The Department of Health’s “totally inadequate” leadership was responsible for the “chaos” caused by the Modernising Medical Careers programme, the House of Commons Health Select Committee has concluded in a damning report published today, which warns that the problems remain “unresolved”.

The MMC was set up in 2003 to address long-held concerns about the UK medical workforce, in particular the postgraduate medical training system, with some doctors at Senior House Officer level and many at Staff Grade and Associate Specialist posts experiencing poor training and indifferent career prospects. But, in 2007, the programme plunged into crisis. The new centralised Medical Training Application Service recruitment system proved highly unpopular, while the number of applicants was much higher than expected, creating fierce competition for posts and making thousands of doctors deeply anxious about their future prospects, say the Members of Parliament.

“Following intense public pressure and major demonstrations by junior doctors, the DH set up the Douglas Review Group to make changes to the recruitment system. Several senior resignations, a legal challenge, two major security failures and a number of emergency statements by the then Secretary of State followed, however, as the crisis deepened. Elements of the MTAS system were subsequently abandoned and, although most training posts were eventually filled, the events of 2007 proved a disaster both for the Department of Health and for the medical profession itself,” they add.

New arm's length body to oversee medical education
A major enquiry was held, led by Sir John Tooke, and in January 2008 it called for major changes to the structure of training and the creation of a new arm’s-length body, NHS Medical Education England (NHS:MEE), to oversee medical education. The Select Committee has broadly agreed with Tooke’s conclusions. However, they dispute Tooke’s suggestion of creating a new arms’ length body, warning that this would be “expensive and time-consuming”. Likewise they do not endorse his suggestion of ‘core’ and ‘higher’ training schemes.

Like the Tooke enquiry, the MPs say they have found serious problems with the MMC’s management, but also wider issues with policy development and leadership. In particular, they describe co-ordination between the DH and the Home Office on restricting medical migration as “woefully inadequate.” The government’s many initiatives failed to prevent open access to training places for doctors from around the world in both 2007 and 2008 and, as a result, hundreds of UK graduates have been unable to continue with their training, while tens of thousands of non-European Economic Area doctors have suffered inconsistent treatment.

“Efforts by the DH, the Home Office and the Treasury to manage the situation have been poorly planned, badly communicated and inadequately coordinated,” say the MPs, who add that, “amazingly,” the Home Office told them it had no plans in place if the Law Lords found the DH guidance on overseas doctors to be unlawful. Mr Barron called this lack of coordination “inexcusable,” and the report stresses that this “embarrassing problem” must be resolved as a matter of urgency.

Moreover, the introduction of new Speciality Training arrangements in 2007 was “disastrous and resulted in a short-listing process which was little more than a creative writing exercise for candidates,” the Committee goes on.

The MPs conclude that DH’s management of MMC reforms was “inept…the governance systems were over-complicated, roles and responsibilities were ill-defined and lines of accountability were irrational and blurred,” while the arbitrary division of responsibilities between the CMO and the Workforce directorate was “a fatal fault line in the programme’s management.”

“The Department of Health, other relevant government departments and the medical profession must get a grip and resolve this mess that has diminished the reputations of all those concerned, and resulted in untold amounts of stress on junior doctors across the country and beyond,” said Mr Barron.

CMO overboard?
Although committee members were keen to emphasise that they were not calling for the resignation of Chief Medical Officer Sir Liam Donaldson, the report is scathing. “the CMO, despite being the chief architect of the reforms, did not take responsibility for the 2007 crisis”. It further states that “the confidence of the medical profession in the CMO has been seriously damaged by MMC”.

Nor is the medical profession spared: “often more concerned by factional interests than by the common good”. Committee chair Kevin Barron and independent MP for Wyre Forest Dr Richard Taylor both pointed to the lack of common leadership by the fragmented medical profession, and called for the “weak and tokenistic” Association of Royal Medical Colleges to be replaced by an executive body with authority to make decisions.

BMA: ‘we told you so’
The BMA welcomed the report as “a damning indictment of the government’s failure to listen to doctors” and points out that they called for the system to be delayed “as far back as June 2006”.

