Tuesday, 24 April 2007

The parliamentary debate on MMC

The issue of Modernising Medical Careers was debated in the House of Commons today. In summary the opposition gave the government an absolute roasting on the rank incompetence that had been exhibited with their management of medical training. Patricia Hewitt and Labour offered the same old lame defences, and amazingly tried to claim credit for trying to remedy the 'teething problems'. Incredibly Patricia Hewitt left the house shortly after speaking, demonstrating her utter contempt for the junior doctors that she has royally shafted with her reforms. The human and economic cost were very well emphasised by the opposition, and by Nadine Dorries MP in particular. Importantly it was revealed that John Tooke's review group members have not been revealed by the government. The cutting of medical training budgets by 136 million pounds was also mentioned, the government had promised the opposite. Hewitt did return to the house eventually so that she could further insult junior doctors with a typical show of insensitive brazened arrogance in the background.

The Channel 4 news covered proceedings very well, well done to Dr Nicholl for remaining so calm under the pressure and performing so well.

I have summarised what went on in the debate today in my typically long winded manner:

Andrew Lansley (Conservative shadow health secretary MP) started by outlining his aims, which included outlining a way ahead as regards medical training and trying to find a workable solution that is acceptable to the medical profession.

The lunacy of the MTAS process were well exposed, as was the inadequacies of MMC as regards its undervaluing of clinical experience. He exposed various examples of the government ignoring warnings on the issues of MTAS, these warnings have since turned out to be true. An excellent point was made that a demoralised sub consultant led service would hardly be progress. It was also cleverly pointed out that one of the aims of MMC was to provide an extended choice and more flexibility for juniors, this has demonstrably failed with MTAS and MMC.

Several speakers reinforced the point that it is a negligent waste of tax payer's money to lose so many talented highly trained juniors. The mocking of the idea of using VSOs from this leaked DoH document was well done. Lansley went on to say that the application process had become 'arbitrary' in trying to be objective and that a lot of the best doctors may well be emigrating. The lack of continued expansion of consultant numbers that had been promised by Labour was also exposed. Hewitt's calling the unemployment issue 'absurd' was rammed down her throat vigorously, Lansley pointed out that this went against even her own department's views.

Lansley then went on to present one interviewing consultant's views of the interviewing process which described it as 'the antithesis of a fair process'. Hilariously one speaker then asked the Prime Minister if he would appoint the cabinet using a similar technique to MTAS, this was greeted with guffaws of laughter from the house. Hewitt was also mocked again and she responded with one of her condescending sneers.

Andrew Lansley used the information obtained by the ferret fancier's FOI request on the review group to expose the lack of independence present. He also commented on John Tooke's review, and made it very clear that the members of this review group must be announced. He also validly made the point that John Tooke's review would only come to a head in September, one month after jobs had been dished out.

Lansley next pointed out the unfairness of restricting candidates to only one interview, the difference between different countries and the overwhelming consultant opinion against the MTAS process. It was also mentioned that it was simply not fair to protect Foundation year trainees, while simply dumping senior house officers on the scrap heap. The idea of converting non training posts into training posts was mentioned, Lansley said this was possible but that currently Labour were raiding the training budgets due to their financial mismanagement of the NHS.
A very amusing point was made by an MP who suggested that we ban non-UK EU grads from applying for this year, as it would take the EU so long to reply that it could be got away with! It was emphatically stated that the government had not expressed their regret for the complete shambles of MTAS.

Hewitt then took the stand.

She limply trumpeted the triumphs of the independent review group.

She tried to pretend that the old system was worse than the current one, this hardly condones her departments horrendous mismanagement of the new process.

The same old lame defence that all the royal colleges and 'representatives' of junior doctors were involved was used by Hewitt. Hewitt was accused of using a 'straw man' in trying to divert attention away from the real issues. The Foundation program was trumpeted as a great success by Hewitt, no mention of the lack of decent training in so many posts unsurprisingly.

Hewitt then denied that it had been an 'unmitigated disaster'! She pretended that the GP process was a remarkable success, and amazingly she then wanted credit for dealing with the problems! Unbelievable. Yet again she ignored the real issues and rambled on about the great progress of the review group, the record just never changes.

She was asked explicitly if she had been informed of any potential problem as regards the unemployment of juniors, this was ignored. There was another question that asked her what she would do to guarantee to that the government would live up to its promise of jobs for all juniors, again this question was not answered. She instead said that more doctors would be needed but did not mention how this was going to be done.

She then came out with yet more meaningless waffle about support for juniors and work that was being done to remedy the problem. She couldn't resist mentioning her poodle Neil Douglas and his review group again.

The dangers of the August switch to patients, when all juniors will be moving posts and therefore be attending induction, was side stepped in typical Hewitt fashion in that she didn't answer the question at all! She even said it 'was nothing new' for all juniors to be changing jobs at the same time; actually it is the first time it has happened on this scale and Hewitt has been caught out yet again. She even claimed that "every trust grade will continue their job on August 1st", so the changeover will not be a problem; this is yet another lie.

She then mentioned that the NHS 'has far too many cardiothoracic surgeons' as a result of changes in practice. I think several recent publications as regards the benefits of CABG over less invasive procedures may even change this considerably. Hewitt then tried to defend the VSO matter and she lambasted the media for being irresponsible on this matter. She also claimed that there would be a round 2, this runs contrary to several leaked documents that make in pretty clear that there will be no time for this to happen before the August deadline.

Amazingly she carried on claiming that there would not be unemployed junior doctors come August, the gap of over 10,000 between jobs and applications didn't seem to enter her thinking. She again mentioned that she had announced the terms of reference of John Tooke's review group, importantly there is no mention of who will make up this review group, a rather key mission. Hewitt's main point was then that it was all 'best for patients' and that she should get some credit for doing so much good in dealing with the problems with the system.

