Saturday, 31 March 2007
"Dear Professor Sir Liam Donaldson,
I recently resigned as medical student advisor to MMC.
Despite claims from the health minister that the new Foundation Programme has ‘widely been acknowledged as a success’ there are, and always have been, huge misgivings about it at student, junior doctor and all other levels. I hoped that access to the MMC team would give me an opportunity to make these views heard. I was wrong. Although you continually tell us that you are ‘working with the profession’ you are not, at any level, listening to it. This is why I resigned: please find enclosed my letter of resignation to Professor Alan Crockard.
From a grassroots level upwards, your recruitment of those from the profession has been tokenistic at best. My role was little more than a publicity stunt. You want to be seen to be involving us but care little for the reality of what we actually have to say. Even at the highest levels you have been seen to charge professionals with responsibility but withhold authority.
It is not my job to outline the infinite professional, personal and philosophical problems that blight your new systems – the 12,000 junior doctors who recently marched through London could do this more eloquently than I could ever hope to – but it is my job to expose the growing chasm between yourself and the profession.
Your agenda does not meet with the approval of the profession. You must acknowledge this. It is not acceptable for you to enlist members of the profession from all levels and to then ignore them. It is not acceptable to use your implementation team – MMC – as a vehicle for spin, as a way to convince the profession that things are other than they are. It is not acceptable for you to hide behind the responsibility you have dispensed to MMC and at the same time maintain your authority so you can push through your own agenda.
And yet, this is what you are doing. No matter what the profession says, no matter how vociferously it protests, no matter what damage is done to families up and down the country, this is what you will continue to do. How kind of Lord Hunt – at a time when faith in your systems is at its nadir - to illustrate the DoH’s utter contempt for the profession, by saying “I would like to reconfirm our commitment to MMC which aims to recruit and train the best doctors to provide the best possible patient care.”
This is your project. Everyone else – from MMC to MTAS, from the royal colleges to PMETB, from the advisors to the spin doctors – are merely your implementation tools. Ultimate authority rests with you. It is now time for you to take responsibility. If you continue to force through these reforms, I want you to know that it is obvious - even from a medical student level - that you are a million miles away from being the ‘bridge between the profession and the government’ that you claim: you could not be acting more undemocratically if you tried.
If you find this image unappealing, your options are clear: take heed of the groundswell against you and your agenda and cede your authority back to the profession. If this is also unpalatable to you,
then you must resign.
Spot on. This young man has veritable balls of titanium and I salute you.
This is a letter sent by the ex-medical student adviser to MMC to Alan Crockard on 18/3/2007.
I am sorry to inform you at what must be an impossibly busy time that I wish to resign from my position as medical student advisor.
When I took the position I had many reservations with the MMC systems but believed that I would be able to help students get the best deal from these changes. Seven months on, I retain these reservations and regret that I have not been able to have the impact I had imagined.
Now as then (when I presented you with a petition signed by 1300 students), I believe:
• The nature of the new application system effectively randomises medical students to jobs across the country
• The importance of academic achievement has been downgraded
• The importance of other achievements at medical school has been nullified by the nebulous nature of questions and the lack of a CV
• Two years is not long enough to decide on one’s specialty, to gain a broad enough range of experience, to become a good enough doctor: pressure is on to decide early, but the random nature of the application leaves no scope for strategising or planning ahead
• Morale at medical schools is low; they are not the aspirational, centres of excellence they should be, rather ‘centres of competence’
• This anxiety has filtered down to those students considering applying for a place at medical school
Through contact with a wide range of students over the last seven months, I know that these views are widely held. Just two nights ago, I talked to a Bristol student representing a group of 40 who echoed my above sentiments. I have, however, come to realise that continuing to transmit such views to the MMC team can have no effect as it is focused on the successful implementation of a system rather than the guiding principles and details of that system.
In my limited experience, the role of student advisor is not used, as MMC aspires, to ‘encourage dialogue with the stakeholders’. Instead the role seems to be a token attempt to suggest the involvement of students in MMC strategy; a publicity vehicle to lend validity to a system that has not, in fact, considered student opinion and insight at all.
When I was asked recently to find some students / SHOs who were happy with the new system to help build some positive press, I knew this role was not for me. I am not interested in spin or image, in making something seem other than it is. I am interested – perhaps naively - in getting the popular voice heard and acted upon and in standing by my own personal, political and professional principles. I now realise that in order to do this effectively, I need to be working within a different framework.
I would like to thank you for giving me the opportunity to fill the role and personally wish you all the very best for the future. I can honestly say that I have enjoyed meeting you and having the chance to work with you and the team as a whole.
What a comprehensive assassination of MMC. As he says, they are downgrading what should matter and deliberately churning out propaganda while only attempting a token consultation. Alan Crockard resigned on 30/03/2007, I wonder how much this letter had an effect.
The big news today is that Remedy has launched a legal challenge to MTAS. Other bigger organisations have lacked the courage to speak out vociferously against this unjust process, and Remedy has showed it has the courage that others lack.
Friday, 30 March 2007
Overall the response to the report was very mixed and several proposals were particularly unpopular, including the burden of proof change and handing work to the incompetent PMETB. The consultation process was conducted in a particularly subtle manner, meaning that the time people had realised there was a consultation it was already finished. There were also several gaping flaws in the process; it was ludicrous to listen to the opinion of patients on the lowering of the standard of proof, but then again this government only ever ask the people who it knows will give the 'correct' answer.
The following questions were sent to the DoH under the Freedom of Information act. The DoH is using some very fishy stalling tactics as we speak.
" I am writing as regards a FOI request about the CMO's
report from July 2006. I have some specific questions.
1. Before the report was published, with who did the CMO
discuss the possible content or suggestions to be included
in the report?
2. Did the CMO receive any advice advice before embarking
upon his work on his report? If so who was the advice
from and what records do you have of this advice?
3. Was the possible content of the report discussed by
the CMO with the prime minister, any ministers or
politicians, government advisers, senior DOH officials, or
4. If the content of the CMO's report was discussed with
any of the above people, I would like to see records of
precisely what was discussed and who was present.
5. What evidence do you have that the consultation
process for the CMO's suggested reforms has been adequate?
