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Modernising Medical Careers

We have had an excellent debate this afternoon, involving a total of seven Back-Bench speakers, all of whom contributed, in their own way, to our deliberations. I start by declaring my interest as a registered medical practitioner, although mercifully I am not one of those caught up directly in the shambles that we have been discussing, or one of those involved in events outside this place today. A number of us went outside to speak to the representatives of Remedy UK and to listen to what they had to say. I recommend that Ministers listen to what they have to say to them, too, because they have done a wonderful job in highlighting this issue to Members. An NHS consultant whose daughter is a junior doctor emailed yesterday to say:"““The whole concept of MMC had some merit but the way it has been planned and carried out is nothing short of scandalous.?" That is a pretty good way of epitomising what many of us feel about this issue. The hon. Member for Wyre Forest (Dr. Taylor) gave a series of worrying accounts in a similar vein from other consultants throughout the country. My hon. Friend the Member for Putney (Justine Greening) gave further evidence from junior doctors who had written to her with personal stories of how this catastrophe has affected them in a direct way. In her excellent contribution, she was right to ask—as a number of other Members did—that the second, Tooke, review be truly independent. That means that when Sir John Tooke chooses his team, its membership should not include those previously involved in this process, because they would inevitably bring to the debate preconceived ideas. It is important that this issue be approached with fresh eyes. We Conservatives have always supported the evolution of a consultant-led, increasingly consultant-delivered service, and we support the principles of MMC that underpin it. We can, of course, debate points of detail such as the removal of the influence of the medical royal colleges and their replacement by the expensive training quango PMETB in 2005. It is salutary to remember that those are the same UK royal colleges whose supervision of medical education and training was described by the Health Secretary on 16 April as ““second to none?. However, having agreed with the Government in principle, we turn to implementation. At the heart of this, of course, lies MTAS. As he threw in the towel as MMC’s national director, Professor Alan Crockard said that MTAS"““has lacked clear leadership from the top for a very long time.?" Others have used that quotation and I make no apology for repeating it. We have to ask what he meant by ““the top?; I leave Ministers to draw their own conclusions. Professor Shelly Heard was similarly scathing as she quit as MMC national clinical adviser. The courageous hon. Member for Wolverhampton, South-West (Rob Marris), in a thoughtful intervention on the Health Secretary on 16 April, asked who would be held to account for the debacle that we are examining today. She replied in her trademark, rather breezy fashion:"““As far as I am aware, no disciplinary or performance management steps are being taken in the Department, but no doubt that can be considered as appropriate.?—[Official Report, 16 April 2007; Vol. 459, c. 48.]" So nobody has taken the rap for what doctors have described as the biggest crisis to hit British medicine since the start of the NHS. The hon. Member for Bassetlaw (John Mann) suggested that Ministers should avail themselves of the services of the Cranleigh or Henley school of management. Of course, those schools teach leadership, which is what is needed now. Next, my hon. Friend the Member for Gosport (Peter Viggers) underscored the seriousness of the crisis. He asked that Ministers give the House regular situation reports as the reviews go on. That is important, given the enormity of the problems facing the NHS. Much of MMC and MTAS has been designed to remove the influence of the old boy network—I suppose that one can call it that—that Ministers believe has been responsible for the appointment of junior doctors in the past. NHS Employers is a metastasis of the Government’s cheerleader, the NHS Confederation. In its briefing note, it identifies the twin crimes of ““patronage? and ““bias? in the appointment of junior doctors. In its zeal for reform, it does not pause to consider at what terrible cost those sins have been purged. Many will believe that the Health Secretary’s surgery has been somewhat worse than the disease. Apart from the drearily predictable NHS Confederation, there have been remarkably few apologists for the mess over which the Health Secretary has presided. Let us set aside for a moment the administration of MTAS, which has caused so much heartache, and focus on modernising medical careers. We can applaud the intention to move forward to a more focused, competency-based training that reflects what has been happening in other trades and professions, and in other countries. We hope that training will be more flexible and, as women make up half the medical work force, that it will facilitate a better work-life balance. It is surely right that doctors are better able to communicate with patients and colleagues, and that communication is a key element in any training or assessment process. Modernising medical careers recognises that, but we have grown an inflexible monster that forces early job choices on young doctors that will be difficult to move out of and into. Practical experience will be curtailed and all of a sudden that ““second to none? training about which the Health Secretary boasted in her speech last week is beginning to look far less robust. MTAS is truly remarkable. In place of a CV and hard data encapsulating hard-won academic qualifications and clinical experience, applicants are invited to furnish a load of soft mush. Other hon. Members have mentioned scoring, and the hon. Member for Stafford (Mr. Kidney) referred to that. The essential concern is that the influence of PhDs, for example, has, as we discussed earlier, been eclipsed by offerings in essay form that are made up at short notice and in a way that, as my hon. Friend the Member for South Cambridgeshire (Mr. Lansley) noted, is capable of being imparted in a course that costs very little. Certainly, the current system encourages creative writing and theatricality. No doubt they are invaluable attributes, but they are hardly core competencies for aspiring consultants—even, if I may say so, for consultant surgeons. I understand from a written answer sent to me on 13 March that MTAS will cost £6.3 million over five years. Can the Minister who will wind up the debate confirm that that does not include the cost of the paraphernalia of failure—review groups, appeals, judicial reviews and so on? I assume that it does not, because last week the Health would cost. On 16 April, the Health Secretary said of the extra resources required by the first—the Douglas—review that"““the service around the country will in many cases need to release consultants from their planned activities in order to make time available for the additional interviews.?—[Official Report, 16 April 2007; Vol. 459, c. 45.]" What assessment has the Minister made of the cost in front-line patient care caused by the crisis? What will be the impact in the next few weeks of the redeployment of medical staff apparently necessary to patch up MTAS? How many operating lists will be cancelled, how many clinics scratched, and how many ward rounds foregone? The hon. Member for North Norfolk (Norman Lamb) is worried about logistics, costs and wastefulness, and rightly so. I am delighted that the Liberal Democrats will support our motion this evening. On 19 March, the Health Secretary said that"““shroud-waving about unemployed doctors is absurd?—[Official Report, 19 March 2007; Vol. 458, c. 582.]" On 16 April, we had more assurances from the Secretary of State when she said that she wanted to take"““the opportunity to refer to the thoroughly misleading statements made in recent weeks about the prospect of thousands of junior doctors finding themselves without work. This is complete nonsense.?—[Official Report, 16 April 2007; Vol. 459, c. 46.]"