House of Commons
Tuesday 24 April 2007
The House met at half-past Two o’clock
[Mr. Speaker in the Chair]
Oral Answers to Questions
The Secretary of State was asked—
NHS Information Technology
The digital technology being delivered through the national programme for IT is already being used widely by clinicians on a daily basis, and 91 per cent. of general practitioners have made a booking through choose and book. Most importantly, it is bringing benefits for patients by improving their care, safety and experience, and by improving the efficiency of services across the NHS in England.
The Minister will be aware that the British Medical Association’s working party on information technology is concerned about the non-compatibility of the IT systems of the four home countries, and in November it wrote to the director general for IT in the NHS to express that concern. Will the Minister please say why it was not thought appropriate to design compatibility into the systems from the outset, and what effect does she think that lack of compatibility will have on patient safety, particularly in border areas?
Of course we are working with our colleagues across the borders of England to set standards and to consider issues of interoperability. For example, although the devolved Administration in Wales have chosen to adopt different approaches to the development of IT in relation to the health service in Wales, we are in discussions about how we can facilitate the migration of existing NHS shared administrative services, so that the NHS care record service data spine can be used. We are working together, and I am pleased to say that across England, we can prove that we can work with the system to produce results daily. Choose and book is rapidly being taken up across the country, and we are making progress on electronic prescriptions and many other measures. I am sure that that is something that the devolved Administrations will want to consider.
Will my hon. Friend take this opportunity to congratulate the managers and staff at the Clatterbridge centre for oncology, which several years ago introduced an innovative IT scheme enabling its nine new Linux scanners, which deliver radiotherapy, to be chosen and booked by people who are expecting treatment? That ensures that there is huge productivity, and waiting lists for radiotherapy, which used to be very long, have now plummeted. People are getting their cancer treatment at the time of their choice, much faster than ever before.
Exactly. Our ambition is to provide better and safer services, quicker than ever before, and innovative clinicians are working with managers in the health service, and are co-operating with us, to do exactly that. I pay tribute to those people at her local hospital, who are making a difference to the lives of the patients whom they serve.
The April Public Accounts Committee report on the national programme for IT reported that the care record service is running two years behind schedule, with no firm plans for deploying the necessary software. Clinicians do not have faith in the programme. Four years after its start, there is uncertainty about the costs for the local NHS, and one of the largest suppliers, Accenture, has bailed out. Why is it that under Labour management, the NHS appears to be in the information super lay-by, when it should be on the information super highway?
We acknowledge the PAC report, but it happens to be a year out of date, and it is based on a previous National Audit Office report— [Interruption.] Let us just hear what the NAO has to say about our programme for improving technology in the NHS. It says that the NHS connecting for health programme
“has adopted the highest security standards for access to patient information”,
“The Programme has the potential to generate substantial benefits for patients and the NHS.”
It also says:
“The Department and NHS Connecting for Health have made substantial progress with the Programme.”
On the electronic patient record, it is important that we take time to get it right; that is better than speeding ahead and getting it wrong. [Interruption.] The Tories had 18 years to get on top of the technology, and not a lot was done. The question was asked—
I thank my hon. Friend for raising that important point. We are moving from old-fashioned X-ray films to digital images, which will transform the NHS. Over 170 hospitals are already using the system, and all NHS hospitals will have it by the end of the year. I congratulate St. George’s hospital on its commitment to providing the best possible service. On top of all that, within the first year we expect to save £40 million.
Among the large number of answers that I have received from Ministers is one from 4 September last year in response to a question about what information the Department collects from primary care trusts, acute trusts and strategic health authorities on the allocation of budgets for choose and book, as well as information returned about assessment. The answer was “None”. How can the Minister, in response to earlier questions, suggest that the Department is satisfied that it can make an assessment about the choose and book system if it is clearly not collecting any kind of information from people who are using the system?
We regularly collect information in different ways on the choose and book system and how it is working. I was pleased to visit a GP practice on Monday, and I talked to the GP about how it was working in that area. One thing is true: the IT to support choose and book has been delivered; the IT to support electronic prescriptions has been delivered; the broadband network has been delivered ahead of schedule; and digital X-ray machines have been fully deployed across London and the south of England. That is what is happening, and it is transforming lives. We will collect information where necessary, but we would rather provide the facility and ability for the local health service to get on with the job and produce the results.
The Minister says that everything has been delivered, but the blunt truth is that twice the Government have set a target for choose and book, and twice they have missed it. Last year, Lord Warner promised to resign if choose and book was not delivered this March; in December he scuttled off on a fix-up job and is now blaming GPs and MPs for his failures. David Nicholson has criticised the bunker mentality of connecting for health, and today—
We are delivering connecting for health on time and on budget—but perhaps the hon. Gentleman’s question was written by Professor Ross Anderson, who is an independent adviser on IT to the Select Committee on Health. Among a number of suggestions for Conservative party policy, he proposed a fresh look at IT policy, suggesting that in each civil service department there should be a chief information officer at grade 1 and that
“the top 50 per cent. performers should expect a knighthood”,
based on their IT advice. If that is the best advice that the Opposition can obtain for operating a modern Government using the modern technology necessary for our public services, so help them.
Delivering high-quality social care and health care in every area while securing maximum value for money can be achieved only by NHS bodies and local authorities working together to make the best use of the available resources. We have made it very clear that cost shunting is not acceptable.
Can the Minister confirm that 17 per cent. of NHS capital resources are locked up in that problem? Does he agree that it does not matter whether we rebrand bed blocking as delayed discharge or cost shunting, because we are dealing with some of the most vulnerable people in our community, many of whom suffer from dementia? It is not just embarrassing, it is shameful that no Government Department is prepared to get a grip on the problem, whether it is the Department for Communities and Local Government funding local authorities, or the Department that runs the health service. We cannot go on with wards full of people who should not be in hospital and need not be there, because it is all down to accountancy.
Some very specific things have been done to bring local authorities and the NHS together at the local level. Local area agreements bind them together through shared objectives and targets, joint appointments are increasingly made between the health service and local government at local level, and the Local Government and Public Involvement in Health Bill requires a duty of partnership for the first time from local government, primary care trusts and other health bodies. I have to say to the hon. Gentleman that Members on both sides of the House remember when winter crises were an annual event under the Conservatives, so we will not take any lectures on bed blocking from him.
Does my hon. Friend agree that one issue for social services has arisen because of the success of the NHS in dealing with more patients and discharging more patients? With that increased throughput, many such patients have more intense needs, so will my hon. Friend look at developing more intermediate care schemes in which health and social care departments can work to discharge people into the community, but with more support so that they can go back into their own homes?
My hon. Friend is absolutely right. That is at the heart of the debate about re-engineering services away from the acute end of the national health service into community-based health services and social care. That leads to more investment in early intervention and preventive services, and it increasingly gives people what older people and their families tell us they want—care so that individuals can be supported to continue living at home for as long as possible. It is shameful that the Opposition automatically present all those changes as cuts, not as changing services to meet people’s needs.
To what extent will greater co-operation and accountability be introduced by pooling budgets? Is the Minister aware of Cornwall county council’s local government review submission, which proposes exactly that? Are any discussions taking place at a cross-departmental level to encourage that?
I have a great deal of sympathy with what the hon. Lady says. We need to move from a notion of partnership between local government, the NHS and the voluntary sector to a notion of integration in every local community. We must move away from health care and social care being provided separately, so that local government and the health service locally truly secure the health and well-being of the local population, strongly focused on the needs of individuals, older people, disabled people and their carers, and families.
Is there not some risk that the discussion will develop into blame shunting, as David Stout, the newly appointed director of the PCT Network, has suggested? Local people do not know who runs what, and if organisations blame each other, public confidence in both sectors will deteriorate. How can we restore the momentum towards co-operation between social services and the NHS that my right hon. Friend the Member for Holborn and St. Pancras (Frank Dobson) set in train all those years ago?
I agree entirely with my hon. Friend. We must break down the Berlin wall between the NHS at local level and local government. No longer is the prize simply the integration of health care and social care. The full range of services that local government provides make a difference to the quality of life of older people, disabled people and vulnerable people. Local area agreements, a statutory duty of partnership, guidance on how services should be commissioned in an integrated way—all these matter, but so does the culture at local level. We expect leaders in the NHS and local government to provide leadership. We expect professionals to put aside their professional prejudices, organisational boundaries and historic enmities and focus on the needs of the people who require services.
Acute Hospital Services
The future of acute hospital services increasingly lies in high-quality, independently regulated and locally accountable NHS foundation trusts, such as Frimley Park in the hon. Gentleman’s constituency.
The Minister is aware that accident and emergency units in hospitals that serve my constituents are threatened with closure. What she may not know is that the so-called clinical evidence base justifying these cuts on medical grounds has been drawn up by someone who is not even a doctor, and the officials executing the cuts refuse to make improving clinical outcomes one of the aims of their work. Is it not clear that the cuts have nothing to do with helping people in pain and everything to do with ministerial mismanagement?
The hon. Gentleman is talking absolute nonsense. Hospitals are changing because medicine is changing, and there are discussions going on in Surrey and other parts of the country about how to improve services—in some cases by giving more treatment closer to patients’ homes in health centres, community hospitals or GP surgeries, but also about how to ensure, for instance, that for people who have suffered a heart attack or stroke, specialist life-saving care is available in specialist centres. That will not be the case in every single local hospital—but no formal proposals have been made yet on service improvements and changes in Surrey. They will be made in due course, and consultation on them will not start until the summer. That is the appropriate time to have a debate about how services in Surrey can be improved to give people better care and a better chance of having their lives saved.
The Secretary of State knows that there has been a promise of new money for Leicester—£700 million for the pathway project. Although there will be a delay in the application for foundation status, will she reiterate the Government’s full support for the rebuilding of the hospitals that was promised under pathway, including refurbishment of the Leicester general hospital, so that in Leicester we can provide the best possible care in the best hospitals in the country?
My right hon. Friend and I have taken a close interest in this matter over several years, and I am delighted to say that last year the Minister of State, my hon. Friend the Member for Leigh (Andy Burnham), who has responsibility for reform and delivery, announced a private finance initiative rebuild across the three hospitals of the University Hospitals of Leicester NHS Trust. My understanding is that, following some discussions with the private sector partner about the cost, a review is taking place, but I have no doubt that that investment will continue for the benefit of people not just in Leicester but across Leicestershire and other parts of the east midlands.
Does the Secretary of State agree with the Department of Health document “Keeping the NHS local: a new direction of travel”, which in referring to smaller acute general hospital reconfigurations states:
“The objective is to provide at a minimum a ‘first port of call’…a service able to receive and provide assessment, initial treatment and transfer where necessary”?
As the hon. Gentleman knows, we have recently published a series of reports from the clinical directors—the tsars—on, for instance, accident and emergency medicine, heart attacks and stroke. He will also be aware that, because of the rapid changes taking place in medicine, we now have an opportunity to ensure that some of those assessment and diagnostic services to which he refers can be provided even more conveniently than in a local district hospital—for example, in a walk-in centre, a GP centre or an urgent care centre—but also that some of the more specialist services need to be provided in specialist centres with enough patients to ensure that the doctors and other staff there can provide the best possible care. However, as I recently saw at Harrogate district hospital—one of the two best hospitals in the country, according to the Healthcare Commission—it is very possible for a small hospital that has made itself the focal point for a wider network of care to provide outstanding services to patients within its community.
My right hon. Friend’s visit to the Manor hospital in Walsall was very welcome. Apart from the reduction in waiting times, was she shown the extensive building plans, the largest development of the hospital since it was built in the 19th century, which was the subject of an Adjournment debate of mine last June to which the Under-Secretary of State for Health, my hon. Friend the Member for Bury, South (Mr. Lewis) replied? As I say, I am pleased that she did visit.
My hon. Friend has been rock solid in his support for Manor hospital and the trust, and the substantial investment programme for the new hospital, which is so badly needed on the Manor hospital site. I congratulate the staff at Manor hospital and the local primary care trust. It will be one of the first hospitals in the country to ensure that for almost every patient with almost every condition there will be a maximum of 18 weeks—and far less than that, for many of them—between GP referral and hospital operation by the end of this year, one year earlier than we pledged in our manifesto. That kind of excellent, fast, safe care was never delivered in hospitals around the country under the Conservative party. It is now being delivered, thanks to the investment and reforms that we are making.
The Secretary of State will be aware that in Surrey the accident and emergency provision at St. Peter’s hospital and at the Royal Surrey county hospital are under threat. My hon. Friends take the view, as I do, that this will be deeply damaging. Is the Secretary of State worried that although the proposals have been floated since last year, the promised consultation document did not come out at Christmas, in January or in March, as we were led to believe, and is now promised for some time in June? Can the right hon. Lady guarantee that this suspense for the people of Surrey will not be dragged out much longer? It is a great burden for them at present.
