Tuesday, 30 June 2009

Head in sand doesn't make everything all right

Modernising Medical Careers (MMC) was allegedly the reform of medical training for the better, as many of us have since learnt the government lied about the real motives that lay behind this Trojan Horse of festering garbage. When everything when so spectacularly tits up back in 2007, the government had to pretend to act because things had got so bad that the media had started to take notice. In actual fact MMC had been doing damage to training for several years before 2007, the creation of the lame 'competency based model' of Foundation training and the useless application process for these jobs had already been about for several years by 2007.

After some excellent Freedom of Information ferreting I have managed to get hold of documents which detail correspondence between the Secretary of State for Health and the deputy CMO Martin Marshall on the topic of the MMC inquiry. I have highlighted some interested snippets for you to have a look at, taken from Martin Marshall's letter to the SofS:


....Whilst there have been successes as well as problems...

I understand the NAO are coming increasing pressure to undertake a review, either of the immediate issues with MTAS, or of the wider MMC program. I would hope that the announcement of an independent review would influence this decision, or at least its timing.

The purpose of the independent review would be to examine the framework and processes underlying the design and delivery of the whole MMC process and to make recommendations to ensure improvements for 2008 and beyond. This is likely to involve revisiting some significant issues but not to review the principles underlying MMC. These principles, to develop a competency based training program for doctors based on defined national standards, have widespread support amongst professional leaders.

The leading candidate is John Tooke... He is a committed educationalist, extremely well respected by the profession and more widely, and informal soundings suggest that he might be willing to accept the role if asked."

The above snippets are quite revealing. Not only do they show that the Department of Health has a remarkable habit of being completely unable to realise when it has made a mistake, but they only act when they are forced to by outside forces. The DoH appears to live in a permanent state of denial, completely unable to see just how incompetent their own actions are at times; they only ordered an Inquiry into MMC as they were afraid the NAO were about to nail them with a much more damaging review at a later date.

It is very revealing that the 'principles underlying MMC' were not to be called into question by this review, these were untouchable and allegedly already widely supported by our professional leaders, this all smells of fish to me. Interesting that the 'principles of MMC' seem to change every few days, according to the MMC website they are:

"One of the intended benefits of Modernising Medical Careers (MMC) was to ensure a transparent and efficient career path for doctors."

So much for that efficient transparency, MMC has reminded me far more of corrupt cock ups than anything else. The real motive of MMC was this:

"MMC aims to provide consistent national standards for training through better-structured and managed programmes with competency-based curricula approved by the independent Postgraduate and Medical Education and Training Board (PMETB)."

In reality MMC has resulted in a less flexible top down system which has done nothing but paper over the catastrophic effects of EWTD on medical training. Tons of extra paperwork and curricula will not help train specialists in less years with less hours per year, training cannot be purely competency based tick box numpetry, training must be common sense based and time based to a degree.

This government has dishonestly tried to force through the subconsultant grade with MMC, they lied to us and pretended that MMC was about better training and better patient care when it was about nothing of the sort. MMC was much worse than simply doing nothing as if nothing had been done we would have had to address the evils of the EWTD, as things stand the DoH and the government have stuck their empty heads in the sand and pretended that MMC would fix all our training problems including the EWTD. At the same time many new problems have been created by MMC including a lot of competency based damage to training and rain forests, an erratic and under performing Foundation training system, as well as numerous problems with various job application systems including an invariably useless Foundation scheme application system.

I've rambled on, mainly because it makes me very angry when people stick their heads in the sand and pretend everything is OK when it obviously is not. A lot needs to happen to fix this mess, the failings of competency based training and Foundation training need to be addressed fast before it is too late, maybe an NAO review of MMC would be a good thing to push for as well, while the EWTD monster needs to be taken on at some point. I don't have all the answers by any means, but the first step is to own up to the massive problems that exist, not living in arrogant denial like some choose to do on a rather regular basis.


David L. Cox said...

No rambling there, Garth. Succinct, and to the point.

The difficulty remains the incompetants in the DoH, who continue to maintain the value of MMC, despite the clear and obvious failings. Their presence, evidenced by the ludicrous time scale in the approach to considering the effects on training brought about by EWTD, will remain a drag to sensible decision making and the only approach which could help matters is their removal.

Roll on Remedy!

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