Monday, 30 April 2007

The MMC wolf needs to be stripped naked

This is quoted from the shadow health secretary Andrew Lansley MP from last week's debate:

"The principle of modernising medical careers is accepted and we also accept many of the principles in the documents of 2002 and 2004 that led to it. We should not rely on doctors in training for service delivery and training must be limited in time. It cannot be open-ended. As Sir Liam Donaldson said in his report about the “lost tribe” of senior houses officers, we cannot have junior doctors who drift from one SHO job to another for years without ever making progress in specialist training.

Let us remember that one of the principles of MMC was that it was intended to be flexible and widen career choice. Where did that one go in the translation of principles into practice? The way in which MMC has been implemented is lamentable. When people look at the political gravestones of the figures in the Government, they will see carved on them, “It should have worked in principle, but it didn’t work in practice.” The Government started out with good intentions, but time and again they have failed to deliver. Here is another lamentable and shocking example of how they have failed to turn what, five years ago, was a straightforward set of principles into something that works in practice for those in the NHS today."

The seven principles underpinning MMC are:

  1. Trainee centred
  2. Competency assessed
  3. Service based
  4. Quality assured
  5. Flexible
  6. Coached
  7. Structured and streamlined
Given recent events I wanted to ask do these principles mean anything and does it mean anything to say that one supports the principles behind MMC?

There are some very contradictory statements and principles here. Even Andrew Lansley says 'training must be limited in time' and that ' it was intended to be flexible', surely one goes against the grain of the other? While in the seven principles of MMC there is no mention of training having to be 'limited in time' specifically, however if this is what 'structured and streamlined' is supposed to mean then surely this contradicts the 'flexible' principle?

The principles of 'trainee centred' and 'service based' also seem to be somewhat contradictory. Training and service provision are inextricably linked and it is all about getting the correct balance between the two, while ensuring that trainees are adequately supervised without wrapping them in cotton wool. Training will be damaged by focusing too much on service provision and vice versa, while the consequences of focusing solely on short term service provision will be catastrophic for the service in the long term. It is also ludicrous to claim that 'service provision' is not an integral part of training; learning when to call for help with adequate levels of supervision is a very important part of maturing as a doctor.

In fact the genuine motives behind MMC have yet to be revealed, in fact the DoH has gone remarkably quiet on this matter.

The principle of modernising medical careers is accepted"

In this context the above statements come to mean absolutely nothing. Modernising Medical Careers is a wolf in sheep's clothing, a beast that has been dressed up in secret and released on an unsuspecting public amid a blaze of propaganda. The principles amount to nothing concrete, they are designed to be a vague politically correct smokescreen that will mask the real cynical political motives that lie beneath.

MMC is a framework designed to produce less skilled and hence cheaper doctors under the cloak of "proven competence". The government realise that the public won't be happy to be seen by less skilled doctors, hence the need for the 'cloak'. The blame when things go wrong will be conveniently placed at the door of their lovechild quango PMETB.

The Department of Health has been warned of the danger to patients posed by MMC and MTAS, a warning which they ignored like many others. Even ministers have been caught on the record stating that MMC was not hatched in secret, it is therefore strange that the DoH is with holding the motives behind MMC from the public. I argue that 'Modernising Medical Careers' has come to represent these hidden motives and however well intentioned the principles may be, in reality they mean nothing if they are being used to force through a hidden political agenda.

It is obvious that we all want better medical training so that as good a sustainable service for patients as possible can be provided for many years to come, however MMC dressed up in its sham principles will not help achieve this; it may well do the very opposite. A new approach is needed, one that consults the medical profession and its grass roots properly, and one whereby the process is conducted completely out in the open in a genuinely democratic and transparent manner.

Until then, the principles will mean nothing and must be actively opposed; as if the wolf manages to trick his way into the field full of sheep, the consequences will not be pleasant.

More from our special friends

There is yet more invigorating news from our favourite combo, MTAS and DoH; they have released another statement today:

"This may delay the resumption of the service and may potentially cause delay to the interview schedule. We are sorry for this and will work as hard as we can to reinstate the service as quickly as possible."

The 'minimal impact' that Lord Hunt claimed and the 'up and running by Monday' seem to be more than slight stretches of the truth. I have stopped getting angry now, the incompetence and delays have become the norm.

"Our profession is experiencing huge anger and frustration. It is imperative that this anger is directed, with force, against the right people. I am sure that united we will be able to ensure a better outcome for current and future applicants. I also hope that the Government will learn from this mistake and realise that the voice of the profession is not one they can afford to ignore."

