Evidence of Lord Hunt lies

Lord Hunt from the House of Lords transcript:
"Let me make it clear that applications were scored only by doctors. "

http://www.theyworkforyou.com/lords/?id=2007-03-19a.1041.1&s=modernising+medical+careers#g1048.1

This is not ambiguous, this statement leaves room for only one interpretation of events.

This following email has come to my attention:
Copy of E-mail from West Midlands DEanery to Birmingham Medical School:


"As you may know, the old junior doctor grades have been replaced by a new career structure, whereby postgraduate medics complete two foundation years, before applying for specialist training. This is the first year for recruitment to the new specialist training grades, and the Deanery, which processes the applications for the West Midlands region, has experienced a much higher volume than anticipated, 11,000 in total. Each application must be reviewed by two people, one of which must be a clinician. The Deanery has been able to arrange for each application to be reviewed by a clinician. However 2,000 applications have yet to be reviewed by a second person. The Deanery is therefore seeking volunteers from its partner organisations to act as a second reviewer for the remaining applications, as the deadline for completion of this task is quite tight. The second reviewer does not need to be a clinician. Academic Related staff of grade 7 and above would be eligible to act as a "lay" second reviewer, provided they had some knowledge of the NHS. Volunteers would be required to spend a day (or half day minimum) between Friday the 16th and Wednesday the 21st of February at the Deanery, which is located very near the Medical School, at the top of Vincent Drive. Refreshments and lunch are provided, along with expenses for excess travel. The Medical School would like to be able to assist the Deanery, and hope that appropriate staff in the following groups/ departments will be able to
volunteer:
Clinical academics
Divisional managers
MSEU, including Medical Education Developers and the Ed Tech Team
School Office
Senior Management Team"

This contradicts Lord Hunt absolutely.

This is while a deeply flawed process continues to be rail roaded forwards, despite even the 'independent' review admitting these gaping flaws.

The latest fudges do not make the process fair. It is still unfair and it must be halted at once.

Thes hopes and dreams of thousands of junior doctors ride on this, and it is not just them that will be affected; their friends and families are suffering too, often in silence.

A large majority of RCS members want MTAS scrapped, and the vast majority of the medical profession agress with this, apart from a small bunch of politicised educationalists who are dictating to us from the top.

The majority must prevail and MTAS must die.

Ridiculous fudged MTAS wheeled forward

The latest on MTAS is nothing short of a disgrace. There is another fudge of the process and a letter from Alan Crockard.

The latest absurd modifications to MTAS insinuate that all applicants will get their first choice interview, however that is it. If candidates have already been interviewed for their first choice with a different interview structure then this is going to be unfairly compared to the new candidates who will have a different interview structure. Also candidates will have no more than one bite at the cherry, if they have had interviews for their 2nd/3rd/4th choice of job then it is suggested that these will be scrubbed.

This is truly absurd, as well as being unfair; it also turns the process into a gigantic game of poker where bluff and double bluff will come into play. Will top candidates choose to use their golden bullet in a ultra competitive UoA (unit of application), or will they exploit the competition ratios and apply to a less competitive UoA to increase their job chances? The truth is that no one knows the answer to these questions and this makes MTAS nothing more than a tombola.

This is no meritocratic system, as by having no short listing at all the best candidates hold no advantage over the worst candidates, as everyone is handed their their one golden bullet. They are in effect saying that we have one chance and one chance only at the career we want, after years and years of grinding towards this goal. The lack of any decent short listing is unacceptable and it means that all it comes down to is one thirty minute interview. The potential for many excellent candidates to be overlooked in favour of deficient candidates is enormous, as the process is no way near thorough enough to adequately discriminate between candidates.

Those behind this farce must resign at once. There is no other option but to scrap MTAS round 1 completely and revert to the old tried and tested system. Does anyone seriously believe that MTAS is its current modified form is fairer than the old system? If you do then you are either a member of the review panel or one of the elite group of junior doctors consulted on MMC.

when will this farce be stopped?

