Saturday, 31 March 2007
Dear Professor Sir Liam Donaldson,
I recently resigned as medical student advisor to MMC.
Despite claims from the health minister that the new Foundation Programme has ‘widely been acknowledged as a success’ there are, and always have been, huge misgivings about it at student, junior doctor and all other levels. I hoped that access to the MMC team would give me an opportunity to make these views heard. I was wrong. Although you continually tell us that you are ‘working with the profession’ you are not, at any level, listening to it. This is why I resigned: please find enclosed my letter of resignation to Professor Alan Crockard.
From a grassroots level upwards, your recruitment of those from the profession has been tokenistic at best. My role was little more than a publicity stunt. You want to be seen to be involving us but care little for the reality of what we actually have to say.
Even at the highest levels you have been seen to charge professionals with responsibility but withhold authority.
It is not my job to outline the infinite professional, personal and philosophical problems that blight your new systems – the 12,000 junior doctors who recently marched through London could do this more eloquently than I could ever hope to – but it is my job to expose the growing chasm between yourself and the profession.
Your agenda does not meet with the approval of the profession. You must acknowledge this. It is not acceptable for you to enlist members of the profession from all levels and to then ignore them. It is not acceptable to use your implementation team – MMC – as a vehicle for spin, as a way to convince the profession that things are other than they are. It is not acceptable for you to hide behind the responsibility you have dispensed to MMC and at the same time maintain your authority so you can push through your own agenda.
And yet, this is what you are doing. No matter what the profession says, no matter how vociferously it protests, no matter what damage is done to families up and down the country, this is what you will continue to do. How kind of Lord Hunt – at a time when faith in your systems is at its nadir - to illustrate the DoH’s utter contempt for the profession, by saying “I would like to reconfirm our commitment to MMC which aims to recruit and train the best doctors to provide the best possible patient care.”
This is your project. Everyone else – from MMC to MTAS, from the royal colleges to PMETB, from the advisors to the spin doctors – are merely your implementation tools. Ultimate authority rests with you. It is now time for you to take responsibility. If you continue to force through these reforms, I want you to know that it is obvious - even from a medical student level - that you are a million miles away from being the ‘bridge between the profession and the government’ that you claim: you could not be acting more undemocratically if you tried.
If you find this image unappealing, your options are clear: take heed of the groundswell against you and your agenda and cede your authority back to the profession. If this is also unpalatable to you, then you must resign.
Thursday, 29 March 2007
Full story to follow.
Yesterday MPs voted themselves an extra £10,000 per annum (each) as "communications allowance". This is on top of the £150,000 a year they are already allowed in expenses (and much of it not requiring a receipt).
Why do they need it? They can appear on local radio (free) when ever they want to, they can write to the local newspapers (pretty well certain to have their letter published) , and they can set up a web site such as this. They already get unlimited free postage and stationery, and free usage of the telephone. So what on earth do they need another £6.5 million for?
This is a pre-election promise: when I am elected I will not be claiming this money.
Saturday, 24 March 2007
Dear Mr McKay
I was idly studying the website of the East of England SHA (www.eoe.nhs.uk) and looking at the papers for the board meeting to be held on Thursday 15th March 2007.
One of the items relates to next year's (2007/8) budget for postgraduate medical education and training. The SHA is the regional budget holder for this money. The alocation from the department of health for next year is £332.8million; this sounds a lot but it covers the salaries of junior staff as well as education and training, postgrad centres etc.
The SHA then cheerful announces that it intends to remove £34.6million from this ring fenced money "to the SHA strategic reserves to support the EoE financial position"
This seems a disgraceful subversion of funds properly intended for the vital functions of education and training, and I would value your comments
Dr Barry Monk
Thursday, 22 March 2007
There is a graphic account on the BBC website of the breakdown in medical care there:
For the people of Iraq, it may be the ultimate nightmare.
Most of the best medical staff have left after being targeted by insurgents. Many have fled the country just in the last few months.
Drugs and equipment are almost non-existent. The notorious militias target patients inside hospitals, and doctors inside the health ministry.
All this in a country that used to pride itself on the best medical services in the Middle East.
There has been a "disastrous failure" of NHS workforce planning creating a "boom and bust" approach, MPs say.