6. Do you have any records or documentation of any
possible discussions of this consultation process between
the CMO, DOH officials, ministers and advisers?
7. If you think the consultation has been adequate then
how would you reassure members of the public and medical
profession who are concerned with certain areas of the
These are the CMO's alleged intentions for his dismantling of medical regulation:
"• improving patient safety;
• harmonisation of regulation for all health professions;
• stronger management of fitness to practise at local levels;
• more co-ordination of actions between regulators, employers and
other related bodies;
• clarification of the standards expected of health professionals."
If these were his genuine intentions then why would the DoH be so keen to withhold this vital information that has been requested under the FOI act? This makes the whole process look corrupt and underhand, and his quoted intentions appear to be nothing more than a smokescreen. His real intentions are arguably:
"•achieve further personal honours and career progression
•hand control of the medical profession to politicians in order to catalyse NHS privatisation"
This story has more to roll. Watch this space.
The news that everyone knew was coming is out, Professor Alan Crockard has resigned. Here is an extract from his resignation speech:
'Manifestly, specialty training is an order of magnitude more complex than Foundation, but it became obvious that the MMC team¹s expertise was less used in planning of specialty rollout.'
'From my point of view, this project has lacked clear leadership from the top for a very long time.'
'I realise that the service must continue to allow patients to be treated and I know little of the law, but it seems to me basically unfair to advertise the possibility of four interviews and then suggest that these might not be honoured.Equally devastating would be the suggestion of some stakeholders, that the completed interviews be discarded and the process be rerun. I accept that in many areas and in many specialties, this round of recruitment and selection has been acceptable. But the overriding message coming back from the profession is that it has lost confidence in the current recruitment system.'
About time. I just hope that those above him including Patricia Hewitt and Liam Donaldson do the honourable thing next.
There is some very amusing comment here and here on this topic from a very imaginative blogger.
What are the implications here for MTAS? Crockard is openly admitting the system is unfair, and this certainly should not be ignored.
Thursday, 29 March 2007
This document has been sent to trainees in a certain part of the country. Have a read in full of the lies they have spun here. There are so many flaws in this long winded piece of hogwash that it may take a while, anyway here it goes:
1. "The old system was fairer and meant that the right candidates got the right job.
- Highly debatable"
Highly debatable? So restricting candidates to one application and having NO short listing is fairer? You'd need to be pretty handy at debating to argue that one.
2. "The old system had more jobs - this is just cutting posts by another means.
Incorrect – the number of jobs in the NHS for junior doctors isn’t going to change. There will still be jobs for junior doctors who don’t get a training place."
I think we should hold you to that. They are saying there will be no unemployed doctors come August?
3. "The online system has failed and is to be replaced
The Department of Health has set up an audit of the MTAS system to investigate concerns that will report on Monday. Initial findings are that the system is sound, applications have not been lost and that anecdotal reports of data loss and system failure have little, if any, substance."
My lord, these verbose morons are trying to persuade us that there was no data loss and no system failure! I think even Prof Field disagrees with this.
4. "Aren't you testing doctors on skills they don't need - like writing - instead of their clinical skills?"
Their attempted justification of this is very weak indeed, almost Hewitt-esque; it was discussed with stakeholders blah blah. They still fail to address the point that writing creatively about something does not equate to being good at doing that something.
5. "If the system is so shaky that you feel the need to test it now, how can you be confident it has worked?
Feedback to date is that interviewers have been impressed with the quality of candidates - there is no evidence to dispute that only applicants who meet the high standards required for appointment will be offered jobs."
It does not mean that the system has worked just because there have been some good candidates interviewed! There is a large amount of evidence that some of the best candidates got no interviews, hardly evidence of a solid system is it?
6. "Don't you need to halt round one in order to guarantee fairness?
No – this would be unfair to candidates part way through the process. The BMA, Academy of medical
What about the whole system being unfair to everyone, is that not a slight problem? I think they may find that the BMA walked out of the review panel too.
7. "Are you going to have an independent review?
Yes – this is ongoing and will report by the end of March."
The review is not independent as has been pointed out by many involved.
8. "Did Patricia Hewitt know a year ago that there was a crisis looming over this new online system?
The BMA JDC did call for a delay in the implementation of MMC, but the view of all four UK Health Departments was that deferment would not be helpful and would cause greater uncertainty for trainees (particularly those in the second Foundation year).......The JDC has also been a key stakeholder in planning the recruitment process – and many of its suggestions were taken on board. Just before Christmas the JDC indicated its support for MTAS (need to find statement on this if possible). "
It is amusing how the BMA JDC walking out of the review panel has been ignored by this Q&A.
9. "Isn't this just another government IT blunder? And how much has it cost the taxpayer?
No – despite the difficulties this year, MTAS will provide an auditable process which brings transparency to the appointment of junior doctors and will ultimately realise significant savings in bureaucracy for NHS employers. "
There is a significant amount of evidence of IT failures in MTAS, see Prof Field's email for evidence from a Dean involved. Where is the evidence to suggest that this unwieldy system will be of any benefit? Also I think Patricia Hewitt, when asked in parliament, didn't even know how much it actually cost; where is your answer to this?
10. "Have you lost 1300 application forms?
No – this is incorrect: there is no evidence of applications being lost by the MTAS system"
Actually there is, see Prof Fields's email admitting that 1300 applications were lost!
11. "Will the whole process be put on hold while this is sorted out?
No - interviews for the first round are going ahead as planned. High quality applicants have been selected for interview. Only those who meet the high standards for selection will be appointed."
It should be put on hold. Indeed high quality applicants have been 'selected' for interview, but this is only because everyone is going to be interviewed; thus it would be hard to miss people! The lack of short listing and selection consisting of only one short interview opens up a huge potential for selecting the wrong candidates.
This Q&A is yet another insult to the junior doctors who are being forced to endure these months of torture. What will the consequences of this stress be on the hearts and minds of our junior doctors? I am not making this point in a blazee fashion, but it really is a serious concern. Medicine is a stressful job normally, but how much damage will be done in enduring these last few weeks of not knowing, of chaos and indecision, of umpteen changes to the system, of unfairness and corruption; while working hard in challenging jobs at the same time.
My heart goes out to anyone who is having to go through this cruel process. The web of propaganda being spun by the deaneries and members of the medical establishment are beneath contempt.