Even the BBC are reporting that the BMA JDC chairman has now walked out of the MTAS 'independent' review group. A DoH spokeswoman said that they would push on with things. This is after the 'independent' review group press release this last night. The review panel's efforts are at best a fudge to try and make MTAS slightly less unfair. They have missed the clear logical point that either interviewing everyone for all their jobs or scrapping round 1 entirely are the only truly equitable and fair solutions to the MTAS shambles.

Do these morons ever stop pushing their lame policy that they present as 'reform'? I'm rather at a loss as to why government health policy is called 'reform' as I have seen precious little evidence of any improvement that the word 'reform' implies. Junior doctors are against the scheme, consultants have walked out of interviews, Hewitt has been caught with her pants down in parliament on the issue, leading academic professors have spoken out against the reform, 12,000 doctors have marched over government reform of training, over 80% of the Royal College of Surgeons want MTAS round 1 scrapped, the BMA have now walked out of the review; how much more does it take for the DoH to realise they are wrong?

What does it take these days for incompetents to be forced to resign? Do these stooges have no shame? Where are the apologies that should be being heard loud and clear?

These politically motivated cronies do not care for junior doctors, the medical profession or the electorate. They are the lowest of the low, motivated by selfish greed they demonstrate sheer contempt for the health of the nation. It is about the pursuit of power at any cost, something that doctors hold a rather special contempt for given their role of caring for patients. The sheer hypocrisy of citing 'patient safety' as the reason for these changes is astounding, especially when it is the poor patients who will suffer in the long run as a direct result of these hasty changes.

I would like to create a list of individuals who should be forced to resign over this utter shambles, feel free to add any other names as you see fit in the comments:

Professor Neil Douglas

Patricia Hewitt

Clare Chapman

Professor Liam Donaldson

Professor Alan Crockard

Professor Shelley Heard

Professor Martin Marshall

If any of you have time to read this, when you're not destroying this country's healthcare system, then I suggest you do the honourable thing and resign.

Cronyism again

From the health services journal:

"London chief defends Corrigan and Warner's appointments

22 March 2007

NHS London's interim chief executive has defended her new top team against claims they include political appointments meant to push through New Labour reforms.

Ruth Carnall acknowledged that two appointments were always likely to be politicised, namely former health minister Lord Warner as chair of the new London Provider Development Agency, and Number 10 adviser Professor Paul Corrigan as the strategic health authority's director of commissioning and strategy.

But she told HSJ that London was 'lucky to have' the team, adding: 'I understand why [Professor Corrigan's appointment] seems controversial but for us it was an easy decision. He applied for the job and was the best person for it. We are lucky to have him.'

On Lord Warner's appointment, she commented: 'I think it is a shame for Norman that it has been politicised because he is fantastically able man and will be really great in this role.

'The notion that I have put in place a team with the aim of privatising the NHS in London is nonsense.'

Her comments came after shadow health secretary Andrew Lansley wrote to senior officials at the Department of Health and to NHS London expressing his concerns.

Mr Lansley alleges Lord Warner's appointment breaches the ministerial code of conduct and has written to permanent secretary Hugh Taylor to demand answers to a series of questions about the appointments process, its timing and whether permission has been sought.

He argues that Professor Corrigan's appointment, which comes on the eve of a major shake-up of London health services, is 'deeply unwise' and should be abandoned.

He said: 'These appointments of people who have been at the most senior level pushing the proposals for the reconfiguration of hospitals are unacceptable. They undermine the credibility and independence of the NHS in London for reaching its own view about what is in the best interests of patients in the capital.'

HSJ understands that Mr Lansley has not received a response to either letter.

Unison also has concerns about the appointments. London head of health Chris Remington said: 'I think they will use London as a test bed. We will see the wholesale shifting of staff into the private sector.'

However, Ms Carnall said there was no impropriety in Lord Warner's appointment. She described the allegation that Lord Warner has set up the Provider Development Agency as 'completely untrue'.

Chief executives in London backed up Ms Carnall, saying she had put in place a strong team that would take a lead in developing the capital's NHS.

One said: '[Lord Warner's] appointment is an absolutely brilliant idea. They have created a semi-detached organisation that now has someone with the weight to give it seriousness.'

Another described Professor Corrigan's appointment as 'fresh and exciting', although one chief executive added: 'I have suspended my disbelief. It may just work although it's hard to imagine.'

