Friday, 25 April 2014

Letter to Niall Dickson

Niall Dickson has written in the BMJ and here is my response:
"The two year foundation programme was introduced in 2005 (as part of the Modernising Medical Careers programme) and has had broad support, reflected in Aspiring to Excellence (the report of John Tooke’s independent inquiry into Modernising Medical Careers) in 2008..."

I read this particular part of Niall Dickson's piece with great interest and am far from convinced that the Foundation programme has had broad support.  The Tooke review found many problems within Foundation training including the fact that a “sub analysis of the e-consultation response from 398 FY2 doctors revealed that 60% did not feel that the year had added value over and above further patient exposure”(1) and consequently recommended that “Foundation Year 2 should be abolished as it stands but incorporated as the first year of Core Specialty Training”.  Professor John Collins’ subsequent review of Foundation training in 2010 detailed numerous significant concerns including the “assessment of Foundation doctors is considered to be excessive, onerous and not valued’, and concluded that “the lack of an agreed purpose and of prospectively collected evaluative data made it difficult to accurately quantify how successfully the Foundation Programme is delivering against these objectives” (2).  A survey that I organised also demonstrated clear failings in the Foundation Programme including a lack of acute emergency exposure for FY1 trainees.  It appears strange that Niall Dickson equates the above with ‘broad support’.

I have requested documentation from the GMC relating to the motives behind Professor Greenaway’s review under the Freedom of Information Act:

“Has the Chair of the review (Prof Greenaway) discussed the review with any ministers/civil servants? If so may I see the documentation of these meetings and who was involved?”

Strangely the GMC are blocking this request, using a public interest argument for withholding this vital information.  This is particularly strange for an organisation that claims as one of its five core organisational values “We are honest and strive to be open and transparent”.  The emerging consensus opinion of the medical profession appears to be that the Shape of Training Review is highly flawed and the public deserves to see all the information that may shed light on the true motivations behind such a review. 

1.       Tooke J. Aspiring to excellence: findings and final recommendations of the independent inquiry into Modernising Medical Careers. Jan 2008.
2.       Collins J. Foundation for Excellence. October 2010.
     3.       Dean BJ, Duggleby PM. Foundation doctors' experience of their training: a questionnaire  study. JRSM Short Rep. 2013 Jan;4(1):5. doi: 10.1258/shorts.2012.012095. Epub 2013 Jan 14.

Wednesday, 23 April 2014

Letter to NICE on 'preventable' deaths due to acute kidney injury (AKI)

I have a simple request relating to your press release:
"Around 20 per cent of emergency cases of AKI are preventable which would save around 12,000 lives each year in England."
I would like to know how you calculated this figure of 12,000 'preventable' deaths.
The best recent research estimates that in total there are only approximately 11,859 preventable deaths per year in the whole NHS.
I would be grateful if you could justify this 12,000 number for AKI or consider withdrawing it from your website and press release, as in my opinion it is inaccurate and potentially scaremongering,