A patients’ guide to Modernising Medical Careers – Volume II – in which we lobby parliament

It was cold on Tuesday, but at least it wasn’t raining.  The turnout for the Remedy Mass Lobby of parliament was pitifully small.  Rota swaps make it hard to get to London during the week and you can’t lobby MPs at the weekend, but the truth is that our doctors are punch drunk and have lost much of the will to fight.  So there weren’t many of us, though a lot of us had come a long way, and we did get questions asked in parliament as a result of our efforts.

Then the few of us who where there faced the problem of educating our MPs in the issue before we could ask them to help, and it is so complicated and unbelievable that there is no simple way to explain it.

The long and the short is that there is already inadequate cover on the wards – our wards, where your mother’s recovering from a fall, where my father-in-law has pneumonia, where your sister has breast-cancer, where your daughter’s having a baby – and this inadequate cover is a direct result of the restrictions placed on doctors’ choices by the government policy called “Modernising Medical Careers”.

There are thousands of unemployed doctors, and thousands of unfilled jobs – what’s the problem?

Ah.  This is government sleight of hand: they are encouraging you to confuse “jobs” with “careers”.  There is now a two-layer career structure for doctors in hospitals, with generalist posts providing ward-cover and specialist posts including training and career progression.  Doctors who want to be generalist and do the same thing year after year become GPs, work normal hours and don’t risk being sued for misunderstandings or mistakes.  You see, surgeons and specialist medics tend to be an ambitious lot, thank goodness, or we would have no Consultants and Registrars at all.  Doctors who are drawn to the more competitive paths of surgery or specialised medicine are – duh – more competitive, they are turned off by being told that they can never, ever, progress beyond where they are at the age of 28.  Do you want to be treated by a depressed and demotivated doctor?  No, neither do I.

Yes, this is a caring profession.  Yes, they have £30 grand’s worth of debt to repay and if they leave it may take them decades to do it.  And yes, many doctors have an emotional need to be needed.  But we can’t take the piss out of them forever.  They are clever, highly trained, used to working under pressure, and – get this – ambitious.  They’ve had to be ambitious to get this far.   They can go.  Many have already left.  Many more are leaving.  Those who have stayed as locums and staff-grade posts are keeping the NHS going, but are suffering enormously as a consequence.  The consultant psychiatrist who’d travelled to be at Westminster on Tuesday said she had never had to treat so many juniors for depression.   The government has turned our doctors into patients.

But why can’t they just apply for another training post?  

They aren’t allowed to.  This is so implausible that the government have got away with it.  No-one other than those directly affected believe it’s true, but tens of thousands of doctors are in the position where they have lost their one and only chance at a training post.

How can this be?

Imagine a railway station.  In the bad old days you’d mill around and catch a train that took you one stop down the line, and then you’d have to get off.  Then you’d catch the next train that was going in roughly the right direction and travel one stop down the line.  And so on.  Doctors took a series of 6 month training posts for several years, gaining experience, being trained, gradually becoming more specialised and progressing towards registrarship and then consultancy where they added accountability to their life and death responsibilities.  It was unsettling, geographically disruptive, nerve-wracking and all in all a very unpleasant way to spend your twenties and early thirties, but it did get you there in the end.

Now, instead of a flexible system, doctors have one chance and one chance only to catch the train.  This is so completely barking that no-one believes it’s true.  But if you wait at the station even a month too long, taking locum jobs or staff grade posts without training, you can no longer apply to get on the train.  You are forced onto the waiting busses, which just drive you round and round the car-park of locum shifts and ward cover and don’t go anywhere at all.  Or else you take a taxi to the airport and a job in Australia, New Zealand, or just walk out and get a rapid-grad job in a bank or law-firm.

Does this matter?

The fact that there is already inadequate cover on the wards really matters, and shifts all over the country are being run without the doctors needed for patients to stay safe and staff to keep sane.   No-one wants to locum – it’s perceived as failing in the profession, and this is a direct result of creating a two-tier profession.  As a result, hospitals are desperate for locums, and locums can and do name their hours and say “no night shifts, thank you”.

In terms of the medics themselves, then I think it matters that an entire generation of doctors has been prevented from progressing in their profession, though I know there are vindictive labour politicos who regard doctors as power-crazed middle-class hypocrites and MTAS and MMC as a job well done.

