A shot across the bow

Following on from the DoH's refusal to disclose vital information that would reveal the real motives behind MMC and the sub consultant grade, a letter has been written to the Chief Medical Officer:

"Dear Sir Liam Donaldson,

I am writing as regards FOI request 'Our ref: 2800R' which has been refused following an internal review at the Department of Health.

The Freedom of Information request is about MMC and the sub consultant grade. The DoH has admitted that 'I can confirm that the Department does also hold correspondence in relation to consultations between Government Ministers and interested parties, including expert advice in the development of policy in this area.', however following the internal review this correspondence has been withheld. The reasons given by the internal review are:

"Reasons against disclosure:

Section 35 covers information relating to the formulation or development of government policy. This include officials being able to provide frank advice to Ministers in an environment that is as free as possible from public controversy on issues about which opinions may be strongly held.
The advice should allow Ministers and officials to conduct rigorous and candid assessments of the Department’s policies and programmes, in this case, the issue of a "sub-consultant" grade being introduced. Disclosure might close off such discussion and prevent the development of better options;"

http://www.dh.gov.uk/en/Publicationsandstatistics/Publications/PublicationsPolicyAndGuidance/DH_4010460
(Modernising medical careers: the response of the four UK Health Ministers to the consultation on "Unfinished business - proposals for reform of the senior house officer grade")
http://www.dh.gov.uk/en/Consultations/Responsestoconsultations/DH_4071823
(Unfinished business proposals for reform of the senior house officer grade: Consultation outcome)

I quote from the unfinished business consultation outcome:

"Many of these criticised the inclusion of these proposals in a report on SHO training as disingenuous and suspected secret agendas and underhand attempts to introduce important change without proper consultation. Others accepted it was not possible to reform the SHO grade in isolation and that a “whole-systems” approach was correct."

Openness is also regarded as a key pillar of Clinical Governance.

http://www.cabinetoffice.gov.uk/regulation/consultation/code/criteria.asp

"Code of Practice on Consultation
2. Be clear about what your proposals are, who may be affected, what questions are being asked and the timescale for responses.

As far as possible, consultation should be completely open, with no options ruled out. However, if there are things that cannot be changed because, for example, they are part of a European Directive or due to prior Ministerial commitments, then make this clear. The risks and consequences of doing nothing should be outlined."

This is taken from the Cabinet office guidelines as regards consultations. The motives behind MMC, SHO grade reform and the sub consultant grade are inextricably linked in my opinion.

For a consultation process to be deemed proper and fair, it is stated that the 'consultation should be completely open'; this appears not to have been the case with 'Unfinished Business', MMC and the sub consultant grade. I say this because it appears that the DoH is not releasing the aforementioned correspondence that may potentially reveal the real motives behind these reforms. Until this correspondence is released into the public domain, then I believe it is hard to say that an 'open and transparent' consultation has definitely occurred.

"Disclosure might close off such discussion and prevent the development of better options"

This is the reason used by the DoH to justify withholding this vital correspondence. I think that the opposite is more likely to be true, as by withholding this information the DoH is arguably closing off the discussion and therefore potentially preventing the development of better options. The current problems with the implementation of MTAS and MMC are arguably down to a lack of an 'open and transparent' consultation process.

I believe that the withholding of this potentially vital information is not the best way of encouraging a culture of healthy and open debate by which our public services could be more effectively improved. I would therefore like to ask you the following questions:

1. Are you aware of what is contained in the withheld correspondence?

2. Given that this potentially vital correspondence concerning the reform of medical training is not being released by the DoH, can the consultation processes for 'Unfinished Business' and MMC be deemed to be 'open and transparent', and consequently valid?

3. Do you think that the aforementioned potential inadequacies of the consultation processes for medical training reform should result in an immediate delay in the implementation of MTAS, MMC and 'the sub consultant grade'?

4. Do you not think that the withheld correspondence should be released into the public domain, in order to encourage a more open and honest discussion that would reveal better future options for medical training reform and consequently patient care and safety in the future?

5. Recent problems with the implementation of MTAS and MMC are arguably down to the lack of an 'open and transparent' consultation process. Surely encouraging an 'open and transparent' culture is the best way of driving future improvement in our public services?

6. Given the importance of the OWAM (an Organisation With A Memory) report and consequently organisational learning; do you not want to now know, better understand and share the learning from this unfortunate episode to avoid similar errors repeating either at home or abroad?

I would greatly appreciate your opinion on this matter,

yours sincerely"

Given recent revelations from within the MMC team, it seems that there is a great deal of pressure building up and even the CMO's position may be under threat. I do hope he is still in a job by next week so that he can asnwer this lovely letter.