I beg to move,
That this House
acknowledges the UK's exceptional history of medical training which has produced some of the best medical professionals in the world;
supports medical training designed to improve patient care which is well implemented, flexible and applied in a way which ensures the necessary level of clinical experience;
believes that these objectives have been undermined by poor planning, inadequate consultation and lamentable implementation;
notes with particular concern the flawed electronic application process (MTAS) which has breached legitimate expectations that selection for entry to programmes must be open, fair and effective;
regrets the lack of ministerial leadership for MTAS and the failure of the Government's review to deliver strategic solutions;
accepts that training posts are competitive but believes that insufficient allowance has been made for the number of trainees coming through the Foundation years in addition to the Senior House Officer (SHO) route;
calls on the Government to create additional training posts to allow transition for SHOs into specialty training in 2007, 2008 and 2009;
deeply regrets the distress and loss of goodwill among junior doctors in training;
and further calls on the Review Group led by Sir John Tooke to listen to the medical profession in reviewing the structure of Modernising Medical Careers to ensure that the original principles, including flexibility, are sustained and command the confidence of the medical profession.
The reason why we have called this debate and given up Opposition time to such an important subject is that time and again we have sought answers from the Secretary of State for Health and Ministers about what has happened to the modernising medical careers programme, in particular the recruitment and selection process. With your consent, Mr. Speaker, we put an urgent question that the Secretary of State had to answer, because previously she had provided no good answers. Last Monday, she came to the House to apologise unreservedly—about time—but also to announce a further review and the conclusions of the first review group she had instituted. Serious questions and issues remain, however, and many junior doctors across the country and the consultants responsible for the interviewing process feel they have not been answered.
Our purpose today is therefore threefold. First, we want to secure some answers; secondly, through our motion, we want to make clear the necessary steps that the Government should accept to regain the confidence and support of the medical profession; and thirdly and not least, we want to demonstrate to the many junior doctors who have come to Westminster today to tell their Members of Parliament of their personal experiences, their disillusionment and, in many cases, their anger at what has happened to them that Conservative Members at least understand and accept their views. I suspect that many Labour Members, on the Back Benches at least, understand the problem. We will see later whether they are willing to come to the House to express to Ministers the sentiments that they have no doubt expressed to their constituents in private.
Does the hon. Gentleman agree that whatever the flaws or otherwise of the electronic system, the underlying problem is the surplus of applicants compared with places? Will he commit his party to increasing funding to the health service by the same level as we are committed to doing so that these doctors have a real prospect of a future in the NHS in the years to come?
The hon. Gentleman must know that, in the general election the year before last, we committed ourselves to exactly the same level of funding as applies now. However, we are talking not about the next election, but about what is happening now. We are committed to the same level of funding, but we are also committed to a far more efficient use of that funding.
The hon. Gentleman could have said, "By the way, the Government spent £72 million on the NHS university," but that turned out to be completely wasted. What was their response to that waste of money? It was to try to suppress the report by Sir William Wells that was designed to examine where all that money had gone. Let us first be concerned with spending money effectively before we start debating how much money there will be beyond the comprehensive spending review.
The Secretary of State is sometimes at pains to challenge us on whether we agree with the principles behind modernising medical careers. Yes, we agree that modernising medical careers is a necessary process. To put it at its simplest, let us consider whether services in the NHS should be provided in the long run by specialist doctors or by doctors in training. Patients and the public would expect the services to be delivered by specialists and that it would be a consultant-led and increasingly a consultant-delivered service. When one looks across the world, one sees that this country has been unusual in the extent to which services in NHS hospitals, in particular, have been delivered by doctors in training rather by doctors who have their specialist certificates.
The principle of modernising medical careers is accepted and we also accept many of the principles in the documents of 2002 and 2004 that led to it. We should not rely on doctors in training for service delivery and training must be limited in time. It cannot be open-ended. As Sir Liam Donaldson said in his report about the "lost tribe" of senior house officers, we cannot have junior doctors who drift from one SHO job to another for years without ever making progress in specialist training.
Let us remember that one of the principles of MMC was that it was intended to be flexible and widen career choice. Where did that one go in the translation of principles into practice? The way in which MMC has been implemented is lamentable. When people look at the political gravestones of the figures in the Government, they will see carved on them, "It should have worked in principle, but it didn't work in practice." The Government started out with good intentions, but time and again they have failed to deliver. Here is another lamentable and shocking example of how they have failed to turn what, five years ago, was a straightforward set of principles into something that works in practice for those in the NHS today.
My hon. Friend is putting forward an excellent case. Like many hon. Members, I have been meeting young doctors, including some who are now going to go abroad. Those doctors are worried that they will not receive sufficient training under MMC. For example, orthopaedic surgeons received 22,000 hours of training under the old system, but they will receive only 6,000 hours of training under MMC. There might well be a happy medium, but the Government have certainly not got this right.
I understand exactly the point that my hon. Friend makes. I have had exactly the same conversations. I think that most junior doctors would acknowledge that it would be difficult to sustain the degree of clinical experience that used to obtain and that that would probably not be consistent with the delivery of services by specialists. However, my hon. Friend is right that there is a balance to be struck. Surgical specialties, especially, are, in effect, crafts as well as academic disciplines. While the structure of MMC and its focus on specific competencies address important issues, the programme has significantly failed to reflect accurately the importance of clinical experience and academic achievement, which should be involved in the selection of candidates.
I, like Ministers, care about what is happening, but perhaps Opposition Members have been more open about some of the problems. Locally, we have discovered that filling out 150 words is worth the same as a PhD, which involves three years or more of hard work. An explanation of that is needed. On the first day the system opened, it was apparently not possible to apply for a job within 50 miles of Worthing or for one in genito-urinary medicine. The problem is not the computer or the method of consulting the people who put the thing together. The problem was caused because the system was not run as a trial in at least one region to evaluate the experience. Will my hon. Friend commit us to go on working not only for senior and junior doctors, but for those in the MMC system who resigned because of a loss of confidence, by backing the doctors and, if necessary, saying to the Government, "Why don't you drop your defences and join in working out the problems and solving them?"
My hon. Friend has captured exactly what we are trying to achieve through this debate. If hon. Members read the motion, they will see that its objective is not to engage in the easy task of saying, "It's all gone wrong and the Government are to blame." The motion engages with the question of what needs to happen now, although I note that the Government amendment says nothing at all about that.
The Government have been given warnings and they have to account for why they did not accurately reflect on the problems. Dr. Palmer, who asked the Whips' question and then left the Chamber, said that this was about the number of applicants. However, I remember standing at this Dispatch Box on
There was a good deal of forewarning. The royal colleges rightly told the Government that the programme should be piloted, as my hon. Friend the Member for Worthing, West suggested, but that did not happen. Last year, junior doctors in the British Medical Association wanted a delay of a year. To be fair, I was not sure that that was the right thing to do because it would have harmed the circumstances of the foundation programme graduates. None the less, the BMA was rightly pointing out serious unresolved problems.
I strongly support the hon. Gentleman's motion. Does he agree that the key point about MMC is that the number of training posts will not meet the need of the people who want to apply? The principle should be that all those who are qualified for a training post, and who are capable of being trained to consultant level and wish to be trained to that level, should have a training post; otherwise, we are wasting money by putting them through medical school and house jobs. A solution in which those people are parked in career-grade posts, so that they become fellows or hold staff grades or trust grades, is not acceptable, because then the service will be delivered not by consultants, but by a demoralised and often racially segregated group of doctors who are not fully trained and who are not specialists—and that is not the way we want our health service to go.
The hon. Gentleman is leading me further into what I was hoping to say. Let me just respond to that point. From what I know of the interviews that are already taking place, many consultants holding the interviews are meeting well- qualified applicants; I see that the Secretary of State is nodding merrily. However, unfortunately, we know that many well-qualified applicants did not get interviews. As Dr. Harris suggests, we need a process in which well- qualified junior doctors have progressive opportunities to enter specialty training, and that is what our motion says. It also suggests that it may not be possible for all well-qualified applicants to secure specialty training or run-through training posts this year, but we have to put a stop to the current structure, which, in effect, limits the ability of some people, particularly senior house officers, to enter specialty training next year, or the year after that, if they do not enter the run-through training process this year.
Surely specialisms are to be held by the people best qualified to fill the posts, but how can that be reconciled with a situation in which people are confined to applying for posts in certain geographical areas? That means that if there are only two or three posts going in an area, and someone is the third or fourth best qualified person in the area and so does not net the post, they are unable to qualify, or even to apply, for similar posts in other parts of the country, even though they may be much better than the people who are allowed to apply for those posts.
I am grateful to my hon. Friend, who makes an important point. He reminds us of the most important reason why we are debating the subject. I have received hundreds of e-mails on the subject, and I have met many constituents, as I am sure that colleagues from across the House have done, who are concerned for their careers, for their livelihoods, for the fulfilment of their vocation to be a doctor and care for patients, and often for their family life. I ask hon. Members from across the House to imagine how they would feel if they were junior doctors—highly motivated professionals who have gone through graduate education, and who have, in some cases, worked in the health service for several years. They are senior professionals by any measure, but the net result of the current structure, including the way in which the review group has changed things, is that there is one interview for one unit of application, and that might be for a post anywhere in the east of England, from Hemel Hempstead to Cromer. That is the sum total of their ability to exercise control over the future of their career.
Dr. Mary Weisters and Dr. Tracy Graves practise general surgery and neurology respectively. Between them, they have 25 years' experience, which includes education, training and hands-on practice in the national health service. According to the figures, they have a one in 30 chance and a one in 13 chance respectively of securing a job at a time of rising demand for medical services. Does my hon. Friend not agree that it would be a scandal bordering on criminal irresponsibility if they were shunted out of the national health service or, as happens at present, patronisingly encouraged to go abroad—something that they do not have the slightest desire to do?
I am grateful to my hon. Friend, because he further reinforces my point. I have often met married junior doctors who are wrestling with the issue of how they can both secure posts in a way that is consistent with maintaining their family life. That is intensely difficult. My hon. Friend's point is a fair one; the British Medical Association is today warning that literally thousands of junior doctors could end up going overseas. What is the Government's response? Well, we saw the document produced in the Department of Health last week. It was not published, but it found its way out. The Government are "volunteering" junior doctors to join Voluntary Service Overseas, so that they go abroad. [ Interruption. ] Well, it struck me that VSO is about volunteering—not the distressed reallocation of doctors from the United Kingdom to overseas, which is outrageous.
Further to the point made by our hon. Friend John Bercow, how do I explain to my constituents at the Horton hospital that we are likely to lose 24/7 consultant-led paediatrics, consultant-led obstetrics and a special care baby unit in the near future, because we have been told that there are insufficient doctors? How is a community like north Oxfordshire to accept on the one hand that there is a substantial downgrading of NHS services in Banbury and the surrounding area in a way that has never taken place before, while on the other it can see that junior doctors are being thrown on to the scrapheap?
There is only one way for my hon. Friend to explain that to his constituents: it is chronic mismanagement of the national health service by the Government. It was the Government's intention to continue the expansion of consultant posts, but that has been torpedoed by the mismanagement of finances and deficits in the health service so that across the NHS posts have been frozen, consultant posts have disappeared and specialist consultants in some specialties cannot find posts. The consequence is seen not only in the impact on Horton hospital in my hon. Friend's constituency, but across the country. The increase in medical school output or in the number of junior doctors coming through would have been consistent in due course with a larger throughput into consultant posts, but the Government's attitude is that those consultant posts have been lost for financial reasons and they are cutting back on the hospital sector, so they want to maintain a tight bottleneck at the point at which junior doctors enter the further reaches of specialty training. They are stopping the flow, and they are literally forcing large numbers of doctors to leave the country.
The Government may believe that the doctors who will leave this country will be those who came from overseas in the first place, but that is not how it is working out. It is an arbitrary system. The scoring system, recruitment and application system have been made "objective" in a way that has become virtually arbitrary. Those who are selecting candidates for posts across the country were unable in the initial process to see anything like sufficient of the clinical experience, the academic achievements and the character of the candidates presented to them. It turned into a scoring system in which someone could literally—I have evidence in my file—pay £129, go on a course, and be told how to answer the questions to be selected for interview. That is utterly outrageous.
Following my hon. Friend's extensive research for this debate, can he explain why there is such a misfit between the 30,000 junior doctors who started out with an aspiration to reach those higher posts and the 22,000 opportunities that exist? Who created that over-supply of 8,000 junior doctors, and has he worked out the cost to the economy, never mind the human cost, of that enormous waste of unplaced talent?
My right hon. Friend may be aware that we are constantly searching for accurate figures as to precisely how many applications and run-through training posts there are. Of the 18,500 posts in England—I think that the Department would acknowledge that figure—we have not even been told how many are run-through training posts and how many are fixed-term posts. The disparity between the figure of 18,500 and anything up to 34,000 posts is principally the result of the combination of two annual cohorts coming together because the new MMC process is shorter than the old training process, the right of European economic area nationals to apply without legal restrictions in this country, and a large number of overseas doctors who, for example, have highly skilled migrant programme visas.
There is no reason, as far as I am aware, why the Department should not have anticipated all those components. As little as four months ago, the Department, in the guise of the former health Minister, Norman Warner, was about a third out on the number of potential applicants. It is not good enough for Ministers to say, "There were more applicants than we expected so it all went wrong." They were responsible for the process. They are responsible for the number of junior doctors who have access to training in this country. They should have known the likely outcome and dealt with it.
