Patricia Hewitt
From Mmc
video of House of Commons statement
Secretary of State for Health, Patricia Hewitt’s House of Common’s statement on Modernising Medical Careers (MMC) and the Medical Training Application Service (MTAS)
16 April 2007
With permission, Mr Speaker, I should like to make a statement on the progress we are making in relation to Modernising Medical Careers.
As I explained to the House in my written statement on 27 March, the independent Review Group continued its work over the Easter recess, including two important announcements to applicants for training places, copies of which are being placed in the Library today.
The Review Group decided that it would be wrong to abandon the process of interviews now under way and concentrated instead on how to change the process in order to meet the needs of junior doctors themselves and the NHS as a whole. Furthermore, it concluded that the problems that have arisen relate in the main to the implementation process and not to the underlying principles of Modernising Medical Careers.
Following the Review Group’s recommendations, recruitment to General Practice training programmes – which has not generally given rise to problems - will continue as planned, though the timetable may need to be revised to make sure it is co-ordinated with the revised timetable for other specialties.
The Review Group is undertaking further work on recruitment into academic medical programmes and will make a further announcement shortly.
In relation to recruitment for speciality training – where most of the recent problems have arisen - the Review Group’s statement on 4 April sets out the changes needed. The Group’s proposals have the support of the Academy of Medical Royal Colleges and the BMA and are now being implemented by the NHS with the Postgraduate Deaneries.
For applicants who have already been short-listed, all interviews already conducted in Round 1 will be honoured and the outcomes will count.
Eligible applicants will also be able to revise their preferences, later this week, in the light of published competition ratios and will be offered an interview for their first preference post if they have not already had one.
Eligible applicants who were not previously short-listed will also be able to revise their preferences and will be guaranteed an offer of an interview for their first preference.
We expect job offers to begin to be made in early June. Not all jobs will be filled at this point. There will then be a second round of recruitment for applicants who do not get a job in the first round. This second round will be based on a revised short-listing and interview process including a structured CV.
Mr Speaker, this has been a time of great distress for junior doctors and their families and I apologise unreservedly to them for the anxiety that has been caused. I believe that we now have the right way forward for this year’s recruitment to general practice and speciality training and that applicants can be confident they will be treated fairly.
I want to record my thanks to Professor Neil Douglas and his Review Group for the very considerable amount of time and expertise they have already contributed. They will continue their work and, as I have said previously, we will publish their final report.
I also want to thank the NHS consultants and deaneries who are being asked to conduct a large number of extra interviews within a short space of time. We will keep the timetable under review.
The Health Departments in the other home countries will be making their own announcements on the arrangements that apply there.
Finally, Mr Speaker, the Review Group was set up to deal with this year’s recruitment process. We are now some two years into Modernising Medical Careers that began with the successful launch of Foundation Programmes in 2005. The time is now right to undertake a wider review, to clarify and strengthen the principles underlying MMC and to ensure that, where necessary, we make further changes for future years. Historically, Britain’s medical education and training system is rightly regarded as second to none. The creation of a competence-based training system, which is widely accepted, remains the right way forward. But all involved must feel confident that the pursuit of excellence remains at the heart of the system.
I am therefore establishing a second independent Review to consider these and other broader issues.I am very pleased to say that Professor Sir John Tooke has agreed to chair the independent review. Sir John is Dean of the Peninsula Medical School, Chair of the Council of Heads of Medical Schools and Chair of the UK Health Education Advisory Committee. We are working with Sir John on the terms of reference and membership of the review and I will make a separate announcement as soon as possible. Because MMC is a UK-wide programme, the devolved administrations will, of course, be fully involved in the process.
I commend this statement to the House.
Letter to Daily Telegraph 24 March 07
Sir - Ten years ago, the NHS was on its knees, with staff shortages, recruitment difficulties, and widespread vacancies. We've eliminated recruitment difficulties and rewarded hard-working professionals.
Staff now get paid more for doing more. The NHS now has 300,000 more staff, with vacancy rates at an all-time low, and we've trained more than ever, so that the need for staff is matched by the numbers of high-quality applicants.
Any redundancy is regrettable, but there were only 1,446 compulsory redundancies in trusts and strategic health authorities by December 2006, and eight out of 10 were non-clinical staff. Where we can cut the number of admin jobs, we have done.
