Hewitt point by point

I could easily insult Patricia Hewitt until the cows come home, however not wanting to sink to her depth I shall instead take apart her responses to parliamentary questions point by point.

http://www.publications.parliament.uk/pa/cm200607/cmhansrd/cm070319/debtext/70319-0003.htm#0703198000001

1.“Martin Horwood (Cheltenham) (LD): We are still waiting for two things: first, an apology from the Secretary of State and, secondly, an unambiguous answer to the question that the hon. Member for Norwich, North (Dr. Gibson) asked about quality assurance, which is one of the safeguards available to anyone who introduces new systems, however much they are needed. Will she give an unambiguous answer? Have the final MMC and MTAS systems been subject to formal quality assurance—yes or no?

Ms Hewitt: My understanding is yes.”

Garth: MTAS has not been validated or piloted or quality assured. A small flawed study in 2005 showed that long assessment centres were a good selection tool for GP trainees, however there is no evidence anywhere to back up the MTAS short listing process.

2. Hewitt“On the issue of MTAS, let me quote the independent PMETB:”

Garth: The PMETB is hardly independent; it’s head is appointed by Patricia Hewitt herself and its board is largely appointed by her.

3.Hewitt:“A similar system has been operating successfully in the USA for over half a century.”

Garth: The system in the US is rather different as all US students take a rigorous exam (USMLE) that ranks them on ability thus making the short listing process very different indeed to MTAS’.

4.Hewitt: “My hon. Friend is right. A great deal of development work, quality assurance and so on went into the MTAS process and, more broadly, into modernising medical careers. There have been real problems this year, as I said in my statement, which is why we are working with the review group to sort them out and learn further lessons for round 2, and for next year.”

Garth: Stretching the truth again. Where is the evidence of the quality assurance for MTAS?

5.Hewitt: “Gentleman speaks of introduction being rushed, but work on modernising medical careers and on its implementation has gone on since about 2003. That could not possibly be described as rushed.”

Garth: I think Hewitt’s logic of saying something has not been rushed because it has been going for four years is hardly compelling. It is a rather large project and it can very easily be claimed to have been rushed in this context.

6. Hewitt: “In a sense, the hon. Gentleman’s suggestions have already been considered by the review group, which has received evidence and listened to representations from a very wide range of people.”

Garth: Has this really happened? The 'independent review group appears to have listened to no one other than pro-MMC cronies and the DoH (are they the same thing?)

7. Hewitt:“It has always been the case under the new system that when applications are submitted, the full CV and portfolio can be, and generally are, attached.”

Garth:This is a complete falsehood. The CV and portfolio cannot be attached to the application.

8. Hewitt:“The hon. Member for South Cambridgeshire, however, believes that we should go back to the old non-computerised system, under which junior doctors had to fill in a different application, with different information and using a different format, for every post around the country for which they wanted to apply. It was a completely absurd system.”

Garth: Why was this system absurd? It’s how all other jobs in the country are applied for! Either everyone else is absurd or maybe Patricia herself is.

9. Hewitt:“I have heard others suggest that some candidates’ applications were lost in the process—and I understand that that too is untrue.”

Garth: I think evidence may come to prove her wrong here.

10.Hewitt: “The hon. Gentleman asked whether there would be 8,000 jobless doctors. There will be nothing of the kind.”

Garth: Does Patricia not know that 29,000-22,000 is 7,000 unemployed or is she just a bit dim?

11.This question posed: ‘will a majority of the review panel be composed of people who did not set up the original scheme?’

She does not answer this as she knows the panel is very much 'dependent'.

12.Hewitt: “I do not think that the hon. Gentleman has been following the discussion. He assumes that thousands of doctors will be out of work, but the applicants—more than 29,000—who are currently working in the NHS will continue to be needed in the service, whether they have moved on to run-through training programmes or are working in staff and other NHS jobs. Those jobs will continue to be needed, because those doctors are at the heart of the NHS.”

Garth: Again, 29,000-22,000=7,000. Patricia is one thick politician. Just because doctors are ‘needed’ won’t make jobs magically appear!

Overall a rather nasty new labour specimen gave several wrong answers and a very compelling case could be made that she did in fact lie to parliament on more than one occasion.

The one thing that stood out was her complete refusal to even apologise to those who have been affected by these weeks of turmoil. She even tried to take credit for the 'success of MTAS' in her final statement.

What merits resignation from the new labour front bench these days? Surely downright incompetence should be enough? But then again, just look at the man in command of this lot and it then becomes abundantly clear that these people have no morals, no shame and no respect for the people they claim to serve.

Physicians Assistants- DoH’s weak response

The DoH has replied as regards questions on PAs via the freedom of information act.

When asked about the lack of evidence for PAs, the reply was:

‘All Department of Health publications are subject to the necessary level of scrutiny and reflect the necessary levels of consultation. They are not usually academic/scientific papers that need a peer-review process – the scrutiny to which they are subject is in different terms.

Department of Health documents on New Ways of Working are written in collaboration with the NHS and tested with key stakeholders (e.g. Royal Colleges, regulatory bodies). The information is easily accessible on the Department of Health website and is open to public scrutiny. ‘

What is meant by necessary level of scrutiny? This is simply justification for the DoH not using any proper scientific evidence to back up its lame duck ideology. Their idea of public scrutiny seems to be merely putting up information on a well hidden part of their website.

The evidence of the efficiency of PAs comes from the ‘There is substantial evidence from the US of Physician Assistants increasing productivity in healthcare settings. Please see the AAPA website www.aapa.org. ‘. Another completely biased source, of this is all the DoH can offer than I really do fear for our healthcare system.

Again when asked on the evidence, the only piece is this vague bit that has not been published! “http://www.hsmc.bham.ac.uk/publications/pdfreports/Physician%20Assistant%20final%20report.pdf

I then responded to this weak piece of evidence:
'I am not convinced by this rather long winded piece of writing. It has not published in a journal and has not been peer-reviewed. Do you not have any evidence other than this? And by evidence I mean something that has been published in a reputable peer-reviewed journal.

Birmingham University Health Services Management Centre is a renowned research centre. It is their decision as to whether and where they publish their research.”

To which they replied:

‘As the role is new to this country, there is no other evidence apart from testimonials from a number of Consultants and General Practitioners who have worked with PAs.’

