Tuesday, 20 May 2008

Hot air from Darzi

"Education, training leadership and the NHS review" was the topic for debate held at the Royal College of Physicians on workforce, education and training led by Lord Ara Darzi with Professor John Tooke, Professor David Sowden of MMC and Clare Chapman, Director General of the NHS Workforce.

Darzi talked of improvements needing to be made and a framework of accountability, but never touched upon how this would actually be done, while he also ignored calls for ring fencing training budgets. There was also a lot of banter about 'learning agreements' that were seen as some kind of magical fix by some, however how on earth they would force Trusts to take training seriously was not explained adequately.

Sir John Tooke saliently pointed out that there was no one in charge of training, that there was no one to blame if things went wrong. An excellent question was posed by Richard Marks of Remedy UK as regards the workforce planning as regards junior doctor numbers. Do we appoint trainees in a number proportional to the consultant posts that will be available in the future or related to the service needs? Clearly the government wants to flood the market with 'training posts' in order to force down wages by creating a sub-consultant non-training grade, this must be opposed.

Clare Chapman farcically talked of 'openness and honesty', I don't think she intended this as a joke but this is how it came across to me. Given that her malignant Department is behind the dumbing down of training and the deliberate creation of a surplus of demoralised doctors, I doubt her comments would pass a lie detector test. An excellent workforce point was made by Sir John and one Oncology trainee, who both pointed out that demands for particular specialists may change massively over short times; meaning that it would be sensible to ensure that all trainees receive several years of more generalised training before sub specialising, so that they are more prepared to adapt to future workforce needs.

Some superb comments were made about the naivety of educationalists who think that more training content can be easily achieved by fiddling with the bureaucratic elements of training. Darzi was then thoroughly unconvincing when he tried to explain the massive cynicism that the audience felt towards politicians, Darzi claimed that this cynicism was all part of 'democracy', he should have added in the word 'corrupt' before the democracy I feel.

The general dumbing down of undergraduate education was mentioned, as was the massive step backwards that competency based training assessment methods have been. Trainees have gone from being closely monitored by one senior clinician to being grossly unsupervised in their training. The excellent point was also made that doctors are being downgraded in the context of the MDT, doctors in training have to take a lot of the clinical responsibility but are treated with a lack of respect and sometimes disdain by other members of the MDT. If this kind of lack of respect and disdain was shown by doctors to other members of the team, then the doctors would be in great trouble; unfortunately with the current ethos of all Health Care Professionals being equal doctors are being downgraded and routinely bullied to satisfy the government's need to enslave the profession. Clare Chapman was quite pathetic in her comments on this topic.

Overall Darzi appeared all talk, there was a lot of hot air expressed as regards how genuine his role was and how things were so different at the top, with clinicians being engaged. This battle is only just starting, but it was clear from the overall opinion expressed that doctors are not happy with being treated undervalued and bullied by their employers; medical training needs to be completely depoliticised so that patients can be better cared for in the long term. Doctors genuinely want better training because they want to be good at what they do, hence they are fighting the government's desire to dumb down training in order to catalyse the privatisation of the NHS. I'd love to get Darzi on a lie detector.

6 comments:

David L. Cox said...

"Darzi talked of improvements needing to be made and a framework of accountability, but never touched upon how this would actually be done, while he also ignored calls for ring fencing training budgets."

2 comments, Garth.

1) Clearly Darzi is all talk - or he could remind some of his colleagues, especially Ms Chapman and of course Ol' Ginger, that taking responsibility requires some real action and most would see falling on swords as appropriate in these cases.

2) Why is it that Health politicians avoid talking of spending money on what it is for? If there is a TRAINING budget, why should it not be ring-fenced, especially considering the history of the mis-management of such training monies in the past?

Sam said...

"Do we appoint trainees in a number proportional to the consultant posts that will be available in the future or related to the service needs?"

But shouldn't the number of future consultant posts reflect service needs?