Patricia Hewitt, Secretary of State for Health, London SW1
Ministerial Statement
Modernising Medical Careers
19 March 2007 3.34 pm
Mr. Andrew Lansley (South Cambridgeshire) (Con) (Urgent Question): To ask the Secretary of State for Health if she will make a statement on modernising medical careers.
The Secretary of State for Health (Ms Patricia Hewitt): In the written ministerial statements of 7 and 13 March, I set out the Department of Health’s plan for an immediate review of the first round of the new national recruitment and selection process for doctors in postgraduate training. As part of the modernising medical careers reforms of postgraduate medical training, new speciality training programmes will be introduced in August 2007.
To support implementation, a new national recruitment and selection process was introduced earlier this year, facilitated by the online medical training application services. That process sets out national recruitment and selection criteria and documentation and standards, thus replacing the countless local application processes that had previously been in place. The new arrangements were developed with the help of the medical royal colleges, trainee doctors and others. We will continue to work with them to ensure that trainee doctors are properly supported and fairly treated, and that the NHS is able to train and recruit the best doctors for the future.
Doctors have been applying for their preferred specialty training programme since 22 January and interviews have already begun. A large number of posts will not be filled in the first round and we have stressed to those interviewing in round 1 that they should not appoint unless they are absolutely satisfied with the calibre of candidates. It is clear that there have been concerns about the selection process, and that the process as a whole has created a high degree of insecurity amongst applicants, and, indeed, more widely in the profession. We therefore commissioned an immediate review to establish what had gone well and what needed to be improved to create greater confidence in the process.
The review is independent. It is being led by Professor Neil Douglas, vice-president of the Academy of Medical Royal Colleges and president of the Royal College of Physicians of Edinburgh. Members of the review group include representatives of the royal colleges, the British Medical Association, the four United Kingdom health Departments and employers. The review group has considered a wide range of evidence and listened carefully to the concerns of the profession and NHS employers. As a result, the review group has agreed, and the Department is implementing, immediate action, but the group will also continue its work throughout March.
The review group decided that round 1 should continue, with a number of changes to strengthen implementation at every level. All eligible applicants for level 3 and 4 speciality training will be guaranteed an interview for their first or second choice of training post. All applicants at ST1—specialty training level 1—who have not been shortlisted for any interviews will have their applications reviewed and may be offered an interview in round 1. If not, they will be offered career guidance and support to enter round 2. All applicants for ST2 who have not been shortlisted for interview will be offered a face-to-face review with a trained medical advisor to determine whether they meet the shortlisting criteria. Those who meet the criteria may also be offered an interview in round 1. Those who are not selected for interview will be offered support to enter round 2.
As a result of those changes, agreed and asked for by the review group, we expect more than 5,000 more doctors to be interviewed in round 1. We will also publish on the MMC and MTAS websites details of competition ratios by specialty and entry level to help applicants to consider their options for the second round, together with further advice and information for candidates. In addition, further significant changes will be made to the application form and the scoring system to improve selection in the second round. The revised approach will be tested and agreed with the royal colleges, junior doctors, postgraduate deans and employers. I am very grateful to Professor Douglas and his colleagues for their continuing work on the review group. We will publish the group’s final report once it is completed.
Mr. Lansley: Having dragged the Secretary of State here to make a statement, I am truly sorry that it fails to answer most of the key questions. Before I reach those questions, however, let me ask the right hon. Lady why neither she nor any other Labour Minister took the trouble on Saturday morning to join 12,000 junior doctors who were marching because of their concerns about the arrangements. My right hon. Friend the Leader of the Opposition and I went, and we listened. Had the Secretary of State come, she would know why the process has been such a shambles. Those junior doctors would have told her, from their personal experience, how years of training, clinical experience and academic achievement are being thrown away. They would have told her how they want real training, not a dumbed-down system in which they go down from 21,000 hours of training to only 6,000 hours. Why did the Secretary of State not just listen as junior doctors related their experiences?
Let me ask the Secretary of State these questions. First, how many applications have been made and how many training posts—real training posts—will actually be available in England? Secondly, will the review group that she talks about really be independent? Junior doctors need to know that they will have additional representatives on the review group. Indeed, will she appoint to the review group some of the consultants who have decided that they cannot proceed with the interview process as it is, so that they are represented on the review group, too? That would be advisable. Will she promise that the consultants who do the interviewing and shortlisting will be able to see the full application, not just parts of it, and that applicants can send a full CV to those who are doing the shortlisting?