My lord. There is no evidence at all behind their PA scheme. Unbelievable.

When the DoH are asked as to how can they justify thousands of unemployed skilled junior doctors:

‘There will always be inefficiencies in a macro workforce planning system based upon the fluctuating needs of employers, the amount of funding available and the global migration of healthcare workers. Whilst it can be seen as wasteful to train too many it is also unwise to train too few as the NHS experienced this problem in the late 1990s. The history of the NHS has proven that there is not an ideal system or formula that accurately defines the future workforce needs across health and social care. ‘

What a pathetic answer. There will always inefficiencies! Well if idiots in the DoH actually employed junior doctors rather than spending millions training these quacks then things would be significantly more efficient.

The BMA has backed the scheme: http://www.bma.org.uk/ap.nsf/Content/mcpconsultation

Will doctors be able to apply for the PA posts? (Surely they are adequately trained) and if not, why not?

‘No. The reason is that although they are doctors, their training allows them to work within the scope of practice of a doctor - not as a PA. The danger is that they may work outside the scope of practice of a PA because they have the skills and knowledge of a doctor. If they worked outside their scope of practice as a PA and something went wrong, the GMC would not be able to adjudicate. At present, if they are employed as a PA, the supervising doctor (as PAs are not regulated yet) takes some responsibility as set out in the GMC Code of Good Medical Practice.’

This is absolutely nonsensical. It is expected, as if by magic, then PAs will miraculously know their exact range of competency and hence know when they are outside this range. This is hogwash. PAs will not know when they are outside their area of ‘competency’ as they are under trained and undereducated for their role. Oh and they aren’t regulated yet, why the hell not?

How can they be bringing forward PAs but they haven’t come up with a regulation system as yet? This is simply dangerous and reckless in the extreme.

It seems all reform in the NHS today. I wonder if you have any evidence that nurse practitioners or physicians assistants are more cost effective that doctors? (as surely what is the point in changing the system if they are the same cost- the measures to put changes in place will make the overall process more expensive)

‘The development of new roles should not be based on cost alone (either the cost of training or employment). Health and social care employers need to ensure that there are career pathways for the diverse range of school leavers and graduates from further and higher education programmes. There has to be a range of skills available to meet the range of patient care needs and a range of career options to ensure employers can attract the most appropriate recruits to the care environment. As an example of this it is unfortunate that not all male school leavers have the ability to become doctors and most don't want to be nurses so we need to attract them into front line healthcare with alternative career pathways’

Another lame reply. So rather than provide a good cost effective service, it seems the DoH wants to provide jobs for everyone leaving school! This is a bizarre and flawed argument.

‘In recent years, as nurse practitioners have become more numerous, there is a much wider appreciation of what can be expected of a health professional, calling themselves by this name. It has become evident that their practice is characterized by higher levels of decision-making, independent action and the ability to make complex judgments. In addition, there is a growing body of research showing where nurses with these advanced level skills are taking on roles previously the preserve of doctors, the outcomes they achieve are at least as good, and patients as satisfied or more satisfied with their care

Though we are aware of the contribution nurse practitioners are making, and continue to support their development, it is vital that local organisations are able to make investment decisions based on local conditions. We trust our front-line doctors and nurses to know what is best for their patients, which is why we have introduced practice-based commissioning, so that their decisions can be put into effect, within the strategic intent of the PCT. ‘

Absolute rot again. The DoH seems very happy to make baseless statements backed up by hot air and no evidence. Where is the ‘research’ they point to?

Given that the DoH keeps going on about their policy being open to public scrutiny:

I quote the DoH "The information is easily accessible on the Department of Health website (http://www.dh.gov.uk/) and is open to public scrutiny." How is the information open to public scrutiny other than by being accessible via the website? Why not introduce some kind of on lone voting process whereby members of the public can agree or disagree with policies?

‘You then asked how what other ways other than the website is information open
to public scrutiny. Department of Health publications may also be ordered via the Parliamentary hotline (0845 702 3474). However, the Department of Health website is an excellent vehicle for publicising DH policy and is very widely used having 875,897 unique users in November 2006, 618,055 in December 2006 and 830,614 in January 2007. With regard to your suggestion on lone voting, the Department is always looking to update and improve its website. Your suggestion has been passed to the Department of Health website management board for consideration in future website updates.

Additionally, if you have concerns regarding Government health policy, you may wish to consider contacting your local member of Parliament, who, as your elected representative, is best placed to take up your concerns on a national level.’

Overall Physicians Assistants are another in a long line of poorly thought out policy that is based on no credible evidence, and this is not an efficient use of tax payer’s money. The biggest concern is that the DoH’s logic circuit is wired incorrectly.

It appears that the DoH can create and justify any quack practitioner as long as they have a defined competency area. They then make the assumption that because they have a defined area of competency, the particular quack will automatically know when they are practicing outside their specific area of competence. Unfortunately this assumption is flawed as instinctively knowing when one is working outside ones area of competence is only something that comes with extensive experience and training. Many of these quacks, such as PAs, will not be safe to practice unsupervised after such short periods of training and supervision. They will frequently not realise when they are outside their ‘area of competence’. They are accidents waiting to happen and the patients will be the ones to suffer.

It is also exceedingly worrying that this regime will use rather inconsistent and illogical arguments to justify its pursuit of policy based on ideology. They care not for evidence and efficiency, they are simply pursuing a predetermined ideological path at any cost. This is negligent and it is a danger to us all.

The march - a sign of things to come

What a fantastic event and what a show of unity against our pathetic government. The day after the 'Mtas review muppets' came up with their bizarre and nonsensical changes to the MTAS process, the doctors in this country showed them where they should stick their useless ideas. It was somewhere the sun doesn't shine I believe.

http://nhsblogdoc.blogspot.com/2007/03/mtas-march-first-reports.html

An excellent clip from a very well spoken neurosurgeon telling it like it is.

http://www.telegraph.co.uk/news/main.jhtml?xml=/news/2007/03/17/ndoc117.xml

Apparently the young lady hugging Dave Cameron said 'We love you and I'm a socialist!'.

http://www.channel4.com/player/v2/player.jsp?showId=5407

Lord Hunt made to look like the absolutely clueless tosspot he is; apparently unaware that the BMA have called for the MTAS process to be halted, having one BMA rep on the review panel is hardly representative is it? Especially if that BMA member doesn't push for the views of his own organisation! Lord Hunt, rhymes with..........