The Health Committee said little thought was given to long-term planning as managers strived to hit "demanding" government targets. MPs said vast rises in staff numbers had been followed by redundancies, cuts to training and recruitment freezes. They added regional health bosses had to make planning more of a priority and ministers stop "micromanaging".
Tuesday, 20 March 2007
Monday, 19 March 2007
Her statement includes four comments which were lies.
1. She stated that the MTAS process had been subject to an assessment of quality assurance : it has not
2. She stated that the Computer system had not crashed : it had
3. She stated that she was unable to give a statement as to costs, yet these had been the subject of a Commons question in January
4. She denied that applications had been lost : they had.
In other words, Patsy Hewitt lied to the House of Commons
An entire generation of junior doctors has been betrayed and the public have been misled by a government intent on disempowering and downgrading the medical profession.
We have already heard about the MTAS fiasco, but I want to talk about the politics behind MMC.
The Labour Government has a clear agenda to disempower and control the medical profession so that it can push forward it reforms more cheaply and easily. You only have to mention loss of self regulation, the National Institute of Clinical Excellence, PMETB, and last but not least MMC, to understand this. Doctors are the greatest advocates of patients so it follows that patients are also being disempowered.
MMC is a political tool designed to downgrade the medical profession by mass producing “fit for purpose” subconsultant grade doctors who will be cheaper to employ, easier to manage, and ideal workforce fodder for Foundation Trusts and ISTCs. This goes completely against the NHS Plan which promised a consultant led service. The public has been completely misled. Patients are going to be operated on by surgeons with 8,000 hours of training rather than the traditional 30,000 hours. This may be fine for a routine procedure, but what happens if a complication occurs? – in the blink of an eye a surgeon can go from being “fit for purpose” to completely out of their depth. This shows the complete lack of understanding from DH officials. Patient safety is clearly at risk with MMC. The competency based training methods of MMC are completely unvalidated so the pieces of paper that show a doctor is competent are meaningless. This is simply a smoke screen to fool the public that they are being seen by an appropriately trained doctor.
MMC will reduce experience, autonomy, career opportunities, which in turn will damage morale, ambition, service building and development, research teaching and ultimately professional standards. This is what the government wants of course, but is this what patients want? We clearly need to open this debate up to the public. I believe in the democratic process. If the public want a subconsultant led service then we will all have to accept it. However, the public haven’t even been consulted about this and were sold a different promise altogether. This has all been done by stealth, a common trait of this government.
Sunday, 18 March 2007
The NHS is spending thousands of pounds to hold job interviews with junior doctors in luxury hotels, football stadiums and even at a racecourse.
Despite the health service having a deficit of more than £500 million at the end of the last financial year, meeting rooms in hospitals have been shunned in favour of expensive external locations which include the Reebok Stadium, home to Bolton Wanderers, and Newmarket Racecourse.
Friday, 16 March 2007
But even they seem to be getting the message: to quote David Cameron
"The appalling shambles made of Modernising Medical Careers risks undermining the morale and the future of the medical profession."
Sir - It is important that everyone realise that the failure of the new absurd and inappropriate method for appointing junior doctors to suitable training posts is not an isolated or unpredicted event, but the result of unrelenting government intervention designed to destroy the independence of the medical profession.
The medical profession has been independent and self-regulating since the 15th century. In modern times, it continued to supervise the quality of postgraduate training, approve training programmes and examine the suitability of trainees for medical practice, while the General Medical Council undertook the task of self-regulation.
Independence and self-regulation have long been an anathema to politicians who believe that they should control everything. Serious attempts to destroy the medical profession's independence began in the 1990s, when many hospital trusts sought to abolish the statutory requirement that all NHS consultants should have a college certificate of completion of training and be on the Specialist Register.
This was successfully resisted, but recently the Government established a quango - the Post-Graduate Medical Training Board - to replace the colleges' specialist training boards. It gave this board the power to overrule college examiners and recommend that candidates deemed unsuitable by the colleges be placed on the Specialist Register.
The Post-Graduate Medical Training Board is the source of the present debacle. It has changed the college training programmes to meet NHS needs (replacing quality with quantity). It has ignored the destructive effect of the EU Working Time Directive on the quality of training, and it has produced a common training schedule inappropriate for many specialities. It appointed a group of deans and educationists to devise the Medical Training Application Service.