I understand the uncertainty that is inevitably caused when the local NHS considers how best to improve services. As I have just said to the hon. Member for Surrey Heath (Michael Gove), there will be a consultation on specific proposals in relation to hospital and other services in Surrey, and the commitment is that that will start in the summer. The important thing is to ensure that the proposals are right and clinically based, and now that the NHS is back in balance and the NHS in the hon. Gentleman’s part of the country has made such enormous progress in getting on top of the financial problems that have arisen, I hope that he and his constituents will accept that the changes proposed will be driven by the need to improve clinical outcomes for patients, not the need to balance the books.
Will my right hon. Friend join me in welcoming the action taken by my local hospital, the Queen Elizabeth hospital in Gateshead, which is another of the 13 early adopter sites? That will ensure that the 18-week target is hit by this December—one year early, as she said in reply to my hon. Friend the Member for Walsall, North (Mr. Winnick).
I am grateful to my hon. Friend for giving me the opportunity to thank and congratulate the staff at that Gateshead hospital and others. Eighteen hospitals will expect to achieve that 18-week target one year ahead of time by the end of this year. Staff at Gateshead, Walsall and other hospitals are reorganising services. For instance, in the case of orthopaedic patients at Walsall, the staff found that it was taking 200 hours of staff time, much of it administrative, to take a patient from initial receipt of the GP referral through to the hip replacement or other operation. By reorganising the way in which they worked—not by putting in more money—they reduced that to just 30 hours, enabling them to transform the lives of between six and seven people in the time they had previously taken to treat just one. That is the kind of improvement that we are seeing, thanks to NHS staff.
Is the Secretary of State aware of a document called “Squaring the Triangle”, which is intended to be the basis for the reconfiguration of acute hospital services in west Surrey? It says:
“Current Department of Health and Strategic Health Authority guidance suggests that to be viable, a full A&E Department in the future would need to be supported by a catchment population of between 450,000 and 500,000 people. On this basis only two full A&E Departments (rather than the existing three) will be viable for the West Surrey population in the future.”
Is the Secretary of State aware of that? Does she endorse or reject that reference to Department of Health guidance?
As I have said, there are as yet no settled proposals for service improvements in west Surrey—or, indeed, in east Surrey. As the hon. Gentleman will be aware from Professor Sir George Alberti’s recent report on emergency medicine, there is already a very wide range of different kinds of A and E departments, from those providing the full range of trauma centres down to those providing—[Interruption.]
Thank you, Mr. Speaker.
There is already a very wide range of services provided by different A and E departments. I hope that the hon. Member for South Cambridgeshire (Mr. Lansley) would be as focused as we are on ensuring that A and E services give the best possible care to every patient, whether they need it locally, much closer to home, or in a specialist centre, possibly slightly further away, in order to save their lives.
The Secretary of State is not answering the question. I am focusing on both specialisation and access, and quality of services includes the issue of access. Will she answer the question? Does she endorse or reject the reference to Department of Health guidance? If this is acted on in west Surrey, the implication is that an A and E department will shut. If it were to be acted upon in the north-west of England, where there is one type 1 A and E department to every 207,000 people, half the A and E departments in that region would have to shut. Why do not we not see that happening in the north-west of England, when my colleagues in Surrey see their A and E departments threatened, apparently on the basis of Department of Health guidance?
I think that we can all see the next Conservative party campaign coming, with the misleading propaganda that we have come to expect from it on health. The hon. Gentleman completely misses the point that different A and E departments will offer different sorts of services. For the most specialist services, including stroke services, about which I know he has a long-standing concern, a larger population is required to ensure that specialist staff are available 24 hours a day, seven days a week to deal with the patients who need that care. Different A and E departments will provide a different range of services. That will be one of the key themes of the guidelines and proposals on urgent and emergency care that the Department will publish shortly.
CATS Services (Chorley)
I suspect that this answer is a direct response to my hon. Friend’s persistence on the matter, Mr. Speaker. Central Lancashire primary care trust has agreed with Lancashire Teaching Hospitals NHS Foundation Trust that CATS services will be provided at the trust’s hospitals, including Chorley and South Ribble hospital.
I thank the Minister for reaffirming the position. He could possibly go as far as congratulating the primary care trust on listening to the people of Chorley, because the decision is ground-breaking. It ensures not only that no private company will operate CATS in Chorley but that the services will be run and funded by the NHS and based at the local hospital. That is good news for Chorley. Does my hon. Friend agree?
I congratulate my hon. Friend on the points that he has been making for some time about this issue. The consequence of the PCT’s decision is that patients in my hon. Friend’s constituency and in neighbouring constituencies will get the choice that they deserve, and any unacceptable waiting times for particular treatments will be slashed. In many areas, that requires a contribution from the independent sector. However, the PCT in Chorley has shown that where the NHS believes that it can do the job and achieve the outcome, it is chosen as a suitable provider. Most importantly, waiting lists and times in my hon. Friend’s constituency will be reduced.
The first wave of independent sector treatment centres was paid 11 per cent. more than NHS organisations for carrying out exactly the same operations. What is the uplift? How much more will private sector, not NHS, CATS be paid for carrying out precisely the same operations in future?
In the context of the first wave and incentives, the issue was creating a position whereby we could ensure that, in communities where waiting lists and times were unacceptable—and should be unacceptable to the NHS—the independent sector could build its capacity and help the NHS treat those patients as quickly as possible. Whatever debate there may be about the specific amount of the incentive, that was why it was required at that stage in the process.
Community Hospitals and Services
We are committed to community hospitals when they represent the best solutions for local communities. To support that, we have set up a five-year £750 million programme to promote the development of community hospitals and services. To date, we have allocated around £100 million to 14 different schemes. Decisions are outstanding on a further 18 schemes.
Bringing community care and health care closer to individuals will have a profound effect on their lives, ensuring that people live longer and healthier lives. The PCTs have a vital role to play in that. Will my hon. Friend join me in condemning the Lib-Dem council in Brent—also known as the Fib-Dem council—
It is tempting to do as my hon. Friend asks, and I would like to, Mr. Speaker. However, perhaps I shall simply say that I agree with her that patients support the move to provide more and extended services in the heart of communities, including those in London. That comes through time and again in all the consultations that the Department has carried out.
Does the Minister agree that minor injury units are an essential part of community hospitals but that the services provided are often cut, as are the hours of opening? Will he ensure that community hospitals are adequately funded to ensure a consistency of service for minor injury units and look into standardising those services in order to ensure that when people go to such units, they know what services they are going to get?
The hon. Gentleman makes an important point. Minor injury units are an important part of the 10 community hospital schemes that I announced recently. I agree that PCTs should take a view locally on where those schemes can help to fill an identifiable need. That is precisely the sort of scheme that we want. In looking further at the range of schemes recently approved, I found that many are very innovative and are offering new kinds of services to communities that have often had poor to patchy general practice in the past. It is all about bringing better and extended services to communities that have not benefited from such services in the past.
May I thank my hon. Friend for his recent announcement about the building of a new primary care centre in Rotherham? Does he accept that that will not only provide patient services seven days a week, but will have further benefits to services in the acute sector? Does he also agree that those reconfigured services in the NHS are improving the level of service to patients and should be welcomed by everyone and not cried against by Opposition Members every time we attempt to improve patient services?
The points that my right hon. Friend makes about the links between pressure on accident and emergency departments and acute hospitals generally are extremely well made. The scheme that we recently put forward and approved in his constituency includes a walk-in centre and a minor injuries unit. It also includes access to diagnostic facilities, dietary services, physiotherapy and audiology, so it truly provides a step forward for my right hon. Friend’s community. He is absolutely right that the beauty and benefit of those schemes is that they can take the pressure off local acute hospitals and give patients another option rather than trekking into accident and emergency as the only available option for treatment.
Mental Health Patients (Children)
We have made a commitment to eliminate within two years the use of adult psychiatric wards for children younger than 16. My officials are writing to strategic health authorities informing them that if a child younger than 16 is placed on an adult psychiatric ward, it should be reported directly to the Department so that we can take appropriate action.
Given that the Government’s own commissioner, Professor Sir Al Aynsley-Green, has said that children who go into adult wards for treatment come out in a worse state than when they went in, will she guarantee that the current provisions in the Mental Health Bill that require age-appropriate treatment settings will remain unamended?
No, I will not. One of the problems with the House of Lords amendments to the Mental Health Bill is that, in certain circumstances, they restrict the ability of clinicians to treat 16 or 17-year-olds, for example, who might be better placed on an adult ward. That imposes quite a straitjacket in terms of the clinician’s ability to place people. There is also the issue of emergency treatment and the Lords amendments create further problems in that respect. However, as I said, we are certainly committed to ensuring within two years that children younger than 16 are not treated on adult wards.
As my right hon. Friend is aware, during recent consideration of the Lords amendments to the Mental Health Bill, a number of interesting suggestions and proposals were made. Will she give me a guarantee that she will consider them very carefully?
My hon. Friend is right to say that this is an extremely important issue. I know that he is concerned about it, and he has raised the matter with me separately. As I have said, the problem with the House of Lords amendments is that they would create a clinical and legal straitjacket, but that is not to say that important issues have not been raised, and I am sure that we shall discuss them in Committee.
My constituent, Miss Fiona Gale of Sherston, having been treated in an adult mental health care ward and abused in various ways while she was there, was then discharged against her wishes. Tragically, she committed suicide in front of a train in my constituency shortly afterwards. The coroner agreed that she should have been treated in a separate children’s ward and that there should have been a halfway house between the completion of her treatment and her discharge into the community. I welcome what the Minister has said about under-16s; will she also consider what I have said about the provision of a halfway house?
It is absolutely tragic to hear about such cases. The hon. Gentleman mentioned that the child had been discharged against her will, and that obviously should not happen if a child is still in need of psychiatric help. The hon. Gentleman will be aware of changes made to the Mental Health Bill in the House of Lords that we are seeking to overturn, but one of the provisions that we are seeking to introduce is supervised community treatment. That would enable someone to be discharged but to remain under the care of health care professionals.
What evidence is there that primary care trusts and mental health trusts are discharging their duty of care to the under-18s who need mental health treatment? What proportion of under-18s have access to early intervention provision, which has proved highly successful in treating psychosis among people of that young age group?
I cannot give my hon. Friend the exact number of children using the early intervention teams, but the spending on child and adolescent mental health services—CAMHS—increased from £284 million in 2002 to £530 million in 2005. With that increased investment, we have managed to employ more staff. There were about 7,700 in 2003; that figure went up to 9,800 in 2005. The case load has also risen by about 40 per cent. between 2002 and 2005, however. The extra investment is making a difference, but we certainly accept that there is some way to go, particularly in the development of CAMHS services, and the Under-Secretary of State for Health, my hon. Friend the Member for Bury, South (Mr. Lewis), is continuing to work on further improving those services and, in some instances, integrating them more effectively with the other services.
Yesterday in Committee Room 16, in front of MPs and Members of the Lords, two teenage girls, Lois and Antonia, gave harrowing accounts of their experiences in acute mental wards. Those were adult, often mixed-sex, wards, which contained people who had committed homicides, in which the girls were subjected to sexual abuse and invasion of privacy, and received little or no age-appropriate treatment from inappropriately qualified staff and no help with their education. On behalf of the hundreds of children placed in those wards—the number is growing—they begged for the age-appropriate amendments to the Mental Health Bill to be retained. They do not think that the Lords amendments would prove to be a straitjacket, because they would provide for age-appropriate treatment and allow for emergency admission. Why are they wrong?
They are wrong because—[Interruption.] I am not saying that those girls are not well intentioned, or that we do not want to ensure that the situation improves. At the moment, the number of such bed days—that is, the number of days when a bed in an adult ward is occupied by under-16s and 16 to 17-year-olds—is dropping. We need to ensure that we have more accurate information about that.
The Lords amendments include the proposal that a child should be seen by a specialist practitioner—in this instance, a CAMHS specialist. If they were on an adult ward, that would be difficult to achieve. In that sense, the problem is a real one because the CAMHS specialist would not be assigned to an adult ward. Were it more appropriate for the care of an individual aged 17 to 18 to place them on an adult ward, they would not have access to the specialist. As I have said, however, there are certain problems with the Lords amendments—
Basic pay for a newly qualified nurse has increased from £12,385 in 1997 to £19,645 by November this year.
I thank my right hon. Friend for putting into context the large and fully justified pay increases for student nurses since 1997. New nurses need to know, however, that they have an adequate career path once they enter the service. Will she indicate what “Agenda for Change” means for nurses throughout their careers?
My hon. Friend makes an extremely important point. One of the most important reforms introduced by “Agenda for Change” was to open up new opportunities for nurses to build their skills and take on new responsibilities. Under the old Whitley scale, a clinical nurse specialist grade 1 could hope to achieve a salary of £26,000—barely twice that of a newly qualified nurse. Under the new system of “Agenda for Change”, by November this year a nurse consultant at the highest level will be able to earn more than £90,600, which is a measure of the change and improvement that we have been able to make.