Some more fantastic speeches here:

http://www.mmc360.com/latest/latestnews.php?a=c&cid=03172007083948&tt=

So Hunt, Donaldson, Crockard, Blair, Hewitt, Douglas and the rest of you; you better stand up and take notice of what is happening because people have had enough of being treated like small idiotic children. Your time is running out and it is about bloody time that your corrupt ideology caught up with you. The medical profession will not bend over for you any longer, today is the start of something rather special. Today is the potential platform from which we must go on to force their hand. This government must be made to regret its systematic destruction of medical professionalism in the cynical pursuit of power. This day must be a day that is looked back on in years to come as a great turning point. It will take a lot more hard work and lot more militancy over the weeks ahead, but the medical profession has its belief back and the momentum must be exploited.

Bring the ruckus

Today is the day of the March.

https://www.mtas.nhs.uk/info/review_panel_1603.html

What a surprise that the 'independent' review panel has done absolutely bugger all. These cronies who are behind MMC and MTAS were never going to do anything more than chat a lot of hot air and make some mild changes to MTAS. This part of their pathetic statement sums it up for me:

"Deaneries across England have said that they have already interviewed many excellent doctors and that the new system is an improvement on the less structured nature of the old system. The GP recruitment continues to work very well with a record number of GPs being recruited into the NHS."

These people do not care that the whole selection process is unfair, deeply flawed and overtly corrupt. They have ignored what is happening on the ground, and they merely speak to the people they know will agree with themselves. They are downright scum. Have these absolute idiots seen how many consultants have withdrawn, how many consultants who have expressed concern and how many juniors who want to see the whole system scrapped. It is symptomatic of a medical dictatorship that never consults the profession on anything because it knows its own policies are deeply corrupt.

"The JDC has also called for Prof Crockard's immediate resignation. An MMC spokesman declined to comment on the matter."

These people, who include Liam Donaldson and Alan Crockard (they do not deserve their titles in my view), do not show their faces in the media and they never subject themselves to public scrutiny. They are part of an increasingly shady and authoritarian regime that is happy to spin baseless propaganda as being good for us all, but they hide away from any questions and are never seen in public to explain themselves. Like their political mistress, Patricia Hewitt, they mysteriously go missing for weeks in times of crisis and will never appear in the media to justify their negligent errors.

www.remedy.org.uk

March, march, march. Make these political stooges regret the day they sold their souls to the DoH mainframe. They are quaking in their boots as we speak.

consultants continue to abandon the MTAS ship

"Dear XXXXX,
It is with the greatest regret that after serious deliberation, I have decided to write to you with my resignation from the position of Chairman of the Emergency medicine Training committee of the Eastern Region. This is in protest over the shambolic MTAS recruitment process that is unravelling which I believe is threatening to destroy the high standard of medical training in the UK.Last Friday, 9th March, I was urged by XXXXXX and many of my colleagues to continue and I agreed to stay and interview the ACCS ST1 and ST2 shortlisted candidates since it was felt it would be unfair on them not to do so at the time.

However, having reflected over the weekend, I have decided I can no longer support the current MTAS recruitment process. I believe it has not been thought through properly, its implementation rushed, and it is unfair to the trainees. Hence it seriously threatens to undermine the high standard of medical training and moral among trainees and consequently patient care. I have spoken to many trainee doctors of all grades who are seriously demoralised and concerned; They don’t know what to expect from one day to the next, as they receive contradictory advice and the rules keep changing constantly. My sympathies are with them.I may be criticised as abandoning the ship during the storm -or as XXXXXXXX puts it “leaving in the middle of a major operation with blood on the floor”. However, my record of 13 years as Program Director and Chairman of the Eastern RTC overseeing the ‘Calman’ changes successfully in the 1990’s and helping develop an expanding and successful emergency medicine training program in our region speak otherwise. I am not aversed to change. I believe the MTAS recruitment process and the MMC changes in their current form are detrimental and unworkable. I don’t wish to be associated with them any longer and hence have no other option but to resign from the Chairmanship of the Emergency medicine Regional Training Committee.
Yours sincerely"

This is after several interviewing panels of consultants have pulled out of the unfit MTAS process, for one example:

http://www.thestirrer.co.uk/0503072.html

How much longer will this farce be allowed to continue?

The wounded MTAS beast is wheeled forward

How deeply flawed, corrupt and lame must a policy be for the DOH to scrap it? Stupid question. They won't scrap anything that they create; if the DOH had made the Titanic, then they would still be talking up its chances of rising from the ocean to set sail once more! I do not exaggerate. MTAS is at the bottom of the ocean, it is disintegrating before our very eyes; yet the DOH have not yet written in off. The DOH have revealed their true colours once again. They are nothing more than scum, intent on forcing through an ill conceived and corrupt ideology upon us.

Several groups of consultants have withdrawn from the interviews already and the vast majority of opinion (other than the 'independent' review panel) lies in favour of scrapping this failed system. In fact doctors are marching on the 17th of March in London and they are not a bunch to take to the streets without good reason. Even the Royal College of Surgeons are firmly against the process:

http://rcs.niss.ac.uk/public/pns/DisplayPN.cgi?pn_id=2007_0006

I do not use the word 'scum' lightly. The agenda behind MMC and its side arm MTAS is truly despicable. The aim is to take control of the medial profession and create a cohort of drones to undertake service provision. With a disempower and less trained medical profession it will be much easier to force through the privatisation of NHS services. The problem with this plan is that it will wreck the health system completely. Many doctors will quit medicine and many more will flee to greener pastures abroad, where they will be treated with more respect and dignity. The new cohort will be poorly trained thanks to MMC, which emphasises form filling 'competency' at the expense of proper clinical experience. Hence even if the good doctors stay around to be trained, they will not be half as good as the current crop of consultants. One must also add to this that doctors do not like to be treated as machine-like service providers and they will continue to emigrate to countries where they are treated better. The creation of a service-providing privatised service will be a recipe for worsening health inequality in the UK, it will also be more bureaucratic and less cost effective than the current system.

http://careerfocus.bmj.com/cgi/content/full/334/7591/77

All in all MMC is a cynical and corrupt plot from a nasty government that would rather bully people than cooperate with them. The long term impact on our health system and patient care will be truly devastating if the cronies pushing MMC forward are not stopped firmly in their tracks. It's also a great shame that the government has no trust or respect for its people, as it would be much cheaper and more effective to engage with the medical profession to come up with a workable long term solution. History has taught us that bullying very rarely creates long term harmony, and MMC will be yet another example of a bullying failure to add to this list unless something is done.