Time and again we have told Ministers that thousands of junior doctors would be left without training posts. The response of the Secretary of State is always to misinterpret that and say, "You're saying that they are all going to be unemployed, and that's shroud-waving." She said on
"the shroud-waving about unemployed doctors is absurd."—[ Hansard, 19 March 2007; Vol. 458, c. 582.]
In a letter to me on
"It is wrong to conclude . . . that there is a danger that these doctors will be unemployed"—
The Secretary of State says that is right, but in her own Department a document is being circulated, the purpose of which is to try to deal with the fact that up to 10,000 junior doctors will be unemployed. That is what it says—unemployed or without training posts. It was not absurd. We were not shroud-waving. It was a fact and the Government knew it, but they would not admit it.
The Secretary of State has been in appalling denial about all this. I shall try to avoid a long quote, but I want the House to listen to the words of one consultant who wrote to me describing the process from the interviewer's point of view. We are hearing from junior doctors about how appalling the process has been. The consultant wrote:
"Today was the first occasion in 20 years that I was asked to make important decisions on the careers of our future colleagues, with no CV or application form to review in preparation for the face-to-face. The only information I received was a list of candidates—in no particular order—and a start time and venue. Each candidate arrived armed with a brief one-page summary, hand-written immediately prior to interview and a portfolio the size of one or two telephone directories. Three colleagues and I were supposed to review these in 30 minutes flat, at the same time as we conducted a structured interview, marked each domain individually, and finally came to an agreed score for each domain that will be forwarded to MTAS . . . I never saw any references and there was no opportunity to review our decisions. This process is the antithesis of fair employment and equal opportunities."
That is from the consultant's point of view. Imagine how it seems from a junior doctor's point of view. I have a quote from a junior doctor who describes his experience. He states:
"I have a first-class degree in medicine/neuroscience, medical degrees with distinction, two research doctorates . . . in behavioural neuroscience, nearly 30 scientific publications including text books and commercialized research software, research prizes, three years' experience as a lecturer in neuroscience at the University of Cambridge, and two years' experience as a medical SHO at teaching hospitals . . . whilst I was short-listed for an ST2 medical position I failed to be shortlisted for ST1 psychiatry, which requires no previous psychiatry experience. Presumably, in some way my answers to the 'anecdote' questions didn't fit the psychiatry scoring system, whatever that was".
That reflects precisely the point made by my hon. Friend the Member for Worthing, West. A candidate can end up with all those qualifications but fail to be shortlisted because of the scoring system, under which a PhD was worth one point and 150 words on how one copes with stress was worth four points.
Perhaps one should ask whether the Prime Minister would appoint the Front-Bench health team on the same kind of system. Will my hon. Friend join me in posing a question to the Secretary of State for answer at the end of the debate? Is it true that the review group has said that each candidate will get one interview in their primary area? Is it true that under the MTAS system people who are to be interviewed this weekend are being told that there are no jobs available—that all were filled on the first round, so they cannot select their first choice? The advice is that they contact the deanery directly. The Secretary of State shakes her head. Will my hon. Friend join me in asking her to get that checked by the end of the debate and tell the House what applicants are being told under the system today?
I am grateful to my hon. Friend. I am sure that the Secretary of State heard what he said, and I hope she will respond. On interviews, I suspect that she is not looking forward to the one with the next Prime Minister.
The Secretary of State has been in denial. She has told the House about the outcome of the review group. In a letter to me on
"The Review Group is independent and responsibility for membership rests with Professor Neil Douglas".
But a freedom of information request to the Department secured the answer:
"I can confirm that Clare Chapman, Director General of Workforce at the Department of Health, had overall responsibility for considering who was appropriate to sit on the review group."
It was not independent at all. It is no wonder, given the lack of a strategic solution from the review group led by Professor Douglas, that the Secretary of State has had to announce a new and a second review.
Professor Crockard, who was responsible for the modernising medical careers process, resigned, and in a letter to Liam Donaldson, the chief medical officer, said:
"I have become increasingly concerned that the well intentioned attempts to keep the recruitment and selection process running have been accompanied by mixed messages for the most important people in the whole process—the young doctor applicants."
It is basically unfair to advertise the possibility of four interviews and then suggest that these might not be honoured. Shelley Heard, the clinical medical adviser to the MMC process, said:
"The Review Group has not done this strategically or with an eye to the future."
This is why we are here this afternoon. The Secretary of State and the Government are in denial about the scale of the process and the many difficulties and problems with the scoring system and the recruitment process, which I have not had time to go through, and are not coming forward with viable solutions for the future.
The hon. Gentleman makes a fair point about the lack of independence of the first review group, on which the great majority had close involvement with the creation of the MTAS and the modernising medical careers project. Does he hope that Professor Sir John Tooke, in agreeing the complement of his review group, will not include anyone who has played any part in any of the processes that have had so many problems during the past few months and years?
I am grateful to the hon. Gentleman for that. The Secretary of State will no doubt tell us more in a moment, but she has this afternoon announced the terms of reference for Sir John Tooke's review: that it will be independent of the four health departments—good; and that it will have an independent secretariat—good. But there are two problems. First, she has not announced the membership, and I entirely endorse what the hon. Gentleman said. It is essential for the confidence of the medical profession that Sir John Tooke's review is conducted by people who are in no sense, whether positively or negatively, associated with the decisions that have hitherto been made about the MMC and MTAS processes.
The other problem with what the Secretary of State has announced this afternoon is that she is asking Sir John Tooke to report on an interim basis in September. Hon. Members will know that the problems that we are encountering now with the outcome of the second review group will come to a head in August, so she appears to be precluding the possibility of Sir John Tooke and his colleagues, whoever they may be, intervening more or less immediately to say that steps need to be taken.
The Opposition motion includes essential measures. The review still has serious problems and it will be subject to legal challenge. There is a good argument that legitimate expectations of junior doctors in the application process have been completely failed, and there are still problems in trying to manage the application process. People cannot obtain interviews and are being logged out and obstructed, and there is scope for gaming for those who have already had interviews. To that extent there is an uneven playing field between those who had first round interviews and those who are in round 1B. It is astonishing that in England junior doctors are being restricted to one interview, whereas in Scotland and Northern Ireland all four original interviews are being offered.
It is far from clear that consultants throughout the country will be prepared to participate in what they regard as an unfair recruitment process. The consultants at Addenbrookes in my constituency sent me the results of a consultant survey that they had recently undertaken, and three quarters of those consultants said that they would refuse to take part in further interviews. Ninety-seven per cent. of them wanted to see the previous system of appointments restored for this year. I do not necessarily agree with that. However, there is something that we can and must do between now and August. It is not good enough to wait for Sir John Tooke's review in order to produce a report in September. We must consider foundation programme graduates who should, in all cases, be able to access specialty training. If they are not getting access to that training, posts will need to be created to enable that to happen. That was clear from the original principles of MMC, as stated in April 2004 in "Modernising medical careers: the next steps":
"It is not acceptable that they"— that, is foundation programme graduates—
"should at this stage fall out of the training system".
Yet, according to the Department's own document, between 500 and 1,300 such foundation year graduates might fall out of the system.
It is not acceptable that this shambles means that large numbers of senior house officers, many of whom have excellent clinical experience, good academic qualifications and fine references, are going to be closed out of the ability to enter specialist training. We must turn more trust grade posts into training posts. I said that to the Secretary of State on
The hon. Gentleman is absolutely right. He is also right as regards the financial cost, or otherwise, of converting staff grade posts and trust grade posts to junior doctor training posts. Clearly, some service functions may have to go with the loss of those service posts, but I think that most junior doctors will be prepared to do some supervised service as the price of having a career in training. Does he agree that if the Government plan junior doctor posts, there must be some central planning to get the consultant expansion that is needed to underpin all of this?
On the latter point, it is fair to say that one of the essential things that John Tooke must do is to establish a new work force planning arrangement that is owned much more by the profession and the service than by the Department of Health, which has handled it so appallingly.
The hon. Member for Oxford, West and Abingdon makes an important point. As I am sure that the Secretary of State would agree, turning trust grades to training posts is not without cost. That would have to come from the MPET—multi-profession education and training—budget in strategic health authorities. The Government have admitted that in the last financial year—2006-07—they cut £350 million from education and training budgets. Three or four weeks ago, the chief executive of the NHS said that that was for one year only. We are now at the start of the new financial year. It is clear from the SHA board papers that some SHAs are already planning to cut £136 million out of their training budgets for this financial year. We know where the money could come from for more training posts, because there is money in the training budgets, yet the Secretary of State sits there saying that the Department cannot afford them. It could afford them were it not mortgaging the future of the NHS to deal with its financial mismanagement to date.
Let me make it absolutely clear what we want. On
It is not only a matter of the time and energy that junior doctors put into getting qualified but the massive student debt that they incur. Medical graduates now have an average debt of £21,000.
It is no wonder that not only Australian medical recruiters who come to this country but the City try to recruit junior doctors. Some of them will understandably be tempted precisely because of the point that my hon. Friend makes.
The hon. Gentleman says that we should ensure that there are career prospects for our best young people in this country. Given the unique circumstances that give rise to the issues that we are debating—two strings of training are concluding in one year—does he believe that the Government should ban doctors from Europe from applying for jobs in this country? Given that Europe takes so long to respond to anything, the year would be over and we would be into a second one before it had caught up with what we had done.
I am grateful to the right hon. Gentleman but I fear that, legally, his suggestion is impossible. I do not propose it because I do not believe that the Government could legally take such action.
We cannot allow investment in junior doctors to be abandoned—that appears to be a risk as a result of the Government's policies. The vocation to serve patients in our national health service must not be lost to this country. The human needs of junior doctors—to pursue their career and maintain their family life—must not be ignored by the way in which the process is administered. We need to return to the profession greater control over its education and training. It is vital to find a solution that wins back the profession's confidence, which the Government have lost.
It is vital that Sir John Tooke's review not only has the option of making immediate recommendations but can be independent, representative of the profession and the service, open in its analysis—not closed, as previous review groups have been—and strategic in its outcome.
In a briefing paper for the debate, the Royal College of Physicians described what has happened as:
"The worst episode in the history of medical training in the UK in living memory".
The medical profession is rightly angry. Its members have been disempowered and they are demoralised. That has happened on the Secretary of State's watch. We have brought her to account and we want a solution. The Government's amendment makes no reference to the appointments and recruitment systems or MTAS. Worse, it contains no expression of regret. Our motion expresses on behalf of Parliament our deep regret about the distress caused to junior doctors and the loss of good will in the medical profession. We do not hear that from the Government. That is why hon. Members should reject the amendment. I commend our motion to the House.
Before I call the Secretary of State to move the amendment, I point out that a demonstration took place in the Public Gallery. I know how seriously members of the public take the matter and I understand that things can get heated. However, I must tell the House that, if there is another demonstration, the Serjeant at Arms' officers have the authority to clear the Public Gallery. That might be unfair to those who have travelled a long way to hear the debate.
I beg to move, To leave out from "House" to the end of the Question, and to add instead thereof:
"recognises the international reputation for excellence of medical training in the UK;
acknowledges the need to modernise medical careers to ensure all doctors are properly trained to nationally recognised standards, including a fairer and more transparent process for applying for specialist training;
notes that Modernising Medical Careers (MMC) will deliver training to a consistently high standard which, combined with the expansion of the number of doctors, will provide high quality safe care by appropriate skilled medical staff;
notes the wide consultation that took place on MMC and the strong support for the need to improve doctors' training amongst doctors' representatives including the medical royal colleges and the British Medical Association;
welcomes the external review that is already being conducted into how MMC has worked to date and the changes made as a result;
and supports the longer term review recently announced to ensure MMC works well in the future."
Let me begin by stressing, as I did last week, that my ministerial colleagues and I are in no doubt about the distress, anxiety and uncertainty that has been caused to junior doctors by the problems with this year's applications system. Those problems should not have arisen, but they have, and we are all—Ministers, officials in the Department, the medical royal colleges, the British Medical Association, the postgraduate deaneries—completely focused on sorting them out so that, as I said to the House last week, we have a system for this year that is fair to junior doctors and enables the NHS to make the right appointments to all the posts involved.
In addition to the urgent questions that Mr. Lansley mentioned, there have already been three written ministerial statements as well as last week's oral statement. I will, of course, continue to update the House on the work of the review group under the leadership of Professor Neil Douglas, which will remain in existence while we continue to sort out the problems that have arisen with this year's applications system.
Before I return to the question of the applications system and look forward to Sir John Tooke's review, I want to say a little more about the new medical training system and what it replaces. As on previous occasions, the hon. Gentleman has simply understated the very real problems of the old system that modernising medical careers replaces. That system, as the whole House would acknowledge, has always produced outstanding doctors for the NHS, many of them world leaders.
However, that system was also wasteful, inconsistent, often unfair and, indeed, as the Royal College of Surgeons said several years ago, "most unsatisfactory". Some junior doctors had to apply for a new training post every six months. They were sending in different applications in different formats to different hospitals and different post-graduate deaneries at different times of the year. There was no proper national curriculum and no standardised assessment process. It has always been the case that, because of the intense competition for medical training posts, junior doctors who could not secure the senior house officer job that they wanted found themselves filling in time in the wrong post—from the point of view of the skills that they wanted to develop—in non-training posts or as a locum. Sometimes, as Conservative Members pointed out, they had to do so for years on end.