I understand the concerns of nurses and other health service staff about the staging of the pay award. When we accepted the independent pay review body recommendations across the public sector, not simply those for the NHS, we decided to stage the implementation for this year as we took account of the wider economic position on inflation and interest rates. That is not only fair to nurses and other public sector staff, but right for the public as a whole.
I acknowledge the increases in pay over the years, which were clearly needed. Nurses are still, however, one of the lowest- paid groups of professionals in public service. Does the Secretary of State accept that nurses this year are getting a real-terms cut in pay, and that the impact on morale of the phased increase, combined with the fact that many newly qualified nurses have no job at all, is really damaging the profession? Is she proud of that situation as we approach the 10th anniversary of the Labour Government?
I have just explained, as I have on many occasions, why it was necessary to take account of the wider economic circumstances. It would not be in the interests of newly qualified nurses or anybody else were we to see inflation and interest rates return to the levels that they reached under the Conservative Government. We will not take risks with the economic stability and strength that have been achieved, particularly as a result of the policies of my right hon. Friend the Chancellor. The hon. Gentleman mentioned newly qualified nurses and their difficulties in getting jobs. We are making great efforts to ensure that the NHS in each region finds appropriate posts for newly qualified NHS staff to address that precise issue.
Not only are nurses receiving a real-terms cut but the Department of Health originally argued for a pay rise of only 1.5 per cent. Given that the independent review body for nursing not only rejected the Government’s figures but criticised the Department of Health for failing to provide any evidence as to how its estimate was reached, does the Secretary of State understand how angry and cheated nurses up and down the country feel when the Government seem to be plucking figures out of thin air in order to keep salaries low?
Salaries for nurses and other NHS staff are a great deal higher than they were under the Conservative Government, and a great deal higher than they would have been under the Conservative party’s new policy of cutting public spending to make way for tax cuts.
I remind the hon. Gentleman that there are over 80,000 more nurses in the NHS now than there were when we were elected 10 years ago. Not only has their pay increased substantially and not only will it continue to rise substantially this year as a result of the increments under “Agenda for Change”, but nurses are increasingly enjoying more flexible working conditions and support for child care needs—and, of course, much better holidays, maternity and paternity leave and pay than they ever enjoyed under the hon. Gentleman’s party.
Asylum seekers, including those who have been victims of human trafficking, are entitled to free NHS treatment for as long as their applications, including any appeals, are being actively considered by the Home Office. Any ongoing treatment will continue free of charge for unsuccessful applicants until their removal from the United Kingdom.
Trafficked women inevitably display mental as well as physical damage. Can the Minister guarantee that all victims who have applied for asylum will receive mental health support, some kind of counselling, and psychological care—not just to help them gain security and confidence as required by article 12 of the Council of Europe convention on action against trafficking in human beings, which the Government signed only last month, but to help the criminal authorities pursue traffickers?
I pay tribute to the work done by the hon. Gentleman as chair of the all-party parliamentary group on trafficking of women and children..
People who have been trafficked and who claim asylum can gain access to mental health services, but the Department, along with colleagues in the Home Office, intends to review access to health services for foreign nationals. We hope to report in October this year. As the hon. Gentleman will know, as part of the action plan to which the Government are committed and following the signing of the convention, we are examining ways of preventing trafficking and identifying its victims, as well as considering what services are needed. The POPPY project, which we have funded, now has funds to provide an outreach service, which will be very important to the many agencies that will play a role in supporting the needs primarily of women, and in some cases of children.
I thank my hon. Friend, who I know takes a huge interest in this issue. I should make clear that my original answer related to those who have been trafficked and are claiming asylum. As for my hon. Friend’s question about visitors’ visas, emergency treatment is available to those who present themselves provided that it has priority over establishment of their status or ability to pay. That underpins the way in which we run our health service.
There are issues involving people who should be paying and the reclaiming of funds. I understand that the Minister of State, my right hon. Friend the Member for Doncaster, Central (Ms Winterton) and colleagues across Government are examining a range of issues relating to health service access for foreign nationals, which may include insurance issues.
On 3 April we published “Maternity Matters”, which sets out how we propose to deliver on our commitment to improve maternity services for women. By the end of 2009, for the first time, mothers-to-be will have a guarantee that the NHS will give them real choice. That will include the opportunity to be supported during births, either at home or in midwifery units, by midwives whom they know and trust to care for them.
St George’s hospital in Tooting has an excellent maternity department. Both my children were born there. This summer, the hospital will open a new midwifery-led unit for low-risk women. Does my right hon. Friend agree that such units, which help to create a home away from home for women and their families, should be offered to all who wish to have their babies delivered naturally?
I strongly agree. That kind of midwife-led unit, which can provide superb support for women and their partners and babies, is exactly the kind of development that we want to see repeated in other parts of the country. I congratulate midwives and other staff at St. George’s on that excellent development. The fact that there are 60 more midwives at St. George’s than there were 10 years ago is in part what has helped make that improvement possible.
On 17 March we heard the devastating news that the proposed new children’s and maternity hospital in Leeds would not go ahead, despite having been approved by the then Secretary of State for Health in July 2004. Why has the project been pulled despite leading local specialists having said on 27 March that current services are “not fit for purpose” and that they are anxious about the continuing safety of children in hospital? When will the people of Leeds get the children’s and maternity hospital that they so badly need?
There is no doubt that the people of Leeds need a new children’s hospital and improved services; that has been recognised for a long time. Following the recent concerns and the possible delay in respect of that new hospital, the Minister of State, my hon. Friend the Member for Leigh (Andy Burnham), recently met the strategic health authority and colleagues from the trust to discuss that and to ensure that issues, particularly to do with cost, can be looked at so that the scheme can get back on track.
Will the Secretary of State congratulate my sister-in-law, who happens to be a constituent, on the recent birth of her son, Thomas, at the Royal Surrey county hospital, and does the Secretary of State share my hope that my constituents continue to benefit from its excellent maternity unit for many years to come?
I am happy to congratulate everybody whose children have recently been born at that hospital, or anywhere else—perhaps I can cover all congratulations at this point. As we discussed earlier, proposals will come forward for improvements and changes in services in various parts of the country, and there will be proper and full consultation on those proposals. It is important to ensure that in the constituency of the hon. Member for South-West Surrey (Mr. Hunt) and everywhere else women and their partners have the proper choice of having a baby at home if that is what they want and it is safe, having a baby at a midwife-led unit, or having a baby in a hospital, where there would be a consultant-led unit as well as a midwifery team. We will guarantee that choice.
On the basis of results reported at quarter three, we believe that the NHS is on course to deliver at least a balanced financial position at the end of the 2006-07 and continues to perform well against key service targets.
I thank the Minister for that reply. He might be aware that the Health Service Journal recently published some very out-of-date and inaccurate information about the financial aspects of various trusts, one of which was the Shrewsbury and Telford Hospitals NHS Trust. Please will he issue the latest figures so that publications such as the Health Service Journal have up-to-date figures? Also, does he agree that Tom Taylor, the chief executive of the Royal Shrewsbury hospital, is doing a great job of turning around the finances of our hospital?
I agree that the chief executive is doing an outstanding job. The hon. Gentleman might be aware that the latest figures at quarter three show that the trust was forecasting a £2.3 million deficit for year-end, but I can update that by telling him that the view of the strategic health authority is that the trust continues to make improvements and the expectation is that it will continue to improve in this financial year. The expected improvements relate to both the application of resource-accounting and budgeting and the effect of the national payment by results policy. Therefore, there is good news. The hon. Gentleman is right that his trust is on an improving course, and I hope that we can look forward to having his support in continuing to help it get into financial balance.
Will my hon. Friend the Minister congratulate my primary care trust on getting its books back into balance and, pursuant to his response earlier on community hospitals, will he ensure that the next round of investment takes into account fabulous community institutions such as Ellesmere Port hospital, which are especially fabulous for patients such as stroke victims?
I certainly pay tribute to my hon. Friend’s primary care trust and to others around the country, which have done an outstanding job in difficult circumstances in getting the NHS into a position whereby we can predict that overall, it will balance its books this year. It is because we have asked the NHS to take some of those difficult decisions and to tackle overspending that PCTs such as my hon. Friend’s can support the excellent community services that he rightly draws attention to. It has been a difficult year for many PCTs, but we can now look forward to a year in which we can bring down waiting lists and improve the range of services for patients.
In April 2006, primary care trusts had commissioned 75 million annual units of dental activity; by January 2007 that had risen to 78.4 million.
The chief dental officer leaked to the press on Friday that instruments used to perform root canal treatments will now have to be disposable. The excellent NHS dentist on North End road is concerned about access, pointing out that those regulations could cost £35 per root canal treatment, which is half the total that a PCT typically spends on a whole course of treatment. Given those new regulations and the fact that no extra funding is being provided, is not the Minister’s purpose to create an NHS dentistry system that is solely about tooth extraction?
First, I challenge the hon. Gentleman’s assertion that this information was leaked; it was sent to all dentists, and there was a ministerial statement about it. Moreover, and as he knows, this was a safety issue relating to Creutzfeldt-Jakob disease. Dentists with a good NHS commitment are given some £80,000 towards their business expenses and are expected within that to offer proper equipment and treatment and proper staff to carry that treatment out. So such expenses are perfectly well covered by the existing amount given to dentists to help run their businesses.
Point of Order
The hon. Gentleman was stopped because he had no right to criticise any hon. Member who had not been notified of such criticism in advance. I said at a later stage that the matter was finished with, and I hope that the hon. Member for East Worthing and Shoreham (Tim Loughton) will leave it at that.
Carers (Identification and Support)
I beg to move,
That leave be given to bring in a Bill to require health bodies to identify patients who are carers or who have a carer; to require identified carers to be referred to sources of help and support and to make further provision in relation to such arrangements; to make provision in relation to the responsibilities of local authorities and schools for the needs of young carers and their families; and for connected purposes.
In March 2006, I introduced a Bill with the same aims as the first part of this new one. As I told the House then, 1 million carers in the UK care for more than 50 hours per week. The 2001 census figures show that carers are twice as likely to suffer ill health if they care for 50 or more hours a week. Medical research also suggests increased ill health among those caring for a person suffering from dementia or stroke disease. It is my view that we must intervene to identify and support the most hard-pressed carers, who care for more hours than the hours of any full-time job.
In my Worsley constituency, the highest level of caring commitment is needed in the two wards with the highest levels of people with stroke and heart disease, and with cancer. While the national average is one in five carers caring for more than 50 hours a week, that rises to one in four in Walkden North ward in my constituency, and to one in three in Little Hulton ward.
Those carers play a vital role in health and social care. They are key partners in care for the NHS, but their own health is also threatened and there is a need for recognition of carers’ health needs. In 1999, the Government gave GPs and primary health care teams a five-point checklist for use with carers in their practice population. The first requirement in the list was that GPs should identify those patients who are carers or who have a carer. Eight years on from the launch of that national strategy, research shows that the work done nationwide by GPs and primary care teams to identify carers in their practice population is still inconsistent. Research by the Princess Royal Trust for Carers concludes that only a small proportion of the total number of carers is being identified. Even GP practices with good links to their local carers’ organisations are not doing the work necessary to identify all those carers whose health might be affected by their caring responsibilities.
Two carers known to Carers UK provide examples of how important it is to identify carers. Valerie Low of Carlisle cares for her husband, who was severely brain- damaged in a car accident in 1997. For years, Mrs. Low did not know that advice or respite care were available to help her as a carer. Now that she has been identified, she arranges respite care from Crossroads.
Tracy Barker from the Isle of Wight has cared for her son for 16 years. He has autism, asthma and epilepsy. Like many parent carers, Ms Barker did not see herself as a carer and had no idea of the support available to help her. She struggled to pay bills, yet she had not been told about carer’s allowance. Eventually, she had to move to a different area for financial reasons, and then she suffered depression. Now that she has been identified as a carer, she receives carer’s allowance and has attended a number of courses that have helped her.
If they are not identified, carers will struggle without the help or support that they need. My Bill would require that primary care trusts and local health boards ensure that effective procedures exist within primary care to identify carers, and that carers are referred for advice and given regular health checks.
The Pensions Bill also requires the identification of those carers caring for 20 or more hours per week so that they can earn the carer’s contribution credit. My hon. Friend the Minister for Pensions Reform has made a commitment to use the Government’s review and update of the national carers strategy as an opportunity to explore how that identification can be carried out by health and social care professionals. That is a welcome step forward.
In previous years, hon. Members of all parties have given their support to carers week, which this year runs from 11 to 17 June. Its main objective is to enable new and “hidden” carers to access support and services.