This is the last paragraph of a letter written by the president of the BMA James Johnson to doctors about the recent MTAS debacle. In my humble opinion it's been too little too late from the BMA; actions always speak louder than words and Remedy have been the only ones acting to prevent this disaster. There has been a lot of chatter and talk in some quarters, but these words are starting to look very hollow when there is no tangible action to back them up. It was the BMA's job to make the government realise that they could not ignore the voice of the profession, this was not successfully done.
All along the government has not listened to the voiced concerns; thus the only viable option was to unilaterally withdraw support, otherwise the government could use this lack of withdrawal as tacit consent. We have seen in recent weeks how the government has done precisely this; Patricia Hewitt has fallen back on the fact that none of the medical bodies involved in sculpting MMC/MTAS, including the BMA, has withdrawn from proceedings. Surely a unilateral withdrawal became the only practical option quite some time ago? It is always easy in retrospect, however those leading the profession are meant to be canny and politically astute; either they are not as cunning as we think or they deliberately and knowingly went along with these catastrophic reforms.

Like it or not, the BMA and the Royal Colleges have become complicit in the faulty implementation of MMC and MTAS. I remain a sceptic and will be tend to judge people on their actions, not their hollow words.

Sunday, 29 April 2007

'Absolute nonsense'

Click on the Sky News logo to watch a rather enjoyable interview with Patricia Hewitt getting a rather vigorous grilling from Adam Boulton. Hewitt tried the 'absolute nonsense' line for the umpteenth time and it did rather rebound in her face.

It is interesting that she mentioned the word 'doctor' so many times, it seems rather coincidental that these decisions as regards not treating smoking/obese patients were the same across whole PCT areas. It seems pretty obvious that these are PCT rationing decisions as a direct result of the government imposed deficits. It was good to see Adam Boulton not letting her get away with her typically illogical arguments.

I do love a good grilling.

Votes, elections and the remedy

Votes and elections form an important part of the democratic process, and if this area becomes corrupt then it has the potential to undermine the whole democratic process. No wonder Labour keep trying to fiddle with votes, it seems they are it again. An undercover investigation has shown examples of blatant corruption, I just wonder how widespread this kind of activity is? There was illegal activity a plenty at the last general election, with the postal vote seemingly a particular weak spot. Is enough being done to counter this threat? Is the man in charge of countering this threat doing enough? At least something is being done to prevent partisan think tanks spinning party propaganda while pretending to be balanced and perfectly neutral.

A man who is very well clued up on the government's growing powers at the expense of our liberties is Henry Porter, he has written another well researched piece here. The rising quangofication of the country runs against the principles of good open democracy, PMETB are the perfect medical example of this.

There was a small meeting in London yesterday, the BMA Junior Doctor's Committee conference; while those attending probably thought it to be of great importance, I think the majority of junior doctors have lost faith in the BMA for a number of reasons. It certainly does not help that the structure of the BMA allows it to function as an undemocratic autocracy, this has led to the organisation being dominated by politically climbing committee loving cronies who represent themselves at the expense of their members. The BMA has become deeply dysfunctional as its structure allows it to get away with ignoring the majority of grass roots opinion. In this day and age it is very easy to regularly assess the opinion of members or ballot members on important issues, the BMA has failed to do these simple things time and time again. It appears to me that trying to achieve change at the BMA would be a bit like entering Kafka's castle, the complicated rules and regulations are enough to drive anyone to distraction. The majority of those involved with the BMA seem pretty oblivious to this and are happy to blame the grass roots members for their 'apathy'. The BMA seems in desperate need of reform.

Remedy UK on the other hand are an organisation that does represent the grass roots of the medical profession, they are showing the BMA how it should be done. Remedy regularly surveys its members for their opinion and then represents this opinion, hardly rocket science but this is something that the BMA cannot manage. Remedy have now applied for a judicial review in the Administrative Court between Legal Remedy (the Claimant) and the Secretary of State for Health (the Defendant) regarding MTAS. PMETB, CoPMED, the BMA and NACT have been named as interested parties.

Metaphorically the BMA has been playing 'keepy-uppies' in a closed circle for a while; now Remedy has stepped in, broken up the circle, taken the bull by the horns and booted the football firmly into touch. Well done Remedy UK. Have it!