The selection system invented by this group has failed. The previous selection system that produced top-class NHS consultants has been destroyed.
I could give many other examples of interference with standards and the undermining of professional independence by the Government.
Some groups of consultants and (I am pleased to note) the Royal College of Surgeons and the BMA have at last had the guts to rebel. This rebellion must continue until the politicians' many attempts to destroy the medical profession's independence stop.
Doctors know best how to train doctors, assess their competence and treat their patients. If the medical profession fails to regain its independence, doctors will become a poorly trained, inadequately tested group of government-controlled lackeys. And who will suffer? The patients.
Professor Sir Norman Browse, Former Chairman, Joint Consultants Committee, Former President, Royal College of Surgeons of England, Alderney, Channel Islands
Thursday, 15 March 2007
Wednesday, 14 March 2007
Monday, 12 March 2007
Over the last couple of years, as the true lunacy of NHS “reforms” is revealed to an increasingly astonished medical profession, many of us have wondered whether there really was some sort of deranged madman driving the agenda. Surely no sane person could have devised this mayhem. Well, astonishingly, it seems that these dark suspicions have more than a grain of truth in them.
Much of the drivel peddled at vast expense by the management gurus of which the Department of Health seem so fond, and whose wisdom is lapped up so enthusiastically by ministers, stems from a theory known as “performance management”. Performance management is a big number; type it into Google and you get 350,000,000 hits. Performance management is the basis of the application of targets to health care and of the introduction of competitive forces to health care providers; it also lies behind MMC and MTAS.
Performance management is the product of a shadowy organization called the RAND Corporation, an American think-tank funded by the US military. It is an important body; among those who have worked for it are Condoleezza Rice, Donald Rumsfeld and Lewis “scooter” Libby (Dick Cheney’s former senior adviser recently sentenced to 25 years in prison). One of the RAND corporation’s brainwaves was the application of performance management to the Vietnam War; when things were going badly it was suggested that commanders in the field should be given weekly killing targets. Not wanting to upset their political masters, soldiers started either systematically lying about their kills, or shooting random innocents to achieve their targets.(sounds horribly familiar to some of our targets in the NHS).
The RAND Corporation has also done extensive research into the organization of health care., although as an aside I note the current mayhem in the American military’s own organization and today’s sacking of the US Surgeon-General
And where, pray, did the RAND corporation get its own ideas from? Much of its work was derived from the mathematical modelling and games theory of John Forbes Nash, a mathematical genius with paranoid schizophrenia of such severity that he spent 10years in a mental hospital, and who worked at the RAND Corporation..
(Author’s footnote : before anyone points it out, mental illness in general and schizophrenia in particular are not funny.)
The last two weeks has seen the Medical Profession in the UK torn apart by an Exocet we should have seen coming. That Exocet is called MMC and in particular its job application arm, MTAS. The howls of anguish from the juniors have been silenced only by …. well, the silence of the seniors. The Colleges have offered extreme sympathy. We, the undersigned, are roused, belatedly, to express incandescent outrage at the apparent vandalism taking place before our eyes. Although it might ease our conscience to shelter behind our Colleges and Presidents, they in turn pick the mood of their electorate, and silence shifts perception of the line to be drawn between collaboration and appeasement. In negotiations with MMC over a process which rides roughshod over the Colleges’ Royal Charters to protect education and training, the Presidents must have felt between the proverbial rock and hardplace – marginalised in opposition, complicit in submission. This is not the time for recrimination, but for a united and rockhard opposition to MTAS, offering whatever help is necessary to find a workable and worthwhile version of MMC.
The speed and scale with which the Exocet has struck is truly awful. Stories from top juniors flung on scrap heaps after a decade of training, from seniors marking applications who had to look up Medical Schools to see if they existed, and interviewers too embarrassed to look candidates in the eye, and with no CV’s or references to guide – oh so elitist and incorrect when choosing a safe doctor. Stories all so bizarre and spontaneous they have to be true, and yet the process proceeds apace while proper documentation of problems is awaited… And all the while the Deans, and the myriads of helping Consultants distracted from their day-job of patient-care, are congratulated for their superhuman efforts – for their efficiency and ingenuity – some tossing coins to choose among applicants, some threatening to leave applications unread by the deadline, collecting dust while the applicant learns from the internet that he is no longer fit for purpose. Doctors intelligent? What other group in society would be such hand-maidens to their own apocalypse.