In the news today Margaret Beckett has been slammed for her role in the fiasco of reforming farm subsidies. The Environment, Food and Rural Affairs Select Committee reported that she oversaw a shambles that has already seen millions of tax payers cash wasted, and several poor farmers have committed suicide as a result of the affair. There was also a mention of a useless computerised system that crashed, sounding familiar isn't it. You can read more about it here, here, here and here.
So what happens to Margaret Beckett afterwards? She is promoted to foreign secretary. That's yet another example of how accountable our politicians are for their negligent work. It does seem to stem from their leader a one Tony Blair, who did take us to war on very shaky grounds indeed, a decision that has since been shown to have been based on propaganda and not credible evidence.
This tale of useless reform, wasted tax payer's cash and crashing computers sounds remarkably like our good old buddy MTAS (Medical Training Application Service). The lack of accountability demonstrated by those who have forced this ill considered reform upon on is quite remarkable. I am referring here to the likes of Liam Donaldson, Patricia Hewitt, Alan Crockard, Neil Douglas and possibly even people even higher up the chain of command.
It heartens me to learn that Professor Alan Crockard has been reported to the GMC for his role in the MTAS debacle. It will be very interesting to see whether the GMC feel he has remained true to their 'Good Medical Practice'. It does seem that the GMC's guidelines are routinely ignored by several senior doctors involved in the current government reform agenda, one rule for them and another for us. Our 'self appointed' leaders are seemingly unaccountable for huge decisions that affect millions, while we are held accountable for much smaller decisions that affect individuals. Totalitarian justice has appeared.
This letter from Ian Gilmore regarding MTAS has found its way here:
MTAS - Real progress achieved
RCP Council met on Wednesday 21 March and discussed the MTAS situation. Members of Council recognised and acknowledged the anger and frustration felt by Fellows and Members taking part in this flawed system, and agreed the following principles:
* the shortlisting process was so seriously flawed that it could not be relied on to select candidates for interview fairly
* as a result, every applicant must be offered an interview, whether applying for ST1, ST2 or ST3 for their 1st choice
* the College must be satisfied that there would be no significant differences between interviews that have already occurred and those yet to take place. Otherwise, to be fair round one will need to be stopped and a new round instituted
* employers must support and allow consultants to be released to undertake the necessary interviewing, even if this means cancelling clinics or other non-urgent duties at short notice
* there must be an independent review at the end of the selection process that will examine the role of PMETB, Colleges, Deans and MMC in the MTAS process and the introduction of MMC
* there are particular issues for academic careers that must be addressed
* furthermore, it is vital that the Colleges work together
I took these principles to the Review Group on Thursday 22 March and I am pleased to announce real progress has been achieved. Major changes have been made to the application system - from now on all eligible applicants for ST1, ST2 and ST3, whether they have been interviewed or not, are now guaranteed an interview for their first choice preference. Applicants who have already been interviewed:
* can change their order of choice
* can ask for an interview for their new first choice
* if already interviewed for their stated first choice, that interview may stand
Information on competition ratios for Deaneries and specialties will be available on the MTAS website to support decision making. I appreciate that this will result in more consultant time spent interviewing, but we ask you to support the process in the interest of maintaining fairness for all candidates, whether they have been previously interviewed or not. I am very grateful for the time and effort taken by all of you and hope that we now have a fairer, firmer basis for selection. In implementing these short-term changes we have not lost sight of the need for a full independent review of the process, and have had reassurance that this will be forthcoming. We have also been reassured that the ability to identify and promote academic physicians of the future will not be compromised.
Professor Ian Gilmore
Wow, that really is such fantastic news Dr Gilmore. That real progress you have so nobly achieved has really cheered me up. You have taken an unfair process and fudged into a new type of unfair process, that is such 'real' progress.
It's very strange that you don't mention how people who have had interviews for their 2nd/3rd/4th choices, now have to have these scrapped; that is such progress isn't it?
The current situation where candidates must play this game of poker in choosing their one 'golden career bullet' is beyond a joke. This is not fair, it restricts applicants to just one application. There is also no short listing at all and it therefore comes down to just one short interview, meaning that the potential for selecting the wrong candidates is huge. There is no alternative but scrapping things now.
That is such 'real progress'. Turkey twizzler anyone?
Wednesday, 28 March 2007
Following on from the ridiculous new targets for the under fives, it turns out that our government is soon to start testing children for signs of a 'criminal tendency'. Here is the official No 10 document that attempts to provide a justification for this control freakery. What would Orwell say today?
As one reads the document it is actually very funny until one remembers that it is no joke, this is real. The shiny 100 plus page pdf talks of increasing cohesion and reducing bureaucracy, I fail to see how more needless reform can possibly result in either. I can't imagine people being happy that their children are going to be tested for 'criminal tendencies', whatever that means, and what the hell will they do when the child admits that want to be 'the chief fundraiser for the Labour party' or 'a dictator who goes to war illegally'- fast track them into the government? The cohesion of communities is hardly going to be strengthened by children being forcibly wheeled away for baseless psychological tests against the will of their parents, and it seems ironic that yet another reform program back up by huge amounts of bureaucracy is claiming it will 'reduce bureaucracy'; Patricia Hewitt will know what she's talking about soon and a small squadron of pigs will be seen crossing the channel by air.
Just to draw a slight tangent from there, this piece of BMA material is an example of how controlling and almost totalitarian our institutions are becoming. This must be seen in context of a government that is compromising patient confidentiality by forcing a national computer database of patient records upon us, while there are many other examples of this increasingly controlling nature in policies such as ID cards/regulatory reform/anti-terrorism law that ignores civil liberties. This is one of the more worrying quotes:
"Arguably, training may be more important than selection.18 Perhaps all that selection requires is identifying minimum requirements and then it is the training process which defines and ensures a competent doctor."