Remedy UK, the newly formed group that has been so critical—understandably so—of this year's problems says in its briefing paper on MMC that many of those in the old senior house officer job were in short-term or non-training posts or endured poorly planned training with no clearly defined end points. There were certainly deficiencies in the selection and appointment procedures, along with inadequate supervision, assessment and career advice. It was precisely because of those problems that, following the leadership of the chief medical officer, the Department of Health sat down with the medical royal colleges, with the British Medical Association, with the postgraduate deaneries and others—including, of course, representatives of the junior doctors—to devise modernising medical careers, which almost everybody agrees is the right way forward. Indeed, Professor Douglas's review group has confirmed that.
The right hon. Lady is setting up a straw man. Absolutely no one here is trying to suggest that we should have stuck with the original system. Her job here today should be to explain the shambles that we are now in and how we are going to get out of it, rather than to review what might have been the case in the past.
I have to tell the hon. Gentleman that in a debate titled "Modernising Medical Careers", it makes sense to remind the House of how it came about, why we committed to it in the NHS plan of 2000 and why its underlying principles and direction of reform for medical training are absolutely right.
I share the right hon. Lady's view that the problem with the old system was that too many doctors at senior house officer level had nowhere to go to get into training, so they had to mark time, go into career grade posts or SHO posts that were not really training posts. Does she accept that the test of the new system will be how many fewer people in that situation either have to leave training against their will when they are capable of being trained to be consultants or have to go unwillingly into career grade posts below specialist training level? Does she accept that that will be the test of the success of her new system?
What I accept in response to the hon. Gentleman's question is that it has never been possible for every junior doctor who wants to pursue training through to a consultant post to do so, particularly in the specialty that they originally wanted to follow. I will come back to that point in a moment.
I want to make a little more progress before I give way again.
The first part of the new system—the two-year foundation programme—was successfully introduced in 2005. In line with the principles that will operate throughout modernising medical careers, that will give every medical graduate a series of properly supervised placements in medicine, surgery and a range of other specialties and settings, with formal training based on a national curriculum developed following wide consultation with the profession, including the medical royal colleges, and approved by the Postgraduate Medical Education and Training Board. It will also provide our medical graduates with regular workplace-based assessments of competence, a national learning portfolio and formal access to careers advice, all of which were missing from the old system.
I am sure that the hon. Lady will not accept my word for it, but if she just looks at the several statements made by the review group under Professor Neil Douglas, she will see that it has not been a complete, unmitigated disaster. The applications system has actually been working well in many places, particularly for GP posts. Many problems have arisen that I have acknowledged since the scale of the problem became clear and taken action on, particularly by the appointment through the Academy of Medical Royal Colleges of Professor Neil Douglas to lead the review group and to sort out the problems. Just as I am acknowledging the problems, I wish that the hon. Lady and her hon. Friends would acknowledge that we are taking this matter seriously. We have apologised for the fact that the problems arose, and we are now seeking to correct them and to sort this out.
A serious problem exists today, but the review group will not report for some time. I listened carefully to Mr. Lansley, and there was nothing in his speech that I could disagree with. My right hon. Friend cites Remedy UK; I met one of my constituents this morning, and they are calling for more training posts to be created. There is nothing in the Government's amendment today to tell us how we are going to get out of this situation, and I hope that my right hon. Friend will address that problem.
That is precisely the point that I am coming to, but I wanted first to make the rather important points about why we are changing to modernising medical careers.
No, I want to make some more progress before I give way again.
As I told the House last week, Professor Douglas's review group has already agreed on significant changes to the system. They have been announced to the House and to junior doctors, and they are now being implemented. The review group decided, after careful discussion, that it would be wrong to abandon the process of interviews that is now under way. It concentrated instead on how to change the process so that it would be fair to junior doctors and meet their needs and the needs of the NHS as a whole. In particular, every eligible applicant was invited to reaffirm or revise the order of their application preferences and was guaranteed at least one interview for their revised first preference specialty. That is now happening and, over the past few days, more than 25,000 applicants have taken the opportunity to revise the order of their preferences and have done so successfully on the much-maligned medical training application system—MTAS. Those interviews are now under way, and they will continue right through next month.
I am grateful to the Secretary of State for her courtesy in giving way. Will she put on record for the benefit of the House the fact that, while receiving submissions from her officials when the new training methods were being devised, she never received any message at all from any official or from anyone concerned with medical training or medical manpower planning that there would be a problem with two streams of trained doctors arriving at the same time and chasing the same posts? Did she ever receive such advice?
Last year, the main focus of the discussions, particularly with the British Medical Association, was on the number of training posts that would be available. That is not dictated by Ministers or the Department of Health; it is determined by the individual trusts and postgraduate deaneries on the basis of what is needed by the service. We spent several months and a great deal of work establishing the number of training posts that would be available. The noble Lord Warner, then the Minister responsible, made a statement on that subject towards the end of last year— [Interruption.] If I may remind Mr. Jack, Lord Warner said in that statement that we did not and could not know how many other applicants there would be, particularly from overseas.
The junior doctors who have been in contact with me are not now so concerned about the process, which they find rather academic, but they are desperately worried about their jobs. When the crisis began to unfold, the Prime Minister said that he expected that the vast majority of doctors coming up for appointment would gain appointments. Will my right hon. Friend have an opportunity this afternoon to outline the measures that she has directed to ensure that that pledge is fulfilled?
First, in response to my right hon. Friend Mr. Field, and to other questions, I want to clarify the total number of training places available: about 23,000 postgraduate medical training appointments are available across the UK this year, which is more than ever before. Of those, 3,000 are being filled by recruitment to general practice, and just over 19,000 places are available on MTAS at the moment, with a further 700 to be added to the system. We all know very well that there are more applicants than training posts. That has always been the case, but it does not mean, as headlines and some press reports claimed at the weekend, that there will be 10,000 unemployed doctors.
Of the 32,000 or so eligible applicants for those training posts, about 30,000 are already working in the NHS, about 6,000 of whom are completing their foundation programme, and about 8,000 of whom state on their applications that they are working in non-training posts—trust jobs, staff jobs, locum posts and so on. About 16,000 say that they are working as senior house officers, but because of the deficiencies in the present system, many of those posts are not proper training posts either. Regardless of the outcome of applications for the new training posts, the NHS will continue to need all those jobs and possibly more in the future, because the number of patients is increasing, and so is the number of doctors—the NHS now has over 30,000 more doctors than 10 years ago.
Someone who is currently working in the NHS in a non-training post, whatever it is called, who does not get the training post for which they applied this year, will be disappointed, just as many were last year, the year before and every other previous year. They will still, however, have their job. Those who do succeed in getting a training post will leave a vacancy that can be filled by a doctor—with appropriate experience, of course—who has failed to get the training post that they sought this year.
A couple of years ago, the province of Ontario in Canada abolished grade 13, which led to a double cohort going to university, for which steps had to be taken. My right hon. Friend talks of posts for medical graduates, but the difficulty is that no steps appear to have been taken to plan for the inherent and entirely foreseeable problem of the double cohort of SHOs at one end and recent medical graduates at the other. SHOs who started under the old system are competing with recent medical graduates for an insufficient number of training posts—I stress the word "training" to my right hon. Friend. As I understand it, a lot of those people will be redundant from
The number of posts must be based on the needs of patients and the service as well as the needs and wishes of trainees. As I have tried to stress, it has always been the case that some doctors in training have either had to change their specialties or been unable to progress in their training to consultant grade. The new system does not change those realities.
I want to make a little more progress before I give way again.
I fully recognise that it would be quite wrong to leave a junior doctor part-way through his or her training with no clear prospects. Until the whole process of interviewing and job placement is completed in a few months time, we will not know which trainees—whether they are just completing the foundation programme or are more senior—have obtained specialist training posts. However, I assure my hon. Friend and the House that we will give them proper support.
As part of the review, we are working urgently with the royal medical colleges and the NHS to establish the need for additional training posts—which will of course have to be approved by PMETB, the Postgraduate Medical Education and Training Board—including one-year placements and more senior posts. We are also considering how we can provide more effective training support for doctors in service posts—that is, non-training posts—to maximise their development opportunities. That is the issue on which Professor Douglas's review group is now focusing, having dealt with earlier problems involving the application process, and it will make a full statement—as will I, to the House—on the support that will be available very shortly.
The right hon. Lady referred to the needs of patients. When we envisage circumstances in which every junior doctor in every grade and in every specialty changes job on the same day, the spectre is inevitably raised, and was articulated to me only this morning, of wards either empty or massively understaffed, potentially thereby—I choose my words carefully—imperilling public and patient safety. The right hon. Lady shakes her head, and she is entitled to do so, but can she assure me that there will be no such scenario anywhere in the country? If she is confident that she can, will she say precisely what contingency planning is being done to enable her confidently to make that prediction?
As I have just said, the great majority of applicants who are already in non-training staff posts, trust posts and a variety of other non-training posts will still have those jobs because they will still be needed in the NHS. Each hospital trust, and the board of each trust, has a responsibility to its patients to ensure that on
Further to the point made so eloquently by my hon. Friend John Bercow, is the Secretary of State aware that in my constituency Queen Elizabeth hospital has made it clear that because of the changeover date of
The issue of the changeover date is nothing new. Trusts have to plan for it very year, and that is what they are doing this year. It is not exactly unpredictable or novel. As I have said, it is up to individual trusts to decide how to organise staff in order to meet their patients' needs.
I want to make a little more progress before I give way again. I have been quite generous in taking interventions.
We hear from Conservative Members and others demands for the creation of an unlimited number of training posts to meet the needs and wishes of junior doctors. We must recognise that it is necessary to balance fairness to doctors in training with the needs of patients and the NHS. It would be completely wrong to create a specialist training post for everybody who wants to become a consultant in a particular specialty, including for people who have in the past applied for training posts year after year, as some have done, and have not been able to progress in their training, or to create posts regardless of whether the NHS actually needs so many consultants in a particular specialty.
Cardiothoracic surgery is an example of such a specialty. Because technology and medical practice have transformed how cardiothoracic patients are treated, the NHS already has far more fully trained cardiothoracic surgeons than it needs. This year alone we have 300 applications for five speciality cardiothoracic posts. It would not be right for the NHS to create another large number of cardiothoracic training posts simply so that there are enough for every applicant who would like to specialise in that field. Equally, however, those applicants who have that field as their first choice and who are disappointed must have the opportunity and support that they need to progress in another specialty. That is an important point, because what we need in terms of training—and I believe that we will get this with modernising medical careers—is a system that not only gives dedicated and excellent junior doctors the chance to progress in their careers, but enables the NHS to have the right number of people with the right skills at a time when medical practice and technology are changing faster than ever before.
It is instructive that the right hon. Lady chose the small specialty of cardiothoracic work, which has always been oversubscribed, and it would be interesting to find out whether she can give any other such examples. However, may I return her to a question that she has still not addressed, despite having been asked it at least three times this afternoon? There was an entirely predictable consequence of the double cohort. What planning did the Department do to deal with the double cohort issue?
The hon. Gentleman is ignoring the fact that, because of how the old system worked—with junior doctors applying for jobs all over the country, and with different application systems and things happening at different times of the year—there was no national system. Therefore, we had no statistics in respect of the number of people who had been applying unsuccessfully for training posts. I agree that it is clear, with the benefit of hindsight, that it would have been better if we had predicted that almost everybody in a non-training post would take the opportunity of this year—the first year of a system that is much fairer and much more transparent, with more training posts available than ever before—to make an application. Of course it would have been better if we had predicted that. We failed to do so, and I have apologised for the problems and distress that that has caused. More importantly, however, we are now putting that right.
I am grateful to the Secretary of State for giving way. What would her advice be to the four junior doctors from my constituency who visited me today, all of whom have been offered training posts, in Brisbane, Toronto and Singapore, bearing in mind that the offer being made by the Secretary of State is that they can have some kind of job in the NHS, even perhaps as a rural GP in Scotland—an example of "Dr. Finlay's Casebook", if ever there was such an example? Would her advice be that it would be best if, despite the £250,000 that has been spent on the training of each of them, they accepted those job offers outside the United Kingdom?
I am unsure whether the hon. Gentleman is prejudiced against general practitioners, or those working in country areas, or those working in Scotland. The job he mentions is in my view an excellent post, and I am sure that someone will fill it admirably. He also ignores the fact that 23,000 postgraduate medical training places will be available across the whole of the United Kingdom, which is more than ever before.
Let me deal with the issue of doctors going abroad, which Mr. Pelling just raised. At the weekend, there was some quite disgraceful reporting in some sections of the press. On the one hand, they were busy saying how disgraceful it is that doctors have had to suffer the distress and added uncertainty of this year's difficulties, while on the other they ran a headline saying that they were all going to be shipped abroad to do voluntary service overseas. That is absolute rubbish. It has always been the case that some British junior doctors have chosen to go abroad at some stage in their training to get extra experience to further that training. Some do voluntary work in, or are on secondment in, the developing world—an issue on which the noble Lord Crisp recently produced an excellent report. However, there is no question of junior doctors being forced into those options or being shipped abroad.