The new team in London

• Ruth Carnall is interim chief executive. She has been open about the fact that she wants the job long term. She has wide support across London, especially from PCT chief executives.
• Professor Paul Corrigan, Tony Blair's special adviser on health and widely regarded as an architect of the current market reforms. He will start work director of strategy and commissioning in the summer.
• Lord Warner, former health minister, now chair of London's Provider Development Agency where he will steer trusts towards foundation status. He starts this month.
• Malcolm Stamp, PDA chief executive. Was one of the first foundation chief executives and will return from New Zealand where his is currently chief executive of Waikato district health board, Hamilton.
• Paul Baumann, a finance director from Unilever, as director of performance and finance. One source described Unilever as 'just like an SHA with mad, uncontrolled subsidiaries.'
• Antony Sumara, turnaround director, known for his work in troubled trusts."

I can't even stir up anger anymore, another useless politicised organisation the 'London Provider Development Agency' run by more cronies of the establishment. There's not much more to say apart from swearing and grinding my skull against the wall.

The tale of an NHS cleaner

A nameless cleaner was scrubbing away on a nameless NHS ward, his back ached and his knees were sore but he immersed himself in the daily grind. He had come to England from a land far away where he once worked as a top researcher in genetics. Political circumstance had unfortunately forced him and his young family to leave their homeland, and to flee to our shores. Life had not been easy for them, in fact they had barely stood still since arriving but at least now things had become a little more settled; he had a regular job, even if he was a little overqualified for cleaning. He still tried to make the best of it and by thinking of what he did have, he avoided falling into a cycle of self-pity. The work was mind numbingly boring and he was not used to the physical toil, but despite this he gained a certain satisfaction from doing things well and to the best of his ability.

His ears pricked up as he heard one of the staff nurses on the ward chatting to one of her friends:

'I can't believe how much these doctors get paid, Kylie, look at this here....', pointing at the front page of the Daily Mail, 'they're earning more than me and you put together, it's disgusting!'

He stayed in his crouched position behind the desk, they obviously hadn't noticed him going about his daily business and they carried on; Kylie replied:

'We work as many hours and we work just as hard as the doctors, and the patients are more grateful for what we do a lot of the time. We're just not valued at all, it's a national disgrace it is!'

The cleaner's head slowly rose into the view of the nurses and they immediately became rather silent, the quiet was broken by the rather softly spoken cleaner who posed a question to the nurses:

'I couldn't help but overhear your conversation there, I don't mean to be rude in saying this...... but why do I not get paid as much as the doctors? I work just as hard, I work similar hours and the patients certainly value my job.'

He looked at them for a moment, waiting for their reply, a few seconds passed before one of them quipped back in a rather mocking manner:

'Well, you're only a cleaner aren't you!'

They both looked at him in a rather condescending manner, as if they expected him to get back to work and accept his place. It was therefore somewhat of a surprise to them when the cleaner stood tall, and asserted himself with some rather firm but softly spoken words:

'I am just a cleaner, that is indeed true. But surely the doctors could point to the fact that you are both 'just nurses'.'

The nurses briefly glanced at each other, and they noticed that they had both turned a rather delicate shade of beetroot. The cleaner paused to observe this reaction and then got back to the job in hand, feeling a little warmer inside that he had before.

MTAS and other news

The MTAS 'independent' review panel are set to cast their positive verdict on the brilliant MTAS this week. Professors, consultants and several large bodies including ASIT are uniting against the farcial process:

http://multimedia.thelancet.com/pdf/mmc.pdf

Also for anyone who is amongst the thousands of junior docs shafted by the MTAS machine, then read this and get e-mailing straight away! It may help you save your career.

http://nhsblogdoc.blogspot.com/2007/03/how-to-get-review-of-mtas-rejection.html

The BBC has been ignoring important issues and peddling drug company propaganda as news again today. Amazing how they conveniently gave minimal coverage to 12,000 doctors marching at the weekend, yet today they are happy to dedicate plenty of column inches to this story:

http://news.bbc.co.uk/1/hi/health/6471485.stm

This 'evidence' consists of a survey carried out by a patients group but funded by Napp, a large pharmaceutical company. The initial BBC article didn't mention Napp's involvement, however after complaints they have amended the original piece:

" Thank you for your email. The research was supported by a grant from Napp, but it was carried out by the Picker Institute and the Patients Association - both respectable and reliable organisations. We have added that Napp supported the research. However, we feel the findings of the research do stand because of the involvement of the other organisations. In addition, the only mention of patches is by the man whose sister died. He had no involvement in the study so has no contact with Napp.

