there are fantastic candidates who are not even getting an interview for specialist medical training
That is the trouble with our healthcare system. There is no flexibility …since junior doctors must always be paid the same, and have their wages negotiated centrally … and have nowhere else to go if the NHS lets them down
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Blair’s parting gift: more doctors for fewer jobs
There comes a moment in every Prime Minister’s Questions when Tony Blair seems to wriggle off the hook. Houdini slips his chains. The greased piglet darts through the ring.
Tony’s trick involves suddenly whipping up his Labour backbenchers like a bunch of drunken Russians at a Black Sea resort. He majestically waves aside whatever charge is being put to him – systematic deception, sale of peerages, you name it – and starts a rhythmic chant about the scale of the expansion of the public sector under his premiership.
“The number of teaching assistants – UP!” he calls, and behind him the puce-faced drongoes of the Labour machine call “UP!” And on goes Blair the bingo compere: “The number of nurses – UP!”, he psalms, and “UP!” yell the Labour MPs, joyously waving their order papers. “The number of junior doctors – UP!” shouts Blair, and by now the crowd behind him is in a rowdy ecstasy, going “Up, up, up!” and jeering at the Tory benches like Millwall fans, though without the natural good manners.
As a way of seeming to be in charge in the twilight of his regime, it is really quite effective; except that we pigletologists have noticed a change in the repertoire in the past few weeks.
He no longer mentions nurses, mainly because the Government has so disastrously mismanaged the education of nurses that thousands of them are leaving university to find there are no jobs available; and now he has dried up about doctors, too.
Which is not surprising, since the final ludicrous achievement of the Blair NHS is indeed to have boosted the number of junior doctors – and by a feat of almost superhuman incompetence to have timed this sensible adjustment with a dramatic cut in the number of jobs available.
The result is chaos. It must have been a couple of weeks ago that I first got wind of the problem, when a consultant chum said he urgently needed to bend my ear about an NHS horror story; and I am afraid I didn’t give it my full attention, because the NHS is full of horror stories.
Then the letters started to come in, and the picture became clearer, and then yesterday morning a couple came up to me at the station and entreated me to do something about their son.
They told me that, for six years, they had helped him to pay for his studies, and, although they were not rich people, they had paid many thousands of pounds in the hope that he would become one of the anaesthetists this country needs so badly, and that he was now in a quandary because he had been told that there were no vacancies, and he was thinking of going to Australia.
Even by the standards of this Labour Government, the new system for recruiting junior doctors is an amazing cock-up, and a stupefying waste of money, time and talent.
The nub of it is that, this year, there are 30,000 applicants for employment as junior doctors, on the first rung of the medical ladder that leads to becoming a consultant. They are our nation’s future cardiologists, oncologists, dermatologists, and so on. They are the people, bluntly, who are going to be looking after us all.
They have already cost, on average, about £250,000 to train; and yet the Government has so catastrophically organised things that there are 30,000 of them chasing 22,000 jobs, with the result that about 8,000 will be unemployed from August.
It is not just that many good doctors will therefore be driven to other professions, or to seek a living overseas. As my consultant friend points out, there are fantastic candidates who are not even getting an interview for specialist medical training. Excellent would-be cardiologists are being forced to train as GPs, when they are ideally suited to be hospital physicians, and many good candidates – like the winner of Oxford’s most prestigious medical prize – are losing out altogether.
As with many epic bungles, this one has several causes. You can blame the sinister new internet application system, which is meant to be more rational and impersonal and less prone to the vagaries of personal contacts and networks. The trouble is that it involves a series of absurd online tests, such as “describe an ethical dilemma you have faced”, and your potential medical expertise is judged on how well you can answer this in 150 words; and given that there are now websites offering model answers, and given that candidates may not even submit their CVs, it is not surprising that one group of consultants in Birmingham was so appalled at the mismatch between what they expected, and the candidates who appeared, that they stormed out of the whole selection process.
You can blame the NHS computer system, which has crashed several times and even lost at least a thousand applications. You can certainly blame the Government, for causing a bottleneck by somehow contriving it so that two streams of graduates are competing for jobs in the same year – a looming problem to which they were alerted two years ago by my colleague Andrew Lansley.
But all this is really to ignore the fundamental reason for the disaster; and as any doctor will tell you, unless we understand the cause of the illness, the symptoms will simply recur.
I remember going to the Soviet Union in 1980, aged 16, and realising that communism was going to collapse because the shops were full of huge dusty jars of gherkins, and that was because some central planner in Soviet agriculture had decided that gherkins were a good thing to produce, even though the market was clearly saturated.
That is the trouble with our healthcare system. There is no flexibility; there are no price signals, since junior doctors must always be paid the same, and have their wages negotiated centrally, and above all they have nowhere else to go if the NHS lets them down.
There are just politicians like Blair, raving like some Stalinist commissar about “their” increase in the numbers of nurses or doctors, with no proper system to ensure a match of supply and demand.
We continue to have desperate problems in the NHS, like the pitiful plight of the injured Servicemen forced to share civilian wards; but we will never sort out those problems as long as the planning of the NHS is settled by politicians according to what gets a cheer at PMQs.