asked Her Majesty’s Government:
In the light of Sir John Tooke’s report into Modernising Medical Careers, how they intend to ensure that the nation benefits from its investment in medical education.
My Lords, I express my and the Government’s thanks to Sir John for the enormous dedication that he has shown in completing his review. It is a substantial and timely contribution for which the Government are tremendously grateful. I also thank the medical profession for the help that it gave him throughout the review. The department will respond swiftly to his recommendations. The Government are determined that the nation will benefit from world-class medical training in England.
My Lords, I thank the Minister for his reply and his fitting tribute to Sir John. I declare my interest in postgraduate medical education. Having invested £250,000 in each undergraduate’s training in the UK, how do the Government plan to deal with the overprovision of 40 per cent in relation to doctors applying in this round, and to ensure that they can access their e-mails to see their job offers when working in the NHS? Given the failure that was identified in managing the MMC process, are the Government considering the need for and the purposes and functions of a co-ordinating body for NHS medical education in England, as has been proposed by Sir John Tooke, to lead on and take responsibility for training issues into the future?
My Lords, let me make clear two important points when we talk about medical education. There are two separate entities of doctors: those who are employed, whom we are not talking about, versus doctors in training opportunities. This year, there will be nine opportunities for postgraduate training across England and a further 10,000 training posts, which are already filled through a run-through training system. We can never predict the number of applicants to a specific number of training posts, but that is separate from opportunities to obtain a job in the NHS.
On Sir John Tooke’s recent recommendation, which is of great interest, we have to remember that it was not in the interim report. However, it is fresh thinking and certainly welcomed by the department. It is extremely important that we think about the functionality and the clear accountability of structures before we create a structure. We have had that experience in the creation of the MMC structure. The recommendation is very creative, but we should think quite hard about it.
My Lords, I am sure that my noble friend agrees that an efficient and caring workforce is a happy one. One of the serious problems now is that young doctors are applying for jobs where they do not necessarily know the consultant or the team for whom they are working. Will the Government look again at the system under which we both trained—the old firm system—whereby one can have a close relationship with a group of doctors and work much more as a team, something which is, sadly, increasingly lacking from the NHS and is compounded by the problem of Modernising Medical Careers at present?
My Lords, my noble friend raises the important issue of the relationship between a trainee and the trainer. The purpose of Modernising Medical Careers was to get over the variability in the quality of training. In certain parts of the country, there was no agreed curriculum or standard of assessment. I strongly believe that the ethos of MMC is correct. However, when it comes to the selection and the process in which MMC should be implemented, my noble friend raises an important point. In 2008 we feel that the deaneries at a local level should be carrying out the selection. I also agree with him that the NHS and its local needs should determine the number of posts at a local level. That should also be considered in the light of the Tooke recommendations.
Cross Bench!
My Lords, does the Minister accept that ever since the National Health Service began, there has been fierce competition for the best registrar posts, particularly in the most popular specialties? However, in the light of the evidence and the numerical information included in these reports by Sir John Tooke—they are admirable and have been doing their best to correct what has become a very serious situation—is it not now necessary to increase the number of specialist registrar posts within the National Health Service to make the best use of the training opportunities for these young doctors? We should bear in mind that an increasing number of general practitioners and consultants are taking early retirement, and it is crucial that there be suitable replacements for them when they retire.
My Lords, the noble Lord makes a point about increasing the number of training opportunities. I am conscious that there is a desire to increase those numbers. However, this is taxpayers’ money and we need to recognise that opening the tap on one end is not going to deal with how we manage those who end with fully trained and certified job opportunities in the future.
My Lords, could the Minster turn towards the microphone please?
Yes, my Lords, I will. I was referring to the caution that we should have if we increase the number of training posts. We would have difficulties in creating consultant opportunities at the end of that training ladder. However, forecasting workforce needs is becoming a global challenge, because the medical workforce is becoming a challenge for most countries trying to design their medical education needs.
My Lords, will the Minister give us an assurance that in future the Government will ring-fence money given to trusts for the training of doctors, and not allow it to be used for paying off their deficits?
My Lords, the funding for the multiprofessional educational and training budgets that the noble Baroness, Lady Tonge, refers to is about £4.3 billion a year, an increase of about 3.6 per cent. I certainly guarantee that that budget will be ring-fenced for education and training needs. The budget for medical education has increased from nearly £590 million in 1997 to about £1.6 billion. That is an increase of 170 per cent in the funding for training opportunities for medical doctors.
My Lords, the Minster and I are aware of the meetings held in hospitals throughout the land every week to discuss possible mistakes that have been made. In view of all the mistakes that have been made over this subject, will the Minister consider introducing similar meetings into the Department of Health to discuss all the mistakes? We call them mortality morbidity meetings; we would only be interested in morbidity.
My Lords, I acknowledge the mistake in relation to the implementation of MMC last year. I was one of the trainers and carried a number of trainees with me. That was a difficult and challenging time. The previous Secretary of State has publicly acknowledged that that was a mistake and apologised to the trainees and their families.
The noble Lord raises what happened around 1 August. I am sure that he will agree that it is important to put on record that clinical colleagues took a lot of their free time to interview candidates across the country to ensure that the right individuals were appointed at the right time. The deaneries and strategic health authorities co-ordinated that activity around June or July, which ensured that our hospitals will be fully staffed on 1 August this year.