This is a very scary statement indeed, it is trying argue that 'competency based training' is so good that it can effectively mould anyone into the shape of a good doctor, in a way largely irrelevant to the person's abilities. This is a very dated take indeed, and shows that those behind training reform are believer's in the massively discredited Standard Social Science Model (SSSM). These psychobabbling educationalists who have taken a long holiday from reality are also trying to introduce personality testing into the selection process. Fortunately there is no evidence to back this approach up, but thus didn't stop them with the competency based questions in MTAS:
"In asking important questions such as ‘is there an optimal doctor personality?’, ‘how do we test
for potential?’ and ‘are tests reliable and valid?’, it is clear that there is no simple answer. What is clear is that more research is needed in all areas of selection design from competency modelling to predictive validity of tests specifically for UK doctor samples. While it is encouraging that work has started in some specialties and at an undergraduate level, there appears to be a long way to go before some questions can be answered. Trainability and performance in job training programmes as outcomes has been studied in other industries and medical education can learn from this research."
To be fair to the document it does stop short of recommending anything new, as it does freely admit there is no evidence behind 'competency based questions' and personality testing. The point I am trying to make is that there is a deliberate drive here towards a mode of thinking that has been largely proven to be baseless by the scientific community.
New Labour and its institutions see the human being as fully malleable entity that can be trained and conditioned into anything they want it to be, they are therefore monitoring us in an increasingly 'big brother' manner so that they can mould us into the perfect compliant citizens. It is no coincidence that some of the nastiest and most totalitarian regimes of the past have had faith in very bad science indeed, for example Lysenkoism. The government wants to poke its nose into our daily lives in an ever intrusive manner, it wants us to trust her because she claims she wants to help; however there is precious little evidence that this government will help, they are far more likely to lock someone up for a crime that they have yet to even consider committing. In trying to control us and mould us into drones, they are revealing their true colours. They want more power and they do not care who gets treated unfairly in the process.
Does anyone really want to live in a country where an individual can be treated as a criminal before they have committed any offence, where the state rides roughshod over civil liberties to 'protect us' and where the authoritarians in power treat humans with such overt contempt? This government is now showing its true colours and these reveal a vicious avaricious psychopathic monster lurking with a rather worrying intent.
The rules that punished NHS trusts twice over with a 'double whammy' of debt repayment have been scrapped.
"Steve Bundred, chief executive of the Audit Commission, which recommended last year that RAB not be imposed on individual NHS trusts, added: "Deficits are not being written-off. But an unfair system is being corrected. Trusts will no longer effectively have to recover deficits twice.""
It still leaves a rather gaping question unanswered, what happens to the money that trusts have had to pay back TWICE over to the government? Will the trusts be recompensed with interest for the extra cash they have unfairly had to pay back to the government? I very much doubt it. The trusts will be forced to carry on cutting front line services thanks to the deliberate imposition of the deficits.
The Chancellor Gordon Brown must clearly shoulder a large amount of the blame for this situation; he has been enforcing these stupid rules that have directly resulted in cuts to frontline services. It is also rather pertinent that this same Chancellor is happy to give black cheques to CFISSA/PFIs and other profligate initiatives. Double standards and a hidden agenda perhaps, make up your own mind.
Front point sytems also points out certain NHS budget problems, as well as rising readmission rates that are arguably down to the pressure of our favourite propaganda producing targets.
Meanwhile Lord Hunt quoted from today:
"I would like to correct a statement which I made to the House on 19 March about the medical training application system in answer to a question asked by my noble friend Lord Harris of Haringey. I said that doctors alone were involved in short-listing candidates for specialty training. It has since been brought to my attention that in some cases other staff, including senior non-medical clinicians or senior deanery human resources staff, are involved in the process. Guidance was issued to the deaneries, and it was they who decided on the composition of the short-listing panels. Since my Statement to the House on 19 March 2007, the independent review group has recommended that all applicants who were long-listed are to be invited to attend an interview for their preferred choice of training opportunity. This means that the short-listing process is far less significant than it was.
I offer my unreserved apologies to the House for the inaccuracy of my initial Statement."
Lord Hunt still hasn't apologised to the juniors affected by this mess. He also states that the short listing process is of far less significant than it was, this is slightly disingenuous as the lack of short listing is now of huge significance; how having no short listing at all and one interview per candidate can be seen as fair is beyond a joke. Lord Hunt has lied to the house and he should not be allowed to get away with this; but given this government's lack of intergrity he'll probably carry on regardless I'd imagine.
This leaked document has been brought to my attention. It is written by the postgraduate Dean of the West Midlands Deanery, this is the deanery where a group of surgical consultants withdrew from the interviewing process for ethical reasons concerning the complete failure of MTAS. The Dean is also a board member of PMETB, a board that is largely appointed by the secretary of state for health- one Patricia Hewitt.
One could be forgiven for thinking that the piece is written by someone with a multiple personality disorder given the self contradictory nature of most of it. Numerous MTAS system failures are recorded, including an amazing admission about lost data:
"Countless problems with data loss – we lost over 1300 applications on the day before the closing date and had many separate episodes of data loss – candidates also appeared on the screen unannounced during the short listing period! – As a consequence, the staff have no confidence in the system."
"Someone who was coached could gain lots of marks and be a poorer candidate who was honest and factual."
There are countless other tales of other shocking MTAS errors, I do not have time to list them all. The most remarkable thing about what is written by the Dean is his dogmatic belief that MMC and MTAS are the way forward.
"The workforce deanery fully supports Modernising Medical Careers and the philosophy behind the MTAS system and wishes to be part of the review process to get the system to work effectively for the good of our junior doctors, our staff, the service and our patients."
"MMC/PMETB together will raise standards and help produce the types of specialists and GPs that we need for the service and more efficiently."
The first of the two above statements is virtually comical in its logic. The Dean supports 'the philisophy' behind the system, whatever this is supposed to mean. My god, the man is even saying that he thinks the PMETB will help raise standards! He's either got a very dark sense of humour or he is a crony of the highest order.
Dr Crippen and front point systems have both taken Prof Field apart into several small bite size pieces. I particularly love the mocking of Prof Field's claims that foundation years and GP selection work so well; in fact he is cheaply trying to emphasise that they are better than MTAS, hardly an achievement I feel Prof. I have laid turds that are better than MTAS but you won't hear me boasting about them here.
In reality Professor Field knows what MMC and MTAS are really about. They are not about a fairer process for all, they are cynical politically motivated policies designed to introduce the 'sub consultant' grade by stealth and in so doing make it easier to privatise the NHS. I am sure he supports this philosophy, as it is the corrupt philosophy of the DoH and if he didn't support it, he would find himself rather rapidly out of a job.