Young carers are perhaps the most hidden of all carers. The 2001 census records some 175,000 young carers, but only 30,000 of them are known to young carers support services such as the Princess Royal Trust for Carers and other children’s charities. Indeed, a survey by NCH and Carers UK showed that fewer than one in five of known young carers have received an assessment of any kind.
The Princess Royal Trust for Carers believes that it is likely that the most vulnerable young carers, including some of the 13,000 who care for more than 50 hours a week, continue their caring role throughout their childhood without any support. Young carers may have parents with substance misuse or alcohol problems, and the extent of that problem is not fully understood. The “Hidden Harm” report estimated that 250,000 to 350,000 children have parents with serious substance misuse problems. The alcohol harm reduction strategy for England states that between 800,000 and 1.3 million children are affected by parental alcohol problems. In the families of alcoholics or problem drug users, children may find themselves responsible for their parents’ safety.
My Bill would place duties on social services authorities to consider what support services are needed to sustain the parenting role in such families. When a parent is assessed for community care services, support services should be offered if it is found that the adult relies for support on the caring role of his or her child. In that way we can ensure that the health, education and well-being of the child or young person are not impaired by caring responsibilities.
Young carers may have a parent with an illness such as multiple sclerosis, or with a learning or physical disability. The parent may rely on the care from their child, as a case known to the Princess Royal Trust for Carers illustrates. A single parent was diagnosed with multiple sclerosis and loss of mobility, which affects not only her but her children, aged 8 and 12, who have to provide her with the round-the-clock support she needs.
Such children are missing out on their education and, like other young carers, they find themselves misunderstood at school, treated as truants and bullied by other children. Schools need written policies stating the support that they will offer young carers. My Bill would require that both schools and local authority children’s services have policies in place to support such young carers.
Many health and social care professionals are frustrated by the difficulties they experience due to different thresholds for service provision for different client groups. An adult mental health worker may be aware of several children affected by their parent’s mental health condition. However, unless the children are at risk of serious harm the health professional will probably not be able to help them. The general duties to young carers and their families outlined in my Bill would help. A simple joint working protocol between children’s and adult services, combined with a training programme for staff, would help to solve the problem.
Census figures tell us that a minimum of 2 per cent. of all children in the UK are young carers. However, work by Professor Saul Becker of Nottingham university and others suggests that the true number of young carers could be much higher—possibly 1 million of the 3 million children and young people who live in families where there is serious illness or disability. Whichever figure we use, we need now to bring in measures so that schools and local authorities recognise the issues faced by young carers.
I have outlined how the measures in my Bill would ensure that health professionals identify carers and refer them to much needed help and support. As we move towards the Government’s review of the national strategy for carers, I hope the measures outlined in the Bill will offer a sturdy framework for improved services and support to carers. My Bill is supported by Carers UK, Contact a Family and the Princess Royal Trust for Carers. I thank Carers UK and Luke Clements for helping me to draft the Bill and Alex Fox of the Princess Royal Trust for Carers for his input on young carers. I also thank the House for giving me the opportunity to present it today.
Question put and agreed to.
Bill ordered to be brought in by Barbara Keeley, Tony Baldry, John Bercow, Mr. Paul Burstow, Annette Brooke, Dr. Hywel Francis, Helen Goodman, Lady Hermon, Mrs. Sharon Hodgson, Ms Diana R. Johnson, Ms Sally Keeble and Lynda Waltho.
Carers (Identification and Support)
Barbara Keeley accordingly presented a Bill to require health bodies to identify patients who are carers or who have a carer; to require identified carers to be referred to sources of help and support and to make further provision in relation to such arrangements; to make provision in relation to the responsibilities of local authorities and schools for the needs of young carers and their families; and for connected purposes: And the same was read the First time; and ordered to be read a Second time on Friday 19 October, and to be printed [Bill 92].
[9th Allotted Day]
Modernising Medical Careers
I beg to move,
That this House acknowledges the UK’s exceptional history of medical training which has produced some of the best medical professionals in the world; supports medical training designed to improve patient care which is well implemented, flexible and applied in a way which ensures the necessary level of clinical experience; believes that these objectives have been undermined by poor planning, inadequate consultation and lamentable implementation; notes with particular concern the flawed electronic application process (MTAS) which has breached legitimate expectations that selection for entry to programmes must be open, fair and effective; regrets the lack of ministerial leadership for MTAS and the failure of the Government’s review to deliver strategic solutions; accepts that training posts are competitive but believes that insufficient allowance has been made for the number of trainees coming through the Foundation years in addition to the Senior House Officer (SHO) route; calls on the Government to create additional training posts to allow transition for SHOs into specialty training in 2007, 2008 and 2009; deeply regrets the distress and loss of goodwill among junior doctors in training; and further calls on the Review Group led by Sir John Tooke to listen to the medical profession in reviewing the structure of Modernising Medical Careers to ensure that the original principles, including flexibility, are sustained and command the confidence of the medical profession.
The reason why we have called this debate and given up Opposition time to such an important subject is that time and again we have sought answers from the Secretary of State for Health and Ministers about what has happened to the modernising medical careers programme, in particular the recruitment and selection process. With your consent, Mr. Speaker, we put an urgent question that the Secretary of State had to answer, because previously she had provided no good answers. Last Monday, she came to the House to apologise unreservedly—about time—but also to announce a further review and the conclusions of the first review group she had instituted. Serious questions and issues remain, however, and many junior doctors across the country and the consultants responsible for the interviewing process feel they have not been answered.
Our purpose today is therefore threefold. First, we want to secure some answers; secondly, through our motion, we want to make clear the necessary steps that the Government should accept to regain the confidence and support of the medical profession; and thirdly and not least, we want to demonstrate to the many junior doctors who have come to Westminster today to tell their Members of Parliament of their personal experiences, their disillusionment and, in many cases, their anger at what has happened to them that Conservative Members at least understand and accept their views. I suspect that many Labour Members, on the Back Benches at least, understand the problem. We will see later whether they are willing to come to the House to express to Ministers the sentiments that they have no doubt expressed to their constituents in private.
Does the hon. Gentleman agree that whatever the flaws or otherwise of the electronic system, the underlying problem is the surplus of applicants compared with places? Will he commit his party to increasing funding to the health service by the same level as we are committed to doing so that these doctors have a real prospect of a future in the NHS in the years to come?
The hon. Gentleman must know that, in the general election the year before last, we committed ourselves to exactly the same level of funding as applies now. However, we are talking not about the next election, but about what is happening now. We are committed to the same level of funding, but we are also committed to a far more efficient use of that funding.
The hon. Gentleman could have said, “By the way, the Government spent £72 million on the NHS university,” but that turned out to be completely wasted. What was their response to that waste of money? It was to try to suppress the report by Sir William Wells that was designed to examine where all that money had gone. Let us first be concerned with spending money effectively before we start debating how much money there will be beyond the comprehensive spending review.
The Secretary of State is sometimes at pains to challenge us on whether we agree with the principles behind modernising medical careers. Yes, we agree that modernising medical careers is a necessary process. To put it at its simplest, let us consider whether services in the NHS should be provided in the long run by specialist doctors or by doctors in training. Patients and the public would expect the services to be delivered by specialists and that it would be a consultant-led and increasingly a consultant-delivered service. When one looks across the world, one sees that this country has been unusual in the extent to which services in NHS hospitals, in particular, have been delivered by doctors in training rather by doctors who have their specialist certificates.
The principle of modernising medical careers is accepted and we also accept many of the principles in the documents of 2002 and 2004 that led to it. We should not rely on doctors in training for service delivery and training must be limited in time. It cannot be open-ended. As Sir Liam Donaldson said in his report about the “lost tribe” of senior house officers, we cannot have junior doctors who drift from one SHO job to another for years without ever making progress in specialist training.
Let us remember that one of the principles of MMC was that it was intended to be flexible and widen career choice. Where did that one go in the translation of principles into practice? The way in which MMC has been implemented is lamentable. When people look at the political gravestones of the figures in the Government, they will see carved on them, “It should have worked in principle, but it didn’t work in practice.” The Government started out with good intentions, but time and again they have failed to deliver. Here is another lamentable and shocking example of how they have failed to turn what, five years ago, was a straightforward set of principles into something that works in practice for those in the NHS today.
My hon. Friend is putting forward an excellent case. Like many hon. Members, I have been meeting young doctors, including some who are now going to go abroad. Those doctors are worried that they will not receive sufficient training under MMC. For example, orthopaedic surgeons received 22,000 hours of training under the old system, but they will receive only 6,000 hours of training under MMC. There might well be a happy medium, but the Government have certainly not got this right.
I understand exactly the point that my hon. Friend makes. I have had exactly the same conversations. I think that most junior doctors would acknowledge that it would be difficult to sustain the degree of clinical experience that used to obtain and that that would probably not be consistent with the delivery of services by specialists. However, my hon. Friend is right that there is a balance to be struck. Surgical specialties, especially, are, in effect, crafts as well as academic disciplines. While the structure of MMC and its focus on specific competencies address important issues, the programme has significantly failed to reflect accurately the importance of clinical experience and academic achievement, which should be involved in the selection of candidates.
I, like Ministers, care about what is happening, but perhaps Opposition Members have been more open about some of the problems. Locally, we have discovered that filling out 150 words is worth the same as a PhD, which involves three years or more of hard work. An explanation of that is needed. On the first day the system opened, it was apparently not possible to apply for a job within 50 miles of Worthing or for one in genito-urinary medicine. The problem is not the computer or the method of consulting the people who put the thing together. The problem was caused because the system was not run as a trial in at least one region to evaluate the experience. Will my hon. Friend commit us to go on working not only for senior and junior doctors, but for those in the MMC system who resigned because of a loss of confidence, by backing the doctors and, if necessary, saying to the Government, “Why don’t you drop your defences and join in working out the problems and solving them?”
My hon. Friend has captured exactly what we are trying to achieve through this debate. If hon. Members read the motion, they will see that its objective is not to engage in the easy task of saying, “It’s all gone wrong and the Government are to blame.” The motion engages with the question of what needs to happen now, although I note that the Government amendment says nothing at all about that.
The Government have been given warnings and they have to account for why they did not accurately reflect on the problems. The hon. Member for Broxtowe (Dr. Palmer), who asked the Whips’ question and then left the Chamber, said that this was about the number of applicants. However, I remember standing at this Dispatch Box on 20 December 2005 and making it clear to the Secretary of State that there would be a problem in August 2007 because two year cohorts of applicants would be coming together in one year, so the number of applicants for training posts would effectively double. The Secretary of State said that that issue had to be addressed. With a year and a half in hand, I was foolish enough to imagine that she would solve the problem. When, on 13 December 2006, Lord Warner said that junior doctors in England should be pretty confident about securing a training post and that additional training posts would be created, I was foolish enough to think that the Government had considered the situation and arrived at a solution.
There was a good deal of forewarning. The royal colleges rightly told the Government that the programme should be piloted, as my hon. Friend the Member for Worthing, West suggested, but that did not happen. Last year, junior doctors in the British Medical Association wanted a delay of a year. To be fair, I was not sure that that was the right thing to do because it would have harmed the circumstances of the foundation programme graduates. None the less, the BMA was rightly pointing out serious unresolved problems.
I strongly support the hon. Gentleman’s motion. Does he agree that the key point about MMC is that the number of training posts will not meet the need of the people who want to apply? The principle should be that all those who are qualified for a training post, and who are capable of being trained to consultant level and wish to be trained to that level, should have a training post; otherwise, we are wasting money by putting them through medical school and house jobs. A solution in which those people are parked in career-grade posts, so that they become fellows or hold staff grades or trust grades, is not acceptable, because then the service will be delivered not by consultants, but by a demoralised and often racially segregated group of doctors who are not fully trained and who are not specialists—and that is not the way we want our health service to go.
The hon. Gentleman is leading me further into what I was hoping to say. Let me just respond to that point. From what I know of the interviews that are already taking place, many consultants holding the interviews are meeting well- qualified applicants; I see that the Secretary of State is nodding merrily. However, unfortunately, we know that many well-qualified applicants did not get interviews. As the hon. Member for Oxford, West and Abingdon (Dr. Harris) suggests, we need a process in which well- qualified junior doctors have progressive opportunities to enter specialty training, and that is what our motion says. It also suggests that it may not be possible for all well-qualified applicants to secure specialty training or run-through training posts this year, but we have to put a stop to the current structure, which, in effect, limits the ability of some people, particularly senior house officers, to enter specialty training next year, or the year after that, if they do not enter the run-through training process this year.
Surely specialisms are to be held by the people best qualified to fill the posts, but how can that be reconciled with a situation in which people are confined to applying for posts in certain geographical areas? That means that if there are only two or three posts going in an area, and someone is the third or fourth best qualified person in the area and so does not net the post, they are unable to qualify, or even to apply, for similar posts in other parts of the country, even though they may be much better than the people who are allowed to apply for those posts.