We hope this addresses your concerns

Kind regards

BBC News website"

The small changes to the article are not really satisfactory in my opinion. This is because there is no mention of the glaring conflict of interest involving Napp, who produce opiate patches that they obviously want to increase the demand for. They also do not mention the rather obvious flaws in this partisan survey. The elderly patients selected for interview were not selected at random at all, meaning the survey is not representative of typical nursing home patients. It appears very likely that the survey selected those elderly patients who would say exactly what Napp wanted to hear, ie they selected an unrepresentative group of the elderly who did have chronic pain issues and then asked them leading questions to get the exact answer they wanted. The 'survey' was nothing more than an exercise in gathering propaganda for Napp. It is embarassing that the BBC falls hook, line and sinker for this kind of tactic.

The BBC needs to take a long hard look at the way it covers issues like this, as it is most definitely not the first time they have been used as a vehicle for spreading other agencies' propaganda. The lack of scientific rigour and critique applied by their journalists is deeply worrying.

Non medical prescribing: the actual facts

Some information has been extracted from the DoH on the topic of nurse and pharmacist prescribing via the freedom of information act. Here are the facts of what actually happened:

"The Commission on Human Medicines (CHM) and its predecessor, the Committee on Safety of Medicines (CSM), is the independent body responsible for advising Ministers on matters relating to medicines and patient safety. The Commission is chaired by Professor Sir Gordon Duff and members include several other eminent professors of medicine from the UK.

The CSM has over a number of years advised on the expansion of the then Nurse Prescribers’ Extended Formulary. A sub-group of the CSM considered the options for the future of Nurse Independent Prescribing in September 2005. The sub-group’s recommendation was not based solely on the volume of responses in favour or against any particular option; it also took into consideration the merits of the views and arguments put forward and also had the benefit of advice from practitioners, including doctors, from the NHS.

The full Committee met on 27 October 2005 to consider in detail the responses to the consultations on nurse and pharmacist prescribing, as well as reviewing the sub-group’s findings. Following the meeting, the Committee recommended to Ministers that qualified nurse and pharmacist independent prescribers should be allowed to prescribe any licensed medicine for any medical condition within their competence. Ministers accepted the CSM’s recommendations and the Secretary of State for Health announced changes in November 2005. These changes came into effect in May 2006.

The Department of Health had also commissioned national research under its Policy Research Programme. The University of Southampton’s Evaluation of Extended Formulary Independent Nurse Prescribing, published in June 2005, had concluded that extended formulary independent nurse prescribing was operating safely, clinically appropriately and effectively in practice. The evaluation had sought the views of a range of stakeholders, including doctors and patients, and it was peer-reviewed before publication. A copy of the Executive Summary is on the Department’s website:

http://www.dh.gov.uk/en/Publicationsandstatistics/Publications/PublicationsPolicyAndGuidance/DH_4114084 "

Essentially the CSM typically makes decisions and recommendations on specific prescribing issues such as 'The Committee considered and advised on a medicine to be used in the treatment of diabetes'. It seems very strange indeed that this issue as big as 'non medical prescribing' was left to this small body of pharmacological experts. They are not used to making decisions of this nature, they are not set up for making this kind of decision and they do not seem to be the best qualified to make this decision.

Interestingly there was no vote at all. Here is the the link to the meeting details, followed by the meeting summary:

http://www.mhra.gov.uk/home/idcplg?IdcService=GET_FILE&dID=19345&noSaveAs=0&Rendition=WEB

"The Chairman thanked DH colleagues for their views and clarifications, restating that the Committee would support options D (for nurses) and 5 (for pharmacists) within the context of the concerns they had raised. In thanking the CSM on behalf of herself and the Chief Pharmacist, the Chief Nursing Officer said that while the original limitations on the NPEF were understandable, subsequent expansions had made it complex. Safe practice included making legislation and procedures easy to understand and therefore easy for individuals to act correctly. Adopting the options recommended by the Committee in partnership with clinical governance structures would provide a strong accountability framework which would underpin improvements in patient care and make the best use of professional skills."