Remedy Uk - Summary of grounds for judicial review

For anyone who wants to read the summary of the grounds for a judicial review by Remedy Uk:

A judicial review has been applied for in the Administrative Court between Legal Remedy (the Claimant) and the Secretary of State for Health (the Defendant). PMETB, CoPMED, the BMA and NACT have been named as interested parties.

Papers were lodged with the Administrative Court at the beginning of this week. On 27th April the Court issued an Order regarding expedition. It is estimated that the hearing will take 1.5 days with one day pre-reading, to be fixed on a date as soon as possible after 14 May 2007.

"1. This judicial review is the product of what can only be described as the catastrophic failure of the Medical Training Application Service (“MTAS”), created under the aegis and at the instance of the Department of Health. MTAS has been introduced as part of the Modernising Medical Careers (“MMC”) initiative, in which the specialist training of junior doctors is being radically altered. The focus of this judicial review is MTAS alone, but it must be seen in the context of MMC. At the heart of this case are those junior doctors who are: (a) applying to commence their specialist training this year; and (b) those who are part way through their training and as a result fall into the transitional period between the old system of specialist training and new system to be introduced by MMC. Throughout the UK, there are approximately 32,000 doctors (“the Affected Doctors”) affected by MTAS. At stake in the present proceedings, the Claimant contends, is the fairness/legality of appointments which will “make or break” the prospects of these numerous Affected Doctors in obtaining either long term or fixed term specialist training.

2. Regrettably, MTAS has been a comprehensive failure. The result has been a far-reaching loss of confidence, morale and faith by junior doctors and many consultants in the fairness of MTAS and the consequent integrity/fitness of the NHS. Much of this has been very publicly and vociferously articulated in the general and specialist press and by representative bodies.

3. This mounting pressure forced the Department of Health to convene and appoint a Review Group. Yet even the actions of the Review Group have prompted further acrimony. The Claimant believes that Modified MTAS (and the Decision leading to it) is so unfair as a whole as to amount to an abuse of power. Such a conclusion is supported by four key features of Modified MTAS (each of which is, Legal RemedyUK believe, unlawful in its own right):

(1) The decision of the Review Group has changed the basic architecture of the MTAS scheme half way through the process, in particular ditching the four promised preferences in favour of one guaranteed interview. The changes made do not merely address the shortcomings of the old system in an even handed fashion.
(2) Secondly, the fundamental changes made by the Decision and Modified MTAS have been introduced on an ad hoc basis without any meaningful attempt to consult the Affected Doctors, other than discussion with the BMA, Deaneries and Royal College representatives.
(3) Thirdly, Modified MTAS continues to rely, in modified form, upon the Interview Allocations generated by the old MTAS System (now abandoned), i.e. upon MTAS’s defective decisions as to who should be interviewed. This leads to a basic inequality of treatment and/or lack of consistency.
(4) Finally, Modified MTAS continues to rely upon defective Round 1 Interviews conducted before the Review Group met, which will differ substantially in rigour from the “New Round 1 Interviews”
4. The Claimant contends that each of these factors, and equally their combination, makes the adoption of the Modified MTAS so unfair as to be an abuse of power. If this Court it is so satisfied, then the Claimant suggests that the importance of the issues at stake (namely, the future careers of the Affected Doctors, the credibility of the NHS and its future specialists, public and professional trust in the Department) demand that this Court grant meaningful relief."


The ferret is fursty

It's been a busy week for the ferrets, it started with them scouting out the House of Parliament before the MMC debate:They then tried to get between Tony Blair and the microphone:

Unfortunately some were captured and tortured by the MMC team:

They did manage to escape from their tighly guarded cells:

All that activity has made them very thirsty ferrets indeed:

No evil?

The DoH has again stonewalled a Freedom of Information request concerning Dame Carol Black:

"You ask about Dame Carol’s appointment as the National Director for Health and Work. Specifically, you ask for information about “discussions between senior DOH officials, Dame Carol, government ministers, advisers concerning her role, future role and any terms and conditions of her employment.

I can confirm that the Department holds information relevant to this request. All information which can be released is attached to this message.(they released one pretty much blank letter)

The Department has withheld some information from disclosure under section 35 of the FOI Act.

Section 35(1)(a) provides that information is exempt from disclosure if it relates to the formulation or development of Government policy.

Section 35(1)(b) provides that information is exempt from disclosure if it relates to Ministerial communications.

Section 35 is a 'qualified' exemption and we are therefore required to consider whether the public interest in disclosing the information outweighs the public interest in applying the exemption.