We all need to focus on the interviews that are taking place and that will continue over the coming month, the first round of job offers that will then be made, and the enormous effort that will go in—thanks to the work not just of the review group, but of consultants and the postgraduate deaneries around the country—to matching, as far as is possible, junior doctors with their first preference application, and to match, wherever possible, medical couples with their combined preferences through the medical training application system, which is an issue that was specifically raised. Of course, there will then be a second round of interviews and job offers. Once all that has been done, we will then ensure proper support, as I indicated a moment ago, for those trainee doctors who have not secured the training post that they wanted.
I am very grateful to my right hon. Friend for patiently explaining the issues and for being generous in giving way. She talks about focus, and what I am focusing on is the figures that she has given this afternoon, which I have perhaps misunderstood. She mentioned 23,000 training opportunities and 32,000 applicants. I am focusing not on the MTAS system—good or bad as it may be in terms of the computer system and the lack of CVs—but on the fact that apparently and entirely predictably, 9,000 doctors, whom it costs £250,000 a throw to train and who have been in the system for a minimum of six years, will be redundant. That will be a great loss to the taxpayer, to the NHS and to them personally.
I am afraid that on that point my hon. Friend is absolutely wrong. Well in excess of 9,000 of those 30,000 applicants working in the NHS are working in non-training jobs that the service will continue to need. They are the so-called "trust" jobs—the service jobs—but they also include some of the senior house officer jobs, which are not training posts, despite their name. Those jobs, as well as the 23,000 training places, will continue to be needed and to be filled by junior doctors. That is why the headlines about 10,000 unemployed or redundant doctors are simply wrong.
I am very grateful for the chance to make a second intervention. I ask my right hon. Friend not to answer the Liberal Democrats' endless plea for a post mortem. [Interruption.] Yes, the Liberal Democrats did ask for a post mortem to find out what went wrong. We all know that something has gone wrong—even the Liberal Democrats should understand that simple point—but young doctors in Birkenhead want to focus on the future. In answer to my previous intervention, my right hon. Friend said that, at some stage, she and others would consider the creation of new training posts. Will she please say a word or two about that before the end of the debate?
I did indeed say that as part of sorting out the difficulties that have arisen this year we are already working with the royal colleges, the NHS and postgraduate deaneries to see whether additional training posts can be made available to start, of course, alongside the other ones later this year. We are looking at that issue.
No. I am not going to take further interventions, as I am very conscious of the time.
We are also looking at what additional training and support should be given to those who take the non-training posts—the staff jobs and so on—so that they can continue their development. In some cases, they will be in a position to apply successfully for a training post next year.
We are doing two things. First, through Professor Douglas' review and with the close involvement of the medical royal colleges, the BMA and other bodies, we are sorting out the problems that have arisen this year. Secondly, we are looking further into the future. As I announced last week, we are to set up a wider review of the modernising medical careers programme. It will be led by Sir John Tooke, and the House will know that I published the review's full terms of reference today.
The principal task facing Sir John and his review group will be to examine the framework and processes underlying modernising medical careers to inform improvements for 2008 and beyond. Therefore, the existing group led by Professor Douglas will continue to make sure that we sort out the difficulties for this year, and Sir John Tooke's review will look ahead to next year.
As hon. Members will see from its terms of reference, Sir John Tooke's review will look at questions such as whether the system is flexible enough—one of the main principles of modernising medical careers—or whether the scoring system devised through a very full consultation with the professions is now, on reflection, thought to be inappropriate and in need of revision. I am extremely grateful to Sir John for undertaking the review, and I stress once again that it will be completely independent. Sir John is identifying the members of his review panel and I shall make an announcement about that with him in due course. He will recruit his own secretariat and have a budget for that purpose. He has kindly offered to produce an interim report in September, as that will assist us in planning and making improvements for next year. That interim report will be published, of course, and Sir John has also undertaken to inform us of preliminary findings earlier. I know that Sir John will do everything that needs to be done to involve junior doctors, the medical profession more broadly and the NHS in the review. I have full confidence in him, and I hope that that confidence is shared across the House.
As I noted earlier in this important debate, we have more than 30,000 more doctors in the NHS than we had 10 years ago. We have more trainees and more training places than ever before. We are establishing a new training system that will build on the excellence that British doctors have always achieved. However, it will also give us a much better, fit-for-purpose medical training system.
We are sorting out the problems that have arisen this year, and we are learning lessons to ensure that we can make further changes and improvements next year. It would have been much better, of course, if the problems with this year's transitional year had not arisen. We all regret—I most of all—that they have arisen, but the new system that we are putting in place with modernising medical careers will be fair to doctors and right for the NHS. Above all, it will be best for patients.
I commend the amendment to the House.
I want to start by speaking about the Government amendment that the Secretary of State has asked the House to support. It is remarkable for the fact that it makes no reference at all to the extent of the shambles in the medical training system. I assume that the amendment will win the day this evening, but anyone reading it would not have any understanding of the scale of the discontent in the medical profession resulting from what has happened.
All those involved are left in a state of some despair, because the problem was so avoidable and because the damage that has been done—and the likely disruption still to be faced—have had such a negative impact on the NHS and the morale of the doctors on whom we all rely. Today, the Secretary of State repeated her apology to junior doctors. She was right to do so, because of the stress and anxiety caused to so many young professionals who have committed themselves to the NHS.
Although the impact has been most severe on junior doctors, who feel that their careers are hanging in the balance, consultants too have been left completely frustrated and angered by the utter incompetence that they now have to remedy. They are faced with having to try to clear up the mess by undertaking a vast number of extra interviews in a short space of time.
Of greatest concern, however, is the impact on patients. When doctors have rock-bottom morale, it is not good news for patients. What about the impact on patient care of the recovery programme—all the extra interviews that must take place during May? What will happen on
How on earth did we reach this point? The origins date back to the chief medical officer's report in 2002. Its original principles clearly attracted widespread support. Self-evidently, there is a need for a modernised and focused career structure for trainee doctors. More standardised training based on competencies is the right way forward, and it is entirely reasonable to focus both on clinical skills and on the communication skills that I readily acknowledge are important for doctors. There were also legitimate concerns about patronage and bias in the old system. In any modern service those features are unacceptable and need to be challenged. Career advancement should always be based on merit, not on who a person knows or even the colour of their skin. I suspect that that has been a problem in the health service in the past.
What went wrong? The Royal College of Physicians points to two failures. The first was that modernising medical careers had become a straitjacket. It was too inflexible: it forced early career decisions on young doctors and from that point demanded a training schedule that gave them little opportunity to change direction to a different specialty. It shortened the training period, leaving many doctors concerned that their experience would be reduced as they went through the training process.
The second failure was the introduction of the medical training application service—MTAS—which was set up by the Department of Health to select junior doctors for MMC training posts. The royal college described the system as "deeply flawed, and unpiloted"—it had specifically requested that the system be piloted. Many concerns have been raised about how the unpiloted system has worked. It seems remarkable that so much emphasis appears to be placed on creative writing skills—we have heard about the number of points allocated for that competency—compared with clinical excellence. It seems that doctors who have undertaken research to prepare for a specialism could be disadvantaged. No CVs are considered and there is no proper acknowledgement of academic qualifications. The central question that the Minister of State, Andy Burnham, must answer when he responds is: how on earth did that happen? Is not it incredible that an entirely new, sophisticated web-based system was introduced without proper piloting?
I am grateful to the hon. Lady for that intervention. I disagree with Mr. Field, who seems to think that establishing who was responsible is a pointless exercise: it is essential if we are to hold the Government to account and learn lessons for the future. The hon. Lady made a point about the costs of the recovery exercise. I put that question to the Secretary of State during her statement last week. I did not get an answer, so I would be grateful if the Minister of State could confirm what assessment has been made of the likely additional cost of the recovery exercise.
I was making a point about piloting. The terms of reference of the review highlight several features of the system. They include the assessment methodologies used in the selection process, including the relative merits of competency-based and more traditional methods of selection and recruitment; the level of choice on offer at application; and the lack of flexibility available to trainees on run-through programmes. They are all issues that would emerge from pilot programmes and the problems would be ironed out before a programme was rolled out nationally. How on earth was the system introduced without proper piloting?
The hon. Gentleman is making some excellent points. Before I became an MP, I spent many years working in business and I cannot ever remember any company of any importance introducing an IT system without a full pilot and assessment of it afterwards.
The hon. Lady is absolutely right. Much smaller organisations pilot new programmes before they are introduced. We are talking about a system that is supposed to deal with tens of thousands of applicants across the whole country. It is bizarre and extraordinary that it was not piloted.
Warnings also went unheeded. The Royal College of Physicians warned but was ignored. The British Medical Association said that it tried to get the Government to listen, but it was ignored. During the Secretary of State's statement last week, Rob Marris told the House that he had written several weeks ago to one of the Ministers at the Department—
May I clarify the position for the hon. Gentleman? I wrote last autumn expressing concern about the system and I was assured by the then Health Minister, Lord Warner, that it would be all right on the night. When it became apparent in the spring that it was not all right on the night, I wrote and asked who was being disciplined on account of this failure. After many weeks, I have still not received a reply to that question other than the answer that I received from the Secretary of State in the statement last week, when she said that no one had been disciplined.
I am grateful to the hon. Gentleman for that. Even if no one is disciplined, people could still be held to account for what has happened, but we have had no indication of whether that will happen.
Given that there was no piloting and that all the warnings from professional bodies were ignored, one is left with the sense that the Government have demonstrated total arrogance and total incompetence, or a pretty potent mix of the two. Who is responsible for the debacle? Will anyone be held to account? Surely, it is a pretty damning indictment when the former national director of MMC, Professor Alan Crockard, resigned stating that MTAS
"has lacked clear leadership from the top for a very long time".
What does he mean by "from the top"?
We have heard a fairly solid dose of hypocrisy about this issue in some parts of the debate. No one is suggesting that we return to the absolute chaos of the previous system, in which some doctors suffered considerably. However, may I point out to the hon. Gentleman that Professor Crockard was presumably in on the arrangement from the first and was also acting as a consultant?
I am grateful for that intervention, but I made the point that the principles of the system were widely supported at the start and I highlighted the concerns about the previous system. [ Interruption. ] I did highlight the concerns about bias and so forth; it was absolutely right to bring in a new system. It is the way in which it has been implemented that has caused so many people to be left totally frustrated by the Government's incompetence. Professor Alan Crockard may be partly responsible for the debacle, but when he says that there has been a clear lack of leadership
"from the top for a very long time", we ought to listen to that concern.
I take that point. When the professor says that there is a lack of leadership from the top, we need to know whether he is referring to the Secretary of State, or a civil servant —[ Interruption. ] MTAS is a Department of Health initiative, so we need to know from the Minister to whom Alan Crockford—[Hon. Members: "Crockard."] We need to know to whom Alan Crockard refers when he says that there is a lack of leadership from the top. Will the Secretary of State publish all the correspondence as part of a wider review so that lessons can be learned about what has gone wrong?
Will the Secretary of State publish any written submissions made by Professor Shelley Heard, who has also resigned? Professor Heard was the national clinical adviser and has been quoted as saying that the principles
"have been lost in the detail and acrimony of a recruitment process which should have supported and not driven it".
"we are losing the goodwill of a generation of UK graduates who believed it when we said we wanted to train more UK doctors better and we are losing the goodwill of patients and senior colleagues".
Professor Heard also fundamentally challenged the direction taken by the review group set up by the Secretary of State. She said that the group
"has become so immersed in the detail that it cannot see a way ahead which will be both equitable to doctors and support the aims of MMC".
She found herself
"able to support few of the decisions that the review group has taken since they undermine the principles which are at the core of MMC".
Does the Minister accept that the review group's direction of travel is undermining the principles at the core of MMC, as Shelley Heard suggests? That is a serious challenge to the direction that the Government are taking.
I am an employment lawyer by training, and before I became a Member of Parliament I advised employers on fair recruitment processes fairly regularly. This is not a fair recruitment process. It is fatally flawed, and once a process is flawed, one cannot satisfactorily remedy it. Will the Minister confirm whether the additional interviews for those candidates not hitherto given interviews will be conducted by differently constituted panels? However objective a scoring system, once different assessors are introduced on to a panel, objectivity is destroyed. Once something is flawed, it is always flawed, and that is why I have supported the attempts by Remedy UK to secure a judicial review of the process.
I want to explore the recovery process itself. I understand that all the additional interviews will take place over a four-week period in May. Will the Minister confirm how many extra interviews the Government expect will be required? Will that be logistically possible to achieve? When I put that question to the Secretary of State last week, she said that it would be achievable, but "only with considerable effort". That suggests that there is a risk of substantial disruption to patient services and a possible impact on patients.
I understand that trusts are resistant to allowing consultants time off their clinical work to conduct the interviews. The hospital trusts are all under intense pressure to deliver on waiting time targets, yet they will lose a substantial number of clinical hours to conduct additional interviews. I understand that 10 candidates were originally interviewed for two specialty training level 3—ST3—posts in cardiac surgery in London, but that it is expected that an additional 50 applicants will be interviewed to comply with the review group's new process. Will the targets with which acute hospitals must comply be adjusted to take account of the disruption that will inevitably occur, given that if a surgeon is interviewing, he or she is not operating? A question was raised about the cost of the recovery programme, and I hope that the Minister will give a confirmation of its cost.