The fault? Teething problems blamed on computer glitches and thousands of non-UK European doctors swamping the UK applicants with their numbers; and on wide-scale plagiarism and on answers available for sale to the ridiculous questions designed by civil servants to root out any doctor looking in vain for a box to register a first class degree. Consolation? Yes, it could have been worse if the Highly Skilled Migrants had not been sacrificed during the selection process; with any luck, we have been told with a straight face, many of them have still been given posts and will therefore leave large gaps in the second round if the Appeal Court comes to the rescue.
Do you want to laugh or cry? A few seniors, signing this letter, want to shed tears of contrition and anger. We wish this nightmare to stop now. The juniors can’t stop it. Our leaders’ hands are more tied than ours by diplomatic niceties. We still wish them luck because only they are likely in the long run to succeed in bringing about the improvements required. Meanwhile there is an onus on us, and us has to mean very urgently the vast, silent majority of UK Consultants. Two things must happen. We need to register unmistakably that Consultants can be as roused and exercised by the standards of care of future patients and fate of our juniors, and therefore the NHS, as we were about our contracts, and leave our leaders and MMC in no doubt about our views. And we need possibly to stop the current interviews or, at the least, make sure that only truly excellent candidates are appointed in the first round until sense prevails and a meaningful process installed for a delayed second round.
Neither will happen unless our letter strikes a chord. Our leaders have pressed the MMC and ministers hard for changes before the second round of appointments. We worry whether deckchair movement is enough. And we do not know for certain whether there will be movement, after the news story has moved on, or whether indeed any good posts will be left by then. We fear that something Titanic will hit the profession if chairs labelled MTAS are not removed or re-invented altogether. 35000 applicants – and the new UK medical schools have yet to produce a doctor! Some interview panels have already packed their bags. If isolated reports of the interview process are correct, we hope this knowledge may stiffen the resolve of others confronted with inadequate candidates or paperwork, with snowballing resignations bringing a flawed process to a halt.
How can you register your views? The juniors have set up websites (www.remedyuk.org) and www.mmc360.com and this (BMJ) website will itself take comments. By the end of this week, or earlier, we will have a single- purpose website with short list of questions at http://www.cai.cam.ac.uk/people/mjb14 , which will enable us to petition the Presidents and MMC with exact numbers. And you can decide whether we petition for a temporary halt, a back-to-the-drawing-board halt, the resignation of the architects of MMC. Try to have your GMC number available so that we can prove real and unique people sign the electronic petition. Meanwhile, support the juniors’ websites, and post your responses and experiences here.
We will march with the juniors on March 17th. If you join us now, we may be able to smile that day, not cry.
Morris Brown, Consultant Physician and Professor of Clinical Pharmacology, University of Cambridge
Nick Boon, Consultant Physician and President-Elect, British Cardiovascular Society
Nick Brooks, Consultant Physician and President, British Cardiovascular Society
John Camm, Consultant Physician and Professor of Clinical Cardiology, St. George's Hospital Medical School
Edwin Chilvers, Consultant Physician and Professor of Respiratory Medicine, University of Cambridge
Paul Corris, Consultant Physician and Professor of Thoracic Medicine, University of Newcastle
Paul Durrington, Consultant Physician and Professor of Medicine, University of Manchester
Paul Emery, Consultant Physician and Professor of Rheumatology, University of Leeds
George Griffin, Consultant Physician and Professor of Cellular & Molecular Medicine, St. George's Hospital Medical School
George Hamilton, Consultant Surgeon and Professor of Vascular Surgery, Royal Free Hospital
Alistair Hall, Consultant Cardiologist and Professor of Clinical Cardiology, University of Leeds
Tony Heagerty, Consultant Physician and Professor of Medicine, University of Manchester
Humphrey Hodgson, Consultant Physician and Vice-Dean, Professor of Medicine, Royal Free & University College School of Medicine
Richard Hughes, Consultant Physician and Professor of Neurology, Kings College London
Kay-Tee Khaw, Consultant Physician and Professor of Clinical Gerontology, University of Cambridge
John Lazarus, Consultant Physician and Professor of Clinical Endocrinology, University of Cardiff
David Luesley, Consultant Oncologist and Professor of Gynaecological Oncology, University of Birmingham
John Monson, Consultant Surgeon and Professor of Surgery, University of Hull
Philip Poole-Wilson, Consultant Physician and Professor of Cardiology, NHLI, Imperial College, London
Timothy Rockall, Consultant Surgeon and Professor of Surgery, University of Surrey
Robert Sutton, Consultant Surgeon and Professsor of Surgery, University of Liverpool
Deborah Symons, Consultant Physician and Professor of Rheumatology, University of Manchester
Roy Taylor, Consultant Physician and Professsor of Medicine & Metabolism, University of Newcastle
Doug Turnbull, Consultant Physician and Professor of Neurology, University of Newcastle
Hugh Watkins, Consultant Physician and Professor of Cardiology, University of Oxford
Robert Wilcox, Consultant Physician and Professor of Cardiovascular Medicine, University of Nottingham
Nick Wright, Warden, Queen Mary College, London
Sunday, 11 March 2007
This week, Gordon Brown, unable to access an NHS dentist, had to pay for private treatment.