The purpose of the exemption at section 35 of the FOI Act is to protect the internal deliberative process as it relates to policy making. In other words, the exemption is intended to ensure that the possibility of public exposure does not deter from full, candid and proper deliberation of policy formulation and development, including the exploration of all options, the keeping of detailed records and the taking of difficult decisions. Premature disclosure of information protected under section 35 could prejudice good working relationships, the neutrality of civil servants and, ultimately, the quality of Government.

There is a particular public interest in protecting communications between Ministers, as premature disclosure of such communications could undermine the collective responsibility of the Government. Collective responsibility is a constitutional convention which is described in the Ministerial Code as follows: "Collective responsibility requires that ministers should be able to express their views frankly in the expectation that they can argue freely in private while remaining a united front when decisions have been made." If Ministers feel inhibited from being frank and candid with one another because of the risk of subsequent disclosure, the quality of debate lying behind the collective decision will be diminished.
For these reasons, the Department believes that the public interest strongly favours the application of the exemption at section 35 of the FOI Act.

Some information has been withheld under section 36 of the FOI Act.

Section 36(2)(b)(i) provides that information is exempt from disclosure if to do so would, or would be likely to inhibit the free and frank provision of advice.

Section 36 is a 'qualified' exemption and we are therefore required to consider whether the public interest in disclosing the information outweighs the public interest in applying the exemption.

Section 36(2)(b)(i) recognises the critical role in effective government of free and frank discussion. Premature disclosure of information protected under section 36 could inhibit officials’ willingness to offer advice in the future and prejudice the quality of any advice given. There is a recognised public interest in protecting the ability of senior officials to offer candid advice to ministers, and in protecting the processes by which senior public appointments are made.

For these reasons, the Department believes that the public interest strongly favours the application of the exemption at section 36 of the FOI Act.

Some of the information has been redacted under section 40 of the FOI Act.

Section 40(3)(a)(i) applies to information whose disclosure would contravene any of the data protection principles in the Data Protection Act 1998 (or certain other provisions of the Data Protection Act 1998).
In applying this exemption, we have had to consider whether disclosure of the information would be ‘fair’ (as described in Part II of Schedule 1 to the Data Protection Act). We have given particular consideration to the likely expectations of the data subject regarding the disclosure of the information. We have reached the conclusion that disclosure in this case would not be ‘fair’. The exemption from the duty to disclose personal data where to do so would breach a data protection principle is an absolute exemption; the public interest test in section 2 of the FOI Act does not apply.

The post of National Director for Health and Work is a joint appointment with accountability to both the Department of Health and the Department for Work and Pensions (DWP). The DWP led the recruitment exercise on behalf of both Departments and a separate request would have to be made, therefore, for any further details relating to this appointment which are held by the DWP.

You go on to ask a number of questions about Dame Carol’s appointment to the Board of the Postgraduate Medical Education and Training Board (PMETB).

I can confirm that the appointment process was run by the independent NHS Appointments Commission that is expert in matters of equal opportunities and diversity.

Once the PMETB competitive entry exercise was complete, Ministers were provided with a short-list of preferred candidates. The PMETB Order states that the Secretary of State for Health has the ultimate choice on appointments. "

Hence the DoH does have information detailing briefings that Carol Black received as to her precise role and this is being held back all in the name of the 'public interest'. They also reveal that the Secretary of State for Health had the 'ultimate choice' in appointing Dame Carol Black.

The DoH certainly has a very totalitarian interpretation of what the phrase 'public interest' means. Their interpretation allows them to withhold details about what precisely goes on behind closed doors so that our trusted leaders can discuss policy free from any public scrutiny. This is deemed to be in the 'public interest', as decided by the DoH. The DoH is allowed to act as self-appointed judge, jury and executioner. They can brief their agents in secrecy and then dispatch them into office to do their dirty work.

This government action is in marked contrast to recent orders from the CMO that ordered doctors to ride roughshod over doctor-patient confidentiality in setting up the NHS SPINE. Personally I can think of no reason why certain discussions regarding policy should not be fully open to public scrutiny, as promoting an open and frank culture can only be good for helping root out corruption and sculpting more effective policy; our government either believes otherwise or is overtly corrupt.

There does seem to be a rather worrying trend here; as our government is trying to grab more and more autocratic power, while they are completely unwilling to reveal the real motives behind their agenda. They want us to trust them more and more, while they give us less and less of a good reason to do this. There is certainly something that does not add up.

Saturday, 28 April 2007

These physicians have balls!