What analysis has been undertaken of the impact of all junior doctors starting their new roles on
I suppose that it was inevitable that the changeover for the whole country would be planned for a peak holiday time, when so many consultants are away. That simply adds to the challenge. I have heard that some trusts are starting to suspend the right of consultants to go on holiday in the first two weeks of August. That suggests that acute trusts are anxious about the potential impact on patient care during that period.
On the mismatch between the number of applicants and the number of posts advertised, the Secretary of State indicated that there were about 23,000 training posts, but of those 23,000, she said that 3,000 were general practitioner posts. She then said that the net figure for hospital posts was something over 19,000. I do not quite understand the maths, but that is what she said. She also said that 700 extra posts were being added. I do not understand where that figure comes from, and I would be grateful if the Minister of State could explain when he winds up the debate. Are those 700 extra posts the additional training jobs that the Government said that they hoped to provide, or are we expecting more training posts on top of that 700? The people affected by the problem, many of whom are in the Gallery today, deserve clarity and answers from the Government on that point.
The Secretary of State was right to point out that some, but not all, of the people who do not get training jobs will continue in their existing posts. Will the Minister give his assessment of the number of junior doctors who are likely to be unemployed come the summer? The hon. Member for Wolverhampton, South-West had a stab at providing a figure, but he was told by the Secretary of State that he had overstated the numbers because many people would remain in their jobs, so what is the figure? We know from the document leaked last week that Government planning is proceeding on the basis that thousands may be unemployed. It is incumbent on the Government to tell us the estimated number of junior doctors who will be unemployed this summer.
The document referred to the possibility of junior doctors being sent off with Voluntary Service Overseas. VSO is a fantastic concept and I applaud all the junior doctors and the many other professionals who do voluntary work overseas, but as a human resources solution for a Government who have got themselves into a hole, it is hardly an appropriate way forward. Will the Government publish the document that was leaked last week? I have not seen it. Is it available, and may we see what the Government are planning to do with all the unemployed doctors this summer?
We are told that it costs about £250,000 to train a junior hospital doctor. How many are likely to end up heading overseas or leaving the profession as a result of the crisis? What is the scale of the resources that will be wasted on all that training?
The hon. Member for Wolverhampton, South-West raised the issue of the two cohorts coming together, as did my hon. Friend Mr. Heath in an intervention on the Secretary of State. We still have not had a satisfactory answer on why the Government did not expect that to happen and why they do not appear to have planned for it or its consequences.
I suspect that the right hon. Member for Birkenhead might disagree on this point, but one sensitive, but important, issue is the way in which we treat foreign doctors who work in hospitals across the country, many of whom have given dedicated service to the NHS. How will they be treated as a result of this debacle? My hon. Friend the Member for Oxford, West and Abingdon made the point that, historically, staff grades that are often filled by ethnic minorities and women are, in a sense, dead-end jobs, with no prospect of career advancement. Why can the Government not plan to convert those jobs into training posts, to give the occupants the chance of career enhancements?
Does the Minister accept that the key to the mismatch between the number of juniors looking for training posts and the number of training posts available is the question of consultant expansion? It begins and ends with that, because what patients want—we must remember patients—is a consultant-provided service. The Minister must explain whether medical schools were expanded in order to fill an expanded consultant grade, or whether they were expanded in order to fill trust grades, clinical fellowships and staff grades—all non-training posts, which many people do not want to occupy even though they are in such posts? Does he expect that the consultant expansion we need will take place? In 1997, a British Medical Journal editorial noted that "consultant expansion was insufficient". That editorial was written by a Dr. Evan Harris, but 10 years on, I see that there is still no expansion—
In conclusion, the scale of incompetence is quite remarkable. We need belated recognition from the Government that the problems this year have not been resolved and that the system remains fatally flawed. Remedy UK is seeking judicial review this week and I hope that it succeeds in that challenge to the Government, because the process, as we have all said, is fatally flawed.
I have a great deal of sympathy with the right hon. Gentleman's intervention. We heard earlier that the departing director said that the system had been mismanaged and that there had been a lack of direction "from the top". Where is the top? Is it Ministers? The Secretary of State has left the Chamber, as we have heard, but who will take responsibility? That is the critical issue. I fundamentally disagree with the right hon. Member for Birkenhead. If we are to hold the Government to account, it is right to find out what has gone wrong, who was responsible for it, and for that person to be held to account.
On a point of order, Mr. Deputy Speaker. Is it not customary in the House for a right hon. or hon. Member who has made a contribution to remain in the Chamber long enough at least to hear the subsequent contribution from another hon. Member? Is that still the normal practice in the House, and does it apply to Secretaries of State?
The first point of order and the subsequent point of order are both accurate reflections of the Speaker's views about how Members should behave in the House. It is not the Chair's responsibility as to whether Ministers remain for the debates.
I am sure that there will not be any hon. Members who wish to leave the Chamber until they have had the benefit of hearing my contribution. No doubt those who do so will want to read it in the morning.
I wish to begin by declaring two interests. Of course, my family and I are users of the national health service, which we use, and will continue to use, exclusively. I am an unpaid member, too, of the editorial board of People Management, which is the leading human resources management magazine in the country.
I make the point because I note that there are two young and keenly engaged Ministers on the Front Bench. In the political traditions of this country, one of the problems faced by all Governments is that Ministers change so rapidly. That has always been the case. I have never fully understood the logic whereby successive Governments of all kinds have chosen to keep changing Ministers rapidly, with Ministers moving between different portfolios. That creates a potential problem for Ministers when they inherit the results of the actions of previous Ministers, in addition to the problem of mastering the brief. The point is not specific to the debate today. It applies to the technical issues that arise in attempting to hold the Government to account.
My suggestion to the Government and anyone else who cares to read Hansard tomorrow is that one of the big opportunities missed in the past 10 years, as it has been by successive Governments, and which I hope a change in Prime Minister will grasp, is that Ministers ought to be trained through, for example, the Henley Management college in effective leadership skills to equip them for the management of major Government Departments. This may be the only chance I have to put that on the record before a change of Prime Minister. It is an idea that I have held and discussed with Cranfield School of Management, Henley Management college and others. It is relevant to all parties. How we manage major Departments is fundamental to the effectiveness of Government.
My second observation is how comforting it is to have such a feeling of déjà vu with respect to union organisation and strength, and the solidarity of the closed shop. It is many years since I have witnessed such good union organisation. There are rumblings outside the House—only just outside—in traditional union style, and traditional union briefings. Traditional closed shop arguments have been accepted by the Government.
That takes me back to the time when I tried to negotiate for young engineering apprentices who were doing four years of training but were not guaranteed employment by engineering companies at the end of it. How jealous we were of Fleet street, where there was an age-old tradition of a trade being passed from father to son, apprentices being guaranteed work, and jobs for life. The changes that took place in the mid-1980s were bitterly resented by those families and particularly by the young workers, who perceived entry to that trade as a vocation for life. I see some resonance with the Government's acceptance of the arguments and their guarantees of employment for junior doctors.
There is another game going on, and that is called the knock, knocking of the NHS. The Opposition's motivation in having this debate, and the style of debating used, has been to knock the NHS and run it down, rather than look at the specific technical issues and how they may be improved, as the Liberal Democrats rather more realistically have attempted to do. The party that never really loved the NHS in the first place has a political agenda.
On every occasion the Opposition attempt to suggest that the NHS is in great crisis. The best judges of that are the patients, and my area is as good a judge of the state of the NHS as anywhere else. Since I have been a Member of Parliament, the NHS in my area as been a top performer. Two years after I became an MP it became the top performer in Britain, and remains so.
Mr. Bellingham is no longer in his place but he referred to incompetent NHS local management. That is not what I see. In my regular meetings with management, consultants and GPs, one of whom I met to discuss some of these issues at length last week, I hear pertinent points about where they wish to see improvements, but there is pride in the fact that modern management, modern doctors and modern GPs now receive the funding that they deserve and have the tools to do the job. That is a fundamental difference from the past.
I shall illustrate that with one of the campaigns that I ran. [ Interruption.] Mike Penning from a sedentary position asked what I had had to do with improving the performance of the NHS. Along with thousands of my constituents, I have made a tiny contribution. When there was not a Government but a management move to downgrade my accident and emergency department, I led the campaign—
That is precisely the point that I am leading into. The successful ballot on the accident and emergency department in my hospital was caused for only one reason, and that was that there was a perceived problem in recruiting consultants to cover that department. The issues raised in my hospital and by my GPs are the problems of attempting to recruit both specialists and generalists in a semi-rural area with a district general hospital and GP practices—
I will give way in a minute, but it is important that I make this point because it is precisely on the issue of modernising medical careers in areas that have been underfunded, traditionally and historically, and which because of that have had recruitment problems for many years. The shift in allocation is one of the bravest things that the Government have done. The 11.5 per cent. increase in PCT funding last month was the biggest in the north of England— [Interruption.] This is absolutely on the subject. The subject is how my area can recruit the consultants and the GPs that it needs, and how, in an area such as Cresswell, just outside my constituency in the constituency of my hon. Friend Mr. Skinner, where many of my constituents worked for year upon year, the NHS had not been able to recruit GPs until last week, when a new GP practice was appointed.
I am obviously listening to the hon. Gentleman's rather long speech with interest. I presume that it is long because so few of his own Back Benchers are present to stand up for the junior doctors who face this terrible crisis. I am wondering whether he will ever start talking about the subject of the debate, which is about the junior doctors throughout the country who face redundancy having gone through an horrific recruitment process yet who still do not have an answer from the Secretary of State about what will happen next.
The hon. Lady is choosing not to listen to the point that is being made. The question of recruitment is fundamental to the changes that are taking place in modernising medical careers. What is the point of having large numbers of junior doctors if there are not jobs? I drew an analogy with the closed shop. Many professions would like that certainty of employment in following their careers but do not get it. Equally, what if a hospital such as mine cannot get the consultants it requires to cover accident and emergency and questions whether it should have A and E, or if an area such as Cresswell does not have enough GPs? In the wider area of Warsop, which incorporates Mansfield, there have repeatedly been problems in getting enough GPs to cover the work that is there.
Some years ago, we had a serious problem in the city that I represent, Sunderland—we had the lowest proportion of GPs anywhere in the UK. When we investigated, we found that in many cases, because of the funding arrangements, doctors themselves were not encouraging recruitment into practices. The health authority intervened to deal with the situation, but it was not the fault of the Government or the money going in—doctors themselves were not going out of their way to recruit more doctors in our city.
My hon. Friend makes an excellent point.
Let me ask a couple of questions of Ministers. Under the Government's plans, how will areas such as mine be guaranteed the consultants whom a small district general hospital requires in order to maintain core services by having staff in place and who come from the ranks of junior doctors? How will that be done, and how does it fit into the Government's planning in the longer term?
No; I am going to conclude in a minute because many Members wish to speak. [ Interruption . ] No doubt that includes the rude hon. Member for Hemel Hempstead, who is saying, "Thank goodness."
How can we ensure that an area such as mine, which has top-performing NHS services and where we have moved from small one-man-band GPs to large GP practices, can get the quality of GPs to meet the new kinds of specialties that the Government rightly want to devolve down to primary care from the hospital sector? How does that fit into the vexed question of junior doctors wanting to follow traditional forms of careers when some of the new specialties that are required are in primary care, not in the hospitals sector—an issue which official Opposition Members, as is clear from their barracking, have no desire to debate.
I congratulate John Mann, who made a clever job of distracting attention from the profound concern that is felt in much of the House.
We are facing the worst and most avoidable disaster to overtake young people in professional training. Thousands of young people are being plunged into uncertainty about their careers. The tragedy is that this disaster was predictable and predicted—it is unfolding like a slow-motion train crash. I am grateful for the opportunity to be able to contribute briefly on behalf of my constituents, who feel anger and disbelief about the present situation.
The people involved in this disaster are mainly professionals. Of no professionals is so much asked, in terms of resilience and commitment, as doctors. When doctors commit to the profession of medicine, an enormous amount is asked of them as regards training, and there is an assumption that at the end of their training period they will eventually have an opportunity to work and that that will be reflected in a fulfilled sense of commitment.
There is a need for change in doctors' training and most people agree that it was appropriate to make a change. However, in their manner of doing that, the Government are at fault not only in the detail but in the larger issues. They have been greatly at fault in three main matters: administration, computer failure leading to mismatches occurring, and the number of jobs.
The Secretary of State provided several facts when trying to explain the position. I submit that those facts did not help me—and I followed her contribution carefully—to understand the position better. Apparently, there are to be 23,000 training posts and 32,000 doctors are seeking them. However, she gave us many other numbers, seeking to lead us to believe that there was no problem.
I am afraid that there is a problem, because the Government have failed to deal with the double cohort—the two different groups of doctors who will enter training in August. Some will work under the previous system and others will work under the new system.
The Secretary of State failed to provide assurance in the case of an individual doctor in my constituency, whose mother I met today. The doctor is 28 years old, has been qualified for six years and has always wanted to specialise in intensive care. She was offered a post in August last year. It was a two-year post in anaesthetics, which would lead her to qualify in anaesthetics or go further and use her anaesthetics qualification to specialise in intensive care. Now the two-year post that she was offered in August 2006 has collapsed, leaving her with the prospect of no medical job after August this year. She is not simply a highly qualified doctor but someone who, with one other woman, rowed the Atlantic as part of her gap year.