His dogmatic refusal to admit that MTAS must be scrapped gives the game away, a game in which he is one of a number of Deans that are helping the DoH force through this devastating agenda. They care neither for doctors nor for patients, but they will always back the ideological philosophy pushed by their masters irrespective of the consequent human cost. Their nonsensical propaganda gives them away and they should not be trusted for a nanosecond; as their agenda is darker and that of their masters is even darker.
The government seems very keen to blame it's own failings on those who deliver frontline care in the NHS. Dr Crippen has already touched on Labour's massive failings with NHS dentistry, remember in 1999 when that honest chap Tony Blair promised everyone would have access to an NHS dentist within 2 years; well guess what, it's eight years down the track, and two million people are still waiting. Would Tony have lied about something? There must be another explanation.
This has been released today by the Citizen's Advice Bureau. It turns out that these fabled government 'reforms' have not resulted in any improvement in the percentage of people receiving treatment, while:
"77% of survey respondents said one reason they couldn’t find a suitable NHS dentist was that there were no local dentists accepting NHS patients,
37% said another reason was that there were long waiting lists for local NHS dentists25% of respondents said the nearest dentist was too far away or too expensive to travel to"
The reforms have led to a truly ridiculous situation whereby dentists are going on holiday for the rest of the year because there is simply no more money to pay them, however there is most definitely no lack of patients needing treatment.
The blame lies firmly at the door of Labour and the Department of Health; funny how this partnership seems to be to blame for so much these days. A frankly stupid program of reform has produced a system that just doesn't work. A bizarre system of payment is leaving the PCTs with massive cash shortfalls, and consequently there is no money to pay dentists to do NHS work. This results in dentists going on extended holidays while there are patients a plenty needing treatment; and around 95% of dentists are less confident in NHS dentistry after these reforms.
Meanwhile the minister in charge Rosie Winterton thinks everything is going swimmingly well, as do the DoH; no surprise there then. To quote the 'comical Winterton':
"The overall picture is that, despite the speculation, the number of dentists is growing and rather than leaving they are actually keen to expand their work for the NHS - hardly indicative of a failing system."
Get your head out of that sand pit Rosie, it seems a rather large majority of dentists and patients would disagree with you. It seems that there is a bit of a common theme here. We have government reform that is evidently failing and the blame is being laid at the door of dentists by the government for not 'planning' their work properly. The people in charge, namely the DoH and government, are ignoring the opinions of the dental profession and the patients; while they insist that it's the best year ever for NHS dentistry. Is there a recurring theme here perhaps?
(Check out the excellent front point for a better analysis than mine.)
Those dentists are just so greedy like those damn GPs, how dare they expect to actually get paid for working! It's all their fault, even though they were not consulted properly on government reform that forced a system of payment upon them that was about as likely to work as trying to drill through a pavement with your forehead. I really wish the GPs and dentists were as honest and altruistic as the politicians, then we might not be in the mess we are in today.
Tuesday, 27 March 2007
This 'analysis' report on honest statistics and their importance in driving improvement is spot on from BBC Radio 4.
"This government, when it came in in 1997, threw itself into targets in a far too hurried way, so it was actually setting itself targets using data that didn't exist. Now you know that is just fundamentally daft. "
"Yes, it is quite extraordinary. I mean the Statistics Commission did us a big favour when they put the effort in and ran through all of these targets and found quite a few examples where the government didn�t have any data. There was one on urban congestion that was set by the Department for Transport and the department simply said it is �developing better measures�. And also DEFRA had some targets for food and farming industries where it said that the data was not yet ready to �go live�. So here you have people hoping that something will reduce by 5% or 10% and they haven�t got a baseline point to start from."
"In this country, perhaps more than in any other, figures aren�t very popular anyhow. A lot of people are badly taught mathematics. They�re slightly doubtful about figures anyhow. It�s too easy to make jokes about statistics and all that is a sort of underlay of public opinion. But in addition to that, there is a feeling that there�s too much spin linked with government figures. Politicians have much too much prior knowledge of figures, what we call pre release. Now in most countries politicians get very little pre-knowledge of the figures coming up. Here, they have the figures a couple of days in advance and it must be very tempting, mustn�t it, for the minister to at least hint that there�s good news ahead or bad news ahead if it so suits him or her?"
"I think there�s a two-fold prize. I think there�s a prize in terms of how we feel about ourselves as a democracy; that it would feel as though we had open and fair and equal access to information, so that political decisions which ultimately are what determine policy decisions could be made fairly and justly. I think that would be a major prize, although I suppose not the one that is closest to my heart as a social scientist and an economist. The prize that I think would make the biggest difference is that if we had genuinely independent official statistics, then I think policy making would be better. I think there would be a greater awareness of the underlying state of the economy, the nature of people�s behaviour both as individuals and as companies, which I hope would make a big difference. We�d get specific improvements in policy and I think we�d also find that we were able to think about new areas and change that otherwise might simply be left to the academics and to the think tanks."
Sounds like sense to me. The potential for improvement in public services if neutral statistics were to be gathered by an independent body is enormous. This would replace the dishonest culture of propaganda and spin we currently have, that is driving the service into the ground.
Sunday, 25 March 2007
What a great surprise, New Labour are now dumbing down the ambulance service, it seems they will stop at nothing until they have replaced all their skilled NHS staff with undertrained incompetents. This blogger explains what is really going on. The way they have been 'snuck in' seems rather reminiscent of the introduction of PAs and NPs in certain roles that they are clearly not adequately trained for. It's all down to cutting the service in the name of cost. The worst thing about it is the way it is justified by those in power; they will be sure to list the 'competencies' of these less skilled workers to try and prove that they are just as good as who they are replacing. However you and I know that this competency based argument is fraudulent.
A cracking edition of the Britmeds by Dr Crippen this week. There really is enough to keep you so busy that you don't ever need to read the BBC ever again. This piece really had me fuming and this is Dr Rant at his very best. Look here at more of the same as the 'early years foundation curriculum' is explained. It's yet another example of our 'Stalinist' government trying to nanny us in a rather disturbing and over controlling manner. Targets for the under fives! It will induce untold anxiety in parents if their children don't meet these baseless milestones, and it is completely unacceptable to put the little ones under this kind of pressure. New Labour I proverbially spit on you.
