Modernising Medical Careers
Opposition Day — [9th Allotted Day]
David Kidney (PPS (Rt Hon David Miliband, Secretary of State), Department for Environment, Food and Rural Affairs; Stafford, Labour)
I agree with the hon. Gentleman. I considered whether to intervene on him earlier to say that I agreed with him on that point, but I also intend to say in my speech that developments such as these should be piloted in future. So the answer to his question is yes.
I was describing the personal tragedies that have happened because of the way in which the system has been introduced. I want to remind hon. Members who were not here eight days ago when the Secretary of State made her statement to the House that, on that occasion, I made the point that this concerns individuals who each demand more respect from the system—and the people administering it—than they have been getting over the past few months.
In fairness to the Secretary of State, she has apologised at least three times for what has gone wrong with the system and for the distress that that has caused to those affected. One review has proposed changes that are about to be introduced, and she has also announced a further, broader review, which has been mentioned today. The shadow Secretary of State made a temperate speech today, with many good points. One of them was about the independence of that review, and the importance of all of us having confidence in its deliberations and conclusions. That is an important point for the House to make.
Meanwhile, making a success of the first review, with its guarantee that every junior doctor who applies for a post and states their first preference will have at least one interview, is placing a terrific strain on managers and consultants to deal with the extra work that they are being asked to do over the short space of time between now and August. It is fair to say that they are the hidden heroes who are solving this problem right now, and they deserve our thanks. The hon. Member for North Norfolk made that point earlier. A number of consultants wrote a letter to The Times earlier this month to say that they had been placed under a lot of pressure, at a time when they had plenty of other work to do to meet the demands of patients and the NHS. We owe them a debt of gratitude. That letter, incidentally, also called for the scrapping of MTAS and a return to the previous system, so although I said that no one in this debate had asked for that to happen, other people certainly have. We should remind ourselves, however, that the previous system had serious faults too. It did not find a specialty training place for every junior doctor either.
If the Minister listens to the shadow Secretary of State, and to my hon. Friends who have said the same thing, he will realise that there is the prospect of a win-win situation. My hon. Friend John Mann made the point that certain areas are short-served by the NHS at the moment, and we could create a win-win situation by expanding the number of training places available for junior doctors in those areas and in specialties where there are shortages. Perhaps those shortages exist because people do not want to take on those specialties, and it would be wrong to force anyone to do something that they did not want to do, but this could give us an opportunity to ask people to look again at specialties where there are shortages, in which they might be able to do a good job. We could create a win-win situation by filling the posts that we need to fill and finding places for the people who want them. I hope that the Minister will be able to respond to that point later.
I want to put forward some points on behalf of a doctor in my constituency with whom I have had a good, spirited correspondence on his concerns about modernising medical careers. He and I agree that we are unsure about the evidence on the number of available posts and the number of people applying for them. Obviously, the more transparent Ministers can be about this, the better it will be for people who have fears—whether politically motivated or not—about what is happening. It is clear, however, that there are fewer training places than there are people applying for them.
My doctor correspondent makes the point about the double cohort, observing that
"increased numbers of medical students are passing through their second foundation year and needing specialist training. The shortened training also has a big impact on the large number of senior house officers who also need to find a place on the new training pathway."
The two cohorts are coming together at the same time. He also makes the point that non-EU doctors are competing for those posts. He concludes:
"The new doctors in their second foundation training year have no chance of success against the more experienced senior house officers and the non EU graduates."
I do not know that, and I bet that most people in the House today do not know it, because we are not sure whether we have enough confidence in the system to say whether that is the case. The doctor goes on to say that
"MTAS has had to make its mark by designing an application form in which experience counts for virtually nothing. Selection is largely from the psychology questions which have no tested validity in this field. The marking of these questions is also widely variable between different markers."
All those factors have undermined confidence in the system so far.
I shall not name the doctor without his permission, but it is important to get his views on record. His letter goes on:
"I should tell you that this whole exercise has also been an opportunity for government to reduce the 'power' of doctors and their representative bodies."
Such allegations can be made, and can sound reasonable, because of the mess that we are in at the moment.
There has always been competition for posts, and some people will always find themselves in short-term posts because they cannot get the specialty training that they want. I was pleased to hear the Secretary of State say that support will be available for such people after this year, but will my hon. Friend the Minister tell me more about their prospects in future years? Can they always expect to be treading water and becoming what some people call the second lost tribe, or will they have the prospect of moving on? It is in the context of their fear that they will have nowhere to go that we hear the constant talk of people being forced to emigrate to find a job.
I shall return to the effect that all this is having on my constituents. It is demoralising for them to hear that the state is paying to train bright young people to provide a service that everyone wants and values, only to see them emigrate because they cannot be given a post in their own country. That is very harmful.