The separation of families certainly matters to those involved; on Tuesday I heard of a couple where he took a locum job in Glasgow to be nearer to her in Inverness, though a three and a half hour drive each way is not “near” when both partners work 12 hour shifts.  I also met Lindsay Cooke, whose daughter has emigrated to a job in New Zealand.  Nice work if you can get it, but emigration is always hard on those left behind.  Hell, the one I went to London with on Tuesday would be in South Africa by now if he’d not been offered a training post last year.

What next?

The government accepted that last year was a cock-up and commissioned an independent report on the situation from Sir John Tooke.  Tooke’s report makes dozens of clearly defined recommendations and it  is supported by 87% of the profession.  Tooke spreads blame widely among the government and also among the seniors who run the Royal Colleges and the medical schools, and asks such fundamental questions as what sort of doctors do we want and what sort of training will it take to get them?

The government is implementing only 25% of Tooke’s recommendations, it accepts a further 25% “in principle” – huh? – and is getting Lord Darzi to reconsider the rest.  Divide and conquer, anyone?

And the Mass Lobby?

Did I manage to explain any of this to my MP in a way she understood?  Probably not.  My neighbour runs her constituency office, and they are two members of staff down so even if I write to her asking her to support the BMA’s Early Day Motion, which I will, she will just forward the letter on to the DoH and that will be that.

I did discover that the Members’ Tea Room has the cheapest tea and coffee in London though.  £2.20 for a cup of tea and two cups of coffee – who needs an account with John Lewis if you can score caffeine as cheap as that?  Oh, and attempted acts of terrorism are worth commemorating with novelty foodstuffs if they took place in the 17th century.  I wonder what novelty foodstuffs will be used to commemorate the implosion of the NHS.

Remedy Mass Lobby of Parliament – 18th March

I’ve never had any particular need to be glad that I don’t live on the west side of Leicester before now. The M69 is a pleasant enough minor motorway, and there isn’t really much else one can say about the place. Isn’t it where Adrian Mole grew up?

On the 18th I will be one of a worryingly small number of people lobbying Parliament about medical education and the plight of the missing generation of junior doctors who are too old to benefit from whatever reforms the government introduces as a result of the recent Tooke review, and too young to have made it safely to registrarship already. A year after the original MTAS debacle, I still could not have managed coherency if the MP I were lobbying was Patricia Hewitt.

By lobbying, I force my MP to inform herself on the details of the issues.  The problem of course is that one can only find MPs in their lairs in Westminster during the week, and most doctors will be working then. It is entirely happenstance that we can attend at all – it was the one week during this rotation that the one I’m going with could get for his holiday. I loathe London and all its works and I would far rather be on a cheap beach or a Scottish city, but I am privileged to live in a democracy and it’s important that those of us who live in democracies avail ourselves of the privileges while we still have them. It is important that my MP knows that, when she discussed this with her constituents, at least one of them asked her to vote for implementing Tooke in full.

As I type this I find myself getting more enthusiastic about the whole thing. When I followed Remedy’s directions and wrote to my MP to ask for a meeting I discovered on They Work For You that she voted against the war in Iraq, though she also voted against in inquiry into it. I find that I am looking forward to discovering her views on MMC and MTAS. Does she agree with the government’s proposal to implement about half of Tooke’s report? It’s an opportunity for me to decide whether or not to vote for her in the future. It’s an opportunity for me to become more informed, and for me to contribute and participate. Democracy – use it or lose it

I’m not just interested about my MP – I find myself wondering what’s going on at my local general hospital, (the one I’m going to London with works elsewhere), and I’m beginning to feel the first stirrings of willingness to pick up the fight again. I am, however, very glad that I’m not going to see Patricia Hewitt. If she’d been my MP there was a real risk that I would have lost it completely. Dribbling rage is never pretty.

For up to date comment on Modernising Medical Careers read the Witch Doctor – or even better: subscribe to her blog

To sign-up for the mass lobby of parliament go to the Remedy site – they will provide you with briefings and do all they can to support you.

Remember – it’s our NHS and they are our MPs.

So what’re you gonna do about it, Gordie?

Tooke’s published his report into Modernising Medical Careers and MTAS. If that man ever needs a kidney, bone marrow or unborn children he can come to me, it would be the least I could do.

