AT the heart of the Modernising Medical Careers (MMC) and the Medical Training Application Service (MTAS) programmes for junior doctors is the Blair government’s all out assault on the NHS.
These programmes are about:
1. The removal of hospital doctors and reduction of training places.
2. The shortening in training years to reach consultant.
3. An appointment system no longer controlled by the medical profession.
4. A training and appointment system adapted to the needs of the private healthcare corporations.
Estimates suggest that 33,000 junior doctors are chasing 18,000 training posts. A third of the latter are short term.
Many of the 15,000 juniors left will get non-training posts or no job at all.
At the centre of the government’s plans is the destruction of NHS hospitals as providers of comprehensive care, above all, the dismantling of the DGH.
In January 2006, the government’s healthcare-outside-hospitals White Paper, Our health, our care, our say proposed the continuation of the ‘turnaround’ cuts in the hospitals and the transfer of five per cent of funding from acute hospitals into ‘community care’.
In March 2006, the Department of Health (DoH) suddenly announced the ending of work permits for International Medical Graduates, who staff many middle-grade posts in NHS hospitals.
In September, the new Chief Executive of the NHS, David Nicholson, said that up to 60 DGHs would be ‘reconfigured’, many of them losing their Accident and Emergency departments, and maternity and paediatric units.
In November Patricia Hewitt, the Secretary of State for Health, announced that the NHS was employing far more hospital doctors than it should.
In January 2007, Health Service Journal published a leaked DoH draft, long-term, workforce strategy for the 2007 spending review.
It referred to ‘an excess supply’ of consultants and projected a future of foundation hospital trusts wanting to employ cheaper sub-consultant grades.
It said that it would not be possible to perform ‘workforce planning’ in a future marketised system and that the market would find its own level of employment.
These plans are being forced through all over the country, with devastating consequences.
Hospital managements tasked with addressing huge ‘deficits’, are closing wards, freezing posts, sealing theatres, reducing consultants hours and operating sessions and abolishing junior doctors’ jobs.
Desperate measures are being proposed to find ‘efficiency savings’ e.g. hospital at night schemes, unified rotas, replacing doctors with nurses, removing on-call rooms, not getting locums.
On orders from the DoH, Primary Care Trusts (PCTs) are introducing demand management schemes to divert GP referrals away from hospitals, with consequent loss of funding, are drawing up lists of operations no longer to be performed by local hospitals and are giving contracts to private companies to set up Independent Clinical Assessment and Treatment Services (ICATS) and to take outpatients away from hospitals. Elective surgery is diverted into ITCs.
But it is only NHS hospitals that train juniors to consultant level and employ consultants.
It follows that the loss or conversion of 60 DGHs equals the loss of thousands of training posts which will be followed by the loss of thousands of consultants’ posts.
The MMC plan is to train juniors into consultants in a shorter time. There is considerable doubt about whether this is possible.
Many suspect that the real agenda is to produce Certificate of Completion of Training (CCT) holders who could be forced into a cheaper sub-consultant grade by foundation trusts.
MTAS is a selection and appointment system which has been taken out of the hands of consultants. It is a government agency and does the government’s bidding.
MTAS is needed to crash training, as the NHS is crashed.
The government wants to control and reduce training places and adapt the training system to the needs of the new corporate providers.
They no longer want an independent medical profession, speaking up for the needs of the patient and championing the best and most appropriate care.
Corporate providers require obedient employees who will promote their protocols and treatments, or lack of them, without question.
The role of the British Medical Association (BMA) leaders has been to criticise a little and go along with the government’s reforms.
At last year’s BMA Annual Representative Meeting (ARM), they were rightly accused of not ‘actively opposing’ these reforms.
The leadership has not changed. By not actively opposing, they are helping the government to privatise the NHS.
Remedy should be applauded for leading the campaign against MTAS. Their mobilisation of grass-roots pressure made sure that the BMA’s Junior Doctors Committee (JDC) decided on March 10, to support Remedy’s march today and won the endorsement of the whole BMA.
What is desperately required in the BMA is a new leadership – one that comes out openly to campaign for an integrated, publicly-funded and provided NHS, and for kicking out the corporate providers. This is what it was tasked with doing at last year’s ARM.
The BMA has to oppose the cuts, and fight the reconfigurations and hospital closures.
Junior doctors and consultants should boycott the whole MTAS process.
Scrap MTAS and MMC! This is the only way to safeguard training and the consultants of the future.
Yes, we’re up against the government. NHS Together and the whole of the trade union movement should be mobilised to take strike action and put an end to this government and defend the NHS.