These two excellent pieces from the telegraph sum up how MMC/MTAS are dangers for us all:

http://www.telegraph.co.uk/opinion/main.jhtml?xml=/opinion/2007/03/10/do1002.xml

http://www.telegraph.co.uk/opinion/main.jhtml?xml=/opinion/2007/03/11/do1103.xml

So unless you want a health care system run by poorly trained demoralised doctors, then I suggest you get behind the medical profession in fighting this dangerous government reform. This MTAS debacle is merely the tip of the iceberg, but it does demonstrate that this despicable government cares nothing for the long term future of its people. This government has shown once again that it will not stop railroading through its corrupt ideology until someone stands in its way and says 'enough, no more'. We must join together and fight these bastards to the death, as if we do not and they win; the prospect does not bear thinking about.

Modernising Medical Careers - deafening silence

Some naughty monkey has been emailing the Department of Health about MMC under the freedom of information act. Having probed and teased a little, it has been discovered that the Department is indeed withholding vital information from its stakeholders, the public:


"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, the Department considers that this information is exempt from disclosure under section 35 of the Freedom of Information Act for reasons set out below.

Section 35 covers the formulation of government policy. While the Department appreciates that there is a general public interest in the availability of information about public sector activity, this must be weighed against the public interest in 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. In this case, we have determined that the balance of public interest favours withholding the information."

This has been appealed via the appropriate channels and the most recent DOH comment is here:

"I apologise for the delay in replying to your recent email asking for the outcome of your internal review. Your internal review case is still being processed and you will be informed of the outcome as soon as the review is complete. We hope to send out the outcome by Friday 23rd March 2007 as opposed to 12th March 2007 due date (40 working days as stated on DH website for internal reviews). If we envisage any further delay, we will inform you. I am sorry for this delay."

Mmmmmmmmmmmmmm. Seems a tad suspect that this is being stalled and stalled, maybe it's something to do with the current fiasco surrounding MMC and MTAS. It wouldn't be good for those MMC merchants if documents revealing their real intentions came out now, would it? I'll leave that for you to decide.

Nut basket MTAS

The last few weeks has seen MTAS (medical training application service) start off with more than a few glitches. In fact the system has been called a ‘shambles’ on the broadsheet front pages (1). The potential human cost of such system failure appears to be massive, so it begs the question: is there any evidence that backs up the MTAS process?

This study (2) analysed a new system used to select GP registrars, which incorporated application forms using competency based statements, structured interviews and a lengthy selection day at an assessment centre. Saliently the use of the application forms is all but ignored in the results and discussion. The focus is upon the finding that those candidates who did well at the very long assessment centre selection, which involved several 20-40 minute stations, did better in their jobs three months down the line. This is not a particularly dramatic result; as most people would assume that the more rigorous the assessment centre, the better it would be at weeding out the weaker candidates. There is no mention of a correlation between the application form scores and job performance, this is surprisingly omitted.

“Furthermore, as the comparison and matched group were demographically not equivalent to the initial intervention sample (354 applicants), caution is needed in generalisability of the results”

Quoting directly from the study (2), the authors are admitting that great caution should be taken in generalising from these results, possibly advice that MTAS should not have ignored. There is another similar study (3) that has been published since this, which found that a lengthy rigorous assessment centre process was useful in selecting paediatric doctors for higher training. From what I have gleaned, the evidence shows that lengthy and rigorous assessment centre selections are good at selecting candidates; hardly rocket science is it?

MTAS has used an application form which gives a rather large amount of weight to competency based questions, and a rather minimal amount of weight to concrete provable achievements like royal college exams, prizes, publications and courses. Is there any evidence base on which the MTAS form has been sculpted? This study (4) is about the only evidence around concerning the use of competency based statements. It demonstrated that applicants who added competency based statements to their résumés got higher scores from Human Resources departments. The relevance of this to MTAS seems pretty contentious, to say the least.MTAS does not seem to have much evidence behind its application forms. The recurring theme from the research seems to be that thorough selection days at assessment centres are very useful in getting the best candidates for the jobs. The process of allocating such a high percentage of short listing marks for competency based questions does not seem to have ever been validated or proven, and this makes the current bunch of juniors look increasingly like experimental subjects.

What is wrong with the Curriculum Vitae and good old references? After all, these formats have stood the test of time and are still used as a selection tool to this day by numerous big companies and businesses around the globe. A good reference is the highest commendation one can be given, the referee is putting his reputation on the line for you, and this cannot be summed up into numbers and highly structured scores. It is also insane to pretend that it makes no difference which university one attended or which jobs one has had, this is political correctness gone raving mad.If one assumes that the MTAS process is incorruptible, then we are still left with a new selection tool that has no evidence behind its use. However if one entertains the possibility of a corrupt MTAS process, then we have an even bigger disaster on our hands. There have been rumours that some candidates have had access to confidential information, thus giving them an unfair advantage in this selection process. So either way, the CV is looking like a utopian tool in comparison with MTAS.

The potential human cost of a deeply flawed selection process is massive. Whatever the tool used, the unemployment of junior doctors was going to be a big problem; but with a flawed selection tool, some of the very best junior doctors may be amongst those signing on. How on earth did the MTAS application form come into existence in its current form? As it appears that scientific evidence had very little do with it..If everything that is subjective continues to be brutally destroyed in this manner, it will soon become apparent that not much remains. If things cannot be translated into numbers, it does not mean they are meaningless, far from it. We are humans after all, and by trying to rigidly standardize everything under the sun, we are forgetting this important fact. The subjective human touch is often impossible quantify, but this doesn’t make it worthless; it makes it priceless and we might not be in the pickle we are in today if certain people had remembered this.

