The Department of Health’s handling of the problems with the Modernising Medical Careers (MMC) programme last year was “inept,” and the leadership it showed was “totally inadequate,” according to a report published by the House of Commons’ Health Select Committee.
The damning report from a cross party group of MPs comes days after a House of Lords judgment that ruled that the Department of Health had acted illegally in restricting the right of medical graduates from outside the European Economic Area (EEA) to work as doctors in the United Kingdom (BMJ 2008;336:1037; doi: 10.1136/bmj.39574.363924.DB).
The select committee questions the role of the chief medical officer (CMO) in a situation in which junior doctors struggled with a poorly tested computer based application system and faced unprecedented uncertainty about their career.
“The management of the introduction of the MMC reforms . . .was inept,” says the report. “Project management . . . was equally poor.”
Decisions took little account of the needs and concerns of applicants, and communication with junior doctors was “appalling,” it states, adding that the leadership shown by the department in this period was “totally inadequate.”
The committee member and former consultant physician Richard Taylor was “appalled” that the department failed to heed warnings of impending disaster. “It took no notice of the warnings whatsoever,” he said.
But MPs stopped short of personally criticising the chief medical officer, Liam Donaldson. Instead they want the department to review the remit of the this position.
“I certainly felt the CMO was the leader of the medical profession,” Dr Taylor said. “But he can’t be, because he is a civil servant.”
Keith Barron, chairman of the committee, said that it “would be wrong to turn round and say any one individual was responsible” for the situation.
The committee reiterated many of the concerns voiced by John Tooke in his report earlier this year (BMJ 2008;336:61; doi: 10.1136/bmj.39455.498600.4E). However, it did not support his proposal for a new medical training board, NHS Medical Education England, which Professor Tooke suggested might oversee developments in medical education and hold a budget to do that.
The MPs thought that this would be counter to the department’s plans to devolve responsibility and would be “expensive and time consuming.” Although any future changes in medical education need strong central coordination, Medical Education England was “a step too far,” they said.
They were also concerned that many of Professor Tooke’s recommendations had been shelved pending the review by Ara Darzi, due in the summer. “It’s absolutely crucial to get on with it,” said Dr Taylor, calling for Professor Tooke’s proposals to be considered immediately after Lord Darzi’s report is published.
The MPs also criticised the Academy of Medical Royal Colleges for failing to give stronger leadership, although Dr Taylor admitted that doctors were “the most difficult group of people to coordinate you can imagine.”
The report also describes coordination between the Department of Health and the Home Office about foreign medical graduates as “woefully inadequate.”
“Tens of thousands of non-EEA doctors have suffered inconsistent treatment,” it says. Attempts to manage the situation were “poorly planned, badly communicated, and inadequately coordinated.”
The report considers it amazing that the Department of Health had no contingency plans should the House of Lords rule that it had acted illegally. “Home Office officials stated that no plans were in place and could make no suggestions for dealing with this eventuality,” it says.
Welcoming the report, Hamish Meldrum, chairman of the BMA, said that the department had ignored doctors’ concerns: “This is a damning indictment of the government’s failure to listen.”
But he said that the establishment of Medical Education England should go ahead, as recommended in Professor Tooke’s report. “This is crucial to ensure that future reforms are not hijacked by a political agenda; that the money for medical education is properly protected; and that the dreadful mistakes of MMC are not repeated.”
Remedy UK, a group that took up the cause of junior doctors who could not find jobs or who were disadvantaged by the reorganisation, strongly criticised Professor Donaldson and called for him to stand down.
“He set sail on this ship, and it has sunk,” said its spokesman, Matt Jameson Evans. “For the usual suspects to carry on while saying there are processes that need to change is not acceptable.”
Meanwhile a spokesperson for the Department of Health said that it needed to consider the committee’s report and findings carefully before publishing its response.
“We understand and have apologised for the problems that the 2007 recruitment process created,” said the spokesperson.
“Since then we have created the MMC programme board, over half of which are representatives of the medical profession and junior doctors, to advise ministers on junior doctors training and recruitment. Every single recommendation of that board has been accepted and implemented by ministers.”
Modernising Medical Careers, Third Report of Session 2007-8, is at www.parliament.uk/healthcom.
