Saturday, 20 October 2007

The ferret's guide to Tooke: Part 5

"Recommendation 21
A suitably qualified Director level lead for medical education within DH should be identified and act as the reference point for interactions with the medical profession including postgraduate Deans. The relationship and accountability of this lead to the following should be explicit: CMO, DH Head of Workforce, NHS Medical Director, and medical educational leads within devolved administrations."

This is unadulterated simplicity, will this arrangement make much of a difference?

"Recommendation 22
Recognising i) the importance of linking workforce supply and demand, ii) the very recent devolution of workforce commissioning function to SHAs in England, we recommend that this situation prevails for the moment for initial Postgraduate Medical Training subject to the forging of closer links at all levels with the Higher Education sector. A formal review of the compliance with Service Level Agreements between DH and the SHAs relating to commissioning training and the functionality of the arrangements should be undertaken in 2008/9. Any deficiencies should prompt urgent consideration of a National Institute for Health Education (as outlined in
Recommendation 12) assuming the commissioning function.

Recommendation 23
Funding flows for postgraduate medical education and training should accurately reflect training requirements and the contributions of service and academia. The current MPET Review should lead to a clearer contractual basis reflecting both agreed volumes and standards of activity and should recognise the service contribution of trainees and the resources required for training."

I have to admit that this doesn't make much sense to me, I am lost in jargon.

"Recommendation 24
The Medical Postgraduate Deanery function in England should be formally reviewed to address whether i) the relationships and accountabilities are currently optimal ii) the present arrangements meet redefined policy objectives of optimal flexibility in postgraduate training and aspiration to excellence, and the NHS imperative of equity of access. Any new arrangements should conform to redefined principles, referred to in Recommendation 1, co-developed to govern postgraduate training.

Recommendation 25
Postgraduate Medical Deans should have strong accountability links to medical schools as well as SHAs in line with Follett appraisal guidelines for clinicians with major academic responsibilities. Such arrangements will improve links with medical pedagogical expertise and will facilitate the
educational continuum from student to continuing professional development.

Recommendation 26
Reflecting the fact that Postgraduate Medical Education and Training involves service, academic and workforce dimensions, it is proposed that the Foundation School concept be developed further as Graduate Schools, on a trial basis initially, where supported locally. The characteristics of such Schools, the precise nature of which would depend upon local circumstances and relationships, need to reflect the crucial interface function played by the medical Postgraduate Deanery between the service, the profession, academia and workforce planning/commissioning. Graduate Schools would involve Postgraduate Deans, Medical Schools, Clinical Tutors, Royal College and Specialist Society representatives and would have strong links to employers/service and SHAs. The Graduate Schools could also oversee the integrated career development of the trainee clinical academic/manager (see Recommendation 41), as well as NIHR faculty."

These recommendations appear to be sensible, in that they address the structure of post-graduate medical training for the good, I must admit that I feel a little out of my depth in this particular area, it is a tiny bit small print.

"Recommendation 27
To incentivise Trusts to give education and training sufficient priority they should be integrated into the Healthcare Commission’s performance reporting regime.

Recommendation 28
Responsibility for the local delivery of postgraduate medical education and training should form part of the explicit remit of Medical Directors of Trusts. Part of that responsibility should include regular reporting to Trust Boards on the issue.

Recommendation 29
Training implications relating to revisions in postgraduate medical education and training need to be reflected in appropriate staff development as well as job plans and related resources. Compliance with these requirements should form part of the Core Standards."

The logic behind these ideas is also sound, training should be a much higher priority for Trusts than it currently is; at the moment training is the first to suffer when money is scarce, short termism from Trust management like this must be prevented in the future. I can't help but think that it will take a lot more than Tooke's well intentioned recommendations in this area to have the effect that Tooke wants. The medical unions and doctors as individuals must remain militant in order to force these sensible ideas and principles into practice. As if people become complacent, then these recommendations will be looked back on as yet another load of hot air that achieved very little in practice, like 'Clinical Governance'; who could argue with the ideas, but in practice it is just a pretence at functionality. It takes actions to improve a system, not just words.

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