1. The Daily Telegraph front page 01/03/2007 http://www.telegraph.co.uk/news/main.jhtml?xml=/news/2007/03/02/nhs02.xml2. A new selection system to recruit general practice registrars: preliminary findings from a validation study. Patterson et al. BMJ 2005;330:711-714.3. Randall, R, Davies, H, Patterson, F, Farrell, K (2006). Selecting doctors for postgraduate training in paediatrics using a competency based assessment centre.. Arch. Dis. Child. 91: 444-448.4. Jim Bright and Sonia Hutton. The impact of competency statements on resumees for short-listing decisions. International journal of selection and assessment. Volume 8 Issue 2 Page 41 - June 2000.

The MTAS wheels fly off

Encouraging news is emerging that the MTAS juggernaut may be taking a few hits. Consultants in the West Midlands have taken the unprecedented step of abandoning interviews due to their complete lack of faith in the MTAS process:

http://www.drrant.net/2007/03/medicine-strikes-back.html

This is also being reported in the broadsheets:

http://www.timesonline.co.uk/tol/news/uk/health/article1475236.ece

http://www.telegraph.co.uk/news/main.jhtml?xml=/news/2007/03/06/nsurgeon06.xml

And this is magnificent from the Norfolk and Norwich bosses:

http://www.telegraph.co.uk/news/main.jhtml?xml=/news/2007/03/05/ndocletter105.xml

The BMA are also rather surprisingly showing signs of awakening.

Long may this continue. Long live the revolution.

Words of a junior

I feel like crying.

All my life there has been only one thing that I have wanted to do. I worked hard at school to get to medical school, I then worked hard at medical school to give myself the best shot at the jobs I wanted later on. I passed all my exams, won a few prizes along the way and was generally a good all rounder.

I was warned off medicine by my family and friends, they said it was too stressful and the NHS was in trouble; but I found the subject fascinating and it was not a matter of choice for me.

I have worked hard since I qualified and have had good references from all my employers. I have not taken a single day off ill in my first few years of work, and there are days when I have not felt well enough to come into work. I have passed several postgraduate examinations and attended all the relevant courses, as well as having several articles published in scientific journals.

There are many others just like me. Each of us has made numerous sacrifices because we love what we do. Our study budgets and study leave quotas have been cut, meaning we have had to pay for our own training and attend courses in our annual leave. The trust has also stopped properly reimbursing us for our travel expenses and removal costs. However we carried on because we thought that it would all be worth it, if we could have a job at the end of it doing what we loved.

These last few weeks have been the final straw for many of us. We have been subjected to the most unfair and least meritocratic selection process ever seen, MTAS (medical training application service) via MMC (modernizing medical careers). We have had to sum up our years of work and experience in several politically correct short answer questions, on which we are then judged. Examinations, experience and references are all but ignored in the pursuit of vague waffle.

The computer system crashes time and time again, confusion reigns supreme and hundreds of consultants are appalled by the process. Yet it is allowed to proceed. The short listing results are released in dribs and drabs and thousands of juniors tap away on their keyboards in a state of sheer panic, realizing that their future is being decided by the MTAS tombola.

Some of us have been lucky enough to get short listed for the jobs we want, but we shouldn’t have had to be lucky. The process should have been meritocratic, well organized and fair. It was most definitely none of these.

Young doctors such as myself are appalled by what we have had to endure this year. No one should have to go through such a process again. We all know people who are going to have their hopes and dreams crushed by this cruel joke of a system.

Shame on those who are behind this scheme. Many a tear will be shed this week by many brilliant young doctors who have had their hopes and dreams crushed in a quite barbaric fashion. Many of us will emigrate and many of us will leave the profession; I hope those behind the scheme are proud of these achievements.

Of course we do not all expect to be handed our perfect jobs on a plate. However we deserve not be lied to, we deserve not to be treated unfairly and we deserve to be treated with a little more dignity, respect and humanity than we have in 2007.

MTAS and its corruptible nature

The Medical Training Application Service (MTAS) was brought in with MMC to make the selection process fairer and more meritocratic. The centralised scheme was designed to make applying for a job easy and straightforward. If only things were that way.

I will be careful with my words. Firstly the application system is fundamentally flawed by allocating such a high percentage of marks to the short answer questions. I would argue that it is impossible to effectively discriminate between candidates using this skewed approach.

Each of these short answer questions was marked out of four marks and many problems have stemmed from the rigid marking scheme, as well as the weighting of marks in a way that virtually ignores examinations and other achievements. The MTAS process has not been audited or validated properly either.

" MMC profiteers. Get hold of a copy of Hospital doctor this week as RemedyUK help expose the burgeoning industry of people making a fast buck out of desperate doctors looking to buff up their application form. Of note is one MALVENA STUART TAYLOR, ASSOCIATE DEAN of Wessex Deanery, charging £129 to each of the 100 doctors desperate enough to show up for basic advice on filling out the application form. Helpfully included in her lowbrow 3 ½ hour lecture on the principles and background of MMC/MTAS etc (made possible by industry leaders www.123doc.com) was a seminar aimed at selling financial advice, particularly well received by attendees given their current situation."

I quote from RemedyUK above. They also found that around 1 in 5 SHOs had received formalised advice on filling in their forms.

The muck does not stop flying. Many candidates were helped in filling in their forms by consultants who had insider knowledge as they were involved in the marking and short listing process. Word on the street indicates that confidential marking schemes found their way to some candidates giving them an unfair advantage. Word on the street also tells me that there have been cases of printed confidential marking schemes being handed out to juniors by consultants. The rigid marking schemes meant that the system was inherently biased against doctors who had not been through this bizarre application process before. There are even rumours of even worse.

There have been several examples of companies profiteering thanks to insider knowledge.

http://www.123doc.com/foundationyearmasterclass.php

This course, run by associate deans, claimed that it would help you 'take advantage' of the MMC process. I cannot see much difference between this and 'cheating'. This is by no means an isolated example. MTAS have also admitted that there is no system to ensure that short listing has been completed by all applicants; this is completely unacceptable.

MTAS and MMC were railroaded through under the promise of a fairer application process for all. I fail to see any evidence of this, it seems that the converse is true. The old system was by no means perfect, but no system is perfect; however by using CVs and local applications the process was much more meritocratic that today's. Doctors with greater experience, more motivation and more achievements had a fair advantage in the old system. The CV is a tried and tested selection tool that is still used to this day by all major companies. It is eminently less corruptible.

