Andrew Lansley
From Mmc
20 March 2007
Rt Hon Patricia Hewitt MP
Secretary of State for Health
Department of Health
Richmond House
79 Whitehall
SW1A 2NS
Modernising Medical Careers
Following yesterday’s exchanges in the House, I’m afraid I need to follow up on several points on which you gave inadequate or questionable replies. I hope you will appreciate the urgent need to get this right.
Before turning to these points, let me be clear: we are not opposed to the need for change in the application and training system - we are opposed to the flawed implementation of the changes and your Department’s failure to address them adequately.
So firstly, I am writing to ask you to respond to the following questions, which you failed to answer yesterday in the House:
1.Junior doctors do not regard the review group as independent. There is currently only one junior doctor on the panel which is at odds with your assertion that, ‘it is essential that we have not only the representatives of the junior doctors but the representatives of the medical royal colleges’ (19 March 2007, Official Report col.582). In the interests of delivering the best possible recourse, will you appoint additional representatives of junior doctors; and to demonstrate independence, some of the consultants who decided they cannot proceed with the interview process as it is?
2.You conceded that there were 23,000 training posts for just over 32,000 eligible applicants. Will you explicitly repeat the assurance that Lord Warner gave on 13 December 2006 that, “Doctors in training should consequently be confident about securing a training post”? (DH press release 13 December 2006).
3.Will you confirm whether ‘your understanding’ that MTAS was quality assured; and does this relate directly to MTAS, as it is currently structured?
4.Had you read the scoring system against which applications for training posts are judged prior to yesterday’s debate, and do you agree that is weighted in such a way as to discount relevant clinical experience, academic achievement and references?
5.Will you be prepared to accept that the review group can recommend that MTAS be abandoned in its current form if it cannot be reformulated to be fair?
6.How much has MTAS cost to date?
7.You did not say whether or not, if the review group allow for it, you will sanction the conversion of staff-grade posts to additional training posts. Will you?
8.Will you apologise – as Lord Hunt did yesterday in the Lords – to the thousands of junior doctors who have been thrown into disarray by the shambles that is Modernising Medical Careers?
Secondly, what you chose to say about MMC in the House yesterday at best reveals your limited understanding and at worst is misleading.
I am asking if you will correct the Official Report on the following three inaccurate points you made:
i)‘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’ (19 March, Official Report, 19 Mar 2007: Column 580).
But according to those who use the system this is simply not true. To cite a few examples: “I can categorically state that the submission of CVs along with the online application process was not possible during the entire first round application process” (Research Registrar, Yorkshire and the Humber), “I was not allowed to see the candidates’ CV for short-listing or at interview”. (Consultant, East of England). These are not isolated cases, I and my colleagues have been received dozens of similar letters.
ii)“My understanding is that it is not true to say that the MTAS system crashed ….that others suggest that some candidates’ applications were lost in the process- and I understand that that too is untrue”. (Official Report, 19 Mar 2007: Column 581).
Again, the evidence tells a very different story: ‘My own SHO had his application lost and the Mersey deanery confirmed they had never seen it…this has happened to many other doctors’ (Consultant, North East). And on the 27 February the BMA called for a delay to the computerised system because of “repeated delays and the website crashing”.
iii)‘A similar system has been operating successfully in the USA for over a century’ (Official Report, 19 Mar 2007 : Column 580).
This is a highly inaccurate comparison given: the applications are to a hospital, not a vast region; all US graduates take an exam that ranks them according to their ability and the short-listing is based on these scores; if a programme director is impressed with an applicant he can arrange for an interview and offer a job and CVs are available to interviewers.
Only last month you said,
“The views of staff matter - staff have the knowledge and experience to know what really works and we need to harness this knowledge and engage the experience to help facilitate change”. (22 February, DH press release).
But clearly the views of junior doctors and consultant interviewers don’t matter. You did not engage with the 12,000 junior doctors who marched last Saturday and you failed to harness the information you have no doubt received from many concerned constituents. If you had, you would not have made the incorrect statements above and you would be facilitating change for a fairer application process, which the review group has failed to deliver so far and which junior doctors deserve.
Finally, there is a real danger that unless appropriate action is taken now, the problems will escalate towards the beginning of August when junior doctors are due to start their training; by that time many excellent doctors may not have places, others may be in placed in inappropriate posts and more still may be lost in the profession or to other countries.
I look forward to hearing from you.
Andrew Lansley CBE MP
08 March 07
Thank you for writing to inform me about the problems concerning Modernising Medical Careers. It is appalling that it has taken such a shambles before the Government will admit the need for a serious review of what is being done to medical training. None of these concerns are new. The initial issues were evident in relation to the number of training places available; as you know, the two year foundation scheme finishes at the same time as the training course for senior house officers from the previous training route, creating an unprecedented demand for places. I alerted the Government to this in December 2005 and was assured by the Health Secretary that she was working on a resolution (Hansard, 20 December 2005). A year later, Lord Warner offered further empty assurances, when he said, “Doctors in training in England should consequently be pretty confident about securing a training post”. (Department of Health press release, 13 December 2006). But it is clear from your letter and the many others I have received that junior doctors have been abysmally let down.
In addition to concern about the number of training places, we have received hundreds of letters complaining about the new electronic application system, MTAS. Technical failures mean that many applications were not received, confidential data was open to alteration by unauthorised persons and wrong appointments issued for interviews, wasting both application time and that of consultant scrutinisers. We wrote to the Health Secretary seeking a review and we have repeatedly sought opportunities to put questions to Ministers in Parliament but they have refused. Ministers have not, of course, come to the House to make a statement and answer questions; that is unfortunately all too typical.
We welcome the Government’s last minute acceptance of the case for a review. The review must now be rapid. It must be independent and not constrained by the Department of Health. It must consider whether additional training places should be provided; it should explore whether enhanced evidence of the experience, achievements and references of applicants can be considered; and it must allow for thousands of junior doctors who have not received first round interviews to be considered afresh in the second round in April.
We will continue to hold the Government to account for the failures manifested in Modernising Medical Careers. It is not about political posturing – the Conservatives will work with the Government wherever possible to enable junior doctors to pursue their vocation in medicine in this country. This evening, I am meeting representatives from BMA Junior Doctors Committee to discuss a way forward and hope to meet many junior doctors at the ‘white coat’ rally on 17 March in London.
I wish you all the best. Please keep me informed of your progress and about any other issues of concern.
Andrew Lansley CBE MP
