In rising to propose this motion, I must first declare my interest as the father of two junior doctors, both affected in different ways by the disaster that is the so-called ‘Modernising Medical Careers’ scheme. However, as the motion makes clear, my friend Kieran Deeny and I are also seriously concerned at the effects on patient care.
The MMC scheme has all the hallmarks of a modern Government project. It addressed a situation that, while it was working, could probably work better. Instead of incremental change, it proposed massive, radical changes in that process, with limited justification. This included the new Medical Training Application Service, or MTAS. It depended on a new, untried computerised scheme to administer applications for jobs on behalf of every junior doctor in the United Kingdom. The IT failed, continuously and frequently.
We should remember that the term ‘junior doctor’ conveys an inaccurate impression. It covers all doctors other than hospital consultants and general practitioners: it does not mean those just out of university, but the vast majority of those who staff our hospitals and provide life-saving care to our constituents.
In an effort to redress the ensuing problems, different ad-hoc schemes have been developed in each of the four nations of the UK, in a desperate attempt to ensure that there is some continuity of the national health service when doctors are due to take up their new posts in early August. In the meantime, every significant body of medical opinion, not just the juniors themselves, but representative groups of consultants and the Royal Colleges, have expressed their opinions on this fiasco in terms ranging from concern to horror.
On the other hand, two days ago, the Chair of the BMA, Mr James Johnston, has felt obliged to resign, apparently because he did not express his concerns forcibly enough.
A review has been set up by the Department of Health in Whitehall, but the review team is top-heavy with Departmental apparatchiks – not my words, but those of a large group of medical professors in a letter to The Times last week.
In one respect only has this been different from a classic New Labour scheme. This Government doesn’t apologise. Not even for the Iraq war. But the Secretary of State was forced to apologise to doctors for the distress they had been caused. So far, there has been no apology to patients for the harm they may be caused. It is little wonder that MMC has spun off a number of different versions of the acronym, of which the politest is probably ‘Making Medics Cry’.
It is clear that we are in the midst of an ongoing crisis. So what is to be done?
First, I welcome the reopening of the interview process, so that those who were denied first round interviews by the deeply flawed process now have the opportunity to be considered for their other choices. However, even this compromise is deeply flawed.
In no other field of employment – especially in the public sector – would it be acceptable for candidates for a position to be interviewed under different conditions, with no proper shortlisting, on widely different dates, probably by different panels – and with those who were interviewed in the second round inevitably tagged as failures.
Yet I know of cases where doctors failed to get interviews in specialities where they already had experience and post-graduate exams passed, while they were interviewed for lower choices for which they were less qualified and experienced.
Even the offers which are starting to issue from different specialities leave candidates with unacceptable dilemmas over whether to accept a second choice offer made early, or hold out for a first choice which may come through if others turn it down.
Remember that this is not an issue of a one-off job application, which can be redressed next year. At present, these interviews are supposed to cover a ‘seamless progression’ from the newly instituted foundation programme right through to consultant grade. Fine if you get what you want this month, but an absolute cut off if you fail at your one and only attempt for a career for which you have already spent several years in training, and in which the taxpayer has invested heavily.
I am not a lawyer, but I do know a bit about employment matters. It seems to me that any doctor who fails to get the post they want as a result of this deeply flawed process would almost certainly have redress through the Courts. However, the impression I get is that they would prefer to be able to make progress in their chosen careers, rather than seek compensation through the legal system.
The willingness of the Minister for H, SS and PS to take this issue seriously is a positive sign. I am grateful to him for attending a briefing organised by Northern Irish Medics in the Long Gallery and to recognise that this needs urgent action. Today, he has the opportunity to put substance to his commitment.
It is clear that the current year’s process is so flawed that it cannot be used as the basis for the career pattern for life of almost 1,000 doctors who want to serve the people of Northern Ireland. It would be unacceptable for any Doctor to lose his or her career completely – and the Minister has previously confirmed that there could be over 100 affected at this stage. It would be almost as bad for doctors to be forced into second choice training posts, or non-progression staff grades, with no further chance of starting a new career path.
Similarly, as the current process is compressing two years into one, with the previous introduction of the F1 and F2 training posts for those just out of medical school, there must be no question of doctors being refused posts on the basis of over-qualification. As a potential patient, I quite like the idea of over- rather than under-qualified doctors.
The Minister has previously stated that it is not possible to return to the previous training scheme. That may now be the case, although I know that there are many who would wish to have done that a few months ago.
What doctors – and the entire population – now have a right to expect is for the Minister to confirm that he will ensure action on some key points for the future. These priorities include:
1 That there will be no compulsory redundancies among those junior doctors who wish to work in Northern Ireland when new appointments are made for August this year. This requires the Department to carry out an urgent review of medial staffing right across the region, in every grade.
2 That there will be the full option for transfer between posts next year. In other words, that these appointments will be effectively for one year only for those who are dissatisfied with whatever posts they are appointed to this year.
3 Recognition that the current number of posts proposed for the future is inadequate to provide for the needs of the NHS in Northern Ireland or for those currently engaged in medical training.
4 Agreement that he will set up a Review Group in Northern Ireland to examine the conclusions of the national review of MMC, and that such a review will not be ‘stuffed with Departmental apparatchiks’ but will be broadly representative of the medical profession and the wider community.