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Medical Education

Volume 698: debated on Monday 4 February 2008

My Lords, following the difficulties in 2007 with the implementation of MMC, we have made changes this year in line with the recommendations from the programme board. Recruitments to most specialty training posts are held by the deaneries at a local level. There is no limit to the number of applications an individual can make. Sir John Tooke has produced an excellent report and we intend to respond to many of his recommendations by the end of this month.

My Lords, I thank the Minister for that comprehensive reply. Bearing in mind the great complexity of and, indeed, the tragic history of the department in attempting to manage medical careers, will the Government accept Sir John Tooke’s 47th recommendation—that a new body, NHS Medical Education England, be formed to co-ordinate and maintain standards across the country, as has proved so successful in Scotland? As uncertainty is so damaging, will the Government announce their decision on this recommendation at the end of this month?

My Lords, recommendation 47 in Sir John’s report is a very creative idea and is receiving careful consideration. It is important to remind the House, however, that it was not in Sir John’s interim report, which was published in October, so we have had very little time to consult on it. There are good things about the idea but we have learnt, not least through MMC, as I am sure the noble Baroness will agree, that structures without clarity and explicit lines of accountability can create major problems. We will respond to this recommendation as soon as possible as part of our reply to Sir John’s report. We also need to consider it within the context of the next-stage review and some of the national working groups, which also involve the professional bodies, in coming up with the final decision.

My Lords, given the oversupply of medical students choosing oversubscribed specialties such as the Minister’s own in surgery, what plans do the Government have to encourage medical schools to divert some medical students into undersubscribed specialties such as mental health and other branches of medicine which may appear less attractive at first sight?

My Lords, I am grateful for the noble Baroness’s intervention. She makes an extremely important point. I strongly believe, as she does, that trainees must have more information in guiding them to a final conclusion on what type of specialty they should end up in—particularly at undergraduate level—so that their expectations can be in line with service needs. For example, when I was a trainee, for my first job I wanted to apply to become a brain surgeon, but I realised very quickly that the opportunities in that area were fairly limited. We need guidance and support for trainees, not in their postgraduate years but in their undergraduate years, to ensure that they go into the right specialties.

My Lords, in a letter to me on 24 January the Minister explained that money for medical education and training would not be ring-fenced at trust level but would be based in 2007-08 on,

“a new Service Level Agreement ... and accountability framework”.

Can he explain how this framework will work and how we can ensure that education and training will be protected at trust level?

My Lords, the role of the Department of Health should be to focus on outputs and accountability rather than on ensuring that fixed amounts of money are spent on a particular purpose. For that specific reason, the service level agreement and the accountability framework issued in 2007-08 on the MPET allocations ensure that SHAs and other providers are held to account for the training they support for healthcare students and the NHS workforce, so that they develop the workforce needed to deliver the services required by patients rather than spend that money elsewhere.

My Lords, what arrangements are the Government making to ensure that doctors can still gain experience abroad as part of their education and training? Conversely, what arrangements are being made to ensure that the UK maintains its leading position as an educator of doctors in developing countries, whether that is done at home or abroad?

My Lords, if a trainee seeks a fellowship abroad—which usually means transatlantic—there are the right structures within the deanery to ensure that that individual could take a year or two to gain further experience abroad. I am aware that many of my trainees are seeking some form of post-training fellowship in the US and, in some cases, South Africa. With regard to the UK being a centre of excellence in providing training for those who come from abroad, that is well known historically. The challenge for us now with postgraduate training is how to ensure that preference is given to our UK graduates and that the gaps are then filled with others from abroad.

My Lords, one of the major casualties of the new training arrangements has been the loss of the team approach to care in hospitals. At one time we used to have the consultant, the trainees, the nurses and others working in a cohesive and co-ordinated way on patient care, but most of that has been lost as we have seen a rise in rotas, shifts and the shortening of hours. Is there any way the Minister can see to redress that balance? If he does so, he will earn even more respect than he already has.

My Lords, I could not agree more that the spirit of any team is based on the integrity of that team and, from a patient perspective, the continuity of care. However, we are all aware of certain working time directives, although as it stands the current WTD is coming up to 48 hours a week. We need to ensure that we also have doctors who have slept through the night and are at their full competence when seeing patients. It is a matter of balancing the sleeping hours with the teamwork. I have no doubt that at a local level, with some creative solutions, we can help maintain the integrity of such teams.