The Department and the review group seem to be carrying on with an absurd scoring system. How can applicants’ clinical experience, academic achievements and references be treated as so unimportant in decisions on appointments to training posts? Who designed this crass process of application by anecdote rather than by achievement? I have an example of the scoring system before me. Has the Secretary of State ever read one? How can she justify relevant academic and research experience being worth a maximum of nine points out of 45? A PhD is worth one point, but composing a 150-word answer to a question about how the applicant has coped with stress is worth up to four points. Why do the Government not want the best training posts to go to the best doctors?
If it is clear that the system cannot deliver a fair outcome to thousands of highly qualified doctors, who will be left without good training posts, will the Secretary of State abandon the online system and revert to a conventional application and interview process? If it is deemed necessary by the review group, will she sanction extra training posts by reclassifying staff or trust-grade posts? Will she explicitly repeat the assurance that her former Minister, Lord Warner, gave just three months ago, that
“Doctors in training in England should consequently be pretty confident about securing a training post.”?
I have received hundreds of letters and e-mails from distressed and angry junior doctors, and 12,000 of them marched on Saturday. They are the future of our medical profession, and if we want a consultant-led specialist-delivered service in the future, we will need them. As it is, we risk losing them; we will lose some from the profession, and many others to Australia, Canada and elsewhere. Instead of sticking her head in the sand, will the Secretary of State promise doctors that modernising medical careers will be changed? Finally, will she just say sorry to them?
Ms Hewitt: The hon. Gentleman referred to modernising medical careers as being dumbed-down, but it is nothing of the kind. Modernising medical careers is the outcome of years of work by the medical royal colleges—[Interruption.] I realise that Opposition Members are not in the least bit interested in the views of the medical royal colleges, but they play an important part in the training of our future doctors. Modernising medical careers is the outcome of work by the medical royal colleges, postgraduate deans, the British Medical Association, junior doctors and other key partners, including NHS employers across the country.
If the hon. Gentleman really thinks, as he seems to, that the new system is a disaster compared to the old, perhaps he needs to listen to Dr. Simon Eccles, a consultant at Homerton University hospital, and a former chairman—[Interruption.]
Mr. Speaker: Order. I remind hon. Members that I agreed to a request from the Opposition Front-Bench spokesman for the Secretary of State to come to the Chamber and make a statement; she must be listened to.
Ms Hewitt: Thank you, Mr. Speaker. Dr. Simon Eccles, the former chairman of the BMA junior doctors committee—[Interruption.] I said that he was the former chairman; the hon. Member for South Cambridgeshire (Mr. Lansley) should listen. Dr. Eccles said:
“We mustn’t forget how bad the old system was. I would be given four hundred and fifty CVs to shortlist for twelve places, so…my hospital would send out some four hundred and twenty rejection letters twice a year. Nobody protested and marched through the streets of Hackney because it only happened in a staggered process.”
He described how consultants would decide who to shortlist by simply dividing the piles into two and tossing a coin. One was the lucky pile, and would make the shortlist; the other one did not. That was scarcely—[Interruption.] I am simply quoting a former chairman of the BMA junior doctors committee, referring to some of the reasons why the old system needed replacing.
Both the BMA and the royal colleges have representatives of their junior doctor members on the review group. It has always been the case under the new system that when applications are submitted, the full CV and portfolio can be, and generally are, attached. There was confusion about the interpretation of guidance from the independent Postgraduate Medical Education and Training Board—PMETB—but I am glad to say that that guidance has been clarified. On the issue of MTAS, let me quote the independent PMETB:
“The substance of the application was determined by UK Postgraduate Deans…A similar system has been operating successfully in the USA for over half a century.”
The hon. Member for South Cambridgeshire, however, believes that we should go back to the old non-computerised system, under which junior doctors had to fill in a different application, with different information and using a different format, for every post around the country for which they wanted to apply. It was a completely absurd system.
On the question of numbers, there are just over 32,000 eligible applicants for the available places on training programmes—those figures apply to the UK as a whole—and the number of training posts is about 23,000. May I stress the fact that in many regions, as the postgraduate deans have confirmed, the system is working well, as it is for GP applicants? However, that is not the case everywhere, which is precisely why we set up the independent review group, why we brought in the Academy of Medical Royal Colleges and the BMA, and why every one of their recommendations has been accepted and is now being implemented. Finally, the hon. Gentleman is keen to ask us to spend even more money than we have already invested in the national health service, but he is not willing to vote for that extra investment. His party’s economic policy would mean cuts of billions of pounds in the national health service in one year alone.