This tried and tested method has been replaced with an untried and untested farce. Doctors who lie, who cheat and who are assisted by those with insider knowledge are given a massively unfair advantage. While many of the best doctors with the most achievements are left out in the cold, because they did not fill in a few politically correct questions very well and because they did not lie or cheat. This is what MMC and MTAS has produced, a selection process that is not even as good as a roulette wheel; the roulette wheel is not as corruptible.

It is hard to sum up the human cost as a result of this selection sham. There are juniors who have worked their fingers to the bone for several years with the aim of a job in their chosen specialty. They have passed all the neccessary tests and examinations, they have attended all the relevant courses, they have worked hard to get material published and they have done this all while holding down a rather demanding full time job. Some of these juniors are supporting just themselves, but many are supporting partners and small children while they do all this. They are juniors who have a burning desire for their particular specialty and will be forced to emigrate thanks to recent events. How this new system is going to be good for medicine in the UK is quite beyond me.

Some of us have been lucky, this is true, but can we really sleep at night knowing that some of the best candidates out there have not got a single interview. Some of these juniors are family members, some are friends, but the vast majority are people we will never meet. Doesn't it feel a tiny bit hollow getting an interview when you know that the selection process is such a joke? Imagine how it will feel to get a job in your chosen specialty; it won't feel as satisfying as when the selection process was fair, there will be a nasty nagging emptiness inside of you that will eat away at you because so many juniors have been treated so very unfairly.

There are signs that the MTAS beast may be wounded, the media are starting to take an interest in what can only be described as a massive scandal:

http://www.telegraph.co.uk/news/main.jhtml;jsessionid=CMIJLY1I31CUXQFIQMGCFFOAVCBQUIV0?xml=/news/2007/03/02/nhs02.xml

http://www.telegraph.co.uk/news/main.jhtml;jsessionid=CMIJLY1I31CUXQFIQMGCFFOAVCBQUIV0?xml=/news/2007/03/02/nhs102.xml

Dr Crippen is spot on as ever: http://nhsblogdoc.blogspot.com/

This momentum needs to be kept up, the apologists for MTAS must be made to eat their hollow words, this battle must be won.

Watch this space.

Crony state of affairs

Last night on Channel 4 'Dispatches', government health policy was comprehensively analysed and blown to smithereens. Liam Halligan did an absolutely fantastic job in presenting such a well researched piece of journalism. He put the BBC to shame given their pathetic attempts at commenting on health policy in recent years, where ministers are given notoriously easy rides and tricky areas are just glossed over. Patricia Hewitt was made to squirm like the absolute ignoramus she is, something the BBC has singularly failed to achieve in several attempts.

http://www.channel4.com/news/dispatches/article.jsp?id=1326

http://www.telegraph.co.uk/news/main.jhtml?xml=/news/2007/02/25/nrhewitt125.xml

http://www.telegraph.co.uk/news/main.jhtml?xml=/news/2007/02/25/nrhewitt25.xml

I am sorry but the time for sensible dialogue with the likes of Blair and Hewitt is useless. They have no respect for the NHS and no respect for the public. This is shown by their repeated lies and overt contempt for the democratic process. The NHS reforms are not working, they are the root cause of the problems and things will only improve when these reforms are firmly stopped in their tracks. The politicians so far have not engaged in any fair debate, they merely repeat soundbites and drone on with some manipulated statistics to back up their flimsy arguments.

A rather biased BBC program looking at the David Kelly death was on the other night. Unfortunately all the 'proof' of suicide was kept for the end of the program, in a way that set out to convince people it was actually a suicide. A lovely bit of BBC spin.

http://en.wikipedia.org/wiki/David_Kelly

Were viewers meant to forget the facts that had been presented earlier in the program? These were facts that showed the Hutton enquiry to have less power than a coroner's inquest, that showed the cause of death to be very unclear and unproven, and that showed the Hutton inquiry was deeply flawed and lacking in investigative rigour.

http://www.newstatesman.com/200505020027

As these medical expert say, due process has not been followed in investigating the death of David Kelly. Serious and legitimate questions remain unanswered. Whether it was suicide or not; the David Kelly debate will rage on and on until it is investigated properly. My hat goes off to Norman Baker who seems to be one of a rather rare subspecies of politician; he actually cares and believes in certain principles.

The same cannot be said for Tony Blair and his cronies. Their behaviour in the David Kelly affair was absolutely scandalous, they hung Mr Kelly out to dry in a way that was totally indefensible. There is a complete lack of rigour that seems to apply to politicians when they make decisions that have massive implications. They can take us to war and then when is abundantly clear that due process has not been followed, and nothing happens. If something inconvenient happens to the government and it is investigated; the PM will appoint one of a band of friendly cronies to investigate, thus ensuring the PM will hear what he wants to hear. Even when it is proven that a politician has acted corruptly, it still requires the PM to act for some kind of punishment to occur and we know how often things are simply brushed under the carpet. The PM also has his resident 'poodle', the Attorney General, who he can always pressure for legal backing to any decision if he needs it. This complete lack of accountability seen in politics is in stark contrast to the recent clampdown on medical regulation; doctors will have their reputations wrecked under a civil 'balance of probabilities' rather than the old criminal 'reasonable doubt' and doctors will be constantly living in fear thanks to several other draconian measures imposed upon them by their political masters.

No wonder the NHS is in a mess. The democratic process that we rely on to drive us forwards is failing. This crony government seems to be answerable only to itself, as it goes about wrecking our country's chances of long term prosperity in the pursuit corrupt and idiotic short term gains. The one hope is that they will be made accountable at the next election, but how do we know that the next lot will not do exactly the same?

The shambolic disgrace of MTAS

This year has been the first year that all junior doctors have been blessed with the opportunity to apply for their specialist training posts via MTAS (Medical Training Application Service). I use the word 'blessed' to intimate how those in power see things working.

Junior doctors do not see things like this. The application process has been a disorganised shambles. From the very start there were hundreds of problems with; the application forms, the website crashing, the vague questions asked, the help desk not answering valid questions, the submission of applications not working, chunks of applications going missing, job descriptions changing after applications had been submitted, job numbers changing after applications had been submitted, not forgetting the poor souls who missed the application deadline, as well as countless other problems. The most glaring problem was the fact that the server crashed day in day out, thus losing people's applications, and then when the closing date came: the server ran at the speed of a dead tortoise while crashing every few minutes.