Doctors must be given a guarantee that they will not be forced out of training. A formula must be found to permit their training to continue. The Government need to take exceptional measures and give us progress reports. The matter must be resolved by August—if necessary, by using interim measures.
The county town of Stafford employs a high proportion of public sector workers because it is an administrative centre. There are workers in local government, the hospitals, the university and so on. That means that, when a problem arises in the public sector—be it last year's efforts, which were especially bitter in Stafford, to try to deal with deficits in health trusts, or junior doctors this year struggling to find a training post and feeling that they have been badly treated—it affects not only those who work in a hospital trust or another health setting, but a large proportion of the public because of their affinity with the public sector generally. That might apply to the Member of Parliament who has such an affinity because of political values, the workers because they work in the public sector, and the public, who come into contact with public services perhaps more than in other areas because of Stafford's higher than normal proportion of jobs in the public sector.
The subject of the debate is therefore generally a serious issue for Stafford. I am happy to explain that that is one of the reasons for my participation this afternoon. However, people obviously want to bring the debate to the personal level. In preparation for last week's return to Parliament and the Secretary of State's statement and today's debate, I met the junior doctors' leader in Stafford, local NHS managers and local providers of health education. Like many hon. Members, I have also met a junior doctor from my constituency who lobbied me about his personal circumstances, and representatives of the campaign that Remedy UK has organised for today. I am pleased to have an opportunity to take part in the debate to support the points that they made to me.
It is worth starting from the point of view expressed in the original words of the motion. What has been extraordinary about the history of medical training in this country is that it suffered its share of severe underfunding for decades before 1997, which led to a shortage of training places. That led, in turn, to a shortage of qualified doctors, consultants and nurses in the NHS, which created quite a challenge for the new Government, who were committed to improving the situation very quickly. Although the Government could turn on the tap for more money to pay for more doctors, nurses and consultants, there were not enough of them to recruit because the training places had been cut for years before. That is an important point for hon. Members to take into account about the history of how we came to be in the present situation.
The obvious corollary at the time was that because the money was made available and the posts were there to be filled, we recruited outside the country to fill the vacant posts. That is relevant because while people talk about the double cohort of people coming through to training posts now and the senior house officers also looking for a training post, we also have the added pressure of non-EU citizens in this country whom we recruited who still want jobs in the NHS. There was something of a failed attempt by the Government last year to squeeze them out. That in itself was hurtful to quite a large number of my constituents who came from the Indian subcontinent in order to work in this country because we needed them. All those points should be taken into account when we reflect on the situation today.
It is a good thing, is it not, that more people are in training, completing it and coming forward in greater numbers? It is also a good thing that recruitment and retention generally in the NHS has been good over the past few years. I hesitate to say that it is good now, because I am not reading a Labour party brief and want to tell it as it is. Obviously, the Government's insistence on getting rid of deep-seated deficits, which started last year—an insistence, incidentally, that I support wholeheartedly—has led to a crash in recruitment and retention. That provides a further additional pressure—on top of the three that I have already identified—when it comes to the training places available for junior doctors now. It is easy to add them up and see that four pressures have all come to bear this year on the problem of the number of places available for the junior doctors who are seeking them.
The review body, comprising all the bodies that the Secretary of State described, and then Ministers, took the decision that this year is the year in which modernising medical careers for junior doctors should kick in. It is certainly a difficult year. In the looking back that Norman Lamb called for, and in seeking attributions of blame for the current situation, a good question to pursue would be whether there was any opportunity to hold back from making it this year. However, it is fair to say that modernising medical careers is the right thing to do and has gained widespread support.
It is remarkable that no one in today's debate has asked to turn back the clock and go back to the previous system. Every hon. Member has spoken about how MMC could have been introduced more effectively and how it should be improved in future years. In some areas of recruitment—before it was applied to junior doctors—it has been implemented without the sort of reaction that we are talking about today. General practitioners two years ago provide a good example of that.
When I met the leader of the Stafford junior doctors, she drew my attention to certain issues that I strongly support. First, for example, it is right to standardise training standards for junior doctors seeking specialty posts. It is also probably right in this day and age for there to be an online system. It reminds me of my adult son and daughter who use the internet, rather than pen and paper, as second nature when it comes to compiling a CV for a job application. Those aspects are right and are here to stay.
Other points that we have discussed today, however, included the scoring system, the lack of flexibility, the people who did not get acknowledgements for their online applications and felt that the applications were never read, and the doctors who felt forced to apply for jobs at the other end of the country from their families. All those personal circumstances, which I discussed with the leader of Stafford's junior doctors, were individual tragedies.
The hon. Gentleman is making some fair points in criticising the way in which the system has operated. Are not all the features that he has described evidence and justification for the need for such a system to be piloted before being introduced?
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.
The hon. Gentleman cannot have been listening to what I have said. Under the previous system, not everyone got the specialty post that they applied for, so they did something else. They still had a job, however. The Secretary of State has said that nothing in the new system will change that basic fact. If someone does not get a specialty training place, they will still have a job. That is the point of my question to the Minister. What are the prospects for those people who still have a job, even though it is not the training post that they want? That is a reasonable question.
I mentioned earlier that a university in Stafford offers health training. Admittedly, it does not train junior doctors, so I will not push my luck too far in talking about issues other than modernising medical careers. I want to make the point, however, that there have been superb improvements in medical training in recent years. There have been some great developments, from foundation degrees to professional doctorates. In terms of continuing professional development, relationships between NHS employers and training providers have been much improved, including the excellent development of mentors for newly qualified doctors and other health professionals. Much better recognised training and qualifications have been developed for those in the support teams for doctors and consultants. For example, last week, at Staffordshire university, I heard about training for operating theatre staff, the pilot for primary care staff, and the current deliberations about whether help can be provided in the training of care home staff. We should celebrate all those excellent developments.
Everyone I listed at the beginning of my contribution has said that better work force planning is needed. Nobody would disagree with that. We are dealing with one of the biggest work forces in the world, not just in the country, so it is understandable if it presents more difficulty than others. Clearly, good work force planning involves listening and research, engaging those who know what is happening and have expertise to offer, piloting changes before implementing them more widely, on which I agreed with the hon. Member for North Norfolk, and, having carried out pilots, conducting proper evaluation before the final implementation. If there are lessons to be learned from today, I hope that the Minister will accept that those points cover some of them.
I thank Remedy UK and the junior doctors for the lobby that they organised in a professional and effective way. You were not in the Chair, Mr. Deputy Speaker, when the Public Gallery erupted, rather naughtily, into spontaneous applause earlier. They managed to do something that Opposition Members rarely achieve, no matter how many hours we debate for: to make Government Members hang their heads in shame—
I apologise, Mr. Deputy Speaker.
There are 650 MPs in the House, and I do not know how many of us have three As at A-level. I would imagine, however, that the number is in single figures. Junior doctors have had to plan from childhood to become doctors—deciding that they want to do so when they do their GCSEs and choose their A-levels—because it is incredibly hard to get the results necessary to go into medical training and pursue the career with determination for six or seven years.
The Opposition have agreed that medical careers needed to be modernised, because the system did not work as it did in the past. As a nurse, I know that. What doctors did not need, however, was a computer system that failed hopelessly and abysmally, application dates for interviews extended by days, data lost and the computer system crashing. Junior doctors did not know what was happening to their applications, when or where—or if—their interviews were being held, or whether they would have a training position.
Nor did junior doctors need uncertainty, particularly those who have families or are dependent on their jobs or salaries, as we all are. We are all dependent on knowing how much we will earn this year, particularly if we have a mortgage to pay. Thousands of junior doctors do not even know whether they will be able to make their mortgage payments, let alone whether they will be able to pay any debts that they may have brought with them out of university or medical school, or whether they will be living in a particular area with their families or working in a particular region.
My hon. Friend is making some excellent points. Anyone with primary school-age children is possibly going through the process now of working out which primary school they will be starting in September.
I thank my hon. Friend.
Although we are not allowed to refer to what is happening outside the Chamber, I can legitimately bring some of the comments made by junior doctors to the House's attention. There has been much speculation about how many doctors will not have jobs, and the figure seems to range between 9,000 and 11,000, so we can safely say that it will be about 10,000. We know that the Department of Health is in discussion with VSO about finding employment for our junior doctors, which is a shameful position for the fifth largest employer in the world to be in.
Absolutely. The majority will come back and look for jobs, and we will be faced with the problem later.
Moreover, were I a junior doctor, I might not want to go and work for VSO. I might want to stay in this country. I might have a family and a mortgage, and might want to continue my career in the UK. Dr. Sonia Heyer, of Harrow, Middlesex, said:
"As a junior doctor who may be unemployed this summer as a result of the present recruitment fiasco, I was delighted to learn that we may be required to seek employment with voluntary services overseas.
I would go, provided I could secure the company of the present Secretary of State for Health, in which case I would gladly accept a mapless mission to the Amazon jungle."
She is a braver woman than I—I would not want to go with the Secretary of State for Health. Junior doctors, however, are facing no employment during the summer, or perhaps going to work abroad with VSO, which is not what they want.
The Secretary of State has largely chosen to ignore the problem that she knew, as my hon. Friend Peter Viggers described, was a train wreck in slow motion. As the Chancellor was warned of the pensions fiasco, I am sure that the Secretary of State was warned of what would happen with a double cohort. Another doctor, Dr. Judith Secker, described the process as follows:
"It was the equivalent of taking a decision for all children to leave school at the age of 17 instead of 18. In the year when the change came into effect, all the 17-year-olds and all the 18-year-olds would be seeking university places (or employment)" at the same time. We all know that that would be a complete shambles, and that is what we are faced with today.
I am sure that the Secretary of State was warned about what was going to happen, but what was put in place to deal with it? Absolutely nothing. We have two cohorts of junior doctors looking for placements all at the same time, which has caused unnecessary competitiveness between them, indecisiveness, uncertainty and worry. One doctor, a junior orthopaedic surgeon, has said that three junior doctors in the past two months have burst into tears on his ward because they do not know whether they will have a job from
The fact is that our doctors do not know whether they will be earning a salary. If they do not want to work for VSO, where will they go? A junior doctor in my constituency, as a midwife in my constituency has done, has applied for summer work at Waitrose. That doctor has done seven years' training and 12 months in a hospital. What kind of Government tell our junior doctors to spend their summers working in Waitrose?
I do not want to take up too much time, and I want to allow other Members to speak, but I have some questions that I want to ask the Secretary of State. Will she let us know what will happen to the 10,000 doctors who will not be in employment? Will they be offered compensation? Will they be found work somewhere other than abroad? Will she leave 10,000 doctors without jobs? We need an answer. What will happen to those doctors? If they are unemployed, she will hear a lot more about it. Actually, I am not so sure about that, because the matter will come to fruition and hit the headlines in August, and I am sure that she will not be in her current position by that date.
I greatly enjoyed the engaging speech of John Mann, who stressed the importance of proper allocation of public resources. However, it cannot constitute the best application of public resources to spend a quarter of a million pounds on the training of every junior doctor, and then to face the prospect of so many leaving the country to be employed elsewhere in the English-speaking world.
This afternoon I met four junior doctors, all of whom have had job offers within a very short period—in Brisbane, Singapore and Toronto. Almost all are at the specialist training stage, and they could be described as emblematic of the problems created by MMC. Often those who have made the most progress in their training are most affected. It is a great shame to see £1 million of investment and training going elsewhere, as I did when I met those doctors today. The hon. Member for Bassetlaw would think it a great shame as well if he recognised that this misallocation of resources will make it difficult for his constituents' needs to be met.
The hon. Gentleman has rightly raised the allocation of public resources. Many innovative health authorities, including those in my area, are paying GPs salaries rather than giving money to their practices and giving doctors a quasi-self-employed status. Does the hon. Gentleman support the move towards salaried GPs?
It is certainly worthy of debate, but I want to concentrate on the Secretary of State's approach and what it means to my constituents who came here today. Apparently they will have jobs in the NHS, but not necessarily in their particular specialties. It is rather like telling a promising young libel lawyer that he or she can have a job as a conveyancing solicitor. What those doctors heard from the Secretary of State today was not about jobs for GPs; she seemed to be saying that they might as well emigrate, and with great immediacy take the training jobs that are being offered to them elsewhere in the English-speaking world.
I have seen the Department's leaked document revealing the desperate measures that will be taken to try to find jobs for doctors somewhere in the NHS. The suggestion that somehow jobs can be found in accordance with the model in the highlands and islands of Scotland shows how desperate the situation has become for the Government. Junior doctors cannot retain much confidence in the system when—as my hon. Friend Mr. Lansley pointed out—they see such a demonstration of the arbitrary nature of the selection process. I know of a consultant who had to deal with 650 applications in four hours. The 150 that were not dealt with went straight into round two.
As others have said today, a large number of applicants are not sure whether their applications were even considered. They cannot judge whether they were rejected on grounds of merit or whether their applications were simply neglected. Many junior doctors will look at the MMC site, which states boldly:
"Progress through each stage of training will be through open and fair competition using nationally standardised application forms and guidelines."
