Thursday, 25 October 2007

Tooke - a remedy?

There is undoubtedly much of sense in John Tooke's report. The talk is certainly attractive, however one must always remain sceptical when analysing matters of a political nature, and this is especially the case when the talk turns to unquestionable principles, I must admit that alarm bells do start ringing. Tooke is undeniably spot on when he criticises the powers that be for their negligent role in the implementation of MTAS and MMC, the Department of Health deserves this scorn. His recommendations for improvement in this area do not convince me, I have lost my faith completely in the government and the only thing that would convince me would be for the government to be stripped of its control of medical training.

I welcome several other ideas including pushing for an increasing emphasis of the importance of medical training in the NHS' burgeoning management structures. However practically on the ground we have seen how training is rarely respected by cash strapped trusts, as money is clawed back in rather unethical ways from doctors who are then forced to pay for their own training. The following idea is good, but 'should' is very different to the reality of the BMA:

"Recommendation 18
The medical profession should have an organisation / mechanism that enables coherent advice to be offered on matters affecting the entire profession, including postgraduate medical education and training."

The suggestion to assimilate the useless PMETB with the GMC could do no harm, at best PMETB would no longer be able to inflict its incompetence upon us. When talking of FY1 and FY2 I think he loses the plot, despite the fact that his proposals are an improvement, I would favour a return to a PRHO year of six months of both medicine and surgery that is strictly regulated so as to ensure first year doctors become solid at the bread and butter. There is also far too much talk of 'competency assessment', as if the validity of this new educationalist ideology cannot even be questioned and this fills me with fear. I am also slightly fearful at his talk of standardised national forms, specialty specific questions and standardised assessment scores.

I am most concerned about the lack of consequences for those individuals who played such key roles in negligent implementation MMC and MTAS, will the likes of Liam Donaldson be held accountable for their actions or lack of them? Most worryingly John Tooke's suggestions will have to be listened to and acted upon by the very same incompetents who got things so very badly wrong the first time around, of course this is not Sir John's fault but it does have implications for the end product of his review. At the very same time that the Tooke review was being delivered, these very incompetents were delivering yet more MTAS style disasters in the form of Foundation 'white spaced questions'. While the incompetent workforce planners NHS Employers were delivering yet another piece of malignant rubbish that treats medical training with utter contempt. Undoubtedly training has to change but there are certainly much better ways of doing it than those proposed by the short sighted and cynical NHS Employers. These two examples are by no means isolated.

Various organisations have responded to Sir John's review, including the Royal Colleges and the BMA. There is strangely no mention of the role of the post-CCT doctor and how they fit into this grand scheme. It must be remembered that the BMA and the Royal Colleges have betrayed us more than once with these training reforms, so I would urge caution when listening to their enthusiasm for Sir John's review. That is not to say that I do not agree with much that is contained within the report, however I would suggest that we all remember that there is a long way to go in this battle for the future of medical training. Complacency could be very dangerous, as the good words in Sir John's report will mean nothing if certain malignant reforms are slid in via the back door when our backs are turned.

This is no time to get carried away. Thousands of excellent trainees will not find training jobs again this August, while there are many serious problems facing those trainees that are lucky enough to find a job, competency based fundamentalism and its dominance over experiential learning is just one issue that needs to be dealt with. But surely the most important thing will be that trainees remain militant and become more political than ever before, so that we can force the powers that be to stand up and take notice of what we demand for ourselves and for our patients in the future. After all if we simply roll over, there is little doubt that the government will treat medical training with contempt again; thus ensuring that hopes of excellence will be but a distant memory, and that dumbed down substandard dross will be their order of the day.

1 comment:

David L. Cox said...

A lot of good commonsense here Garth.

I would echo two points that are close to my heart as a mere parent of a junior caught up in the continuing MMC/MTAS mess from end of PRHO in July 2005.

The first and most pressing is the need for a major clear out of incompetents, starting at the top. Donaldson must go; I'd lose Burns as well having read his recent letter to the Herald.

Secondly, the PMETB merging with the GMC should mean its death knell too. To me, and lots of family and friends of those juniors affected by the MTAS/MMC disaster this year, Rubin's Pilate like letter was a dreadful insult, when we looked for seniors and managers for support of our ill-treated families. Now the raison d'etre for PMETB is gone. He should go too!