I am grateful to my hon. Friend, who makes an important point. He reminds us of the most important reason why we are debating the subject. I have received hundreds of e-mails on the subject, and I have met many constituents, as I am sure that colleagues from across the House have done, who are concerned for their careers, for their livelihoods, for the fulfilment of their vocation to be a doctor and care for patients, and often for their family life. I ask hon. Members from across the House to imagine how they would feel if they were junior doctors—highly motivated professionals who have gone through graduate education, and who have, in some cases, worked in the health service for several years. They are senior professionals by any measure, but the net result of the current structure, including the way in which the review group has changed things, is that there is one interview for one unit of application, and that might be for a post anywhere in the east of England, from Hemel Hempstead to Cromer. That is the sum total of their ability to exercise control over the future of their career.
Dr. Mary Weisters and Dr. Tracy Graves practise general surgery and neurology respectively. Between them, they have 25 years’ experience, which includes education, training and hands-on practice in the national health service. According to the figures, they have a one in 30 chance and a one in 13 chance respectively of securing a job at a time of rising demand for medical services. Does my hon. Friend not agree that it would be a scandal bordering on criminal irresponsibility if they were shunted out of the national health service or, as happens at present, patronisingly encouraged to go abroad—something that they do not have the slightest desire to do?
I am grateful to my hon. Friend, because he further reinforces my point. I have often met married junior doctors who are wrestling with the issue of how they can both secure posts in a way that is consistent with maintaining their family life. That is intensely difficult. My hon. Friend’s point is a fair one; the British Medical Association is today warning that literally thousands of junior doctors could end up going overseas. What is the Government’s response? Well, we saw the document produced in the Department of Health last week. It was not published, but it found its way out. The Government are “volunteering” junior doctors to join Voluntary Service Overseas, so that they go abroad. [Interruption.] Well, it struck me that VSO is about volunteering—not the distressed reallocation of doctors from the United Kingdom to overseas, which is outrageous.
Further to the point made by our hon. Friend the Member for Buckingham (John Bercow), how do I explain to my constituents at the Horton hospital that we are likely to lose 24/7 consultant-led paediatrics, consultant-led obstetrics and a special care baby unit in the near future, because we have been told that there are insufficient doctors? How is a community like north Oxfordshire to accept on the one hand that there is a substantial downgrading of NHS services in Banbury and the surrounding area in a way that has never taken place before, while on the other it can see that junior doctors are being thrown on to the scrapheap?
There is only one way for my hon. Friend to explain that to his constituents: it is chronic mismanagement of the national health service by the Government. It was the Government’s intention to continue the expansion of consultant posts, but that has been torpedoed by the mismanagement of finances and deficits in the health service so that across the NHS posts have been frozen, consultant posts have disappeared and specialist consultants in some specialties cannot find posts. The consequence is seen not only in the impact on Horton hospital in my hon. Friend’s constituency, but across the country. The increase in medical school output or in the number of junior doctors coming through would have been consistent in due course with a larger throughput into consultant posts, but the Government’s attitude is that those consultant posts have been lost for financial reasons and they are cutting back on the hospital sector, so they want to maintain a tight bottleneck at the point at which junior doctors enter the further reaches of specialty training. They are stopping the flow, and they are literally forcing large numbers of doctors to leave the country.
The Government may believe that the doctors who will leave this country will be those who came from overseas in the first place, but that is not how it is working out. It is an arbitrary system. The scoring system, recruitment and application system have been made “objective” in a way that has become virtually arbitrary. Those who are selecting candidates for posts across the country were unable in the initial process to see anything like sufficient of the clinical experience, the academic achievements and the character of the candidates presented to them. It turned into a scoring system in which someone could literally—I have evidence in my file—pay £129, go on a course, and be told how to answer the questions to be selected for interview. That is utterly outrageous.
Following my hon. Friend’s extensive research for this debate, can he explain why there is such a misfit between the 30,000 junior doctors who started out with an aspiration to reach those higher posts and the 22,000 opportunities that exist? Who created that over-supply of 8,000 junior doctors, and has he worked out the cost to the economy, never mind the human cost, of that enormous waste of unplaced talent?
My right hon. Friend may be aware that we are constantly searching for accurate figures as to precisely how many applications and run-through training posts there are. Of the 18,500 posts in England—I think that the Department would acknowledge that figure—we have not even been told how many are run-through training posts and how many are fixed-term posts. The disparity between the figure of 18,500 and anything up to 34,000 posts is principally the result of the combination of two annual cohorts coming together because the new MMC process is shorter than the old training process, the right of European economic area nationals to apply without legal restrictions in this country, and a large number of overseas doctors who, for example, have highly skilled migrant programme visas.
There is no reason, as far as I am aware, why the Department should not have anticipated all those components. As little as four months ago, the Department, in the guise of the former health Minister, Norman Warner, was about a third out on the number of potential applicants. It is not good enough for Ministers to say, “There were more applicants than we expected so it all went wrong.” They were responsible for the process. They are responsible for the number of junior doctors who have access to training in this country. They should have known the likely outcome and dealt with it.
Time and again we have told Ministers that thousands of junior doctors would be left without training posts. The response of the Secretary of State is always to misinterpret that and say, “You’re saying that they are all going to be unemployed, and that’s shroud-waving.” She said on 19 March that
“the shroud-waving about unemployed doctors is absurd.”—[Official Report, 19 March 2007; Vol. 458, c. 582.]
In a letter to me on 27 March she stated:
“It is wrong to conclude . . . that there is a danger that these doctors will be unemployed”—
The Secretary of State says that is right, but in her own Department a document is being circulated, the purpose of which is to try to deal with the fact that up to 10,000 junior doctors will be unemployed. That is what it says—unemployed or without training posts. It was not absurd. We were not shroud-waving. It was a fact and the Government knew it, but they would not admit it.
The Secretary of State has been in appalling denial about all this. I shall try to avoid a long quote, but I want the House to listen to the words of one consultant who wrote to me describing the process from the interviewer’s point of view. We are hearing from junior doctors about how appalling the process has been. The consultant wrote:
“Today was the first occasion in 20 years that I was asked to make important decisions on the careers of our future colleagues, with no CV or application form to review in preparation for the face-to-face. The only information I received was a list of candidates—in no particular order—and a start time and venue. Each candidate arrived armed with a brief one-page summary, hand-written immediately prior to interview and a portfolio the size of one or two telephone directories. Three colleagues and I were supposed to review these in 30 minutes flat, at the same time as we conducted a structured interview, marked each domain individually, and finally came to an agreed score for each domain that will be forwarded to MTAS . . . I never saw any references and there was no opportunity to review our decisions. This process is the antithesis of fair employment and equal opportunities.”
That is from the consultant’s point of view. Imagine how it seems from a junior doctor’s point of view. I have a quote from a junior doctor who describes his experience. He states:
“I have a first-class degree in medicine/neuroscience, medical degrees with distinction, two research doctorates . . . in behavioural neuroscience, nearly 30 scientific publications including text books and commercialized research software, research prizes, three years’ experience as a lecturer in neuroscience at the University of Cambridge, and two years’ experience as a medical SHO at teaching hospitals . . . whilst I was short-listed for an ST2 medical position I failed to be shortlisted for ST1 psychiatry, which requires no previous psychiatry experience. Presumably, in some way my answers to the ‘anecdote’ questions didn’t fit the psychiatry scoring system, whatever that was”.
That reflects precisely the point made by my hon. Friend the Member for Worthing, West. A candidate can end up with all those qualifications but fail to be shortlisted because of the scoring system, under which a PhD was worth one point and 150 words on how one copes with stress was worth four points.
Perhaps one should ask whether the Prime Minister would appoint the Front-Bench health team on the same kind of system. Will my hon. Friend join me in posing a question to the Secretary of State for answer at the end of the debate? Is it true that the review group has said that each candidate will get one interview in their primary area? Is it true that under the MTAS system people who are to be interviewed this weekend are being told that there are no jobs available—that all were filled on the first round, so they cannot select their first choice? The advice is that they contact the deanery directly. The Secretary of State shakes her head. Will my hon. Friend join me in asking her to get that checked by the end of the debate and tell the House what applicants are being told under the system today?
I am grateful to my hon. Friend. I am sure that the Secretary of State heard what he said, and I hope she will respond. On interviews, I suspect that she is not looking forward to the one with the next Prime Minister.
The Secretary of State has been in denial. She has told the House about the outcome of the review group. In a letter to me on 27 March she stated:
“The Review Group is independent and responsibility for membership rests with Professor Neil Douglas”.
But a freedom of information request to the Department secured the answer:
“I can confirm that Clare Chapman, Director General of Workforce at the Department of Health, had overall responsibility for considering who was appropriate to sit on the review group.”
It was not independent at all. It is no wonder, given the lack of a strategic solution from the review group led by Professor Douglas, that the Secretary of State has had to announce a new and a second review.
Professor Crockard, who was responsible for the modernising medical careers process, resigned, and in a letter to Liam Donaldson, the chief medical officer, said:
“I have become increasingly concerned that the well intentioned attempts to keep the recruitment and selection process running have been accompanied by mixed messages for the most important people in the whole process—the young doctor applicants.”
It is basically unfair to advertise the possibility of four interviews and then suggest that these might not be honoured. Shelley Heard, the clinical medical adviser to the MMC process, said:
“The Review Group has not done this strategically or with an eye to the future.”
This is why we are here this afternoon. The Secretary of State and the Government are in denial about the scale of the process and the many difficulties and problems with the scoring system and the recruitment process, which I have not had time to go through, and are not coming forward with viable solutions for the future.
The hon. Gentleman makes a fair point about the lack of independence of the first review group, on which the great majority had close involvement with the creation of the MTAS and the modernising medical careers project. Does he hope that Professor Sir John Tooke, in agreeing the complement of his review group, will not include anyone who has played any part in any of the processes that have had so many problems during the past few months and years?
I am grateful to the hon. Gentleman for that. The Secretary of State will no doubt tell us more in a moment, but she has this afternoon announced the terms of reference for Sir John Tooke’s review: that it will be independent of the four health departments—good; and that it will have an independent secretariat—good. But there are two problems. First, she has not announced the membership, and I entirely endorse what the hon. Gentleman said. It is essential for the confidence of the medical profession that Sir John Tooke’s review is conducted by people who are in no sense, whether positively or negatively, associated with the decisions that have hitherto been made about the MMC and MTAS processes.
The other problem with what the Secretary of State has announced this afternoon is that she is asking Sir John Tooke to report on an interim basis in September. Hon. Members will know that the problems that we are encountering now with the outcome of the second review group will come to a head in August, so she appears to be precluding the possibility of Sir John Tooke and his colleagues, whoever they may be, intervening more or less immediately to say that steps need to be taken.
The Opposition motion includes essential measures. The review still has serious problems and it will be subject to legal challenge. There is a good argument that legitimate expectations of junior doctors in the application process have been completely failed, and there are still problems in trying to manage the application process. People cannot obtain interviews and are being logged out and obstructed, and there is scope for gaming for those who have already had interviews. To that extent there is an uneven playing field between those who had first round interviews and those who are in round 1B. It is astonishing that in England junior doctors are being restricted to one interview, whereas in Scotland and Northern Ireland all four original interviews are being offered.
It is far from clear that consultants throughout the country will be prepared to participate in what they regard as an unfair recruitment process. The consultants at Addenbrookes in my constituency sent me the results of a consultant survey that they had recently undertaken, and three quarters of those consultants said that they would refuse to take part in further interviews. Ninety-seven per cent. of them wanted to see the previous system of appointments restored for this year. I do not necessarily agree with that. However, there is something that we can and must do between now and August. It is not good enough to wait for Sir John Tooke’s review in order to produce a report in September. We must consider foundation programme graduates who should, in all cases, be able to access specialty training. If they are not getting access to that training, posts will need to be created to enable that to happen. That was clear from the original principles of MMC, as stated in April 2004 in “Modernising medical careers: the next steps”:
“It is not acceptable that they”—
that, is foundation programme graduates—
“should at this stage fall out of the training system”.
Yet, according to the Department’s own document, between 500 and 1,300 such foundation year graduates might fall out of the system.
It is not acceptable that this shambles means that large numbers of senior house officers, many of whom have excellent clinical experience, good academic qualifications and fine references, are going to be closed out of the ability to enter specialist training. We must turn more trust grade posts into training posts. I said that to the Secretary of State on 19 March, when Ministers sat there barracking me, saying, “That is extra money; it’s going to cost.” Of course, as we now know from a document sent to hospital trusts and strategic health authorities on 5 April, that is exactly what the Department is doing. It has asked hospital trusts and SHAs to respond by 27 April. Will the Secretary of State now commit to an increase in the number of training posts available this year and the holding back of some run-through training posts for 2008 and 2009 so that, as the hon. Member for Oxford, West and Abingdon said, senior house officers—those who have a legitimate expectation of completing their specialty training—will not suffer the guillotine that cuts off the possibility of their securing the appropriate level of training this year, next year or the year after?