The problems didn't stop there. Hundreds of consultants have had to shortlist applicants for interviews based on their answers to vague politically correct waffle. Over 75% of the 'marks' are given for these vague questions, while achievements like exams and work experience are pretty much ignored. This has infuriated consultants who have the impossible job of choosing the best candidates when they effectively have their hands tied behind their backs. Add the appalling lack of meritocracy to the fact that there simply has not been enough time to mark all these applications and complete the shortlisting before the allotted deadline.

This has meant that the deadline has been pushed back to 9am today on the 26th of February. Today it should have been possible for all juniors who had applied to check their applications, see if they had an interview, book the interview and organise the time off work.

Inevitably the theory that MTAS is run by a small band of management consultant monkeys has been substantially strengthened after the events of today. Over half the deaneries have not had time to complete their shortlisting and there are yet again numerous problems with the MTAS website. This practically means that junior doctors are being stressed out beyond belief as they don't know if they have interviews and they don't know if they have to book time off work for an interview (in some cases the interviews are in two days time!) . Dr Rant has a rather good piece on MMC/MTAS et al.

http://www.drrant.net/2007/02/fuck-choice-choose-mmc-again.html

MTAS is symptomatic of this government's gross incompetence, which is revealed by repeated attempts to centralise everything in the naive belief that grand centralised schemes are always better than the systems they are replacing. Junior doctors have not only been shafted by this government's reforms of medical training and the destruction of a healthcare system that can support training in a sustainable manner; they are now been royally rogered by an application system that is nowhere near being fit for purpose. No wonder juniors are emigrating in droves; the true cost of this government's policies will not become fully apparent for years but when they do become apparent, the faeces will emphatically hit the fan.

I'm off to buy my sledge hammer.

NHS getting better! more marvels of the internal market

I just had to come out and say what a revolution to patient care the old 'internal market' is. There's more evidence of the successes of payment by results here in the paper:

http://www.telegraph.co.uk/news/main.jhtml;jsessionid=BJYNJTWMJ5EBDQFIQMGSFFWAVCBQWIV0?xml=/news/2007/02/25/nhs25.xml

The logic is truly poetic. Operations are being postponed around the country because there is no enough money to pay for them! One would assume that there is not enough money to pay for the surgeons, nurses, equipment etc, but this is not a problem at all. The PCTs do not have enough money to pay the hospital to do the work, because of the ludicrous 'internal market' system.

Thus we have highly skilled surgeons sitting around twiddling their thumbs, while theatres sit empty and nurses think of ways to pass the time! These staff and facilities are all paid for and able to do the work, but there is not enough 'money' to pay for it!

Am I an idiot to think that the 'internal market' makes about as much sense as an epileptic monkey on a type-writer? Patricia Hewitt think so, but then she is arguably less articulate that the aforementioned monkey.

Why not just fund the hospitals to pay for the work that needs doing? No, that would be far too simple, more efficient and less bureaucratic! That was the old NHS, this is the brave new NHS.

Looks like the brave new NHS' monkey in charge, Patricia Hewitt, may start feeling the heat in the form of some Channel 4 crafted gusts up her skirt:

http://www.telegraph.co.uk/news/main.jhtml?xml=/news/2007/02/25/nrhewitt25.xml

http://www.mirror.co.uk/news/columnists/routledge/tm_headline=nanny-is-in-a-state%2method=full%26objectid=18664962%26siteid=89520-name_page.html

Get ready for Channel 4 to stick the knife in, it is about bloody time that the 'internal market' and the government's useless mismanagement were exposed for the scandals they are.

(post scriptum- another great piece in the telegraph explaining how the governments policies are destroying things: here:http://www.telegraph.co.uk/health/main.jhtml?xml=/health/2007/02/26/hnhs26.xml)

Dubious flawed and corrupt.............D'oh

Another night shift passes by, my eyes hurt and my breath smells of general unpleasantness. A topic of great controversy in medicine today is that of extending the roles of other non-medical so-called healthcare practitioners.

Trends seem to pass over the Atlantic almost seamlessly at times, and there appears to be little correlation between policy migration and policy quality. For one the UK has miraculously managed to export gang culture from the US of late. There are those who would utter words including privatisation, deregulation, flexible labour market and imperial capitalism. I won't go there for the moment, my fingers are too tired to embark on that journey.

In the UK the role of nurse has been extended in many ways in recent years. There are undoubtedly some new nursing roles that provide a great service very safely. However I would argue that some boundaries have been pushed back way too far, in such a way that we have pseudo-practitioners dangerously practising medicine in areas in which they have not been adequately trained. One example of this is handing the right to fully prescribe to nurses and pharmacists. Another is handing diagnostic work (which includes history taking, physical examination, ordering/interpreting investigations, initiating safe management plans and organising aftercare) to those who have not been sufficiently trained in this area.

These schemes originated in the US and have since migrated to the UK. The motives for handing more responsibility to less skilled staff are arguably linked to the pressures that drive the american healthcare system. The largely privately run US healthcare industry could be said to be trying to squeeze profit at the expense of service. It may be cheaper to replace highly trained and highly skilled workers with undertrained minions, but what of the service provided? It is certainly not unheard of for the private sector to squeeze service for the sake of profit, the term 'fat trimming' is often used to look upon this practice favourably.

Anyways I digress, back to the point, and that was meant to be extending full prescribing rights to non-doctors. In 2006 a vote was passed by a committee that handed out this power to nurses and pharmacists. Dubiously this committee was made up of a majority of non-medically trained individuals and all those who were medical voted 'NO'. The consultation process revealed that an overwhelming majority of medical bodies were opposed to the scheme. Despite this dodgy vote and flawed consultation process, surprise surprise, the government has carried on and it is now law. Someone has therefore tried to obtain a bit more juice on this from the DOH:

"Dear DOH,

I write as regards the decision to extend prescribing in non-medical practitioners in 2006.

Pulse obtained documents in 2006 that showed that not one of 16 medical bodies supported this move for pharmacists.

