The ferret's guide to Tooke : Part 2

"Recommendation 5
There needs to be a common shared understanding of the roles of the doctor in the contemporary healthcare team. Such clarity must extend to the service contribution of the doctor in training, the certificated specialist the GP and the consultant. Such issues need to be urgently considered by key stakeholders and public consensus reached before the end of 2008. Education and training need to support the development of the redefined roles."

This seems a good suggestion, the role of a doctor has been eroded over recent years by the advancement of certain less thoroughly trained quacktitioners, it is therefore important that the role of the doctor is properly defined. However I am no fan of the artificial line that some see dividing service and training, so defining the service role of trainees with clarity may not be such a good thing. I think the roles that trainees have should support training and not the other way around, as Tooke phrases it. I see a little room for some cynical government manoeuvring here.

"Recommendation 6 DH should strengthen policy development, implementation, and governance for medical education, training, and workforce issues, embracing strong project management principles and addressing specifically a) clearer roles and responsibilities for a single Senior Responsible Officer, b) clear roles and accountability for senior DH members, c) better documentation of key decisions on policy objectives and key policy choices, d) faster escalation and resolution of ‘red risks’."

Again I cannot argue with this recommendation, the DoH's incompetence and unaccountability must be addressed; but given the DoH's record on staying with the rules, it is easy to say but probably much harder to put into practice. Surely those at the DoH who played a big role in the MTAS scandal should be held accountable now? This would set a precedent that would deter future DoH miscreants.

"Recommendation 7 The introduction of necessary changes stemming from this report should i) involve all relevant stakeholders especially professional representatives, ii) abide by best principles of project and change management include trialling where appropriate and feasible, iii) be subject to rigorous monitoring and evaluation."

Again good banter, but who does the monitoring and evaluation?

"Recommendation 8 Recognising the interdependency of education, clinical service and research DH should strengthen its links not only within the Department and with NHS providers but also with other Government Departments, particularly the Department for Innovation, Universities and Skills and the Department of Business, Enterprise and Regulatory Reform. Ministers should receive annual progress reports on the development and functioning of such links."

I am sceptical that this ever proliferating band of government departments could actually organise themselves to do anything useful as individual departments, let alone in combination with each other. Are there not too many departments such as these which spend a lot of money not really doing much of any use?

"Recommendation 9 At a local level Trusts, Universities and the SHA should forge functional links to optimise the health:education sector partnership. As key budget holders SHA Chief Executives should have the creation of collaborative links between local Health and Education providers as one of their key annual appraisal targets."

Again, a good idea, but will it happen?

"Recommendation 10 All four Departments of Health in the UK and the four Chief Medical Officers must be involved in any moves to change medical career structures. In many instances it seems likely that the Department of Health in England will continue to have a lead role but from time to time, collective agreement may determine that lead responsibility for specific issues passes to another Health Department and/or its Chief Medical Officer. Regardless of which Department leads, accountability should be explicit and every effort made to acknowledge the views of the four countries."

The problem here is that the Medical Officers do not appear to be guided by the majority opinion of the medical profession, so involving them may not help matters unless the way in which the Medical Officers are selected is changed. An improvement that would guard against cynical government reform, would be to involve the medical unions or the medical profession when selecting representatives such as the Medical Officers. I, for one, have no faith in Liam Donaldson's ability to represent our profession's interests; it appears that he is keener on personal advancement than doing a good honest job.