The hon. Gentleman is absolutely right. He is also right as regards the financial cost, or otherwise, of converting staff grade posts and trust grade posts to junior doctor training posts. Clearly, some service functions may have to go with the loss of those service posts, but I think that most junior doctors will be prepared to do some supervised service as the price of having a career in training. Does he agree that if the Government plan junior doctor posts, there must be some central planning to get the consultant expansion that is needed to underpin all of this?
On the latter point, it is fair to say that one of the essential things that John Tooke must do is to establish a new work force planning arrangement that is owned much more by the profession and the service than by the Department of Health, which has handled it so appallingly.
The hon. Member for Oxford, West and Abingdon makes an important point. As I am sure that the Secretary of State would agree, turning trust grades to training posts is not without cost. That would have to come from the MPET—multi-profession education and training—budget in strategic health authorities. The Government have admitted that in the last financial year—2006-07—they cut £350 million from education and training budgets. Three or four weeks ago, the chief executive of the NHS said that that was for one year only. We are now at the start of the new financial year. It is clear from the SHA board papers that some SHAs are already planning to cut £136 million out of their training budgets for this financial year. We know where the money could come from for more training posts, because there is money in the training budgets, yet the Secretary of State sits there saying that the Department cannot afford them. It could afford them were it not mortgaging the future of the NHS to deal with its financial mismanagement to date.
Let me make it absolutely clear what we want. On 30 March, I sent the Secretary of State a letter with 101 e-mails that I had received from junior doctors about the many problems that they had experienced. I have had no reply. Senior house officers cannot become another new lost tribe of junior doctors in whom we, as the public, have invested not only our taxpayers’ money but an enormous amount of our emotional support in the best young people of this country who have chosen to go into medicine but who might end up never being able to fulfil their vocation or, worst of all, pursuing it overseas, so that all those investments have been lost
The hon. Gentleman says that we should ensure that there are career prospects for our best young people in this country. Given the unique circumstances that give rise to the issues that we are debating—two strings of training are concluding in one year—does he believe that the Government should ban doctors from Europe from applying for jobs in this country? Given that Europe takes so long to respond to anything, the year would be over and we would be into a second one before it had caught up with what we had done.
I am grateful to the right hon. Gentleman but I fear that, legally, his suggestion is impossible. I do not propose it because I do not believe that the Government could legally take such action.
We cannot allow investment in junior doctors to be abandoned—that appears to be a risk as a result of the Government’s policies. The vocation to serve patients in our national health service must not be lost to this country. The human needs of junior doctors—to pursue their career and maintain their family life—must not be ignored by the way in which the process is administered. We need to return to the profession greater control over its education and training. It is vital to find a solution that wins back the profession’s confidence, which the Government have lost.
It is vital that Sir John Tooke’s review not only has the option of making immediate recommendations but can be independent, representative of the profession and the service, open in its analysis—not closed, as previous review groups have been—and strategic in its outcome.
In a briefing paper for the debate, the Royal College of Physicians described what has happened as:
“The worst episode in the history of medical training in the UK in living memory”.
The medical profession is rightly angry. Its members have been disempowered and they are demoralised. That has happened on the Secretary of State’s watch. We have brought her to account and we want a solution. The Government’s amendment makes no reference to the appointments and recruitment systems or MTAS. Worse, it contains no expression of regret. Our motion expresses on behalf of Parliament our deep regret about the distress caused to junior doctors and the loss of good will in the medical profession. We do not hear that from the Government. That is why hon. Members should reject the amendment. I commend our motion to the House.
Before I call the Secretary of State to move the amendment, I point out that a demonstration took place in the Public Gallery. I know how seriously members of the public take the matter and I understand that things can get heated. However, I must tell the House that, if there is another demonstration, the Serjeant at Arms’ officers have the authority to clear the Public Gallery. That might be unfair to those who have travelled a long way to hear the debate.
I beg to move, To leave out from “House” to the end of the Question, and to add instead thereof:
“recognises the international reputation for excellence of medical training in the UK; acknowledges the need to modernise medical careers to ensure all doctors are properly trained to nationally recognised standards, including a fairer and more transparent process for applying for specialist training; notes that Modernising Medical Careers (MMC) will deliver training to a consistently high standard which, combined with the expansion of the number of doctors, will provide high quality safe care by appropriate skilled medical staff; notes the wide consultation that took place on MMC and the strong support for the need to improve doctors’ training amongst doctors’ representatives including the medical royal colleges and the British Medical Association; welcomes the external review that is already being conducted into how MMC has worked to date and the changes made as a result; and supports the longer term review recently announced to ensure MMC works well in the future.”
Let me begin by stressing, as I did last week, that my ministerial colleagues and I are in no doubt about the distress, anxiety and uncertainty that has been caused to junior doctors by the problems with this year’s applications system. Those problems should not have arisen, but they have, and we are all—Ministers, officials in the Department, the medical royal colleges, the British Medical Association, the postgraduate deaneries—completely focused on sorting them out so that, as I said to the House last week, we have a system for this year that is fair to junior doctors and enables the NHS to make the right appointments to all the posts involved.
In addition to the urgent questions that the hon. Member for South Cambridgeshire (Mr. Lansley) mentioned, there have already been three written ministerial statements as well as last week’s oral statement. I will, of course, continue to update the House on the work of the review group under the leadership of Professor Neil Douglas, which will remain in existence while we continue to sort out the problems that have arisen with this year’s applications system.
Before I return to the question of the applications system and look forward to Sir John Tooke’s review, I want to say a little more about the new medical training system and what it replaces. As on previous occasions, the hon. Gentleman has simply understated the very real problems of the old system that modernising medical careers replaces. That system, as the whole House would acknowledge, has always produced outstanding doctors for the NHS, many of them world leaders.
However, that system was also wasteful, inconsistent, often unfair and, indeed, as the Royal College of Surgeons said several years ago, “most unsatisfactory”. Some junior doctors had to apply for a new training post every six months. They were sending in different applications in different formats to different hospitals and different post-graduate deaneries at different times of the year. There was no proper national curriculum and no standardised assessment process. It has always been the case that, because of the intense competition for medical training posts, junior doctors who could not secure the senior house officer job that they wanted found themselves filling in time in the wrong post—from the point of view of the skills that they wanted to develop—in non-training posts or as a locum. Sometimes, as Conservative Members pointed out, they had to do so for years on end.
Remedy UK, the newly formed group that has been so critical—understandably so—of this year’s problems says in its briefing paper on MMC that many of those in the old senior house officer job were in short-term or non-training posts or endured poorly planned training with no clearly defined end points. There were certainly deficiencies in the selection and appointment procedures, along with inadequate supervision, assessment and career advice. It was precisely because of those problems that, following the leadership of the chief medical officer, the Department of Health sat down with the medical royal colleges, with the British Medical Association, with the postgraduate deaneries and others—including, of course, representatives of the junior doctors—to devise modernising medical careers, which almost everybody agrees is the right way forward. Indeed, Professor Douglas’s review group has confirmed that.
The right hon. Lady is setting up a straw man. Absolutely no one here is trying to suggest that we should have stuck with the original system. Her job here today should be to explain the shambles that we are now in and how we are going to get out of it, rather than to review what might have been the case in the past.
I have to tell the hon. Gentleman that in a debate titled “Modernising Medical Careers”, it makes sense to remind the House of how it came about, why we committed to it in the NHS plan of 2000 and why its underlying principles and direction of reform for medical training are absolutely right.
I share the right hon. Lady’s view that the problem with the old system was that too many doctors at senior house officer level had nowhere to go to get into training, so they had to mark time, go into career grade posts or SHO posts that were not really training posts. Does she accept that the test of the new system will be how many fewer people in that situation either have to leave training against their will when they are capable of being trained to be consultants or have to go unwillingly into career grade posts below specialist training level? Does she accept that that will be the test of the success of her new system?
What I accept in response to the hon. Gentleman’s question is that it has never been possible for every junior doctor who wants to pursue training through to a consultant post to do so, particularly in the specialty that they originally wanted to follow. I will come back to that point in a moment.
I want to make a little more progress before I give way again.
The first part of the new system—the two-year foundation programme—was successfully introduced in 2005. In line with the principles that will operate throughout modernising medical careers, that will give every medical graduate a series of properly supervised placements in medicine, surgery and a range of other specialties and settings, with formal training based on a national curriculum developed following wide consultation with the profession, including the medical royal colleges, and approved by the Postgraduate Medical Education and Training Board. It will also provide our medical graduates with regular workplace-based assessments of competence, a national learning portfolio and formal access to careers advice, all of which were missing from the old system.
As my hon. Friend the Member for South Cambridgeshire (Mr. Lansley) has said, there is no argument about the fact that doctors’ careers and training processes needed modernising. The issue is that the process has been a complete, unmitigated disaster, yet the Secretary of State is not accepting responsibility for that.
I am sure that the hon. Lady will not accept my word for it, but if she just looks at the several statements made by the review group under Professor Neil Douglas, she will see that it has not been a complete, unmitigated disaster. The applications system has actually been working well in many places, particularly for GP posts. Many problems have arisen that I have acknowledged since the scale of the problem became clear and taken action on, particularly by the appointment through the Academy of Medical Royal Colleges of Professor Neil Douglas to lead the review group and to sort out the problems. Just as I am acknowledging the problems, I wish that the hon. Lady and her hon. Friends would acknowledge that we are taking this matter seriously. We have apologised for the fact that the problems arose, and we are now seeking to correct them and to sort this out.
A serious problem exists today, but the review group will not report for some time. I listened carefully to the hon. Member for South Cambridgeshire (Mr. Lansley), and there was nothing in his speech that I could disagree with. My right hon. Friend cites Remedy UK; I met one of my constituents this morning, and they are calling for more training posts to be created. There is nothing in the Government’s amendment today to tell us how we are going to get out of this situation, and I hope that my right hon. Friend will address that problem.
No, I want to make some more progress before I give way again.
As I told the House last week, Professor Douglas’s review group has already agreed on significant changes to the system. They have been announced to the House and to junior doctors, and they are now being implemented. The review group decided, after careful discussion, that it would be wrong to abandon the process of interviews that is now under way. It concentrated instead on how to change the process so that it would be fair to junior doctors and meet their needs and the needs of the NHS as a whole. In particular, every eligible applicant was invited to reaffirm or revise the order of their application preferences and was guaranteed at least one interview for their revised first preference specialty. That is now happening and, over the past few days, more than 25,000 applicants have taken the opportunity to revise the order of their preferences and have done so successfully on the much-maligned medical training application system—MTAS. Those interviews are now under way, and they will continue right through next month.
I am grateful to the Secretary of State for her courtesy in giving way. Will she put on record for the benefit of the House the fact that, while receiving submissions from her officials when the new training methods were being devised, she never received any message at all from any official or from anyone concerned with medical training or medical manpower planning that there would be a problem with two streams of trained doctors arriving at the same time and chasing the same posts? Did she ever receive such advice?
Last year, the main focus of the discussions, particularly with the British Medical Association, was on the number of training posts that would be available. That is not dictated by Ministers or the Department of Health; it is determined by the individual trusts and postgraduate deaneries on the basis of what is needed by the service. We spent several months and a great deal of work establishing the number of training posts that would be available. The noble Lord Warner, then the Minister responsible, made a statement on that subject towards the end of last year—[Interruption.] If I may remind the right hon. Member for Fylde (Mr. Jack), Lord Warner said in that statement that we did not and could not know how many other applicants there would be, particularly from overseas.
The junior doctors who have been in contact with me are not now so concerned about the process, which they find rather academic, but they are desperately worried about their jobs. When the crisis began to unfold, the Prime Minister said that he expected that the vast majority of doctors coming up for appointment would gain appointments. Will my right hon. Friend have an opportunity this afternoon to outline the measures that she has directed to ensure that that pledge is fulfilled?
First, in response to my right hon. Friend the Member for Birkenhead (Mr. Field), and to other questions, I want to clarify the total number of training places available: about 23,000 postgraduate medical training appointments are available across the UK this year, which is more than ever before. Of those, 3,000 are being filled by recruitment to general practice, and just over 19,000 places are available on MTAS at the moment, with a further 700 to be added to the system. We all know very well that there are more applicants than training posts. That has always been the case, but it does not mean, as headlines and some press reports claimed at the weekend, that there will be 10,000 unemployed doctors.
Of the 32,000 or so eligible applicants for those training posts, about 30,000 are already working in the NHS, about 6,000 of whom are completing their foundation programme, and about 8,000 of whom state on their applications that they are working in non-training posts—trust jobs, staff jobs, locum posts and so on. About 16,000 say that they are working as senior house officers, but because of the deficiencies in the present system, many of those posts are not proper training posts either. Regardless of the outcome of applications for the new training posts, the NHS will continue to need all those jobs and possibly more in the future, because the number of patients is increasing, and so is the number of doctors—the NHS now has over 30,000 more doctors than 10 years ago.