"Clearly the government wants to flood the market with 'training posts' in order to force down wages by creating a sub-consultant non-training grade, this must be opposed."

Yes, the sub-consultant grade must be opposed but, where is this flood of training posts? Did anyone speak about the fierce round one competition ratios? And, the problem is, no training post means unemployment especially for the FY2s who are not allowed even a career post before the get some sort of training for 2 futher years! Remedy called for training for all leading to a 'consultant led health service' Has this been abandoned?

It's getting more complicated by the day!

It's good you attended Garth, otherwise no one would have known about this conference!

Garth Marenghi said...

I agree david,

why not ring fence the money, there is simply no decent argument for not doing so, as darzi demonstrated quite admirably!

Sam, I didn't go, just listened on DNUK.

The point I was trying to make about numbers was that with EWTD we need many more juniors for the service than ever before, and there will never be enough consultant posts for all these doctors to move into.

Personally I feel we need to expand consultant numbers, but even with this expansion we are training far too many medical students at Universities and there will be a large number of doctors with no long term job at the end of it.

It is also dangerous to make all junior doctor jobs so called 'training' posts as this further dilutes the quality of training along with the reduced hours worked.

The government's solution is to flood the market with loads of junior doctors, hoping that many will accept being career grades for life.

As we know this is flawed, firstly as it won't work as this cohort of doctors won't accept this downgrading and will quit medicine in the Uk or medicine altogether as they are very bright and able individuals, secondly even if these doctors did accept this it is no way to run a system as career grades simply provide a poorer service than their consultant counterparts on the whole.

How would I solve this problem? I think we need a variety of solutions:

-we need to work more than the EWYD 48hrs and this can minimise the damage

-we need to expand the consultant grade

-we need to use our doctors in training better, so much of our time is spent doing admin which could easily be done by other staff, this would result in less junior staff being needed and better training for those in training

-we need training to be prioritised and to be a shared responsibility between the trainer and the trainee, currently trainees are blamed even when their jobs did not give them the proper training exposure

I am sure there are other things to mention but that's a quick fire few.

Sam said...

'Personally I feel we need to expand consultant numbers'

This is the answer Garth, more consultants and more training posts. But, what is happening at the moment is that consultant numbers are being reduced, hence quality of training is going down! I wonder if Lord D spoke about this in that conference?

"but even with this expansion we are training far too many medical students"

Not if we are aiming for self-suffeciency. The problem is, as you say, no Brit will just sit in a career post trap for life, so this needs to be addressed.

The new model of training, as per Prof Swodon during the BMA's junior doctor conference, allows doctors in career posts entry to training. However, with selection as unfair as it has been so far, many an excellent doctor will not get the training opportunity they deserve and will end up in a career post while others of lesser abilities take their place. So, they need to find a fair selection method AND expand consultant numbers to ensure training is not watered down.

Remedy says it will report on this conference soon ... I will try to find a way to see the podcast on DNUK because this was an important meeting as it does give an idea of what Darzi intends to say in his report next month. If he was talking 'hot air' as you say, then there will be plenty of 'gas' in his report next month!

Garth Marenghi said...

we've got to ve very careful what we ask for,

we need new training posts, but these posts must be proper training posts with decent training content,

the last few years have seen numerous non training posts converted into training posts in a rather expedient manner because PMETB and the GMC are very weak as regards enforcing any standards,

we need the Royal Colleges back in charge of training, we need PMETB and the GMC to be kept well away from training

Dr Xavier Ray said...

Darzi is now a dead man walking. He rather foolishly tied his future to that of Gordon-No-More-Boom-and-Bust when it looked like the sun might shine out of his arse but now realises, too late to step away, that it was a piece of brightly coloured shite.
He has lost the respect of his profession and will go into the wilderness with his political puppet-masters when Nulabour are eventually kicked out or have the common decency to call a general election and allow this country to exercise its democracy again.
Its now become a game of how much damage these bastards can do before they leave