Junior Doctors Crisis

Speech by David Ford delivered to Proposing Motion in Assembly, 22 May 2007 on Wed 23rd May 2007

Mr Ford: I beg to move

That this Assembly calls for assurance from the Minister of Health, Social Services and Public Safety that junior doctors will be offered appropriate training to ensure that their careers, and patients' care, are protected.

As others have done, Mr Deputy Speaker, I congratulate you on your reappointment to your office. We look forward to seeing you preside over real business, rather than your duties of last summer.

Before discussing the motion, I must first declare an interest: I am the father of two junior doctors, both of whom have been affected in different ways by the disaster that is the so-called modernising medical careers (MMC) scheme. However, as the motion makes clear, my friend Kieran Deeny and I are also seriously concerned about the scheme's effects on patient care.

The MMC scheme had all the hallmarks of a modern Government project: it addressed a system that, although working, could undoubtedly work better. However, instead of incremental changes, the scheme proposed massive and radical changes, many of which had limited justification. Among those changes was the new medical training application service (MTAS), which depended on a new and untried computerised scheme to administer applications for jobs on behalf of every junior doctor in every region of the United Kingdom. The information technology failed continuously - now where have we heard that before in Government projects?

The term "junior doctor" conveys a rather misleading impression. The term actually covers all doctors other than hospital consultants and general practitioners. It does not mean only those doctors who are just out of university; it means the vast majority of doctors who staff our hospitals and who provide life-saving care for our constituents 24 hours a day and 365 days a year.

In an effort to address the problems that ensued from the scheme, different ad hoc schemes have been developed in each of the four nations of the UK. There has been a desperate attempt to ensure some continuity in the National Health Service when doctors are due to take up their new posts in early August. In the meantime, every significant body of medical opinion - not just the junior doctors themselves, but the royal colleges and representative groups of consultants - has expressed its opinion on the fiasco. Those opinions have ranged from concern to absolute horror.

Two days ago, the chairman of the British Medical Association (BMA), Mr James Johnson, felt obliged to resign apparently because he had not expressed his concerns forcibly enough. For those of us who had never before seen the medical profession rising up, as a whole, to protest, that was an indication of how serious the situation is.

The Department of Health in Whitehall has set up a review, but the review team is, "top-heavy with DoH apparatchiks" - not my words, but those of a large group of medical professors in a letter to 'The Times' last week.

In one respect only has the scheme been different from a classic new Labour scheme. This Government does not apologise - not even for the Iraq war. However, the Secretary of State for Health was forced to apologise to doctors for the distress that she had caused. So far, no apology has been made to patients for the harm that they may be caused. In such circumstances, it is little wonder that doctors are so upset and annoyed, and it is little wonder that the acronym MMC has had a number of spin-offs, of which the politest is probably "making medics cry".

We are clearly in the middle of an ongoing crisis; so what is to be done? I welcome the actions of the Department of Health, Social Services and Public Safety here. In particular, I welcome the reopening of the interview process. Those who were denied first-round interviews by the deeply flawed process - flawed in its implementation and designation - will now have the opportunity to be considered for their other choices. Even that compromise is deeply flawed.

In no other field of employment, particularly in the public sector, would it be acceptable for candidates for the same positions to be interviewed under different conditions, with no proper shortlists, on widely different dates, probably by different panels, and with those who are called to the second round of interviews inevitably tagged as the failures from the first round. That hardly reflects equal treatment of all applications, which is surely a prerequisite of any public appointments procedure.

I know of cases of doctors who have failed to be called for interview for posts in specialisms in which they have experience and have passed postgraduate exams. However, those doctors were interviewed for posts in their lower choice specialisms, for which they were less qualified and experienced. The system is fundamentally flawed.

Even the letters of offer from various specialties leave candidates with unacceptable dilemmas. Should candidates accept early offers from their second choices, or should they hold on in the hope that, due to others turning down offers, one of their first choices becomes available? That scenario would be difficult in any job. However, it is not a one-off job application. The current design of MMC means that that issue cannot be redressed later.

Currently, interviews are supposed to cover a seamless progression from the newly instituted foundation-year programme through to consultant grade. Therefore, the system works fine when junior doctors get the positions that they want and realise their ambitions during the first stage of the process. If they achieve that initial step, they know that they have begun the seamless progression.

However, what happens to the majority who do not get the post that they want or do not get any post at all? What happens to those who fail at their one and only attempt to begin a career for which they have trained for several years and in which the general public, as taxpayers, have invested heavily? The current system is not only damaging to the prospects of the individuals concerned - it is seriously damaging to public welfare and the public purse.

I am not a lawyer, but I know a little about employment matters. It seems to me that any doctor who fails to get the post that he or she wants, as a result of this deeply flawed and variable process, could almost certainly have redress through the courts. However, I do not get the impression that people wish to take those cases through the courts. Rather, they want to be treated fairly, to have the opportunity to make progress in their careers, and to contribute to society. They do not want to seek compensation because of their failure to achieve those objectives.

The willingness of the Minister of Health, Social Services and Public Safety to take the issue seriously is a positive sign. I am grateful to him for attending a briefing in the Long Gallery that was organised by Northern Irish Medics, and for his recognition that this matter requires urgent action. Today, he has the opportunity to add substance to that commitment.

It is clear that the current year's process is so flawed that it cannot possibly be used as the basis for the future career patterns for the nearly 1,000 junior doctors who want to serve the people of Northern Ireland. It would be unacceptable for any doctor to lose his or her career, and the Minister has previously confirmed that, at this stage, more than 100 doctors could be affected. It would be almost as bad if doctors were forced into second-choice training posts or non-progression staff grades, with no further chance of starting on new career paths.

The current process compresses two years into one. With the introduction of the F1 and F2 training posts for those who are just out of medical school, there must be no question of doctors being refused posts on the basis of over-qualification. As a potential patient, I would rather visit an overqualified doctor than an underqualified one.

The Minister has stated that it is not possible to return to the previous training scheme. That may be the case, although there are many who wish that it had been returned to a few months ago.

Doctors - and the entire population - have a right to expect the Minister to confirm that he will ensure action on several key points for the future. His first priority must be an assurance that when new appointments are made this August, there will be no compulsory redundancies among those junior doctors who wish to continue working in Northern Ireland. That will require the Department to initiate an urgent review of medical staffing across the region, in every grade.

His second priority must be the full option for transfer among posts next year. In other words, this year's appointments, under the current flawed process, of junior doctors who are dissatisfied with their posts, should be effective for one year only.

The third priority is that there must be recognition that the current number of posts proposed for the future is inadequate to provide for the needs of the NHS in Northern Ireland, and for those who are currently engaged in medical training. It must be ensured that adequate posts are available to provide the care that our constituents require.

I further ask for the Minister's agreement to set up a review group in Northern Ireland to examine the conclusions of the national review of MMC, as well as an assurance that such a review will be broadly representative of the medical profession and the wider community, instead of being stuffed with departmental apparatchiks.

I thank the Minister for his attendance and for taking the matter so seriously. I commend the motion, and I have no problem with the amendment that Dr Coulter will propose, as it merely adds some flesh to the motion that Dr Deeny and I tabled. I ask for the support of the House and urgent action from the Minister.