The full report is even more impressive than the interim report, and I wouldn’t have thought that was possible. The main difference seems to be that Tooke recommends taking medical education out of the hands of the Department of Health. It would be hard to think of a more damning recommendation, short of burning Patricia Hewitt in effigy.

The more interesting recommendation though is his demand that there should be a definition of the doctor’s role, or more accurately the roles of all healthcare professionals including every kind of doctor. This is very similar to a question that I asked here last year: What makes a good doctor, anyway?

The question of course is how much or how little of it Gordie will implement. Given his recent sound-bite that we should all be screened to pick up illness early, despite the fact he’d just cut back on the early treatment of some of the diseases that early screening would pick up, it seems that taking advice isn’t one of his strengths.

It’s a very different fight this year. Last year it was about getting the information out there, about saying “no, it isn’t as bad as that, it’s far far worse than that”. This year it’s about holding the bastards accountable; it’s about saying “you asked for an independent report, now act on it”.

And yes, of course I’m going to do what I can. Who was I kidding?

Here we go again

I am feeling decidedly shifty about this year’s Junior Doctors’ recruitment.

As you all know, I went off on one for most of the first half of last year while the abortion that was MTAS and the obscenity that is MMC unfurled before my horrified eyes. It affected me personally because the one I mention here occasionally was going through the mill. However he was one of the lucky ones, he got his ticket to ride and he’s ok.

This year is going to be far worse. This year the ratios are worse, the ward-fodder is better informed, and the government is studiously ignoring the Tooke Report. There isn’t a centralised system to horrify us all, instead the disasters are going to be private and personal, tucked away in wards and clinics and locum shifts across the country, but no less devastating to those involved.

But this year I’m not going to be on the barricades. I feel guilty and shifty about this. Last year left me wrung out and emotionally exhausted by the whole bloody mess but nowhere near as wrung out and emotionally exhausted as it left the doctors and partners of doctors who were unlucky then and who are now about to go through the mill again. And this is why I feel shifty. I wept and wailed and gnashed my teeth while the one I worry about was at risk, but I know I am not going to do the same thing again this year, because I know I don’t have the energy to be that angry for that long.

I dislike bad-weather activists, and look at me. My personal sun is shining and devil take the hindmost.

In the meantime, let me tell you that it is apparently a good thing that the application ratios are between 3-1 and 19-1 for training posts. £250k of my money, and yours if you live in the UK, to get a Junior Doctor to the point where their career is officially stalled or where they leave the profession.

The implication in the Daily Mail and other isolationist press that foreign doctors are coming over and nicking our doctors’ jobs is despicable. The International Medical Graduates are the reason we still have an NHS. They came here during the last 7 years on the understanding that they would be treated equally, but the government tried to renege on that deal last year.

Shutting the door on new IMGs seems like a good idea to me, but don’t turn around and bite the hands that came across the water during the last 7 years and saved the NHS.

The BMA are Blackleg scum

What do you call it, when a failing union disrupts the work of a new organisation which successfully represents the membership that’s being stitched up and ignored? My social history isn’t really up to the mark here. How about:

The BMA are Blackleg scum

Yep. I think that sums it up nicely.

The BMA (British Medical Association) have prevented the BMJ (British Medical Journal) Careers Supplement from running an ad for Remedy UK. You may think this doesn’t matter to you, but it does.

Remedy UK is an organisation which was formed by and for Junior Doctors when the BMA stood by and watched them being sacrificed on the alter of government doctrine. In the last 12 months, Remedy has gone from strength to strength, and thousands of doctors have cancelled their memberships of the BMA in outrage and disgust.

Let me now quote from the Remedy website:

As part of a membership drive, the RemedyUK committee decided to place a paid-for loose insert in the Christmas issue of BMJ Careers. The BMJ asked to see the copy before agreeing. They had no concerns about the insert or its content.

We were then told, late last week, that as the BMJ is a wholly owned subsidiary of the BMA, their approval would also be needed. The BMA have banned the insert from appearing. …

It is hard to see how the BMJ’s editorial independence cannot now be open to question. And it is difficult not to draw the conclusion that the BMA’s refusal to allow the insert is an attempt to prevent Remedy from spreading its message more widely.

This matters because – to quote the leaflet concerned:

There are currently 70% more medical students than there were five years ago, but only a minimal increase in training places.

