Goodbye RITA Hello CRAP
Friday, 09 May 2008
  • Parliamentary enquiry into MMC
  • Don't mention the Subconsultant
  • Unfilled Rotas - Mind the gaps
  • Goodbye RITA hello CRAPs
  • Is a Deanery an Employment Agency? (continued)

Parliamentary enquiry into MMC

Universal slating by MPs but Donaldson gets off.

The all-party Commons Health Committee has now completed its enquiry into MMC. The report is highly critical and peppered with words such as ‘defective’, 'unsafe', 'disastrous', and 'inept'. It finds that ‘the leadership shown by the Department of Health was totally inadequate'. Despite this blistering account not one of the architects of this avoidable catastrophe is charged in any significant way for the misery they propagated.

The Committee is also critical of the medical profession, and concludes that 'The reputation of ...the leaders of the profession was severely diminished by the events of 2007.' They are accused of being 'ineffective, divided by factional interests and unable to speak with a coherent voice'. The report singles out the Academy of Royal Medical Colleges as being weak and tokenistic, and considers it should be replaced with a new executive body more capable of making decisions. And it dismisses CoPMED as being 'not an appropriate body to implement reforms'.

Workforce planning is also a mess. "We are concerned by the apparent absence of any systematic basis for calculating postgraduate training numbers, something which should have been established as part of the MMC reforms". It is unable to fathom the basis by which numbers were determined or the rationale for deciding future training numbers.

Turning to the future, their report draws attention to the delay in fully implementing the Tooke recommendations pending the Darzi review, and calls for an immediate response when the review is published.

So who does the Committee think was responsible for all this? The Kafkaesque web of MMC accountability makes this difficult to call, and they draw attention to the way in which the DoH used the complexity of the MMC governance structures both to explain the failings of 2007 and, paradoxically, to absolve individuals from responsibility for them.

Donaldson comes out smelling of something other than roses but he evades personal criticism because his role is ambiguous. Maybe it is his job description that is the problem. Remedy has never called for blood before, but his continued presence as CMO after initiating such abject failure leaves a bitter taste. There must be other senior members of the MMC team who will sleep badly tonight.


Don't mention the Subconsultant

The Tooke enquiry suggested that there might need to be a post-CCT but pre-Consultant career phase for some doctors, especially those in highly specialised fields. This has been highly controversial. The Health Select Committee has also looked at the Consultant grade, and quoted Ian Wilson of the BMA who was opposed to the creation of any new grade and argued instead for the creation of a new 'senior consultant'. The Committee agreed with this and strongly recommended that consideration be given to the introduction of a hierarchy within the consultant grade. Perhaps this is the Newspeak for the dreaded 'S' word.

Meanwhile we have been looking at what is happening at present. We have found that in one region nearly 40% of CCT-holders did not take up a substantive consultant post when they completed their training and took a locum post or other job instead. These locums have inferior status and tenure, and are caught in an akward and uncertain no-mans land. Remedy believes that their plight merits an urgent and honest examination.


Unfilled Rotas – Mind the Gaps

We continue to hear stories of a shortage of doctors, and how this is stretching the good will of those left in post to cover the service. One report from Wales reveals that shortages are resulting in “temporary closure of a particular service”. These shortages came about thanks to the combination of a once-a-year recruitment coupled with the loss of many international medical graduates who were illegally prevented from taking up jobs in the UK.

Remedy first raised this issue months ago, but our concerns were swept under the carpet because there had been relatively little noise from the grass roots. As the summer holidays approach then this shortage is likely to get worse. We urge Trusts and Departments affected by a shortage of juniors to raise this with their clinical managers, and also with their local press, and to warn them if there are likely to be local difficulties or any impact on patient care.

We have written to the GMC asking for guidance on the ethical aspects of unfilled hospital posts. Good Medical Practice states that 'If you have good reason to think that patient safety is or may be seriously compromised by inadequate premises, equipment, or other resources... you should put the matter right if that is possible. In all other cases you should draw the matter to the attention of your employing or contracting body. If they do not take adequate action, you should take independent advice on how to take the matter further. You must record your concerns and the steps you have taken to try to resolve them.'


Goodbye RITA hello CRAPs

One feature of the brave new world of MMC was the replacement of the RITA assessment process with a new Annual Review of Competence Progression (ARCP for short). This new process was defined in great detail within the Gold Guide, the MMC operational bible, with full details of how it should work, how it should be quality-assured and the processes to be followed if trainees fail to achieve standards.

These processes have been too complicated, time-consuming and bureaucratic for some Deaneries to implement to the letter and have been replaced by modified or simplified procedures. Although we understand their reasons for doing this there is a poignant sting in the tail.

For FTSTAs, and others who missed out in the MTAS lottery, their hope of getting a training number, especially at ST3 entry, depends on the numbers of the present run-through ST2 doctors who fail to progress. This Lost Tribe was relying on the ARCP process to have teeth and to create some entry spaces for them to move into. A dumbed-down ARCP process could deny them this opportunity.

We urge Consultants, especially Educational Supervisors, and the College representatives to ensure that the ARCP process is carried out robustly and does not inappropriately rubber-stamp those who do not warrant progression.


Is a Deanery an Employment Agency? (continued)

A month ago we asked our lawyers whether Deaneries should be bound by the terms of the Employment Agencies Act. Broadly speaking an employment agency introduces work-seekers to employers. The Act mandates that agencies should give clear indications to job applicants and information about where they will be working, what they will be earning and other crucial information.

So far our lawyers have not found a clear answer as to whether or not Deaneries have any statutory responsibilities under this Act. We are offering a years free membership of Remedy to the first person who can quote chapter and verse on this one.

Thanks
The Remedy Team.