Someone who is currently working in the NHS in a non-training post, whatever it is called, who does not get the training post for which they applied this year, will be disappointed, just as many were last year, the year before and every other previous year. They will still, however, have their job. Those who do succeed in getting a training post will leave a vacancy that can be filled by a doctor—with appropriate experience, of course—who has failed to get the training post that they sought this year.
A couple of years ago, the province of Ontario in Canada abolished grade 13, which led to a double cohort going to university, for which steps had to be taken. My right hon. Friend talks of posts for medical graduates, but the difficulty is that no steps appear to have been taken to plan for the inherent and entirely foreseeable problem of the double cohort of SHOs at one end and recent medical graduates at the other. SHOs who started under the old system are competing with recent medical graduates for an insufficient number of training posts—I stress the word “training” to my right hon. Friend. As I understand it, a lot of those people will be redundant from 1 August. Will she assure me that a sufficient number of training posts will be available for those doctors?
The number of posts must be based on the needs of patients and the service as well as the needs and wishes of trainees. As I have tried to stress, it has always been the case that some doctors in training have either had to change their specialties or been unable to progress in their training to consultant grade. The new system does not change those realities.
I want to make a little more progress before I give way again.
I fully recognise that it would be quite wrong to leave a junior doctor part-way through his or her training with no clear prospects. Until the whole process of interviewing and job placement is completed in a few months time, we will not know which trainees—whether they are just completing the foundation programme or are more senior—have obtained specialist training posts. However, I assure my hon. Friend and the House that we will give them proper support.
As part of the review, we are working urgently with the royal medical colleges and the NHS to establish the need for additional training posts—which will of course have to be approved by PMETB, the Postgraduate Medical Education and Training Board—including one-year placements and more senior posts. We are also considering how we can provide more effective training support for doctors in service posts—that is, non-training posts—to maximise their development opportunities. That is the issue on which Professor Douglas’s review group is now focusing, having dealt with earlier problems involving the application process, and it will make a full statement—as will I, to the House—on the support that will be available very shortly.
The right hon. Lady referred to the needs of patients. When we envisage circumstances in which every junior doctor in every grade and in every specialty changes job on the same day, the spectre is inevitably raised, and was articulated to me only this morning, of wards either empty or massively understaffed, potentially thereby—I choose my words carefully—imperilling public and patient safety. The right hon. Lady shakes her head, and she is entitled to do so, but can she assure me that there will be no such scenario anywhere in the country? If she is confident that she can, will she say precisely what contingency planning is being done to enable her confidently to make that prediction?
As I have just said, the great majority of applicants who are already in non-training staff posts, trust posts and a variety of other non-training posts will still have those jobs because they will still be needed in the NHS. Each hospital trust, and the board of each trust, has a responsibility to its patients to ensure that on 1 August, or any other day, the right number of the right staff are available to provide safe, high-quality care.
Further to the point made so eloquently by my hon. Friend the Member for Buckingham (John Bercow), is the Secretary of State aware that in my constituency Queen Elizabeth hospital has made it clear that because of the changeover date of 1 August, no elective work will be done during the first week of that month? All day surgery will be cancelled for a week, which will mean the cancellation or postponement of probably 100 operations and a consequent increase in waiting lists. Will that happen throughout the country, and why will it happen in my constituency?
The issue of the changeover date is nothing new. Trusts have to plan for it very year, and that is what they are doing this year. It is not exactly unpredictable or novel. As I have said, it is up to individual trusts to decide how to organise staff in order to meet their patients’ needs.
I want to make a little more progress before I give way again. I have been quite generous in taking interventions.
We hear from Conservative Members and others demands for the creation of an unlimited number of training posts to meet the needs and wishes of junior doctors. We must recognise that it is necessary to balance fairness to doctors in training with the needs of patients and the NHS. It would be completely wrong to create a specialist training post for everybody who wants to become a consultant in a particular specialty, including for people who have in the past applied for training posts year after year, as some have done, and have not been able to progress in their training, or to create posts regardless of whether the NHS actually needs so many consultants in a particular specialty.
Cardiothoracic surgery is an example of such a specialty. Because technology and medical practice have transformed how cardiothoracic patients are treated, the NHS already has far more fully trained cardiothoracic surgeons than it needs. This year alone we have 300 applications for five speciality cardiothoracic posts. It would not be right for the NHS to create another large number of cardiothoracic training posts simply so that there are enough for every applicant who would like to specialise in that field. Equally, however, those applicants who have that field as their first choice and who are disappointed must have the opportunity and support that they need to progress in another specialty. That is an important point, because what we need in terms of training—and I believe that we will get this with modernising medical careers—is a system that not only gives dedicated and excellent junior doctors the chance to progress in their careers, but enables the NHS to have the right number of people with the right skills at a time when medical practice and technology are changing faster than ever before.
It is instructive that the right hon. Lady chose the small specialty of cardiothoracic work, which has always been oversubscribed, and it would be interesting to find out whether she can give any other such examples. However, may I return her to a question that she has still not addressed, despite having been asked it at least three times this afternoon? There was an entirely predictable consequence of the double cohort. What planning did the Department do to deal with the double cohort issue?
The hon. Gentleman is ignoring the fact that, because of how the old system worked—with junior doctors applying for jobs all over the country, and with different application systems and things happening at different times of the year—there was no national system. Therefore, we had no statistics in respect of the number of people who had been applying unsuccessfully for training posts. I agree that it is clear, with the benefit of hindsight, that it would have been better if we had predicted that almost everybody in a non-training post would take the opportunity of this year—the first year of a system that is much fairer and much more transparent, with more training posts available than ever before—to make an application. Of course it would have been better if we had predicted that. We failed to do so, and I have apologised for the problems and distress that that has caused. More importantly, however, we are now putting that right.
I am grateful to the Secretary of State for giving way. What would her advice be to the four junior doctors from my constituency who visited me today, all of whom have been offered training posts, in Brisbane, Toronto and Singapore, bearing in mind that the offer being made by the Secretary of State is that they can have some kind of job in the NHS, even perhaps as a rural GP in Scotland—an example of “Dr. Finlay’s Casebook”, if ever there was such an example? Would her advice be that it would be best if, despite the £250,000 that has been spent on the training of each of them, they accepted those job offers outside the United Kingdom?
I am unsure whether the hon. Gentleman is prejudiced against general practitioners, or those working in country areas, or those working in Scotland. The job he mentions is in my view an excellent post, and I am sure that someone will fill it admirably. He also ignores the fact that 23,000 postgraduate medical training places will be available across the whole of the United Kingdom, which is more than ever before.
Let me deal with the issue of doctors going abroad, which the hon. Member for Croydon, Central (Mr. Pelling) just raised. At the weekend, there was some quite disgraceful reporting in some sections of the press. On the one hand, they were busy saying how disgraceful it is that doctors have had to suffer the distress and added uncertainty of this year’s difficulties, while on the other they ran a headline saying that they were all going to be shipped abroad to do voluntary service overseas. That is absolute rubbish. It has always been the case that some British junior doctors have chosen to go abroad at some stage in their training to get extra experience to further that training. Some do voluntary work in, or are on secondment in, the developing world—an issue on which the noble Lord Crisp recently produced an excellent report. However, there is no question of junior doctors being forced into those options or being shipped abroad.
We all need to focus on the interviews that are taking place and that will continue over the coming month, the first round of job offers that will then be made, and the enormous effort that will go in—thanks to the work not just of the review group, but of consultants and the postgraduate deaneries around the country—to matching, as far as is possible, junior doctors with their first preference application, and to match, wherever possible, medical couples with their combined preferences through the medical training application system, which is an issue that was specifically raised. Of course, there will then be a second round of interviews and job offers. Once all that has been done, we will then ensure proper support, as I indicated a moment ago, for those trainee doctors who have not secured the training post that they wanted.
I am very grateful to my right hon. Friend for patiently explaining the issues and for being generous in giving way. She talks about focus, and what I am focusing on is the figures that she has given this afternoon, which I have perhaps misunderstood. She mentioned 23,000 training opportunities and 32,000 applicants. I am focusing not on the MTAS system—good or bad as it may be in terms of the computer system and the lack of CVs—but on the fact that apparently and entirely predictably, 9,000 doctors, whom it costs £250,000 a throw to train and who have been in the system for a minimum of six years, will be redundant. That will be a great loss to the taxpayer, to the NHS and to them personally.
I am afraid that on that point my hon. Friend is absolutely wrong. Well in excess of 9,000 of those 30,000 applicants working in the NHS are working in non-training jobs that the service will continue to need. They are the so-called “trust” jobs—the service jobs—but they also include some of the senior house officer jobs, which are not training posts, despite their name. Those jobs, as well as the 23,000 training places, will continue to be needed and to be filled by junior doctors. That is why the headlines about 10,000 unemployed or redundant doctors are simply wrong.
I am very grateful for the chance to make a second intervention. I ask my right hon. Friend not to answer the Liberal Democrats’ endless plea for a post mortem. [Interruption.] Yes, the Liberal Democrats did ask for a post mortem to find out what went wrong. We all know that something has gone wrong—even the Liberal Democrats should understand that simple point—but young doctors in Birkenhead want to focus on the future. In answer to my previous intervention, my right hon. Friend said that, at some stage, she and others would consider the creation of new training posts. Will she please say a word or two about that before the end of the debate?
I did indeed say that as part of sorting out the difficulties that have arisen this year we are already working with the royal colleges, the NHS and postgraduate deaneries to see whether additional training posts can be made available to start, of course, alongside the other ones later this year. We are looking at that issue.
No. I am not going to take further interventions, as I am very conscious of the time.
We are also looking at what additional training and support should be given to those who take the non-training posts—the staff jobs and so on—so that they can continue their development. In some cases, they will be in a position to apply successfully for a training post next year.
We are doing two things. First, through Professor Douglas’ review and with the close involvement of the medical royal colleges, the BMA and other bodies, we are sorting out the problems that have arisen this year. Secondly, we are looking further into the future. As I announced last week, we are to set up a wider review of the modernising medical careers programme. It will be led by Sir John Tooke, and the House will know that I published the review’s full terms of reference today.
The principal task facing Sir John and his review group will be to examine the framework and processes underlying modernising medical careers to inform improvements for 2008 and beyond. Therefore, the existing group led by Professor Douglas will continue to make sure that we sort out the difficulties for this year, and Sir John Tooke’s review will look ahead to next year.
As hon. Members will see from its terms of reference, Sir John Tooke’s review will look at questions such as whether the system is flexible enough—one of the main principles of modernising medical careers—or whether the scoring system devised through a very full consultation with the professions is now, on reflection, thought to be inappropriate and in need of revision. I am extremely grateful to Sir John for undertaking the review, and I stress once again that it will be completely independent. Sir John is identifying the members of his review panel and I shall make an announcement about that with him in due course. He will recruit his own secretariat and have a budget for that purpose. He has kindly offered to produce an interim report in September, as that will assist us in planning and making improvements for next year. That interim report will be published, of course, and Sir John has also undertaken to inform us of preliminary findings earlier. I know that Sir John will do everything that needs to be done to involve junior doctors, the medical profession more broadly and the NHS in the review. I have full confidence in him, and I hope that that confidence is shared across the House.
As I noted earlier in this important debate, we have more than 30,000 more doctors in the NHS than we had 10 years ago. We have more trainees and more training places than ever before. We are establishing a new training system that will build on the excellence that British doctors have always achieved. However, it will also give us a much better, fit-for-purpose medical training system.
We are sorting out the problems that have arisen this year, and we are learning lessons to ensure that we can make further changes and improvements next year. It would have been much better, of course, if the problems with this year’s transitional year had not arisen. We all regret—I most of all—that they have arisen, but the new system that we are putting in place with modernising medical careers will be fair to doctors and right for the NHS. Above all, it will be best for patients.
I commend the amendment to the House.
I want to start by speaking about the Government amendment that the Secretary of State has asked the House to support. It is remarkable for the fact that it makes no reference at all to the extent of the shambles in the medical training system. I assume that the amendment will win the day this evening, but anyone reading it would not have any understanding of the scale of the discontent in the medical profession resulting from what has happened.
All those involved are left in a state of some despair, because the problem was so avoidable and because the damage that has been done—and the likely disruption still to be faced—have had such a negative impact on the NHS and the morale of the doctors on whom we all rely. Today, the Secretary of State repeated her apology to junior doctors. She was right to do so, because of the stress and anxiety caused to so many young professionals who have committed themselves to the NHS.
Although the impact has been most severe on junior doctors, who feel that their careers are hanging in the balance, consultants too have been left completely frustrated and angered by the utter incompetence that they now have to remedy. They are faced with having to try to clear up the mess by undertaking a vast number of extra interviews in a short space of time.