Junior doctors, already traumatised by MMC/MTAS 2007, face a recruitment round in less than two months in which competition ratios will be worse than this year, with some small specialties in some regions likely to be offering no ST3 posts at all. The process for selecting people into run-through for subspecialty training is in disarray. And 14,000 juniors face career termination. (My italics).

If you are a patient it matters to you. No one should have to work under the sort of strain described below, and you and your relatives should be treated by people working under this sort of strain:

One particular junior doctor was seen crying quietly in a corner on Monday, coming to terms with having no interviews and perhaps no career. She was in clinic at the time and had taken 5 minutes to check out her future on the MTAS website, 5 minutes after learning her fate she was back seeing patients, doing what she wants to do, what she deserves to do, what she is needed for but what the system might stop her doing come August. – I’m a Medical Student – Get me Out of Here

As patients we deserve the best doctors the NHS can train and recruit. This is not how to find them:

We were on the wards today when the SHO opened her mail to discover that interview for her specialty were scheduled for the same day in the Yorkshire and West of Scotland areas. Its not a large specialty (Rheumatology) so this seems a little weird.

Neither is allowed to change it’s dates due to a protocol … So the chances of a morning interview in Leeds, a 200 mile drive and an afternoon interview in Glasgow seem remote. She said she was not the only SHO in this situation.

Interview dates were published after the SHO’s had ranked their choices, thus they did not know which interview dates would conflict.

It’s crazy… Comment by dyb on Dr Crippen’s blog

We had astonishingly good doctors in the UK: the Department of Health has spent the last year throwing them away:

Unsurprisingly, like many of my colleagues I was not shortlisted for a single interview in this first round of job applications. In fact, of the seven junior trainees in my department, only one of us has been shortlisted for any jobs. Yet our unit is one of the leading tertiary referral centres in the UK. Paul Malone in a letter to the Times (My italics).

Remedy UK fights, among other things, to make sure that medical selection in the UK is fair, transparent and effective at choosing the very best. It is hard to see how this form of interview can do that:

The second station [at my interview] involved ‘Communication Skills’. It was awful. First, I had to fold a piece of paper according to verbal instructions. It did not make a crane – perhaps I did it wrong? Then I was given a random series of shapes on a piece of paper and had to describe them to another Consultant for her to draw them. Hmmph. Goodness only knows how I did on this station. I felt stupid and I know that I didn’t show how well I can actually communicate about real things. What I don’t understand is how this is supposed to supply them with reasonable doctors. If I did it all wrong, am I a bad Doctor? If I did it right, should you fast track me to a Consultant’s post?

Bloody weird. – Junior Docspot – Origami Anyone?

What Remedy UK is doing matters to all of us. The British Medical Association stood to one side and let the Department of Health inflict Modernising Medical Careers and MTAS on the medical workforce, and thus on us all.

The independent report by Sir John Tooke is damning, saying explicitly “the medical profession’s effective involvement in training policy making has been weak”. Well that is down to the BMA. And also saying “… from this experience must come a re-commitment to optimal standards of postgraduate medical education and training. This can only happen if a new partnership is struck between the profession and the Department of Health … each constituency has been found wanting so far.”

Yeah. BMA. Blackleg scum. Sums it up, really.

Pop goes the weekend – Consultation document on MMC available

The following has just arrived in my inbox from Mums for Medics – I guess I’ll be spending the weekend reading the damn thing and trying to work out what I think of it, and where and how best to comment.

The document to which this link will take you –http://www.mmc.nhs.uk/download/consultation.doc – arrived in my inbox this morning. It was published yesterday. As you’ll see, it’s the product of a DoH consultation, which has included RemedyUK, about interim arrangements for recruitment in 2008. Remedy have a copy and will let me know their reaction to it in due course.

The Tooke review will make recommendations for 2009 and beyond and Tooke has been consulted on this document.

Despite the fact that it advertised its availability on the MMC website, as of this morning there was no link or other reference to it. It will have been sent to all those groups, like Remedy, who participated in the discussions that led up to its production but, failing immediate publication on the site, other interested parties may not have been aware of its existence never mind its contents. Certainly Peter Bottomley MP, to whom I sent it first thing this morning, was not aware. This is worrying, as the consultation period is incredibly short: it closes at 10am on Tuesday 25th September. The fact that the link appeared after Peter Bottomley emailed Martin Marshall, the Deputy CMO, to ask why it wasn’t there may, of course, be purely coincidental!