The following letter has been written by the Worthing Hospital Royal College of Physicians College Tutor and Colleagues to the KSS Dean and Lead for Core Medical Training on 25th April 2007:

"I am writing from the physicians as a whole here at Worthing. Following our recent letter about the review process, MTAS and implementation of MMC we have been waiting as many others have for more information about the plans for August.
As interviews have pressed ahead we have been pleased with the reports of the good quality of candidates.

However we are greatly disturbed that no firm information has been relayed to anyone about any amendments to the planned implementation of run-through training for August.

As there has been such a profound failure in MTAS delivery leaving all participants senior and junior with questions about its validity, our consensus view is that there needs to be, at the very least, a delay in the start of Run- through training relating to ST1 and ST2.We fully appreciate that we need to recruit and fill our vacant posts for August. However as selection of candidates into FTSTA posts on the back of this process will virtually preclude any future career progression for them we see continuing with this process as unethical.

We as a body feel we are no longer able to support interviewing in such a situation.

We do hope that we can resolve this situation and will review this standpoint when we have firm assurances about the August implementation. At such a time we will whole-heartedly support interviewing when we can be assured about the various issues that have been previously highlighted and flexibility is returned to the system."'

It is 'unethical' to proceed, here here. Unfortunately so far it has been only a small minority of consultants who have withdrawn from the process, it undoubtedly takes a lot of courage to take such a stand. However this does not condone the actions of those who have not pulled out, or not at least tried to persuade their consultant colleagues to pull out.

It is indisputable that if all consultants across the country pulled out then the MTAS process would have to be scrapped. There is undoubtedly a lot of top down pressure being applied, there are even rumours of intimidation and bullying. This appears to be as a result of certain vested political interests; the scrapping of MTAS would be catastrophic for some people very high up the food chain and hence they will stop at nothing to enforce their will upon those beneath them. For this reason I salute the Worthing consultants, they have done something very brave indeed under a great deal of pressure. It is hard to know what oneself would do in the same situation; I know what I hope I would do, but until you are put in that situation it is very hard to predict how one would act.

Surgeons have bigger balls?

The president of the Royal College of Surgeons has written to his members:

"To Members and Fellows of The Royal College of Surgeons of England

The review Group met again on Wednesday 25th April and I am writing to give you an update on the present position.

You will recall that I put to an earlier meeting, a proposed scheme to enable those who are able, but are not successful in securing a ST3 post this time around, to continue their training in what I called ‘transitional training posts’. During the opposition Day Debate on the 24th April the Secretary of State for Health, Rt. Hon Patricia Hewitt MP, agreed the need for additional training posts.

“As part of the review, we are working urgently with the royal medical colleges and the NHS to establish the need for additional training posts—which will of course have to be approved by PMETB—including one-year placements and more senior posts. We are also considering how we can provide more effective training support for doctors in service posts—that is, non-training posts—to maximise their development opportunities. That is the issue on which Professor Douglas’s review group is now focusing, having dealt with earlier problems involving the application process, and it will make a full statement—as will I, to the House—on the support that will be available very shortly.”

Since I last wrote to you, I have discussed my plans with the Senate (with representatives of all the surgical colleges and specialist associations), ASGBI and ASIT. In the light of all of this feedback, I have refined the plans for additional training posts, in England, which have the support of all of these bodies and which I think will offer the best career prospects for as many of our able trainees as possible.

The plans are currently with a working party of the Review Group to consider the detail.

In essence, selection for specialty training should be at the ST3 level for the next three years and the number of run-through training posts at ST3 level should be expanded. There should be a concomitant decrease in the number of training posts available at ST1 in 2008 and in both ST1 and ST2 in 2009. The numbers at ST1 and ST2, for this year however, will remain unchanged.

All ST1 posts should be FTSTA’s. There are c.760 ST1 posts for surgery in England (910 for the UK)
All ST2 posts should be FTSTA’s. There are c.808 posts in England (1043 for the UK)
There should be an expansion in ST3 numbers over a transitional period of three years from 2007 to 2009.

The case for expansion at ST3 is to meet the College’s stated policy in relation to the future workforce required to provide an acceptable quality of service and to continue to ensure patient safety.

You may be aware of the Independent Review into MMC, announced earlier this week by the Health Secretary to be chaired by Professor Sir John Tooke. I am attaching the terms of reference for information. He telephoned me several days ago and I had the opportunity to discuss the review with him. I have written to him today, expressing my concern that there is no specific mention of the role of PMETB in the terms of reference. I have asked him to confirm that PMETB’s involvement to date and its future is addressed in this review. I will expect changes to be made before we can offer our support.

