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.

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?

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.)

MMC and MTAS – a direct appeal to Junior Doctors

This is a direct plea to junior doctors to hang on to their stethoscopes for at least another 6 months. These are the reasons why I really think it is worth it to hang on in there while the dust settles.

1. MTAS won’t be used next year – recruitment will be done locally
   • It cannot be fixed in time. I it would have to be up and working by October and 5 months simply isn’t long enough.
   • The next Secretary of State is NOT going to put their reputation on the line to try to save Patsy’s. They’ll ditch MTAS as fast as they can say “oh god, not health”.
2. MMC will be changed
   • I believe that those who don’t get a number this time, even at S3 level, will be given a second chance. How gutted would you be to leave now and then find you could have got a number if you’d stayed?
   • I cannot second-guess the outcome of the Tooke Review in the way I can second guess the canning of MTAS, but it is clear that MMC won’t remain the same.
3. You can leave but you can’t come back
   • If you wanted to become a Lawyer or work in the City you wouldn’t have spent the last 7, 10, 12, 15 years of your life working at becoming and being the best doctor you can be. Do you really want to give it up? Hang on in there for 6 or 12 months and stay current.
4. The grass isn’t necessarily greener
   • Face it, there aren’t 8,000 vacancies in the City or the Legal profession. I’ll admit that’s an argument for leaving sooner. But how shitty would it be to abandon a profession you love and are good at and end up being a grockle in another profession because the market just got flooded with doctors?
5. We still need doctors, and the locum rates will be pretty good while the dust settles
   • Face it, in the short term you will be able to get work. Intermittent, unreliable, below your level, in unfamiliar hospitals maybe. But you’ll be able to pay your mortgage and keep current while the dust settles.
6. You don’t know what the future will be like till you get there
   • Many years ago I was facing a future of divorce, personal bankruptcy, loss of my house and the loss of my business. Just contemplating it made me hyperventilate, set off a bout of hysterical screaming tears and gave me panic attacks. I – quite literally – could not think about that future. When I got there I didn’t go bankrupt but everything else I described did happen. None of it was as bad as I expected, and some of it was actually rather fun. I enjoy my life now, and am hugely happier and more settled than I was in the years leading up to that time. The point that I am making is that just now this seems like the end of the world. But in fact it is just a spectacularly unpleasant and traumatic episode in what will be a long and healthy life. When you are looking back on this, you will always think of it as a horrible time of enormous stress and uncertainty. But you will also realise that it was just a turning point, and that the rest of your life is the rest of your life.
7. If you can get a job in Australia, New Zealand or Canada go for it.
   • To be honest I’d give my eye teeth to be under 30 and going to live in any of those countries. They are great places to live and raise kids, and you would keep your options open.
     
     
8. If you hang on in there, you can still be a medic. If you leave now, you never will be again.

MMC – made simple

Here’s a simple, straight-forward and dignified explanation of MMC which I only just came across today:

It isn’t the StarWars tribute; it covers a much wider spread than that and it deserves a wider audience.

Vindictive Fucking Bitch

The Vindictive Fucking Bitch has demanded costs.

From the email update on the Judicial Review from Mums4Medics:

What leaves a particularly nasty taste in the mouth is that the lawyers for the Secretary of State have applied for costs against Remedy, and have made it clear that Ms Hewitt was directly involved in that decision. The judge was very unhappy about this, and suggested in the strongest possible terms that Counsel for the Secretary of State might like to ask his client to reconsider. Counsel indicated that reconsideration was not an option. Reluctantly, the judge awarded costs. To quote the immortal words of Francis Urquart, ‘You might call such an act vindictive, but I couldn’t possibly comment.’

I am so shocked by the bitch’s vindictiveness that I am sending Remedy another donation today – money well spent if you ask me. Click here if you wish to do the same.

PS – the expletives here are all my own unaided work. Mums4Medics are much wiser and politer than I am; only the words in the blue are theirs.

PPS – at least Remedy got under her skin; a thought which gives me a warm glow of satisfaction every time I think it.

Ain’t got no algorithm, baby

Just when I think I’ve got my head around the MTAS debacle, yet another thing happens which takes my breath away.

This, from Remedy’s website, reporting on the Judicial Review of MTAS:

Mr Greenfield states “The decision not to proceed with MTAS for matching candidates to training posts was taken as a result of recent security difficulties and the fact that the Defendant could not be certain that the algorithm necessary to operate the ‘single offer system’ would be effective.“

That statement, right there, is worth the cash I put in their fighting fund.

That’s me, breathless again.

What can you say?

What can you fucking say?