I have alerted Morris Brown, Gordon Caldwell and Andrew Lansley MP and Norman Lamb MP as well as Peter Bottomley. Peter has alerted David Cameron and some press, including the Press Association and I’ve emailed a copy to Victoria Macdonald at Channel 4 News.

This document is not, in my view, one on which it would be appropriate for Mums4Medics to try and form a collective view, but many of you, I know, will want to check its recommendations against the experiences and concerns of ‘your’ doctor and may wish to make individual representations.

Stats tart

Recently one of my MTAS posts has been topping my stats chart. It turns out that it is being sought out by scat-seekers because I had illustrated it with a stolen picture of a turd. Who’d have thought if you put “poop” into Google Images you’d get a link to a post giving my opinions of Ms Hewitt.

Satisfying though it is, I’ve renamed the picture “MTAS” and hopefully the scat-seekers will eventually go away. It pleases me to think that some may do what I did, nick the picture and use it elsewhere, and that eventually a search for “MTAS” will produce a picture of a heap of shit.

An anatomy of anger

Maybe I’ve just been lucky or maybe I’ve been unobservant, but I didn’t know that there were so many ways to feel anger.

I knew that there were many ways to feel happy; there’s the backwash of an endorphin rush generated by laughing for ages with friends about something very silly indeed; there is the animal feeling of well-being which comes from just enough of the right sort of exercise; there is the whooping feeling of joy when something longed-for actually happens, like good exam results. There is the feeling of emotions easing and relaxing when you spend a really enjoyable time doing nothing in the sunshine.

What I hadn’t known is that there are many ways to feel anger.

• There was the feeling of incoherent shock and stomach-sinking horror when Channel 4 revealed the MTAS security breaches which left me breathless and speechless
• There was the sharp feeling of brittle rage at the thought that those responsible for MTAS might destroy the project documentation to hide their accountability and incompetence.
• There has been the ongoing dull ache of anger that Blair and Hewitt were immovably in power, which has been superseded by a persistent feeling of uneasiness about who and what will replace them.
• There has been the sense of joint-aching frustration at the arrogance, disrespect and inhumanity of forcing doctors and their families to up-sticks and move to places they have no desire to be; separating partners, families and generations.
• There have been the sick waves of helpless horror at the administrative cruelties of people who made offers to the most vulnerable individuals – those who will never be permitted to apply for specialist training again – and then withdrawn them with no more than a curt explanation which has been no explanation at all.
• There has been the crawling distaste and visceral withdrawal from the bland complacency shown by the seniors who were happy to hang the whole world out to dry, juniors, patients, health service and all so long as they didn’t lose their chance of rimming Hewitt and Blair in exchanges for political favour.
• There was the pure blast of ice-burning rage at when Hewitt demanded – and got – costs

I had no idea there were so many ways to feel anger, but I guess the thesaurus should have warned me:

In the last six months? All of the above.

You can take the Health Secretary out of Andersens…

You can take the Health Secretary out of Andersens, but you can’t take Andersens out of the Health Secretary.

From the Guardian:

Mr Straw denied reports that officials shredded documents on the troubled NHS IT programme to stop them becoming public.

Mr Heath protested at “the decision of the Office of Government Commerce to destroy the gateway review documents on the cost of ID cards and other misdirected and mismanaged IT schemes”.

Mr Straw said: “My understanding is that these gateway reviews have not been destroyed.”

He said the Freedom of Information Act provided for a “whole series of exemptions” allowing the release of documents to be refused to “ensure the proper functioning of government”.

(If my sarcasm assumes too much prior knowledge, forgive me. Ms Hewitt used to be Research Director for Accenture, the consulting firm spawned by Arther Andersens. Andersens is most famous for shredding tonnes of evidence when one of their largest clients, Enron, collapsed taking Andersens down with them.)

“Fuck MTAS”

Every now and again something turns up in the search terms used to find this blog that is so succinct, so perfect, so concise that I’m flattered that it somehow summarises what I’ve said here.

Today someone found me using two words which really do sum it all up.

Fuck MTAS.

Indeed.