The targets are a joke. They have instilled a dangerous and unhealthy culture in all the public services, as they prioritise the manufacture of political propaganda over quality service provision. It has resulted in managers being selected on their ability to say 'yes' to their superiors, meaning that managers who are actually good at their job are sacrificed in the name of political expediency and 'yes men'. This top down control freakery works based on a culture of fear and intimidation, which stifles open honest debate and hence progress is impossible. Instead of scrapping the targets, our dictators continue to think that introducing more targets will solve the problems that other targets have created. It is all done in the name of gathering data that is used for the cynical propaganda war, a war that can never be won in the long term; as the truth will always catch up with you, no matter how good one is at spinning propaganda.
Watch out New Labour, the truth will catch up with you eventually.
Saturday, 24 March 2007
Lord Hunt from the House of Lords transcript:
"Let me make it clear that applications were scored only by doctors. "
This is not ambiguous, this statement leaves room for only one interpretation of events.
This following email has come to my attention:
Copy of E-mail from West Midlands DEanery to Birmingham Medical School:
"As you may know, the old junior doctor grades have been replaced by a new career structure, whereby postgraduate medics complete two foundation years, before applying for specialist training. This is the first year for recruitment to the new specialist training grades, and the Deanery, which processes the applications for the West Midlands region, has experienced a much higher volume than anticipated, 11,000 in total. Each application must be reviewed by two people, one of which must be a clinician. The Deanery has been able to arrange for each application to be reviewed by a clinician. However 2,000 applications have yet to be reviewed by a second person. The Deanery is therefore seeking volunteers from its partner organisations to act as a second reviewer for the remaining applications, as the deadline for completion of this task is quite tight. The second reviewer does not need to be a clinician. Academic Related staff of grade 7 and above would be eligible to act as a "lay" second reviewer, provided they had some knowledge of the NHS. Volunteers would be required to spend a day (or half day minimum) between Friday the 16th and Wednesday the 21st of February at the Deanery, which is located very near the Medical School, at the top of Vincent Drive. Refreshments and lunch are provided, along with expenses for excess travel. The Medical School would like to be able to assist the Deanery, and hope that appropriate staff in the following groups/ departments will be able to
MSEU, including Medical Education Developers and the Ed Tech Team
Senior Management Team"
This contradicts Lord Hunt absolutely.
This is while a deeply flawed process continues to be rail roaded forwards, despite even the 'independent' review admitting these gaping flaws.
The latest fudges do not make the process fair. It is still unfair and it must be halted at once.
Thes hopes and dreams of thousands of junior doctors ride on this, and it is not just them that will be affected; their friends and families are suffering too, often in silence.
A large majority of RCS members want MTAS scrapped, and the vast majority of the medical profession agress with this, apart from a small bunch of politicised educationalists who are dictating to us from the top.
The majority must prevail and MTAS must die.
The latest on MTAS is nothing short of a disgrace. There is another fudge of the process and a letter from Alan Crockard.
The latest absurd modifications to MTAS insinuate that all applicants will get their first choice interview, however that is it. If candidates have already been interviewed for their first choice with a different interview structure then this is going to be unfairly compared to the new candidates who will have a different interview structure. Also candidates will have no more than one bite at the cherry, if they have had interviews for their 2nd/3rd/4th choice of job then it is suggested that these will be scrubbed.
This is truly absurd, as well as being unfair; it also turns the process into a gigantic game of poker where bluff and double bluff will come into play. Will top candidates choose to use their golden bullet in a ultra competitive UoA (unit of application), or will they exploit the competition ratios and apply to a less competitive UoA to increase their job chances? The truth is that no one knows the answer to these questions and this makes MTAS nothing more than a tombola.
This is no meritocratic system, as by having no short listing at all the best candidates hold no advantage over the worst candidates, as everyone is handed their their one golden bullet. They are in effect saying that we have one chance and one chance only at the career we want, after years and years of grinding towards this goal. The lack of any decent short listing is unacceptable and it means that all it comes down to is one thirty minute interview. The potential for many excellent candidates to be overlooked in favour of deficient candidates is enormous, as the process is no way near thorough enough to adequately discriminate between candidates.
Those behind this farce must resign at once. There is no other option but to scrap MTAS round 1 completely and revert to the old tried and tested system. Does anyone seriously believe that MTAS is its current modified form is fairer than the old system? If you do then you are either a member of the review panel or one of the elite group of junior doctors consulted on MMC.
Friday, 23 March 2007
Even the BBC are reporting that the BMA JDC chairman has now walked out of the MTAS 'independent' review group. A DoH spokeswoman said that they would push on with things. This is after the 'independent' review group press release this last night. The review panel's efforts are at best a fudge to try and make MTAS slightly less unfair. They have missed the clear logical point that either interviewing everyone for all their jobs or scrapping round 1 entirely are the only truly equitable and fair solutions to the MTAS shambles.
Do these morons ever stop pushing their lame policy that they present as 'reform'? I'm rather at a loss as to why government health policy is called 'reform' as I have seen precious little evidence of any improvement that the word 'reform' implies. Junior doctors are against the scheme, consultants have walked out of interviews, Hewitt has been caught with her pants down in parliament on the issue, leading academic professors have spoken out against the reform, 12,000 doctors have marched over government reform of training, over 80% of the Royal College of Surgeons want MTAS round 1 scrapped, the BMA have now walked out of the review; how much more does it take for the DoH to realise they are wrong?
What does it take these days for incompetents to be forced to resign? Do these stooges have no shame? Where are the apologies that should be being heard loud and clear?
These politically motivated cronies do not care for junior doctors, the medical profession or the electorate. They are the lowest of the low, motivated by selfish greed they demonstrate sheer contempt for the health of the nation. It is about the pursuit of power at any cost, something that doctors hold a rather special contempt for given their role of caring for patients. The sheer hypocrisy of citing 'patient safety' as the reason for these changes is astounding, especially when it is the poor patients who will suffer in the long run as a direct result of these hasty changes.
