information to the police authorities.

My answer on the Tooke review is the same as I gave when the noble Baroness asked me about it two weeks ago. Sir John Tooke is a wholly independent person. The review is entirely in his hands and I am sure that it will be conducted as appropriately as possible. We all want to learn the lessons that need to be learnt to make sure that the system works well in the future. That is in everyone’s interest. Having met Sir John Tooke, I am very confident that he will take a rigorous approach. I also take this opportunity to thank Professor Douglas and his group for the help that they have given in the past few weeks and will give in the weeks to come.

The noble Baroness asked me two questions about costs. I cannot give a figure about the cost to the NHS of releasing consultants. However, under the old system, hospitals had to deal with dozens of applications. Consultants spent time dealing with those. I suspect that it would be impossible to make a comparison between the two systems. It is always part of the duty of consultants and hospitals to take part in recruitment for specialist posts, and it will continue to be so.

The cost of MTAS in 2006-07 was £1.9 million. We reckoned that the five-year cost of the MTAS system was £6.3 million. We will look at the company that we contracted with, and the contract, and keep that under review, in the light of both the experience with the security breach and the future requirements of the system.

The noble Baroness will know that a judicial review hearing is taking place at the moment, and it would not be right for me to comment further on that. It has been suggested that everyone should be offered a one-year post, but that would bring a great deal of uncertainty to many people who have gone through the proper process and the interviews and who would, under our present intentions, be offered run-through training. I do not believe that the suggestion is a panacea. The medical organisations, such as the BMA, that sit round the table in the review group chaired by Professor Douglas are all of the clear view that we must continue with the current process. That is the proper way through, and it is the proper way to ensure that at the end of the day we have the best people in these training posts.

I was asked about additional training places. They are subject to discussions at the moment with the NHS and the Postgraduate Medical Education and Training Board. I am not in a position to give any figures, but when we have the full information we will make it available to the House and to junior doctors.

3.47 pm

Baroness Finlay of Llandaff: My Lords, I declare an interest, as my daughter is going through the MTAS system. Can the Minister confirm whether the figure given in the other place is correct and that £1.9 million was spent on IT for this year? By my reckoning, that would cover the cost of about 20,000 junior jobs, which is twice the number of potentially unemployed juniors. What percentage of the posts, which were all educationally approved, are fixed term, and what percentage will be run-through training to allow those doctors to carry on to specialist training? What is being done to increase morale among junior doctors? A paper in the Lancet showed that 95 per cent of juniors are profoundly demoralised and disillusioned with the Department of Health and the way in which this is being handled.

What support will be given to juniors who have to relocate at very short notice when they find that they have a job offer that is outside travelling distance from where they currently live? The lag time to relocate is normally about three months and they will certainly not have that time in hand. Will the Minister confirm that the way in which this is now being run means that those who have had interviews and who have been successful in different disciplines will be given job offers in each of those disciplines and therefore will have an element of choice, rather than finding that they have been shoehorned into one job in one specialty, which is how it started out?

Lord Hunt of Kings Heath: My Lords, I will try to respond to some of those questions. The figure for the cost of MTAS in 2006-07 is correct. I am not sure that it equates to the number of junior doctors that the noble Baroness mentioned; it sounded to me as though the figures did not equate too well, but I am certainly prepared to discuss that with her. The breakdown of the training posts in England, which are the figures that I have, is that 11,943 are for run-through training; for the UK as a whole, that figure is 14,595.

The noble Baroness said that juniors will receive what she described as “short notice” of their new post and will have to consider moving. Of course I understand those issues and the pressure on junior doctors in general, and it is very important to ensure that the right advice and pastoral care is available to help them in that situation; I fully accept that point. There is nothing new about what is happening. This has been an issue for junior doctors for many years. They have applied for specialist training posts; they may have been accepted and they may well have to move to different parts of the country. That is the nature of junior doctors’ training; they have always come under that pressure. I accept that we need to ensure that juniors this year are given as much guidance and advice as possible. We are in close discussion with the postgraduate deaneries to ensure that that happens.

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