"As indicated above, the former Committee on Safety of Medicines (CSM) made recommendations to Ministers, taking account of all responses to the consultations and the advice of the sub-group. The CSM does not conduct its business by vote.": to quote the DoH again; it appears that this massive decision was made on the basis of an undemocratic committee process, which was then pushed through by ministers.

This must be seen in the context of the consultation process. In fact all but one of the medical bodies consulted for nurse prescribing were against the CSM's proposals, while all the medical bodies consulted were against the CSM's decision for pharmacist prescribing. Thus the small committee of the CSM has effectively been made the judge, jury and executioner in this process.

http://www.dh.gov.uk/en/Consultations/Closedconsultations/DH_4112047

http://www.dh.gov.uk/en/Consultations/Closedconsultations/DH_4112774

Unsurprisingly the DoH website does contain the responses to the consultation process on non medical prescribing! This is ridiculous, how can the process be seen to be transparent? Pulse had to obtain the information that all medical bodies were against the moves by the Freedom of Information Act, this information should have been available with the need to use FOI act. The DoH's selective release of information makes this process look very corrupt and suspicious indeed.

The evidence behind non medical prescribing is weak to say the least:

(http://www.dh.gov.uk/en/Publicationsandstatistics/Publications/PublicationsPolicyAndGuidance/DH_4114084)

This 'evidence' consists of a survey of 246 nurse prescribers and ten case study sessions, and....that's it I'm afraid, this is the sum total of DoH backing for their reform. Is their a recurrent theme here?

'The most common conditions prescribed for were skin conditions, family
planning and soft tissue injuries.' and 'Experts made a small number of comments about
possible limitations in nurses’ history taking, assessment and diagnostic skills.' and 'Doctors were positive about the development of nurse prescribers in their teams, although were not able to unequivocally conclude that it had reduced their workload.'

Thus overall this small piece of work showed that nurses could safely prescribe for minor ailments, albeit more slowly than doctors and in a way that didn't provide any real benefit for the patient and healthcare system. This is while some experts were concerned about their clinical skills, a matter that was largely ignored in the conclusions. How on earth this 'evidence' can be then used to allow nurses and pharmacists to prescribe anything under the sun is beyond me. There is a rather glaring gap between the propaganda and the reality of the situation.

It seems the danger began in 1999 thanks to a review by June Crown, mysteriously the panel was made up of a rather large number of nursing managers, pharmacists and the Southampton cohort who produced the earlier quoted 'evidence'. There are no conflicts of interest here of course. The main motives for extending prescribing were:

'• make it easier and more convenient for patients to obtain the medicines they need;
• improve the service to patients, without compromising safety;
• increase patient choice in accessing services; and
• make better use of the skills of NHS professionals. '

It appears to me that the DoH can come up with precisely zero evidence that the service has been improved by extending prescribing rights, and this is surely the most important aim. They can also come up with no evidence that extending prescribing is safe. Their 'evidence' of safety only applies to minor health problems and is a very weak piece of evidence indeed; the sample size is small, there are numerous other flaws in the study design and it has not been peer-reviewed or published. Given that experts had concerns about nurses' clinical skills related to relatively minor medical conditions, then it is obvious that these concerns would be amplified when applied to more serious medical conditions. The potential for compromising patient safety is enormous. Logically the more the less trained are handed more responsibility, the more damage to patient care will result; this piece of logic has not been picked up by the DoH radar.

This is yet another in a long line of examples of DoH policy that is based on zero decent evidence. It is bad enough that this reform is incredibly expensive to research, create and implement; but add to this the fact the the reform is likely be less cost effective in the long term than previous arrangements. The propaganda network established between government reformers, the DoH and a small group of the compliant professionals seems to be the key to the process forcing ideological policy through against the public interest. If this corrupt ideological pursuit is not stopped, then in the future the consequences for patients could be quite disastrous.

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.