Dr Hamish Meldrum, Chairman of the BMA, said,

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The Department of Health’s “totally inadequate” leadership was responsible for the “chaos” caused by the Modernising Medical Careers programme, the House of Commons Health Select Committee has concluded in a damning report published today, which warns that the problems remain “unresolved”.

The MMC was set up in 2003 to address long-held concerns about the UK medical workforce, in particular the postgraduate medical training system, with some doctors at Senior House Officer level and many at Staff Grade and Associate Specialist posts experiencing poor training and indifferent career prospects. But, in 2007, the programme plunged into crisis. The new centralised Medical Training Application Service recruitment system proved highly unpopular, while the number of applicants was much higher than expected, creating fierce competition for posts and making thousands of doctors deeply anxious about their future prospects, say the Members of Parliament.

“Following intense public pressure and major demonstrations by junior doctors, the DH set up the Douglas Review Group to make changes to the recruitment system. Several senior resignations, a legal challenge, two major security failures and a number of emergency statements by the then Secretary of State followed, however, as the crisis deepened. Elements of the MTAS system were subsequently abandoned and, although most training posts were eventually filled, the events of 2007 proved a disaster both for the Department of Health and for the medical profession itself,” they add.

New arm's length body to oversee medical education
A major enquiry was held, led by Sir John Tooke, and in January 2008 it called for major changes to the structure of training and the creation of a new arm’s-length body, NHS Medical Education England (NHS:MEE), to oversee medical education. The Select Committee has broadly agreed with Tooke’s conclusions. However, they dispute Tooke’s suggestion of creating a new arms’ length body, warning that this would be “expensive and time-consuming”. Likewise they do not endorse his suggestion of ‘core’ and ‘higher’ training schemes.

Like the Tooke enquiry, the MPs say they have found serious problems with the MMC’s management, but also wider issues with policy development and leadership. In particular, they describe co-ordination between the DH and the Home Office on restricting medical migration as “woefully inadequate.” The government’s many initiatives failed to prevent open access to training places for doctors from around the world in both 2007 and 2008 and, as a result, hundreds of UK graduates have been unable to continue with their training, while tens of thousands of non-European Economic Area doctors have suffered inconsistent treatment.

“Efforts by the DH, the Home Office and the Treasury to manage the situation have been poorly planned, badly communicated and inadequately coordinated,” say the MPs, who add that, “amazingly,” the Home Office told them it had no plans in place if the Law Lords found the DH guidance on overseas doctors to be unlawful. Mr Barron called this lack of coordination “inexcusable,” and the report stresses that this “embarrassing problem” must be resolved as a matter of urgency.

Moreover, the introduction of new Speciality Training arrangements in 2007 was “disastrous and resulted in a short-listing process which was little more than a creative writing exercise for candidates,” the Committee goes on.

The MPs conclude that DH’s management of MMC reforms was “inept…the governance systems were over-complicated, roles and responsibilities were ill-defined and lines of accountability were irrational and blurred,” while the arbitrary division of responsibilities between the CMO and the Workforce directorate was “a fatal fault line in the programme’s management.”

“The Department of Health, other relevant government departments and the medical profession must get a grip and resolve this mess that has diminished the reputations of all those concerned, and resulted in untold amounts of stress on junior doctors across the country and beyond,” said Mr Barron.

CMO overboard?
Although committee members were keen to emphasise that they were not calling for the resignation of Chief Medical Officer Sir Liam Donaldson, the report is scathing. “the CMO, despite being the chief architect of the reforms, did not take responsibility for the 2007 crisis”. It further states that “the confidence of the medical profession in the CMO has been seriously damaged by MMC”.

Nor is the medical profession spared: “often more concerned by factional interests than by the common good”. Committee chair Kevin Barron and independent MP for Wyre Forest Dr Richard Taylor both pointed to the lack of common leadership by the fragmented medical profession, and called for the “weak and tokenistic” Association of Royal Medical Colleges to be replaced by an executive body with authority to make decisions.

BMA: ‘we told you so’
The BMA welcomed the report as “a damning indictment of the government’s failure to listen to doctors” and points out that they called for the system to be delayed “as far back as June 2006”.

Dr Hamish Meldrum, Chairman of the BMA, sa