Norman Lamb (Liberal Democrat shadow health secretary) MP then took over making some excellent points including that MMC was a 'straight jacket' and that it shortened training. He also stated that there were grave concerns over the 'unpiloted' MTAS process, he asked how could such a system be introduced without piloting. He also wanted to know who precisely was responsible for this mess? 'How on earth was this introduced without proper piloting?'

The same MP also pointed out that the BMA and the royal colleges had been ignored when warning of potential problems with the system. It was revealed that an MP who wrote to Lord Warner had his letter expressing concern ignored, no one has been disciplined for this error. Another MP interjected that the old system was 'total chaos', I don't think many people would agree with this opinion.

It was pointed out that Prof Crockard and Heard had both resigned citing 'a lack of leadership from the top' and 'MMC losing the goodwill of colleagues'. He then challenged the government to release all the discussions that have taken place as regards MTAS and MMC, so that these mistakes can be learnt from.

He then claimed that Patricia Hewitt had stated that all the interviews could be completed in a four week period in May 'with considerable effort', the massive logistical problems with this were pointed out, as well as the devastating impact these interviews would have on waiting lists and patient care. Apparently the NHS will be running on bank holiday staffing levels for the August change over, despite this being a very busy holiday period.

He then challenged the government to confirm exactly how many juniors would be unemployed come the summer, he tried to nail Hewitt down about her previous comments that have arrogantly dismissed all claims about junior doctor unemployment. The scale of incompetence was 'quite remarkable' in his opinion, he also said that he hoped Remedy succeeded with their legal challenge. Another MP asked how big a disaster must occur before someone resigns? Just who is responsible for this mess? Evan Harris MP mentioned that dead end jobs are not the answer to the crisis.

Two points of order were made because Patricia Hewitt left the chamber before she had listened to the speakers that followed her! Absolutely disgraceful, her hypocrisy was pointed out in that she had been previously on record stating that people should stay to listen to comments after they themselves had finished speaking.

Next John Mann MP waffled on about the great progress of the NHS under Labour, he just went on and on and on about irrelevant issues that were nothing to do with MMC. Mann was asked why he was not commenting on the real issues. The Labour MPs attempts to divert attention away from the real issues was truly pathetic, they were visibly squirming under the pressure, cynical divertionary tactics of the lowest order.

The odious John Mann eventually stopped his spouting of sewage. An opposition MP reiterated the rank incompetence of the government as regards MTAS and he wanted the government to ensure that juniors would not be forced out of training.

The debate then somewhat fizzled out with a bit of a whimper, the same points were made again and again. Although it was again mentioned by David Kidney MP that all juniors would have a job, I'm sure they will be held to account over this. Although not as inadequate as Hewitt or as offensive as Mann, Kidney was pretty limp and rehashed a few of the same old flawed defences of MTAS/MMC; to be fair he did mention that he intended to pursue what would happen to those doctors who ended up in dead end jobs and that the workforce planning needed to be improved.

Nadine Dorries MP then reinstated a bit more tempo to proceedings, a lot of respect must go to her for really getting across the terrible predicament that juniors find themselves in. She really got across the human element of things, she mentioned that juniors had been breaking down in tears on a regular basis at work. She finished by asking the absent Hewitt 'what is going to happen to the unemployed junior doctors?'

A few more opposition MPs repeated earlier points about the arrogance of the government, the disaster of poor workforce planning, the shambolic nature of MTAS et cetera. Near the end one MP Richard Taylor brilliantly summarised some opinions of senior consultants involved in medical training as regards the MTAS process. The consultants' opinions brilliantly summarised just how bad MTAS has been, interestingly the consultants mentioned that they were ignored when they expressed their concerns to the establishment. Some consultants had expressed to him that MTAS must be completely completely scrapped. He also mentioned that even Malaysians were appalled at the way medical training was going in the UK, and that they would not encourage their trainees to come to the UK for experience in the future; a sad indictment on this government's achievements. Justine Greening MP also did some good work in criticising the role of the government in presiding over the farcical MTAS. The secretary of state for health will certainly have her work cut out trying to come up with some more lies to answer these questions.

Andrew Murrison MP repeated the fact that no one had 'taken the rap' for what has been described as the biggest ever crisis in medical training in the UK. He beautifully described NHS employers as a 'metastasis' of the NHS confederation. It was emphasised that the 'second to one' training was thanks to the Royal Colleges, who have now been sidelined by the useless quango PMETB. The issue of cost of the whole mess was repeated. He was absolutely scathing with his criticism of the dead end nature of the government's grim vision.

Andy Burnham MP was next up, although it was hard to concentrate on his words when Hewitt could be seen in the corner of the screen nodding away in her typically annoying manner. He claimed that the reforms had been conducted openly and not 'behind closed doors', strange how certain FOI requests regarding MMC are being denied. A lot of laughter greeted Burnham's lame defence of MTAS as he tried to claim that it was progress that all the problems were now out in the open! He then claimed that MTAS had been piloted and that the consultation had been adequate. He talked next on the issue of recruitment and failed to make any decent points. His final points on the so called 'double cohort' and his conclusion merely cemented his role as a mincing weener.

Hewitt's overt arrogance in the background simply could not be missed, joking around and chatting casually while serious points were being made.

They then voted.

Labour won by a majority of 71. Another triumph for democracy.

Anyone who voted against this motion should be deeply ashamed of themselves. It must be noted that a lot of MPs seemingly appeared out of nowhere to vote, when they clearly had not been present for the debate.