Dr. Ian Gibson (Norwich, North) (Lab): Will my right hon. Friend confirm that both the MMC and the MTAS schemes were quality assessed and assured by experts in the field, which is why they were introduced? There was a process to bring them into line with current thinking, both in Europe and in this country.
Ms Hewitt: My hon. Friend is right. A great deal of development work, quality assurance and so on went into the MTAS process and, more broadly, into modernising medical careers. There have been real problems this year, as I said in my statement, which is why we are working with the review group to sort them out and learn further lessons for round 2, and for next year.
Dr. John Pugh (Southport) (LD): Given the shambles, let me begin on a charitable note. The Government have clearly and openly acknowledged the shortcomings in the recruitment system, yet the BMA stated last year that the system was badly organised, did not draw out people’s expertise and would not cope with demand. Was it those shortcomings that the Government had in mind, and do they regret not agreeing with the BMA and failing to act earlier? Do they agree with the Royal College of Physicians that the system was rushed? Do they agree with the royal colleges that CVs should be taken into account, and that previous achievement should not be neglected in application forms? Where else does that happen? Do they agree with Jo Hilborne, chair of the BMA training committee, that junior doctors do receive careers guidance early enough? Do they regret their failure to listen, having scored such an unnecessary own goal?
Turning to other matters, why did the website crash, and how often did it crash? Was that another IT systems failure or another example of lack of anticipation by the Government? Who is responsible for it, and were any warnings given by IT providers? Does it not bode ill for “Connecting for Health”, if and when it is ever up and running? What assessment has been made of the likely destiny of unsuccessful applicants, even under the reformed system? Are 8,000 people to be rendered jobless in this country, and how would that affect future training programmes? How many people in total can expect hospital posts? Finally, on an issue of principle on which there is more than one perspective, do the Government agree with the royal colleges that it was a mistake to take statutory training responsibility away from them, and will that, as well as the fate of our young doctors, fall within the remit of Professor Douglas’s review?
Ms Hewitt: On the last point, as I have already indicated, there has been widespread consultation and agreement about the need to introduce modernising medical careers. The problems that have arisen with implementation this year do not in any way undermine support for the principles and the organisation of MMC.
The hon. Gentleman speaks of introduction being rushed, but work on modernising medical careers and on its implementation has gone on since about 2003. That could not possibly be described as rushed. A great deal of work was done, especially in the second half of last year, to ensure that the systems were as robust as they could be, and that implementation was properly prepared for. What has happened is that, particularly in some parts of the country, and particularly for some specialties, there have been significantly more applications than was predicted. We certainly need, at an appropriate point, to learn the lessons from that for future years.
My understanding is that it is not true to say that the MTAS IT system crashed, although because of the volume of applications there were undoubtedly delays at various stages in accepting them. Although the hon. Member for Southport (Dr. Pugh) did not refer to it, I have heard others suggest that some candidates’ applications were lost in the process—and I understand that that too is untrue.
The hon. Gentleman asked whether there would be 8,000 jobless doctors. There will be nothing of the kind. Of the 32,300 eligible applicants, the vast majority—over 29,000—are already working in the NHS, on foundation programmes, in other training places or in other medical posts in the NHS. Those doctors will continue to be needed, so the shroud-waving about unemployed doctors is absurd.
The hon. Gentleman and the hon. Member for South Cambridgeshire need to recognise that because of our Government’s investment in the NHS, and because we are training more doctors—[Interruption.] The Opposition do not like to hear it, but because we are training more doctors than ever before, competition for consultant training places is greater than ever before. We need to ensure that those candidates, our future doctors, are given all the support they need as they go through an increasingly competitive and inevitably stressful process, and that is precisely what we are doing.
Mr. Frank Field (Birkenhead) (Lab): Will the Secretary of State allow me to emphasise how inadequate the previous system was? Did not she receive, as I did, complaints from women doctors and black doctors that they did not get a fair look-in for training opportunities, and that they felt that the old system was run as an old boy network? And can she give an undertaking to one junior doctor who emailed me: will a majority of the review panel be composed of people who did not set up the original scheme?