So what, you may ask, he has lots of money; but not many earn enough to pay for private dental care, and yet in large chunks of the UK, NHS dentistry is all but unavailable.
It doesn't bode well for the remaining bits of the NHS.
Saturday, 10 March 2007
One of the items relates to next years (2007/8) budget for postgraduate medical education and training. The SHA is the regional budget holder for this money. The allocation from the department of health for next year is £332.8million; this sounds a lot but it covers the salaries of junior staff as well as education and training, postgrad centres etc.
The SHA then cheerful announces that it intends to remove £34.6million from this ring fenced money "to the SHA strategic reserves to support the EoE financial position"
This seems to me to be nothing short of theft. Comments please
Wednesday, 7 March 2007
Many PCTs are massively in debt, and cutting clinical services to balance the books. Why?
This simple graph, prepared by a friend but based on official DoH data explains. The less income a PCT has per head of population, the more likely it is to be in debt. Simple really, so why can't all those well paid managers and management consultants understand?
A Shropshire family doctor today revealed that he might stand as a candidate in council elections to highlight what he claims is the Government’s “systematic destruction” of the NHS.
And Dr Adam Pringle has not ruled out making a bid to become a Member of Parliament to fight changes he claims are harming the health service.
He says he has been forced to speak out because the traditional method of recruiting doctors to posts, based on their skills and experience, is being replaced with selection based on what he says are politically correct answers to an on-line questionnaire.
“The visible failings of this system mean that high quality skilled and experienced doctors are not even being invited for interview and will be forced to emigrate,” said Dr Pringle, who helped to set up the Lawley Medical Practice in Telford nearly eight years ago.
He claimed none of the doctors currently in training in Telford have been invited for interviews, and that at least one panel of Midlands’ consultants were refusing to interview because they knew the system was rejecting quality applicants, and possibly forcing them to appoint poor ones.
Dr Pringle said: “I appreciate that local elections have no bearing on the NHS, but I can see no other way to put the views of the medical profession before the country as a whole, other than to stand for office at the local elections in May, and then if that fails, to consider standing for Parliament in due course.”
Asked if he was going to try for a council seat, he replied: “The way things stand at the moment, it is for me quite likely.”
There was no action doctors could take other than “making a noise and hoping someone listens.”
Dr Pringle said the new recruitment system simply compounds the Government decision to shorten training so that a future consultant will have 10,000 hours of clinical experience instead of 40,000.
“To put that in perspective, I, as a fairly typical GP, have about 10,000 hours of hospital clinical experience.” he said.
“Thus they will provide a ‘consultant delivered service’ as promised, but not consultants as we know them today.”
Dr Pringle says the Government claims to have spent vast amounts on the NHS but much of it is fictional and billions have been wasted on a failed IT system.
He is critical too of the “foolish decision” to sign up to the European Working Time Directive and then apply it rigidly.
And he warned: “This massive reduction in the medical working hours available to the NHS is the primary reason why one of Shropshire’s hospitals will inevitably be closed, but closed in a slow expensive inefficient salami-slicing way, leaving us with one inadequate hospital instead of two.”
