A bungled reform a day keeps the junior doctors away
From Mmc
You can tell that something has gone grievously wrong with a government, probably irreparably so, once the doctors get angry. In my experience, British doctors are naturally rather stoic, phlegmatic types. They are used to working horribly unsocial hours, eating dried-up, lukewarm NHS food and being abruptly confronted with patients in the direst of conditions. It takes quite a lot to get our doctors worked up, and now they are not just worked up but incandescent with fury.
Tony Blair has long seemed the luckiest politician alive: each time he was in a scrape, fate would intervene to distract the public's attention. That luck has now dramatically run out. The Blairite project has suddenly come to resemble Dorian Gray at the end of Wilde's novel, when all his ingrained character flaws were suddenly glaringly visible on his face. As Mr Blair's adventure in Iraq stews in its horrors, and Assistant Commissioner Yates digs for Labour corruption in the cash-for-honours inquiry, the very last thing that the Government needed was a titanic clash with Britain's medical profession.
It has taken me a little while to get to grips with the junior doctors scandal, because it is clearly a monumental cock-up of a rather complicated system liberally strewn with acronyms. The bones of it, however, are this:the Government decided to enact its aim of Modernising Medical Careers (MMC) by the rapid introduction of a computerised Medical Training Application Service (MTAS). This meant inviting many thousands of junior doctors to apply for specialist registrar jobs online, with their applications graded according to a government-approved marking system.
Under the old method there were fewer applicants for a job, and hospital consultants evaluated them, shortlisting the best for interview. The great advantage of this archaic system was that, by and large, it worked.
With the new computerised system, which also encouraged numerous applicants from abroad, already hard-pressed consultants were frequently asked to plough through 500 or 600 applications. Instead of being trusted to use their well-honed professional judgment, they were required to grade these applications according to a bizarrely rigid, illogical points system. Many of the questions were somewhat pious and woolly, and consultants thus found it almost impossible to discern the best candidates from the answers. The result is that many extremely competent candidates weren't shortlisted for any job in any region. Now 8,000 British junior doctors, each of whom cost the British taxpayer £250,000 to train, have been left jobless and deeply demoralised. Growing numbers of principled consultants are flatly refusing to interview shortlisted candidates because the process thus far has been so fatally flawed.
The panicking Health Minister, Patricia Hewitt, hastily ordered an independent review, and some disappointed applicants are to get a second chance to secure an interview. But surely no one can have seen this disaster coming? Yes, they did.
Last summer, the British Medical Association openly pleaded with the government to delay the MTAS, on the basis that the reforms were incomplete and that "information necessary for selection will not be adequate." A contemptuous Department of Health ignored the warning.
This fiasco contains virtually all the elements that have contributed to the dismal failure of numerous Blairite policies: the urge for sweepingly radical gestures without intelligent planning for the aftermath, the failure to listen to experts in a given field and the naive enthusiasm for vast, unwieldy, centralised computer systems.
Britain is now littered with the wreckage of initiatives that were never properly thought through to start with, from House of Lords reform to the NHS patients' database. If Mr Blair's administration were a hospital surgeon it would have been struck off the GMC register long ago, because while it is tremendously eager to operate it has almost no idea of how to get things working efficiently again afterwards.
The political mediocrities in New Labour are instinctively suspicious of professional elites, whether those elites are composed of Oxbridge dons or hospital consultants. No matter that members of such elites are largely there by dint of cleverness and hard work: this Government's instinct is to wrest decision-making power from them in the name of "fairness".
"Fairness" - as the Government dully conceives of it - essentially means that the direction of one's life is determined not by graft or intelligence but by crude chance. That is after all how it wishes to decide which pupils should go to the best local schools, by names pulled out of a hat. That is also apparently how it wishes to decide which junior doctors get jobs of their choice, by a giant computer lottery.
I do not wish to be operated upon or diagnosed by a lottery-winner, blinking bemusedly at his or her windfall job. I wish to be treated by the person whose skills and experience are best suited to the task.
The Government's abject failure to understand such basics makes me think that in Britain we have got matters entirely the wrong way round. Instead of doctors being forced to obey rules set by politicians, should we not have politicians compelled to follow the time-honoured rules of doctors? After all, the most famous edict of medicine is the very one that New Labour so constantly and disastrously forgets: "Primum non nocere: first, do no harm."