Terms of Reference for Independent Review
(full terms of reference then follow)"

It seems that the goalposts have been shifted yet again, how on earth are candidates meant to keep up with these almost weekly changes and how stressful is this never ending mess? The proposed amendments essentially mean that the President has no faith in MTAS to select the right candidates as there will be no run through training posts at the lower levels of ST1 and ST2. These proposals are an improvement however it is yet another example of how unfair the process has become. Clearly there are some candidates who would have applied for ST3 rather than ST2, if they had been aware of these conditions.

It is excellent that he has asked for a definitive answer as to PMETB's role and future, an eye must be kept on this area; PMETB are now in the spotlight and will not be allowed to creep in via the back door.

In my opinion balls of steel would be demonstrated by the President if he were advising a scrapping of MTAS, walking from the review group and proposing an immediate return to local applications. He may have demonstrated tougher balls than the RCP President, but that doesn't say much does it?

Friday, 27 April 2007

The Sun - a pillar of our fine democracy

I was mincing around on the Internet this afternoon and ended up on the Sun's discussion boards; Kelvin Mckenzie had written an incredibly ill informed piece yesterday:

"'I am sick and tired of listening to junior doctors complaining about their job prospects. It's a tough and competitive world out there and the public might be a little more supportive to these gods in white coats if there were fewer cases like those of Gertrude Danforth.'

He then described the
sad case of an 85 year old woman who died after a low blood sodium level was missed. The coroner returned a verdict of natural causes contributed to by neglect.

He then linked this to the current campaign, implying doctors have made mistakes because they are taking time off.

"'Perhaps if they (i.e. junior doctors) spent less time in television studios explaining how they might have to work abroad (we all do these days) and more time worrying about their patients, then we would all be better off and we might, just might, be more sympathetic.'"

Complaints about Mckenzie's bile can be made here.

I then posted a piece on their news board complementing Kelvin Mckenzie on his excellent objective coverage of the Hillsborough disaster and the Falklands war, I also have to admit making mention of Rupert Murdoch being a mother Theresa of the modern world and that the 'sun was my bible'. There may have been a shade of sarcasm involved, however there was certainly nothing overtly offensive within; maybe it was my religious extremism that put them off?

I then posted again asking a simple question to the moderators asking for an explanation 'am I not allowed to mention the Sun's coverage of the Hillsborough disaster by Kelvin Mckenzie?'. I was promptly banned from the fora with no explanation. Before being banned I have saved this little nugget that explains the Sun's brilliant logic:

" "Why was my post removed?

There have been a few complaints about posts that our moderators removed (e.g. 'you are breaching my freedom of speech', 'there's no reason for you to remove these', etc.)

There have also been some complaints about posts that our moderators aren't removing ('you are allowing racist abuse', 'You're not doing enough about bullying on your boards' etc.).

Overall, it seems that we are striking a good balance between allowing people to express themselves, and curbing what is in breach of our Terms and the law. Sometimes the aggrieved individuals play victim to gain sympathy. Sometimes they genuinely don't realise that their post was removed because it was part of a bigger thread in breach of our Terms, or because they innocently put themselves at legal risk.

I'm sorry if you feel offended when your posts are removed. I invite you to read our terms, and information about how we moderate these boards - it is available at the bottom of this page where it says "Standard Terms and Conditions".

If someone came to your house and broke your house rules, you'd have every right to enforce them, or even kick the person out. Same here. We monitor all removals handled by our moderators, and the quality of their work is exceptional.

When signing up to MY Sun, our users agree to our Terms. They are not unreasonable. In fact, compared to a competing publication's site - we'd almost count as unmoderated (they moderate so much, hardly anything is left). Our ethos is all about allowing users to express themselves, and we are proud of the freedom we allow. That doesn't mean we'll let a small minority of obstructers to take advantage. Instead we invite you to enjoy the debate, and to take part in our growing community. We know we do!

As ever,


PS. and yes, if someone came to your house and constantly complained about your house rules and how you enforce them, you'd be right to ask them to shut up or leave. End of." "

I love their logic. I love how they claim that they are 'almost unmoderated', well they probably are compared to Cuba's media. Their philosophy is 'shut up or leave. end of', brilliant.

I refuse to get angry and sink to their deplorable depths. I am therefore going to start a one man campaign of exposing the Sun for what they really are, please free to join my campaign if you wish.