I would like to create a list of individuals who should be forced to resign over this utter shambles, feel free to add any other names as you see fit in the comments:
Professor Neil Douglas
Professor Liam Donaldson
Professor Alan Crockard
Professor Shelley Heard
Professor Martin Marshall
If any of you have time to read this, when you're not destroying this country's healthcare system, then I suggest you do the honourable thing and resign.
Thursday, 22 March 2007
From the health services journal:
"London chief defends Corrigan and Warner's appointments
NHS London's interim chief executive has defended her new top team against claims they include political appointments meant to push through New Labour reforms.
Ruth Carnall acknowledged that two appointments were always likely to be politicised, namely former health minister Lord Warner as chair of the new London Provider Development Agency, and Number 10 adviser Professor Paul Corrigan as the strategic health authority's director of commissioning and strategy.
But she told HSJ that London was 'lucky to have' the team, adding: 'I understand why [Professor Corrigan's appointment] seems controversial but for us it was an easy decision. He applied for the job and was the best person for it. We are lucky to have him.'
On Lord Warner's appointment, she commented: 'I think it is a shame for Norman that it has been politicised because he is fantastically able man and will be really great in this role.
'The notion that I have put in place a team with the aim of privatising the NHS in London is nonsense.'
Her comments came after shadow health secretary Andrew Lansley wrote to senior officials at the Department of Health and to NHS London expressing his concerns.
Mr Lansley alleges Lord Warner's appointment breaches the ministerial code of conduct and has written to permanent secretary Hugh Taylor to demand answers to a series of questions about the appointments process, its timing and whether permission has been sought.
He argues that Professor Corrigan's appointment, which comes on the eve of a major shake-up of London health services, is 'deeply unwise' and should be abandoned.
He said: 'These appointments of people who have been at the most senior level pushing the proposals for the reconfiguration of hospitals are unacceptable. They undermine the credibility and independence of the NHS in London for reaching its own view about what is in the best interests of patients in the capital.'
HSJ understands that Mr Lansley has not received a response to either letter.
Unison also has concerns about the appointments. London head of health Chris Remington said: 'I think they will use London as a test bed. We will see the wholesale shifting of staff into the private sector.'
However, Ms Carnall said there was no impropriety in Lord Warner's appointment. She described the allegation that Lord Warner has set up the Provider Development Agency as 'completely untrue'.
Chief executives in London backed up Ms Carnall, saying she had put in place a strong team that would take a lead in developing the capital's NHS.
One said: '[Lord Warner's] appointment is an absolutely brilliant idea. They have created a semi-detached organisation that now has someone with the weight to give it seriousness.'
Another described Professor Corrigan's appointment as 'fresh and exciting', although one chief executive added: 'I have suspended my disbelief. It may just work although it's hard to imagine.'
The new team in London
- Ruth Carnall is interim chief executive. She has been open about the fact that she wants the job long term. She has wide support across London, especially from PCT chief executives.
- Professor Paul Corrigan, Tony Blair's special adviser on health and widely regarded as an architect of the current market reforms. He will start work director of strategy and commissioning in the summer.
- Lord Warner, former health minister, now chair of London's Provider Development Agency where he will steer trusts towards foundation status. He starts this month.
- Malcolm Stamp, PDA chief executive. Was one of the first foundation chief executives and will return from New Zealand where his is currently chief executive of Waikato district health board, Hamilton.
- Paul Baumann, a finance director from Unilever, as director of performance and finance. One source described Unilever as 'just like an SHA with mad, uncontrolled subsidiaries.'
- Antony Sumara, turnaround director, known for his work in troubled trusts."
A nameless cleaner was scrubbing away on a nameless NHS ward, his back ached and his knees were sore but he immersed himself in the daily grind. He had come to England from a land far away where he once worked as a top researcher in genetics. Political circumstance had unfortunately forced him and his young family to leave their homeland, and to flee to our shores. Life had not been easy for them, in fact they had barely stood still since arriving but at least now things had become a little more settled; he had a regular job, even if he was a little overqualified for cleaning. He still tried to make the best of it and by thinking of what he did have, he avoided falling into a cycle of self-pity. The work was mind numbingly boring and he was not used to the physical toil, but despite this he gained a certain satisfaction from doing things well and to the best of his ability.
His ears pricked up as he heard one of the staff nurses on the ward chatting to one of her friends:
'I can't believe how much these doctors get paid, Kylie, look at this here....', pointing at the front page of the Daily Mail, 'they're earning more than me and you put together, it's disgusting!'
He stayed in his crouched position behind the desk, they obviously hadn't noticed him going about his daily business and they carried on; Kylie replied:
'We work as many hours and we work just as hard as the doctors, and the patients are more grateful for what we do a lot of the time. We're just not valued at all, it's a national disgrace it is!'
The cleaner's head slowly rose into the view of the nurses and they immediately became rather silent, the quiet was broken by the rather softly spoken cleaner who posed a question to the nurses:
'I couldn't help but overhear your conversation there, I don't mean to be rude in saying this...... but why do I not get paid as much as the doctors? I work just as hard, I work similar hours and the patients certainly value my job.'
He looked at them for a moment, waiting for their reply, a few seconds passed before one of them quipped back in a rather mocking manner:
'Well, you're only a cleaner aren't you!'
They both looked at him in a rather condescending manner, as if they expected him to get back to work and accept his place. It was therefore somewhat of a surprise to them when the cleaner stood tall, and asserted himself with some rather firm but softly spoken words:
'I am just a cleaner, that is indeed true. But surely the doctors could point to the fact that you are both 'just nurses'.'
The nurses briefly glanced at each other, and they noticed that they had both turned a rather delicate shade of beetroot. The cleaner paused to observe this reaction and then got back to the job in hand, feeling a little warmer inside that he had before.
Wednesday, 21 March 2007
Also for anyone who is amongst the thousands of junior docs shafted by the MTAS machine, then read this and get e-mailing straight away! It may help you save your career.
The BBC has been ignoring important issues and peddling drug company propaganda as news again today. Amazing how they conveniently gave minimal coverage to 12,000 doctors marching at the weekend, yet today they are happy to dedicate plenty of column inches to this story:
This 'evidence' consists of a survey carried out by a patients group but funded by Napp, a large pharmaceutical company. The initial BBC article didn't mention Napp's involvement, however after complaints they have amended the original piece:
" Thank you for your email. The research was supported by a grant from Napp, but it was carried out by the Picker Institute and the Patients Association - both respectable and reliable organisations. We have added that Napp supported the research. However, we feel the findings of the research do stand because of the involvement of the other organisations. In addition, the only mention of patches is by the man whose sister died. He had no involvement in the study so has no contact with Napp.