Of greatest concern, however, is the impact on patients. When doctors have rock-bottom morale, it is not good news for patients. What about the impact on patient care of the recovery programme—all the extra interviews that must take place during May? What will happen on 1 August? I shall return to those questions.
How on earth did we reach this point? The origins date back to the chief medical officer’s report in 2002. Its original principles clearly attracted widespread support. Self-evidently, there is a need for a modernised and focused career structure for trainee doctors. More standardised training based on competencies is the right way forward, and it is entirely reasonable to focus both on clinical skills and on the communication skills that I readily acknowledge are important for doctors. There were also legitimate concerns about patronage and bias in the old system. In any modern service those features are unacceptable and need to be challenged. Career advancement should always be based on merit, not on who a person knows or even the colour of their skin. I suspect that that has been a problem in the health service in the past.
What went wrong? The Royal College of Physicians points to two failures. The first was that modernising medical careers had become a straitjacket. It was too inflexible: it forced early career decisions on young doctors and from that point demanded a training schedule that gave them little opportunity to change direction to a different specialty. It shortened the training period, leaving many doctors concerned that their experience would be reduced as they went through the training process.
The second failure was the introduction of the medical training application service—MTAS—which was set up by the Department of Health to select junior doctors for MMC training posts. The royal college described the system as “deeply flawed, and unpiloted”—it had specifically requested that the system be piloted. Many concerns have been raised about how the unpiloted system has worked. It seems remarkable that so much emphasis appears to be placed on creative writing skills—we have heard about the number of points allocated for that competency—compared with clinical excellence. It seems that doctors who have undertaken research to prepare for a specialism could be disadvantaged. No CVs are considered and there is no proper acknowledgement of academic qualifications. The central question that the Minister of State, the hon. Member for Leigh (Andy Burnham), must answer when he responds is: how on earth did that happen? Is not it incredible that an entirely new, sophisticated web-based system was introduced without proper piloting?
As the taxpayer is likely to have to fund the reviews of the debacle and its repercussions, does the hon. Gentleman agree that it is important that we hear from the Secretary of State or another Minister exactly who was responsible? We have not yet been told.
I am grateful to the hon. Lady for that intervention. I disagree with the right hon. Member for Birkenhead (Mr. Field), who seems to think that establishing who was responsible is a pointless exercise: it is essential if we are to hold the Government to account and learn lessons for the future. The hon. Lady made a point about the costs of the recovery exercise. I put that question to the Secretary of State during her statement last week. I did not get an answer, so I would be grateful if the Minister of State could confirm what assessment has been made of the likely additional cost of the recovery exercise.
I was making a point about piloting. The terms of reference of the review highlight several features of the system. They include the assessment methodologies used in the selection process, including the relative merits of competency-based and more traditional methods of selection and recruitment; the level of choice on offer at application; and the lack of flexibility available to trainees on run-through programmes. They are all issues that would emerge from pilot programmes and the problems would be ironed out before a programme was rolled out nationally. How on earth was the system introduced without proper piloting?
The hon. Lady is absolutely right. Much smaller organisations pilot new programmes before they are introduced. We are talking about a system that is supposed to deal with tens of thousands of applicants across the whole country. It is bizarre and extraordinary that it was not piloted.
Warnings also went unheeded. The Royal College of Physicians warned but was ignored. The British Medical Association said that it tried to get the Government to listen, but it was ignored. During the Secretary of State’s statement last week, the hon. Member for Wolverhampton, South-West (Rob Marris) told the House that he had written several weeks ago to one of the Ministers at the Department—
May I clarify the position for the hon. Gentleman? I wrote last autumn expressing concern about the system and I was assured by the then Health Minister, Lord Warner, that it would be all right on the night. When it became apparent in the spring that it was not all right on the night, I wrote and asked who was being disciplined on account of this failure. After many weeks, I have still not received a reply to that question other than the answer that I received from the Secretary of State in the statement last week, when she said that no one had been disciplined.
I am grateful to the hon. Gentleman for that. Even if no one is disciplined, people could still be held to account for what has happened, but we have had no indication of whether that will happen.
Given that there was no piloting and that all the warnings from professional bodies were ignored, one is left with the sense that the Government have demonstrated total arrogance and total incompetence, or a pretty potent mix of the two. Who is responsible for the debacle? Will anyone be held to account? Surely, it is a pretty damning indictment when the former national director of MMC, Professor Alan Crockard, resigned stating that MTAS
“has lacked clear leadership from the top for a very long time”.
What does he mean by “from the top”?
We have heard a fairly solid dose of hypocrisy about this issue in some parts of the debate. No one is suggesting that we return to the absolute chaos of the previous system, in which some doctors suffered considerably. However, may I point out to the hon. Gentleman that Professor Crockard was presumably in on the arrangement from the first and was also acting as a consultant?
I am grateful for that intervention, but I made the point that the principles of the system were widely supported at the start and I highlighted the concerns about the previous system. [Interruption.] I did highlight the concerns about bias and so forth; it was absolutely right to bring in a new system. It is the way in which it has been implemented that has caused so many people to be left totally frustrated by the Government’s incompetence. Professor Alan Crockard may be partly responsible for the debacle, but when he says that there has been a clear lack of leadership
“from the top for a very long time”,
we ought to listen to that concern.
I take that point. When the professor says that there is a lack of leadership from the top, we need to know whether he is referring to the Secretary of State, or a civil servant—[Interruption.] MTAS is a Department of Health initiative, so we need to know from the Minister to whom Alan Crockford—[Hon. Members: “Crockard.”] We need to know to whom Alan Crockard refers when he says that there is a lack of leadership from the top. Will the Secretary of State publish all the correspondence as part of a wider review so that lessons can be learned about what has gone wrong?
Will the Secretary of State publish any written submissions made by Professor Shelley Heard, who has also resigned? Professor Heard was the national clinical adviser and has been quoted as saying that the principles
“have been lost in the detail and acrimony of a recruitment process which should have supported and not driven it”.
“we are losing the goodwill of a generation of UK graduates who believed it when we said we wanted to train more UK doctors better and we are losing the goodwill of patients and senior colleagues”.
Professor Heard also fundamentally challenged the direction taken by the review group set up by the Secretary of State. She said that the group
“has become so immersed in the detail that it cannot see a way ahead which will be both equitable to doctors and support the aims of MMC”.
She found herself
“able to support few of the decisions that the review group has taken since they undermine the principles which are at the core of MMC”.
Does the Minister accept that the review group’s direction of travel is undermining the principles at the core of MMC, as Shelley Heard suggests? That is a serious challenge to the direction that the Government are taking.
I am an employment lawyer by training, and before I became a Member of Parliament I advised employers on fair recruitment processes fairly regularly. This is not a fair recruitment process. It is fatally flawed, and once a process is flawed, one cannot satisfactorily remedy it. Will the Minister confirm whether the additional interviews for those candidates not hitherto given interviews will be conducted by differently constituted panels? However objective a scoring system, once different assessors are introduced on to a panel, objectivity is destroyed. Once something is flawed, it is always flawed, and that is why I have supported the attempts by Remedy UK to secure a judicial review of the process.
I want to explore the recovery process itself. I understand that all the additional interviews will take place over a four-week period in May. Will the Minister confirm how many extra interviews the Government expect will be required? Will that be logistically possible to achieve? When I put that question to the Secretary of State last week, she said that it would be achievable, but “only with considerable effort”. That suggests that there is a risk of substantial disruption to patient services and a possible impact on patients.
I understand that trusts are resistant to allowing consultants time off their clinical work to conduct the interviews. The hospital trusts are all under intense pressure to deliver on waiting time targets, yet they will lose a substantial number of clinical hours to conduct additional interviews. I understand that 10 candidates were originally interviewed for two specialty training level 3—ST3—posts in cardiac surgery in London, but that it is expected that an additional 50 applicants will be interviewed to comply with the review group’s new process. Will the targets with which acute hospitals must comply be adjusted to take account of the disruption that will inevitably occur, given that if a surgeon is interviewing, he or she is not operating? A question was raised about the cost of the recovery programme, and I hope that the Minister will give a confirmation of its cost.
What analysis has been undertaken of the impact of all junior doctors starting their new roles on 1 August? The Secretary of State, who I notice has disappeared from the Chamber, indicated that the turnaround had always taken place on 1 August, but I understand from my hon. Friend the Member for Oxford, West and Abingdon (Dr. Harris) and many others that that is not the case. It was a phased process; all junior doctors across the country did not change jobs on one day. It is hard to imagine a more crass arrangement than one in which everyone is expected to start work under a new system at exactly the same time. Induction procedures will take doctors away from their duties, and I understand that many hospitals will, in effect, operate bank holiday working arrangements during that period, cancelling operations and clinics. Newly appointed doctors will find that their predecessors have already gone, leaving inadequate knowledge of the patients on the wards for whom the new doctors are supposed to be caring.
I suppose that it was inevitable that the changeover for the whole country would be planned for a peak holiday time, when so many consultants are away. That simply adds to the challenge. I have heard that some trusts are starting to suspend the right of consultants to go on holiday in the first two weeks of August. That suggests that acute trusts are anxious about the potential impact on patient care during that period.
On the mismatch between the number of applicants and the number of posts advertised, the Secretary of State indicated that there were about 23,000 training posts, but of those 23,000, she said that 3,000 were general practitioner posts. She then said that the net figure for hospital posts was something over 19,000. I do not quite understand the maths, but that is what she said. She also said that 700 extra posts were being added. I do not understand where that figure comes from, and I would be grateful if the Minister of State could explain when he winds up the debate. Are those 700 extra posts the additional training jobs that the Government said that they hoped to provide, or are we expecting more training posts on top of that 700? The people affected by the problem, many of whom are in the Gallery today, deserve clarity and answers from the Government on that point.
The Secretary of State was right to point out that some, but not all, of the people who do not get training jobs will continue in their existing posts. Will the Minister give his assessment of the number of junior doctors who are likely to be unemployed come the summer? The hon. Member for Wolverhampton, South-West had a stab at providing a figure, but he was told by the Secretary of State that he had overstated the numbers because many people would remain in their jobs, so what is the figure? We know from the document leaked last week that Government planning is proceeding on the basis that thousands may be unemployed. It is incumbent on the Government to tell us the estimated number of junior doctors who will be unemployed this summer.
The document referred to the possibility of junior doctors being sent off with Voluntary Service Overseas. VSO is a fantastic concept and I applaud all the junior doctors and the many other professionals who do voluntary work overseas, but as a human resources solution for a Government who have got themselves into a hole, it is hardly an appropriate way forward. Will the Government publish the document that was leaked last week? I have not seen it. Is it available, and may we see what the Government are planning to do with all the unemployed doctors this summer?
We are told that it costs about £250,000 to train a junior hospital doctor. How many are likely to end up heading overseas or leaving the profession as a result of the crisis? What is the scale of the resources that will be wasted on all that training?
The hon. Member for Wolverhampton, South-West raised the issue of the two cohorts coming together, as did my hon. Friend the Member for Somerton and Frome (Mr. Heath) in an intervention on the Secretary of State. We still have not had a satisfactory answer on why the Government did not expect that to happen and why they do not appear to have planned for it or its consequences.
I suspect that the right hon. Member for Birkenhead might disagree on this point, but one sensitive, but important, issue is the way in which we treat foreign doctors who work in hospitals across the country, many of whom have given dedicated service to the NHS. How will they be treated as a result of this debacle? My hon. Friend the Member for Oxford, West and Abingdon made the point that, historically, staff grades that are often filled by ethnic minorities and women are, in a sense, dead-end jobs, with no prospect of career advancement. Why can the Government not plan to convert those jobs into training posts, to give the occupants the chance of career enhancements?
Does the Minister accept that the key to the mismatch between the number of juniors looking for training posts and the number of training posts available is the question of consultant expansion? It begins and ends with that, because what patients want—we must remember patients—is a consultant-provided service. The Minister must explain whether medical schools were expanded in order to fill an expanded consultant grade, or whether they were expanded in order to fill trust grades, clinical fellowships and staff grades—all non-training posts, which many people do not want to occupy even though they are in such posts? Does he expect that the consultant expansion we need will take place? In 1997, a British Medical Journal editorial noted that “consultant expansion was insufficient”. That editorial was written by a Dr. Evan Harris, but 10 years on, I see that there is still no expansion—
Order. I think that that doctor’s intervention is long enough.
It has never been known in the past, Mr. Deputy Speaker. I endorse the question that my hon. Friend put to the Minister and hope that he will be able to respond.
In conclusion, the scale of incompetence is quite remarkable. We need belated recognition from the Government that the problems this year have not been resolved and that the system remains fatally flawed. Remedy UK is seeking judicial review this week and I hope that it succeeds in that challenge to the Government, because the process, as we have all said, is fatally flawed.