This campaign shall involve regular forays onto their discussion boards to demonstrate precisely what the Sun means by 'unmoderated'. If you wish to join in then feel free to email me anything that you have censored on the Sun discussion boards and I will put it up here, within reason of course; the milder the posts that you have removed the better. Watch this space.

More lies from MTAS

It was bad enough that last night MTAS tried to pretend that their site had been closed for 'planned essential maintenance work', they backed down from this pretty sharpish as even they have some degree of shame. However their website still shows the evidence of their lies as above.

MTAS have sent out the following statement today:

"Specialty and GP applicants have not been affected by these issues and they should be reassured that their details remain absolutely secure. It is intended that the interview booking section of MTAS will be available to these applicants again very soon and with the minimal disruption to their application process. Specialty and GP applicants will receive an email to let them know when the system is up and running again. We expect that this will be by Monday, 30 April."

This is a downright lie. The MTAS email correspondence of ALL applicants was left wide open for anyone with access to the Internet. This security breach applies to ALL candidates. This security loop hole was probably left open for several weeks before being noticed.

The DoH and MTAS are coming to resemble a propaganda ministry. Frankly I cannot believe a word they say anymore.

'Independent' my arse

It has been learnt that Sir John Tooke, the man given the job of heading the 'independent' review of MMC and MTAS, was closely involved in the drawing up of MMC from the very beginning! He was a member of the MMC Academic Medicine Committee which was meant to have 'consulted widely with stakeholders to harness as broad a range of ideas as possible'. What a great job they did, the stakeholders are absolutely chuffed with MMC.

It has already been pointed out that the first review of MTAS was nothing more than a sham. So these revelations cast yet more doubt on the claimed transparency of proceedings. Patricia Hewitt stated to the House of Commons this week:

'I am extremely grateful to Sir John for undertaking the review, and I stress once again that it will be completely independent.'

Is this another lie from Patricia? The conundrum here is that any genuinely objective and independent review would inevitably tear the MMC house down, hence the government are trying to avoid this at all costs. I fail to see how anything done by this review panel can be claimed to be independent if it is led by someone who was intimately involved in MMC from the beginning; while the quoted terms of reference appear reasonable, we have got used to wolf-like intentions being dressed up in sheeps clothing by this government.

Department of Health - d'oh for short

Channel 4 covered the latest MTAS breach very thoroughly indeed last night; they even ran an additional story that told of more shoddy government IT security which had leaked the personal details of doctors onto the Internet, this involved a Connecting for Health project run by the eternally bungling Richard Granger.

On the latest MTAS leaks Lord Hunt was quoted as 'it is outrageous that someone has leaked this information'. Obviously our favourite little dysmorphic gnome wants to try and conveniently pin the blame for this on an individual; even when it is abundantly clear that this is a huge system failure involving large numbers of people, and by deliberately rushing through this unfit process the politicians should be the ones ultimately held to account over this. It also came to light that a junior doctor's trainee organisation BOTA had written to Patricia Hewitt in early march to warn her of the slack security in MTAS, I wonder how many reasons for resignation are needed these days?

The lack of piloting and quality assurance of MTAS and MMC has already been commented on by myself, Front Point has taken a peek at specifics in Hansard. This bit seems rather key:

"Ms Rosie Winterton: The Medical Training Application Service (MTAS) processes have been developed following extensive consultation which included both paper based and workshop based reviews within a formal project quality management framework. The MTAS information technology system is provided by an ISO9000 accredited supplier and has been reviewed and found fit to be for purpose.

The Modernising Medical Careers programmes itself has been subject to scrutiny by the Office of Government Commerce Gateway Review process in both 2005 and 2006."

These are a 'very basic form of quality assurance and do not really provide much confidence that the end product will be satisfactory', no surprise there then.

Just to finish with a quote from the incompetent that even his own mother despises, Richard Granger:

"A remarkable number of the general public do entrust information through electronic channels"

Well not anymore they won't. MTAS has now openly admitted to lying regarding the site being closed for 'planned maintenance work', they have now said that they are investigating the latest security breaches.

Incompetence, lies, incompetence, lies, incompetence, lies, lies, lies, incompetence, laws broken, lies, laws broken, incompetence, lies, lies and more damn lies. How much longer until MTAS is consigned to the scrap heap and someone is held to account for this?

Indeed, what next?

Letter to the CMO

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;"
(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")
(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.

"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 pressure building 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.