Ms Hewitt: My right hon. Friend makes extremely important points about the old system. There is no doubt that the old system depended a great deal more on who candidates knew, not what they knew. The result was a great deal of discrimination within the system, which could never be properly addressed or corrected because it was invisible. That is one of the many reasons why modernising medical careers is such an improvement on the old system. It is fair, it is transparent and it sets the same criteria, the same interviewing processes and so on, right across the country. That never happened in the completely devolved and shambolic system that was used previously. On the review group, it is essential that we have not only the representatives of the junior doctors, but the representatives of the medical royal colleges, as they are responsible both for the training and for the development of the specialist curricula for which the doctors are competing.
Mr. Malcolm Moss (North-East Cambridgeshire) (Con): Does the Minister not realise that the new scheme is likely to lead to serious managerial problems in many of our hospitals, which will lead to a diminution of care and an extended waiting list?
Ms Hewitt: No, I do not accept that. Hospitals will benefit from a much better, much more thorough training system that will get rid of the old system—in which, as a former chairman of the Academy of Medical Royal Colleges described it, senior house officers were a kind of lost tribe filling in time between properly structured and assessed training. There is no doubt at all that the improvements in training that will come with modernising medical careers will be good for doctors and good for patients.
Ms Diane Abbott (Hackney, North and Stoke Newington) (Lab): The House accepts that the old system was unsatisfactory and that a lot of work has gone into the new system, but it has left junior doctors genuinely in uproar. Some of them contacted me this morning to ask me to put this to the Secretary of State: given that the implementation of the new system appears to be fatally flawed, is it right to continue to allocate jobs before the review gives its final report at the end of the month?
Ms Hewitt: Whether round 1 should be delayed or scrapped was one of the first issues that the review group considered at its first meeting, and it has come back to it since. The review group has been clear that round 1 should continue, because otherwise the interviews of thousands of junior doctors would be completely disrupted and hospitals could well find themselves in August without the junior doctors they need in place to continue operating. For that reason, the review group recommended, and we accepted, that round 1 should continue but with the immediate changes that it recommended, and we have made, to ensure that the system works properly, that it is fair to junior doctors, and that it enables the NHS to get the best doctors for all the places that it is seeking to fill.
Peter Bottomley (Worthing, West) (Con): Can the Secretary of State explain how going ahead with the first part of the stage 1 interviews and appointments can be fair if the other doctors who are now excluded but will be brought in later are being considered on a different basis? Will she take up the suggestion that she use the MTAS system to carry out a ballot of all the doctors in training to ask them what they think would be fair, and whether it would be better to stop and start again on an equal basis, or to continue on this unequal basis? Will she please get her people to talk to the directors of medical education and ask them to nominate the people who they know should have been interviewed but have not, just to show what has so clearly gone off course?
Ms Hewitt: In a sense, the hon. Gentleman’s suggestions have already been considered by the review group, which has received evidence and listened to representations from a very wide range of people. For instance, 84 per cent. of the most junior of the junior doctors—the ST2 junior doctors who have completed the two-year foundation programme—have already been given a round 1 interview. The remainder are having their applications reassessed, and many will, as a result, also be given a round 1 interview. However, the review group has been very clear—and I support it in this—that the way to proceed is to make immediate changes so that round 1 operates better and more fairly, as it is already doing in other specialisms and in some parts of the country, and then, if necessary, to make further changes for round 2 so that lessons from round 1 are learned. As I stressed earlier, we have made it clear to those making the appointments that they should not appoint from round 1 unless they are absolutely satisfied with the calibre of candidates—although several of the postgraduate teams who are already involved in those round 1 interviews say that they are delighted with the calibre of candidates, and where they are considering making appointments, they are finding it even easier to do so than in the past.
Ms Diana R. Johnson (Kingston upon Hull, North) (Lab): I am concerned about the impact that the bad publicity about this scheme could have on the new medical schools, particularly the Hull York medical school. What reassurance can my right hon. Friend offer me?
Ms Hewitt: There was enormous public and student welcome for the creation of the new medical schools and the additional medical places that we have been able to create as a result of the investment that we have made. It is important that we restore confidence, where that has been damaged, in the whole process of recruitment for consultant training, and that is exactly what we are doing with the help of the review group. When we publish its final report, we will be able to see what additional changes are needed to ensure that next year’s process works without the difficulties that we have encountered in this first yea