However, the oblique standardised forms that replace CVs mean that junior doctors can have no confidence that they have been able to give full expression to their talents or suitability for a post.
Is it not bizarre that that is probably the only recruitment website in the world that does not allow applicants to attach CVs to their applications?
Notwithstanding the bold statement that the process is fair, it can only mean that people who have invested not only years of training, but before that many years securing the necessary qualifications to begin that training, are being given a most unreasonable deal. I would not be at all surprised if the junior doctors whom I met today said, "This is the last straw," and took up those job offers abroad, which are better than anything that the NHS can provide.
The new system involves a great deal of uncertainty. Others have spoken of the danger of court action. There are questions to be asked about the quality of the curricula to be provided, and also about the standing of the medical training that our country provides. That standing is important not only to junior doctors but to the United Kingdom as a whole, but the "gold standard" is in danger of being compromised.
It is always difficult for politicians to recognise that they have made mistakes, and we are grateful that the Secretary of State has been able to apologise. However, as the hon. Member for Bassetlaw observed, it takes leadership to be able to recognise that it is time to cut one's losses. If junior doctors are to be given the confidence that will enable them to stay in this country, they must be offered the prospect of jobs in the NHS through the provision of training jobs in the first place. If we are not to lose a quarter of a million pounds' worth of training for all the junior doctors who will depart these shores within the next few months, we must accept what the Opposition motion says. Jobs—training jobs—must be given to people who have invested so much of their time to become junior doctors and serve the people of this country.
The disaster that threatens to derail MMC is the medical training application service, so I shall concentrate on that.
It seems that whatever topic is raised, it is possible to choose witnesses and evidence. The briefing from NHS Employers glosses over all the difficulties. The date of
"Employers are working with their consultants and junior doctors now to ensure that services for patients are not adversely affected by the change in timing. This is vital as employers need to be confident that well qualified doctors are in place to deliver safe and high quality patient care from August 1 when the new training programmes are available."
Sadly, as the House knows, there are no junior doctors in training in my patch, but as one of the few ex-hospital doctors in the House I have had a great many letters from such doctors. To obtain an accurate assessment of the position outside, I wrote to Hospital Doctor asking for comments from senior consultants involved in training. I invited comments in support of MTAS and comments in condemnation of it. I received exactly 40 letters: one expressing support, one expressing qualified support and the remaining 38 expressing tremendous worry. These are not whingeing letters from consultants. In contrast to the opinion of many Members, consultants work very hard for their patients, and the relationship between a consultant and his junior staff was—I hope that it still is in some ways—that of a father and their family. I remember consultants whom I worked for who were father figures, and I hope that I, too, was such a figure to my juniors. Therefore, I take seriously the comments of consultants.
I cannot express those comments except by reading some quotations, so I have selected brief passages from four of the letters, which I want the Minister to hear. A correspondent from the north-east wrote:
"It is almost beyond belief that the MTAS online application form, which ignored qualifications and previous experience and relied on answers to fatuous questions, was introduced nationally without validation or piloting. Widespread scepticism and concern was expressed by a large majority of colleagues who attended MMC Recruitment and Selection Training courses with us, which was ignored."
Comments from Aberdeen include:
"I have personally witnessed the devastating effects this process has had and is having on our highly trained junior doctors" and
"I have personally seen weak candidates being offered 4 interviews and very strong, able candidates being offered only one."
A correspondent from Cambridge wrote:
"If the madness continues, then in August there will be many unfilled junior hospital jobs and many junior doctors without jobs...this will be dangerous for patients...and the effect on junior doctors cannot be overestimated."
I also received the following:
"We will have contrived a situation where many English trained graduates leave the country and we import doctors to fill the places."
The writer of the letter goes on to say that if he were allowed to do so he could easily fill the jobs by August.
Finally, a letter from Northampton states:
"I have been dismayed by the unfolding disaster that is the Medical Training Application Process. I have discussed these problems with many senior and junior colleagues and know that their views are much the same as mine", and
"We have let down all these young doctors, as well as damaging the present and future health care of patients. Equally important we have lost our reputation for medical training. This is true nationally and abroad. I have just returned from a trip to Malaysia where I spoke to doctors, university educators and other professionals and the common views expressed were amazement at how the UK got itself into this mess and secondly that they would no longer consider it wise to send their bright young people to the UK to train in medicine."
Other problems include the stupidities in the scoring system—such as applicants getting two points for having a PhD and four points for their 150-word description of their personal qualities. There are also problems to do with the time involved for consultants drawing up the shortlists, let alone interviewing, and the fact that the interviewers do not know whether applicants have put their institution as their first choice. Also, to interview all applicants who put a particular training option first would be impossible without cancelling clinics and operations. The knock-on effect on spouses and families has been referred to; such families will now face uncertainty, and there might be splits between partners and between parents. The short time that is available to relocate is also a problem, as are the costs to the NHS of relocating.
What should we do in the future? Many of my correspondents feel that there is only one thing to do: to abolish MTAS. A professor of surgery writes:
"Although some of our leaders are still trying to find a compromise...the bare minimum to restore confidence in our medical students and junior trainees would be disbanding PMETB and MTAS."
"I regard the British parliament as the most democratic institution in the world".
I hope that the House will listen to the voice of grass-roots hospital doctors, and realise that when something is deeply unfair and wrong there is not a compromise to be had, and that instead there must be a restart.
I am pleased to be able to contribute to the debate because, like other Members, I have received many letters from constituents, many of whom are directly involved in the process or who have brothers or sisters or more distant relatives who are directly involved in it. Many of them have been extremely concerned about what has happened. I wish to take this opportunity briefly to express some of their concerns in their own words.
Many described the process that they have been through as "shambolic". One said that, essentially, it was like a "creative writing exercise", and wrote of his colleagues:
"One wonders why they bothered to commit so much time and energy to a profession to have their ambitions potentially shattered in a flawed process. Many of our junior doctors at my hospital are in a worse position and have no interviews and nothing to hope for at all."
Another correspondent says that the online application form is "riddled with error" and that the
"process is spectacularly breaking down".
She described the form as:
"A series of 8 tree-hugging questions with 150 word answers" and that that
"replaced any common sense when it came to qualifications, aptitude, and professionalism in order to assess the candidate. Any idiot could have answered those questions well."
Clearly, we do not want idiots to take up such important positions.
Other people talk about the system crashing when they tried to fill in their applications. One described their first interview, which was in Manchester on
"I took along my portfolio and my cv and offered to show it to the interview panel and they told me that it would not be necessary."
How can we expect good recruitment decisions to be taken when CVs are not even looked at? Another person who got in touch with me was a candidate in a Birmingham interview session which was cancelled at the last minute. Another described the system as a
"vastly unfair, harsh, draconian punitive selection procedure" that has been imposed
"on all junior doctors within the UK. Lives are being destroyed as we speak and the UK will lose its brightest and best doctors of a generation if it is not stopped."
Those are the kinds of impact that the system that we are debating has had on junior doctors.
Many relatives are equally concerned. A father got in touch with me about his daughter. He describes the situation as
"nothing short of a disgrace. The future loyalty to the NHS of these young people on whom we shall depend will have been lost. They have absolutely no confidence that they will be fairly treated now or in the future."
Many Members have been made aware of similar cases involving people who had spent many years training to become doctors and who had almost got to the final hurdle only to find that it had been taken away; they were not even allowed to jump over it at the beginning of this unfolding shambles. The situation is depressing. Getting the Government to take action has been like pulling teeth—to use a medical simile. Over a period of several months, the Minister and the Secretary of State have had to come back to the House to continue to explain what is happening in respect of this unfolding disaster.
One clear way that we can tackle this matter and give some genuine confidence to the junior doctors who are listening to the debate, and to those who will read about it tomorrow in Hansard, is to vote for the motion before the House. That will give them the confidence that the necessary training posts will be in place over the next few years to help us work through this crisis in a measured way, which is what we need to do.
I want to ask the Secretary of State about the Tooke review. It is obviously easier—and, given the judgment calls already made by the Department, more appropriate—to get out of this mess by subcontracting it out to Sir John Tooke. However, in her opening speech the Secretary of State said that Sir John might make recommendations to the House earlier than August if he considers it appropriate to do so. Why is that not her decision? Surely it is appropriate for junior doctors to know much sooner what is going to be done about this problem, rather than having to wait until the end of the summer. By that time, many will have already taken alternative decisions about their careers. People cannot just put their lives on hold until this Government manage to talk their way out of this shambles.
I have another question for the Secretary of State and for the ministerial team who have been involved in this process. What will happen if Sir John Tooke's review uncovers further problems, if the shambles develops in an even more dramatic way and, as my hon. Friends have suggested, we get to August and many junior doctors are left redundant? What will it take for the Secretary of State to say that enough is enough regarding her and her team's role, and to take voluntary redundancy, which many people in her Department have done? Whose career prospects are being damaged more—the Secretary of State's, or those of the many junior doctors who will not get a second bite of the cherry, once they have lived through this shambles?
This is not good enough, and it certainly is not the best year ever for the NHS and the doctors whom we have been discussing today. The NHS has been fundamentally financially mismanaged in the past decade. As an accountant, I was astonished to see financial boom in the NHS followed by bust. Such boom and bust is largely responsible for the destabilisation of recruitment in the NHS—an issue far broader than the catastrophe that MTAS has created. How many more shambles have to occur before the Secretary of State takes genuine responsibility, instead of continually subcontracting Government policy out to other people and putting off taking decisions?
The situation is urgent for those involved; they have not got until August to wait for answers. If the motion before the House is accepted, that would at least provide them with some certainty about their roles and what will happen in the coming years. It would give us the chance to take a thorough look at what has gone wrong, and to consider in detail what needs to be done. As I have said before, as someone who has been in business I know that when many different issues unravel over time one needs to take a step back and to look at the fundamentals of what is going wrong. However, our junior doctors cannot wait for an holistic review process. We need to give them some certainty by voting for the motion before us.
Having read this debate in tomorrow's Hansard, not many people will have much confidence in this Government and their ability to deliver and work their way through these dramatic problems. It is not just doctors who are concerned about the recruitment process. I have no doubt that many nurses throughout the country who are finishing their training courses will be shuddering at the prospect of the process that they will have to go through to find a job over the summer months. It is not good enough to be told that we are having a review, and that there will be no answers before August.
The Secretary of State referred in her opening speech to creating some additional training posts. It is incumbent on her to give the House a sense tonight of the number of such posts. What is the approximate number? What is too low, and what is unrealistically high? That is what we and junior doctors need to know. I doubt whether many of us have much confidence in the management team at the very top of the Department of Health. Frankly, the sooner that that team is changed and we have people who can run professionally an organisation that so many of us depend on—whether we work in it or are treated by it—the better.
We have had an excellent debate this afternoon, involving a total of seven Back-Bench speakers, all of whom contributed, in their own way, to our deliberations.
I start by declaring my interest as a registered medical practitioner, although mercifully I am not one of those caught up directly in the shambles that we have been discussing, or one of those involved in events outside this place today. A number of us went outside to speak to the representatives of Remedy UK and to listen to what they had to say. I recommend that Ministers listen to what they have to say to them, too, because they have done a wonderful job in highlighting this issue to Members.
An NHS consultant whose daughter is a junior doctor emailed yesterday to say:
"The whole concept of MMC had some merit but the way it has been planned and carried out is nothing short of scandalous."
That is a pretty good way of epitomising what many of us feel about this issue. Dr. Taylor gave a series of worrying accounts in a similar vein from other consultants throughout the country. My hon. Friend Justine Greening gave further evidence from junior doctors who had written to her with personal stories of how this catastrophe has affected them in a direct way. In her excellent contribution, she was right to ask—as a number of other Members did—that the second, Tooke, review be truly independent. That means that when Sir John Tooke chooses his team, its membership should not include those previously involved in this process, because they would inevitably bring to the debate preconceived ideas. It is important that this issue be approached with fresh eyes.
We Conservatives have always supported the evolution of a consultant-led, increasingly consultant-delivered service, and we support the principles of MMC that underpin it. We can, of course, debate points of detail such as the removal of the influence of the medical royal colleges and their replacement by the expensive training quango PMETB in 2005. It is salutary to remember that those are the same UK royal colleges whose supervision of medical education and training was described by the Health Secretary on
However, having agreed with the Government in principle, we turn to implementation. At the heart of this, of course, lies MTAS. As he threw in the towel as MMC's national director, Professor Alan Crockard said that MTAS
"has lacked clear leadership from the top for a very long time."
Others have used that quotation and I make no apology for repeating it. We have to ask what he meant by "the top"; I leave Ministers to draw their own conclusions. Professor Shelly Heard was similarly scathing as she quit as MMC national clinical adviser.
Rob Marris, in a thoughtful intervention on the Health Secretary on
"As far as I am aware, no disciplinary or performance management steps are being taken in the Department, but no doubt that can be considered as appropriate."—[ Hansard, 16 April 2007; Vol. 459, c. 48.]
So nobody has taken the rap for what doctors have described as the biggest crisis to hit British medicine since the start of the NHS.
John Mann suggested that Ministers should avail themselves of the services of the Cranfield or Henley school of management. Of course, those schools teach leadership, which is what is needed now. Next, my hon. Friend Peter Viggers underscored the seriousness of the crisis. He asked that Ministers give the House regular situation reports as the reviews go on. That is important, given the enormity of the problems facing the NHS.