The metastatic NHS Employers

On the issue of trust for our esteemed politicians and quangos, given the recent lies from MTAS claiming that their website was down as a result of 'planned essential maintenance'; can we believe anything that comes from this government are any of its associated agencies? I will argue that we certainly cannot believe much that comes from the lips of NHS Employers.

NHS Employers released a 'briefing for MPs' before the parliamentary debate on MMC that took place recently. During the MMC debate one MP called NHS Employers a 'metastasis' of the NHS confederation, I think this gets across the malignant nature of this organisation. They even had the audacity to claim in their briefing:

"NHS Employers supports the main principles of MMC, as does the medical profession."

This statement on its own is enough to discredit the whole document, the medical profession seems to have very serious reservations about the principles behind MMC which the current administration are dangerously trying to brush under their dirty old carpet. The rest of their document repeats a large number of myths that can only be described as clear propaganda. For example:

"A similar system has operated in the United States for many years."

In fact MTAS is nothing like the American system to anyone with half a grey cell.

"This service was launched for Foundation Programmes in October 2006. 6000 applications were submitted with no significant IT or selection problems reported."

It seems the recent security breach might be 'significant' enough to be considered a problem, however knowing the nature of NHS Employers mindset this too is probably just a minor teething 'episode'.

"Shortlisting was carried out by senior doctors in each specialty who were given training on the new system."

It seems amusing that there is no mention of short listing having to be abandoned because no one involved had any faith in the waffling tree-hugging competency based questions.

"The past few months have been difficult for many junior doctors. This was the first year of the process and there have been a large number of applicants for the training places available. With no previous years' experience to draw on, doctors were also understandably nervous about the process."

It is incredible that these spin merchants are trying to put all the fuss over MTAS as being down to 'nervous' junior doctors. They do not even mention that the short listing process had to be abandoned, they say the tools and form 'need to be built on and further improved'. This is downright lying, juniors are angry and demoralised because the process has been a disorganised joke.

They even ask the question 'Is there evidence of MTAS working well?' and try to answer this, it's like asking 'is there evidence the war in Iraq is going well' while not asking the converse. They finish with:

We do not believe that there should be radical changes to the process of recruitment to speciality training at this stage. However, NHS Employers is committed to working with other national organisations and NHS trusts to ensure the system is fit for purpose. NHS organisations want to do all we can to minimise uncertainty, to ensure services for patients aren't compromised and that doctors get the careers advice and support they need."

The first paragraph runs completely against the claims of the second paragraph. How can they believe that any progress can be made without changing this farcical system radically?

I think the only cure for these metastases is radical surgery, this aggressive malignancy needs to be wiped out of existence. However the primary cancer must also be removed, I believe that the Blairosarcoma resides at No 10 downing street. Get your knives sharpened, unfortunately there won't be time for the use of an aspectic technique as this filthy tumour is spreading fast with no concern for our health, it must be excised at once.

Thursday, 26 April 2007

Amazing MTAS - even greater depths plumbed

Dr Crippen has been emailed by a junior doctor who incredibly has found another glaring security fault in MTAS, you would thought that following yesterday's blunders the numpties would have made sure that all the personal information was secure by now, wouldn't you?

But no, there are still gaping holes in their security.

Any candidate can easily access another candidates personal emails by simply changing the digits of his/her own inbox URL. Obviously many of these emails contain deeply personal information that candidates would be shocked to find were freely accessible to other candidates.

It doesn't stop there, I have also learnt that you do not even need to be logged in to access these emails. Incredibly the URL on its own is enough to see the inbox of anyone without any password or log in! It basically means that all correspondence that has taken place is sitting on the Internet completely unprotected, all you need is the URL. Once the inbox URL is known you can even send emails for that person.

This is in addition to the fact that anyone can register for an MTAS account by simply using an anonymous email account, that's all you need. It is entirely possible that there are people with MTAS accounts who have no medical training, and they would be able to access all the correspondence very easily indeed.

My jaw is on the floor. I cannot believe the rank incompetence of those behind MTAS and MMC. Their true muppetry is out in the open for all to see, quite literally.

Spare a thought for the juniors caught up in this, not only are they stressed at having to go through the most drawn out and shambolic application process ever while fearing for their livelihoods, but they are having to cope with all their confidential personal data being freely accessible to all and sundry.

I keep on thinking things cannot get worse, but MTAS keeps proving me wrong.

It is about time MTAS was blown to smithereens.

post scriptum- it seems someone is trying to cover their greasy footprints, closed for 'essential maintenance work'- my arse:

post post scriptum - Channel 4 has now covered events tonight, while even the BBC are stepping up a gear.