He added that maintaining the children’s wards at the Royal Shrewsbury and Princess Royal hospitals used to require eight middle grade doctors but now required 16, at a time when every other UK hospital also needed to double its numbers.
Tuesday, 6 March 2007
Sunday, 4 March 2007
Vow of silence for Dr Monk
By Steve LoweAttempts are being made to gag a senior consultant at Bedford Hospital from talking to the media - about the hospital crisis.
Dr Barry Monk is standing for Parliament on the single issue of saving Bedford Hospital, where he works as the chief consultant dermatologist.
The management of Bedford Hospital has written to Dr Monk about him making statements to the press and TV over the financial crisis at the hospital.
The letter says that his statements have given a poor impression of the hospital and he has not followed normal procedure if he has concerns over the way the hospital is being run.
Dr Monk has been warned that this behaviour may lead to disciplinary action and has been asked to attend a meeting to discuss the matter.
He is being allowed to bring a friend or colleague to the meeting.
Dr Monk admitted he had received a letter but said he had no comment to make, which seemed the wisest course of action at the moment.
A Bedford Hospital spokesman said: "We are not attempting to gag Dr Monk or any other member of staff at the Trust. All staff are expected to abide by the hospital policies and therefore we are discussing with Dr Monk how comments have been portrayed in the media in a way that has caused unnecessary anxiety to patients and the public. Dr Monk received a private letter to this effect."
Saturday, 3 March 2007
Thursday, 1 March 2007
These are quotes from this week's Health Service Journal:
'Hewitt is a disaster, she keeps tweaking things, she's got no idea of the bigger picture, she's indecisive. She's an utter disaster for the NHS,' argues one chief executive of an acute foundation trust in the North.
A Southern-based chief executive puts it even more bluntly: 'She doesn't know her arse from her elbow.' "
This posting was placed on Doctors Net UK by a junior; there have been many other postings with a similar message:
All my life there has been only one thing that I have wanted to do. I worked hard at school to get to medical school, I then worked hard at medical school to give myself the best shot at the jobs I wanted later on. I passed all my exams, won a few prizes along the way and was generally a good all rounder.
I was warned off medicine by my family and friends, they said it was too stressful and the NHS was in trouble; but I found the subject fascinating and it was not a matter of choice for me.
I have worked hard since I qualified and have had good references from all my employers. I have not taken a single day off ill in my first few years of work, and there are days when I have not felt well enough to come into work. I have passed several postgraduate examinations and attended all the relevant courses, as well as having several articles published in scientific journals.
There are many others just like me. Each of us has made numerous sacrifices because we love what we do. Our study budgets and study leave quotas have been cut, meaning we have had to pay for our own training and attend courses in our annual leave. The trust has also stopped properly reimbursing us for our travel expenses and removal costs. However we carried on because we thought that it would all be worth it, if we could have a job at the end of it doing what we loved.
These last few weeks have been the final straw for many of us. We have been subjected to the most unfair and least meritocratic selection process ever seen, MTAS (medical training application service) via MMC (modernizing medical careers). We have had to sum up our years of work and experience in several politically correct short answer questions, on which we are then judged. Examinations, experience and references are all but ignored in the pursuit of vague waffle.
The computer system crashes time and time again, confusion reigns supreme and hundreds of consultants are appalled by the process. Yet it is allowed to proceed. The short listing results are released in dribs and drabs and thousands of juniors tap away on their keyboards in a state of sheer panic, realizing that their future is being decided by the MTAS tombola.
Some of us have been lucky enough to get short listed for the jobs we want, but we shouldn’t have had to be lucky. The process should have been meritocratic, well organized and fair. It was most definitely none of these.
Young doctors such as myself are appalled by what we have had to endure this year. No one should have to go through such a process again. We all know people who are going to have their hopes and dreams crushed by this cruel joke of a system.
Shame on those who are behind this scheme. Many a tear will be shed this week by many brilliant young doctors who have had their hopes and dreams crushed in a quite barbaric fashion. Many of us will emigrate and many of us will leave the profession; I hope those behind the scheme are proud of these achievements.
Of course we do not all expect to be handed our perfect jobs on a plate. However we deserve not be lied to, we deserve not to be treated unfairly and we deserve to be treated with a little more dignity, respect and humanity than we have in 2007."
We all know people who have been shafted by this system and I would like to dedicate this thread to all those juniors out there.