Much of MMC and MTAS has been designed to remove the influence of the old boy network—I suppose that one can call it that—that Ministers believe has been responsible for the appointment of junior doctors in the past. NHS Employers is a metastasis of the Government's cheerleader, the NHS Confederation. In its briefing note, it identifies the twin crimes of "patronage" and "bias" in the appointment of junior doctors. In its zeal for reform, it does not pause to consider at what terrible cost those sins have been purged. Many will believe that the Health Secretary's surgery has been somewhat worse than the disease.
Apart from the drearily predictable NHS Confederation, there have been remarkably few apologists for the mess over which the Health Secretary has presided. Let us set aside for a moment the administration of MTAS, which has caused so much heartache, and focus on modernising medical careers. We can applaud the intention to move forward to a more focused, competency-based training that reflects what has been happening in other trades and professions, and in other countries. We hope that training will be more flexible and, as women make up half the medical work force, that it will facilitate a better work-life balance. It is surely right that doctors are better able to communicate with patients and colleagues, and that communication is a key element in any training or assessment process. Modernising medical careers recognises that, but we have grown an inflexible monster that forces early job choices on young doctors that will be difficult to move out of and into. Practical experience will be curtailed and all of a sudden that "second to none" training about which the Health Secretary boasted in her speech last week is beginning to look far less robust.
MTAS is truly remarkable. In place of a CV and hard data encapsulating hard-won academic qualifications and clinical experience, applicants are invited to furnish a load of soft mush. Other hon. Members have mentioned scoring, and Mr. Kidney referred to that. The essential concern is that the influence of PhDs, for example, has, as we discussed earlier, been eclipsed by offerings in essay form that are made up at short notice and in a way that, as my hon. Friend Mr. Lansley noted, is capable of being imparted in a course that costs very little.
Certainly, the current system encourages creative writing and theatricality. No doubt they are invaluable attributes, but they are hardly core competencies for aspiring consultants—even, if I may say so, for consultant surgeons. I understand from a written answer sent to me on
"the service around the country will in many cases need to release consultants from their planned activities in order to make time available for the additional interviews."—[ Hansard, 16 April 2007; Vol. 459, c. 45.]
What assessment has the Minister made of the cost in front-line patient care caused by the crisis? What will be the impact in the next few weeks of the redeployment of medical staff apparently necessary to patch up MTAS? How many operating lists will be cancelled, how many clinics scratched, and how many ward rounds foregone?
"shroud-waving about unemployed doctors is absurd"—[ Hansard, 19 March 2007; Vol. 458, c. 582.]
"the opportunity to refer to the thoroughly misleading statements made in recent weeks about the prospect of thousands of junior doctors finding themselves without work. This is complete nonsense."—[ Hansard, 16 April 2007; Vol. 459, c. 46.]
The Health Secretary is nodding. In contrast, however, NHS Employers has at least some grip on reality. We learn from its leaked report of how it is desperately scratching around for jobs abroad to offer doctors who it recognises will be unemployed on
While NHS Employers has been trawling the world to see where it can park unemployed British doctors, has it asked our EU neighbours how they might help? Given that many of the available training billets in the UK will be going to European economic area doctors, it seems reasonable to ask where the reciprocity is. Mr. Field spoke about banning European doctors, and that point may be germane here. Certainly, we recognise that the treaty obligations into which we entered—rightly or wrongly—forbid us from banning European doctors. That is simply not possible, but NHS Employers might consider Europe as it trawls around the world. Many Labour Members have been greatly exercised in the past by unpaid researchers attached to MPs' staff. In a like manner, are they not concerned that officials are entertaining a scheme to hive unemployed junior doctors off into voluntary service overseas? What would be the precise terms of such an arrangement?
Heaven for junior doctors will be a place on a run-through training programme. The Government are saying, "Get that and you're well on your way to consultant status, in due course. Fail and you're set for a grisly series of fixed-term specialist training appointments, so-called locum appointments for training, a re-run of your second foundation year"—how depressing must that be?—"Undefined academic appointments of the sort we thought MMC was designed to address, professional 'locuming' and a constellation of low-grade, non-training jobs. You'll be part of your postgraduate dean's euphemistically styled 'talent pool', to be fished out when something vaguely suitable turns up."
I hope that that "something suitable" does not involve working in a supermarket, as happened to the constituent of my hon. Friend Mrs. Dorries. The lost tribe of senior house officers is set to become nomadic as they drift from hopeless job to hopeless job with little chance of breaking out, in stark contrast to the previous flawed, but far less rigid, milieu. It is little wonder that so many dedicated, expensively skilled professionals are set to quit the UK and the NHS, as my hon. Friend Mr. Pelling pointed out, and even to quit medicine altogether.
The Health Secretary's fulsome apology last week was indeed appropriate, but junior doctors facing the prospect of being hung out to dry want to know why she is not joining them.
Dr. Murrison is right to say that this has been a good debate, and I shall do my best in the time available to answer some of the points that have been raised.
This matter is of fundamental importance to the country. We must ensure that patients get the best possible care from highly trained and motivated staff, but we recognise that there has been a significant impact on the lives and careers of those dedicated and hard-working staff who are applying to progress their training as doctors in the NHS. Young people and their families will be watching today's proceedings closely, and we know that they will have gone through considerable anxiety. I know from the e-mails that I have received—and I am sure that other hon. Members of all parties have received similar messages—that there has been considerable anxiety about this matter. It is right for the Government to address that and to give people practical information so that we can map a way forward.
My right hon. Friend the Secretary of State began by setting out the principle of modernising medical careers. One of the interesting things about today's debate was the degree of agreement on both sides of the House, expressed by almost every Member who spoke, about the principles behind MMC. The programme has the potential to benefit both doctors and patients in the NHS and it is important to note that its foundation stages have been successfully introduced. We believe that we can build on that success.
The difference between us and some Opposition Members is that they suggest that all the measures were hatched in secrecy in the Department of Health and that we did not involve anybody else in drawing up plans for this stage of the implementation of the MMC programme. That is not the case. We have worked closely with the Academy of Royal Medical Colleges, the BMA, NHS Employers and others over a long period. However, we are not washing our hands of the issues. We have tried to face up to them, but the important thing is to take action now to help people and to put in train a wider review of the system so that when this year's process is over, we can ensure that lessons are learned and that, in time, we can bring in a strengthened system.
The suggestion crept into many of the comments today that there were no unfairnesses or problems in the old way of doing things. That simply is not the case. If we accept the principles of MMC, we must also accept that there were myriad unfairnesses in the old system. The difference is that those unfairnesses were not out in the open, in the transparent way that they are now— [ Laughter. ] It is because they are transparent that we can work through the issues that have been identified and create a fairer training system for doctors.
Norman Lamb made a speech that was good in many ways. He, too, endorsed the principles of the programme and observed that patronage and bias had been problems in the past. Despite the laughter from the Conservative Benches, the hon. Gentleman was right to identify those problems. He suggested that the system was too inflexible—a point raised by the shadow Secretary of State in his opening remarks. I draw the attention of both Members to one of the points in Sir John Tooke's terms of reference:
"the lack of flexibility available to trainees on run-through programmes".
Sir John will examine that specific point in his review.
The hon. Member for North Norfolk spoke about the lack of a pilot for the scheme. In fact, the electronic portal for foundation recruitment was piloted in 2006. The application form was based on an existing form used in the London area, and the current form was piloted pre-launch in at least two deaneries. At the end of the day, we can review the programme and consider whether there was enough piloting and I shall take on board the conclusions of the review. However, it is not the case that the scheme was rushed through with no attempt to consult or to pilot.
The hon. Gentleman asked how many extra interviews would be required. Originally, 26,000 non-GP interviews were scheduled. The number of extra interviews required following the Douglas review will depend on how many junior doctors change their first preference. As the hon. Gentleman knows, that process has been going on over recent days so it is obviously too early to give him the figures. However, we estimate that guaranteeing one interview for each eligible applicant will require between 13,500 and 23,900 interviews. The number will depend on how many doctors change their preference. We shall of course need to balance the requirements of the service—another point made by the hon. Gentleman. We believe that the provision of extra interviews in round 1 is likely to reduce the number required in round 2, but we shall work through that issue as we go further down the line.
We shall not know how much additional cost will be incurred until the end of the process. However, the proposals have been agreed with the deaneries and NHS Employers. We believe that is the right action to take, because it will bring back a degree of fairness and meet the complaints we faced—that the system was unfair and people were being denied opportunities. Like the hon. Member for Westbury, the hon. Member for North Norfolk asked about the provision of care to patients during the period of the review. We shall not relax any service standards or targets.
The hon. Member for North Norfolk asked my right hon. Friend the Secretary of State about the 700 posts that are to be added. Originally, a small number of one-year posts was held over for round 2. After the review group's recommendation, those posts were loaded on to the system for the extended round 1, so the 700 posts will soon be available on the system. I hope that that answers his question.
My hon. Friend John Mann made an interesting point, which again goes back to the principles of the MMC programme. He asked about the needs of communities such as his, where traditionally there have been problems in the recruitment of both hospital-based staff and GPs. My area is in a similar position. My hon. Friend Mr. Kemp pointed out that in his area, too, there were real difficulties in recruiting more GPs. MMC is being introduced to ensure that we can address those recruitment problems, especially for shortages such as that of GPs in the north of England. In principle, the scheme enables people to move from over-subscribed to under-subscribed specialties and we believe that the review group's proposals for early announcement of recruitment for GP training will encourage applications in that field, which has traditionally been under-subscribed.
Peter Viggers asked about double cohorts and why we could not guarantee everybody a place. May I give him a snapshot of the situation? At present, about 3,000 senior house officers are training in surgical specialties, feeding into about 500 specialist training opportunities for surgery. It is the case, as it always has been, that not everybody can be a consultant surgeon. The difference is that under the old system people hung around trying to progress their careers, but could not obtain opportunities to do so.
I have very little time and I want to do justice to the Members who spoke in the debate, if the hon. Gentleman will forgive me.
Like other Members, the hon. Member for Gosport spoke about the double cohort—[Hon. Members: "Give way."] When I have answered the hon. Gentleman's point I will give way. There has never been any restriction on applications for sought-after training posts—it is not a feature of the new system. Indeed, I am sure that the hon. Gentleman would be the first to agree that it would be wrong if the Government imposed restrictions on people in staff grades applying for those posts, so I am not sure that he was raising a valid point.
Our motion calls for SHOs who are not able to obtain entry to specialist training this year to have opportunities to do so next year and the year after. Will the Minister confirm that the Government will ensure that that is the case?
I was coming to that point, but first I wanted to do justice to the excellent and thoughtful speech made by my hon. Friend Mr. Kidney, as well as to other points that were raised. The shadow Secretary of State makes an important point—that we must do what we can to ensure that help and support is available for doctors displaced this year. Of course, they will be able to apply in future rounds in future years, even if they are applying from a non-training or staff grade post.
There is much more we can do this year. We are working with the service to maximise the number of job opportunities available in and leading up to the end of the 2007 recruitment round. We will invite any displaced doctors to register on NHS Jobs and NHS Professionals so that they can quickly and efficiently be matched to the vacancies that will continue to emerge, to training posts and to locum appointments, as was always the case. Posts will become available in any normal year.
We will work with the postgraduate deaneries to maximise the number of training opportunities available within the overall number of job opportunities. In particular, we will undertake urgent work with the medical royal colleges and the service to establish the need for additional training posts. We will ensure that doctors who take up jobs in service grade posts continue to have support to ensure that the training and development opportunities in those posts are maximised. Those unsuccessful this year will be able to reapply next year. They will also be able to apply for posts that emerge, as they always have, through the course of the year. I am glad that the shadow Secretary of State raised that issue because I am pleased to put that point on the record.
I fear that I cannot do justice to all the sensible points that were made in the debate in the time that I have left. I conclude by saying that we recognise the anxiety that this year's round has caused. We have not sought to dismiss it; we have sought to engage with it and come up with solutions to give people real answers to the difficulties in which they find themselves. Implementing quickly the recommendations of the review group will further help the position that people find themselves in and, crucially, will give support to people who have been displaced by the process and will help to enable them to progress their careers as they had hoped to do.
I am grateful to colleagues for their contributions to the debate. I hope that we can agree a measure of consensus that will provide a good, workable training system for the NHS that will stand us in good stead for many years to come.
Question put, That the original words stand part of the Question:—
Question accordingly negatived.
Question, That the proposed words be there added, put forthwith pursuant to
Mr. Deputy Speaker forthwith declared the main Question, as amended, to be agreed to.
That this House recognises the international reputation for excellence of medical training in the UK; acknowledges the need to modernise medical careers to ensure all doctors are properly trained to nationally recognised standards, including a fairer and more transparent process for applying for specialist training; notes that Modernising Medical Careers (MMC) will deliver training to a consistently high standard which, combined with the expansion of the number of doctors, will provide high quality safe care by appropriate skilled medical staff; notes the wide consultation that took place on MMC and the strong support for the need to improve doctors' training amongst doctors' representatives including the medical royal colleges and the British Medical Association; welcomes the external review that is already being conducted into how MMC has worked to date and the changes made as a result; and supports the longer term review recently announced to ensure MMC works well in the future.