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.

Now you CD it, now you don’t

It is good to see that Paul Gray resigned from his position as chairman of Revenue and Customs. (It was even better to see Alistair Darling squirm, but that was a more vindictive delight). I’m wary of gratuitous scape-goating with this business of the CDs that have gone missing containing the details of 25m people and 13m bank accounts. However, whatever way I look at it I come back to the thought that there are two ways to secure data, and both start right to the top.

The first way to secure data is physical: you make it physically impossible for your staff to export data. You install PCs without CD drives and disable the CD drives on the PCs which have them. While you are at it you disable the USB ports and impose limits on sending emails with attachments. You place limits on the changes that most people can make to their PCs, and provide them with a help desk and an audited order process to use when they want to do something outwith their permissions. None of this is hard and none of it is particularly expensive, though all of it makes things inconvenient for your staff. Not as inconvenient as having to clear up the mess when the details of 13,000,000 bank accounts get into the wrong hands, of course, particularly when the banks turn sulky and say “we’ve done nothing wrong and we aren’t paying for your mistake Mr Darling”. The banks have every right to be irritated since they do make sure that it is very hard for any member of their staff to steal data. This approach does require that those at the top take security seriously and ensure that adequate security policies are written and that the technology is configured to support those policies. Not rocket science, more a question of those at the top prioritising security, employing competent staff and saying “Make it so”.

The second way to secure data is through cultural norms. You make it impossible for someone to think it’s ok to copy personal data on to CDs and bung them in the post. Likewise you make it impossible for someone to think it’s ok to use real data as test data for new systems, or to dispose of confidential waste other than by shredding it, or to walk away from their desk without activating a password controlled screensaver, or to write passwords on post-it notes, or to look up someone’s personal data without a valid reason, or to leave a laptop in a car or an unlocked cupboard. You make it socially acceptable for someone to say “no, I’m sorry, I’m not swiping you in to the building with my card” or “no, you can’t use my account if you’ve forgotten your password”. This sort of security-focused culture is hard to create where it does not exist already, but it is relatively easy to maintain. The code-breaking at Bletchley Park remained a secret until the 1970s despite the fact that over 10,000 people worked there. A culture of treating data security responsibly is, without a shadow of doubt, down to the leaders to create, take seriously, pay for and maintain.

Slackness about data appears to be endemic at HMRC, which is the point that I am making. According to the Guardian “The chancellor explained that in September the records of 15,000 Standard Life customers had been lost in transit from HMRC offices in Newcastle; in the same month a laptop and other materials were also lost.” The article also mentions 41 missing laptops.

So no matter how I slice and dice this one, I cannot let Gordie off the hook. HMRC was his bailiwick before it was Darling’s. This is the government who’s attitude to security was sufficiently cavalier for the personal details including names, addresses, religious beliefs and sexual orientation of tens of thousand of doctors to be posted unsecured on the internet. This is the government who wants to put you full medical history on the NHS spine. This is the government who want to impose ID cards on us all.

Data is incredibly powerful when it gets into the wrong hands.

The problem is, it’s already in the wrong hands.

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.