We hope this addresses your concerns
BBC News website"
The small changes to the article are not really satisfactory in my opinion. This is because there is no mention of the glaring conflict of interest involving Napp, who produce opiate patches that they obviously want to increase the demand for. They also do not mention the rather obvious flaws in this partisan survey. The elderly patients selected for interview were not selected at random at all, meaning the survey is not representative of typical nursing home patients. It appears very likely that the survey selected those elderly patients who would say exactly what Napp wanted to hear, ie they selected an unrepresentative group of the elderly who did have chronic pain issues and then asked them leading questions to get the exact answer they wanted. The 'survey' was nothing more than an exercise in gathering propaganda for Napp. It is embarassing that the BBC falls hook, line and sinker for this kind of tactic.
The BBC needs to take a long hard look at the way it covers issues like this, as it is most definitely not the first time they have been used as a vehicle for spreading other agencies' propaganda. The lack of scientific rigour and critique applied by their journalists is deeply worrying.
Tuesday, 20 March 2007
Some information has been extracted from the DoH on the topic of nurse and pharmacist prescribing via the freedom of information act. Here are the facts of what actually happened:
"The Commission on Human Medicines (CHM) and its predecessor, the Committee on Safety of Medicines (CSM), is the independent body responsible for advising Ministers on matters relating to medicines and patient safety. The Commission is chaired by Professor Sir Gordon Duff and members include several other eminent professors of medicine from the UK.
Essentially the CSM typically makes decisions and recommendations on specific prescribing issues such as 'The Committee considered and advised on a medicine to be used in the treatment of diabetes'. It seems very strange indeed that this issue as big as 'non medical prescribing' was left to this small body of pharmacological experts. They are not used to making decisions of this nature, they are not set up for making this kind of decision and they do not seem to be the best qualified to make this decision.
Interestingly there was no vote at all. Here is the the link to the meeting details, followed by the meeting summary:
"The Chairman thanked DH colleagues for their views and clarifications, restating that the Committee would support options D (for nurses) and 5 (for pharmacists) within the context of the concerns they had raised. In thanking the CSM on behalf of herself and the Chief Pharmacist, the Chief Nursing Officer said that while the original limitations on the NPEF were understandable, subsequent expansions had made it complex. Safe practice included making legislation and procedures easy to understand and therefore easy for individuals to act correctly. Adopting the options recommended by the Committee in partnership with clinical governance structures would provide a strong accountability framework which would underpin improvements in patient care and make the best use of professional skills."
"As indicated above, the former Committee on Safety of Medicines (CSM) made recommendations to Ministers, taking account of all responses to the consultations and the advice of the sub-group. The CSM does not conduct its business by vote.": to quote the DoH again; it appears that this massive decision was made on the basis of an undemocratic committee process, which was then pushed through by ministers.
This must be seen in the context of the consultation process. In fact all but one of the medical bodies consulted for nurse prescribing were against the CSM's proposals, while all the medical bodies consulted were against the CSM's decision for pharmacist prescribing. Thus the small committee of the CSM has effectively been made the judge, jury and executioner in this process.
Unsurprisingly the DoH website does contain the responses to the consultation process on non medical prescribing! This is ridiculous, how can the process be seen to be transparent? Pulse had to obtain the information that all medical bodies were against the moves by the Freedom of Information Act, this information should have been available with the need to use FOI act. The DoH's selective release of information makes this process look very corrupt and suspicious indeed.
The evidence behind non medical prescribing is weak to say the least:
This 'evidence' consists of a survey of 246 nurse prescribers and ten case study sessions, and....that's it I'm afraid, this is the sum total of DoH backing for their reform. Is their a recurrent theme here?
'The most common conditions prescribed for were skin conditions, family
planning and soft tissue injuries.' and 'Experts made a small number of comments about
possible limitations in nurses’ history taking, assessment and diagnostic skills.' and 'Doctors were positive about the development of nurse prescribers in their teams, although were not able to unequivocally conclude that it had reduced their workload.'
Thus overall this small piece of work showed that nurses could safely prescribe for minor ailments, albeit more slowly than doctors and in a way that didn't provide any real benefit for the patient and healthcare system. This is while some experts were concerned about their clinical skills, a matter that was largely ignored in the conclusions. How on earth this 'evidence' can be then used to allow nurses and pharmacists to prescribe anything under the sun is beyond me. There is a rather glaring gap between the propaganda and the reality of the situation.
It seems the danger began in 1999 thanks to a review by June Crown, mysteriously the panel was made up of a rather large number of nursing managers, pharmacists and the Southampton cohort who produced the earlier quoted 'evidence'. There are no conflicts of interest here of course. The main motives for extending prescribing were:
'• make it easier and more convenient for patients to obtain the medicines they need;
• improve the service to patients, without compromising safety;
• increase patient choice in accessing services; and
• make better use of the skills of NHS professionals. '
It appears to me that the DoH can come up with precisely zero evidence that the service has been improved by extending prescribing rights, and this is surely the most important aim. They can also come up with no evidence that extending prescribing is safe. Their 'evidence' of safety only applies to minor health problems and is a very weak piece of evidence indeed; the sample size is small, there are numerous other flaws in the study design and it has not been peer-reviewed or published. Given that experts had concerns about nurses' clinical skills related to relatively minor medical conditions, then it is obvious that these concerns would be amplified when applied to more serious medical conditions. The potential for compromising patient safety is enormous. Logically the more the less trained are handed more responsibility, the more damage to patient care will result; this piece of logic has not been picked up by the DoH radar.
This is yet another in a long line of examples of DoH policy that is based on zero decent evidence. It is bad enough that this reform is incredibly expensive to research, create and implement; but add to this the fact the the reform is likely be less cost effective in the long term than previous arrangements. The propaganda network established between government reformers, the DoH and a small group of the compliant professionals seems to be the key to the process forcing ideological policy through against the public interest. If this corrupt ideological pursuit is not stopped, then in the future the consequences for patients could be quite disastrous.