Also only one of fourteen medical bodies supported the move for nurses.

The moves were unsurprisingly supported by nursing and phamacists' bodies or NHS bodies, all clearly very baised sources to base any decision on.

The questions I want answered are:

1. How can this consultation process have been deemed fair and adequate when it ignored the massive majority of expert medical opinion in making a medical decision?

2. If you still claim the consultation process was adequate then did you have any scientific peer-reviewed research that suggest nurse or pharmacist prescribing is safe?

3. I do not quite understand how nurses and pharmacists can be allowed to prescribe when they have not been adequately trained to take a history, examine and diagnose; this means they cannot be safe to prescribe as these diagnostic skills are key in safe prescribing.

4. I quote Pulse: "A Department of Health spokesperson insisted the recommendations took all consultation responses into account, 'including those from doctors'."; a consultation process does not merely involve pretending to listen to the information achieved via consultation, it involves scrapping schemes where there is an abundance of expert opinion that states the scheme is not appropriate or unsafe. Why did the DOH press ahead despite the wealth of medical expert opinion against the scheme?

5. Specifically I want to who ( if the prime minister, any politicians, advisers or other senior DOH officials) had an input into making this decision to go ahead with these scheme of non-medical prescribing despite a wealth of medical expert opinion against it? I want to see any documents of discussion between officials/minister/advisers about this consultation process and decision.

6. Also there was a vote on this non-medical prescribing. I want to know how the committee that discussed and voted on the issue was decided upon. Were senior minister, politicians, government advisers, senior DOH officials involved in the decision as regards who was on this committee? I want to see documents of any discussion as to who should sit on this committee?

7. Also as regards the vote on non-medical prescribing; I would like to know the details of everyone who was on the committee and which way they voted, and if they had any conflicts of interest ( ie who they worked for and any financial interests of relevance )?

8. Finally where did this idea of giving full prescribing rights to nurses and pharmacists come from? I want to know if there were any high level discussions between the PM, politicians, advisers, senior DOH officials that reveal where this idea came from and the motives behind this idea? Were any private healthcare companies involved in lobbying politicians about this issue?

9. Specifically have any employees or representatives of any of the following companies ever discussed the issue of non-medical prescribing with any politicians, ministers, advisers, DOH officials, civil servants? The companies I am interested in are Boots, United healthcare, Capio healthcare, BMI Healthcare, MercuryHealth, Alliance Medical, Aspen Healthcare, Netcare, BUPA, InterHealth Jarvis, Patients Choice Partners.

10. I would also like to know if any of the following companies' employees or representatives ( Boots, United healthcare, Capio healthcare, BMI Healthcare, MercuryHealth, Alliance Medical, Aspen Healthcare, Netcare, BUPA, InterHealth Jarvis, Patients Choice Partners.) have lobbied or discussed any of the following subjects with politicians, civil servants, advisers, DOH officials? The subjects I am interested are the extension of nurses roles, the new role of the physicians assistant, Modernising medical careers (MMC), ISTCs and PFI schemes? If they have then I want to see evidence of any discussions/negotiations,

many thanks for the excellent service you provide,

yours, "

Comical 'Blair', private equity and patient 'safety'....

Could Tony Blair be copying the tactics of the mighty comical Ali?

http://www.guardian.co.uk/commentisfree/story/0,,2020424,00.html

An excellent piece on those lovely fellows who work in the world of private equity, selflessly making the economy a better place for us all in the long term.

http://www.guardian.co.uk/commentisfree/story/0,,2019475,00.html

A highly respected diplomat tells us what he really thinks of Blair and Iraq.

http://www.telegraph.co.uk/news/main.jhtml?xml=/news/2007/02/22/niraq22.xml

"Sir Ian Kennedy, chairman of the Healthcare Commission, said health ministers had imposed a welter of targets on the NHS since 1997 to change behaviour in hospitals and GP surgeries. But they did not give patient safety the attention it deserved. Apart from a target to reduce deaths from MRSA, there were no other signals from the centre that patient safety was the NHS's most important issue, he told a safety seminar in London.
"Even when targets ruled the day, there were none relating to the [overall] safety of patients. Yet targets were the way the government indicated its priorities. I am not advocating a wholesale return to targets. But I am saying patient safety should be everyone's business and everyone's responsibility," he said."

http://www.guardian.co.uk/medicine/story/0,,2019386,00.html

Indeed, there seems to be no one in the management hierarchy, including Sir Liam and the DOH, who is actually looking after this much repeated phenomenon 'patient safety'.

Could it be something to do with the complete lack of a holistic understanding of the health service in general? Could the deliberate manipulation of systems to fiddle targets, in order to produce ammunition for government spin, be anything to do with the problem?

CFISSA - media blackout

CFISSA- This stands for centrally funded government health initiatives and is a very hush-hush topic in the press. It shouldn't be.

This is because last year 2005-6, CFISSA was over 6 Billion pounds over budget out of a total budget of less than fifteen billion pounds.

Given that operations and investigations are being cancelled thanks to an NHS deficit of less than 1 billion pounds, it makes one scratch one's head and think why is this not reported in the mainstream press?

The NHS deficit has accumulated over many years and is tiny relative to the total NHS budget. While the CFISSA deficit is over six times the total NHS deficit, it has gathered in a relatively much shorter space of time.


http://www.info.doh.gov.uk/doh/finman.nsf/0/e620764d2e48e856802569680048a2e1?OpenDocument

(http://www.dh.gov.uk/PublicationsAndStatistics/Publications/AnnualReports/fs/en

Significant Underspends (2004-2006):
Cancer -77 million
CHD -37 million
Mental health -34 million
Reducing health inequalities -169 million
Workforce -667 million

Significant Overspends (2004-2006):
Older People +165 million (interesting this: an overspend of +374 million, followed by a dramatic underspend of -209 million)
Improving patient experience +68 million
IM&T +696 million
Specialist health services +1065 million (audiology, dentistry, ophthalmic <-- already privatised) Modernisation agency +63 million Primary care +4153 million Residual budgets (eg to SHAs) +3938 million
PCT allocations +5574 million

Those bottom two are very significant as virtually the entire overspend is from these. A couple of ferrets have been sent undercover on a special mission and it is likely there is more to be said on this topic.

Where did all the money go?