Robert Sharp

The NHS will no longer employ doctors from overseas. Too many British doctors have been trained, which has lead to a high demand for places.

Since the NHS has been sustained for so long by migrant workers, clearly there are moral debates to be had: Do we owe anything to overseas doctors who have worked here before? There are also administrative issues too: Where does this leave the Highly Skilled Migrants Programme? However, there are also second order issues, the problems we may not feel for a generation to come.

It is often said that the UK, above other countries, enjoys a good reputation around the world. We are said to enjoy “good links” with other countries, especially the Commonwealth, made up for the most part of former colonies. We know that these good links are embodied not just in formal institutions, aid, and preferential trade agreements, but on the personal level too. Our large immigrant population, with family back in India or South Africa or wherever, form a multitude of individual ties which together forge a strong, enmeshed bond between to countries. We have an army of millions of people around the world, who have worked in the UK at some point in our lives. They are a million secret agents, sleeper cells in their own communities, who will stand up and defend our interests and our reputation when required. This latest decision by the Home Office is the first step in the disbanding of that multicultural regiment, and it will hurt us in the long run. It is another steo away from an open, Internationalist approach that has stood is in such good stead for so long. Let us hope these measures are not extended to other professions too.

I’m sure elsewhere in Blogistan the wags are enjoying the news that all the recent terror arrestees worked for the NHS. No doubt someone will suggest that working under Patricia Hewitt was enough to drive anyone to extremism; no doubt others will quip that the doctors turned to terrorism after failing to secure a job through MTAS. Some might try to suggest that the obvious ineptitude of the terrorists proves what poor quality personnel the NHS is employing these days…

Listening to the radio reports just now, I noticed the repeated use of the phrase ‘linked’. Usually, we hear it as part of that nebulus catch-all, “groups linked to Al-Q’aeda”. To hear instead that the men were “linked to the NHS” manages to portray our Health Serivce in a rather sinister new light.

Perhaps the NHS should be more like Al-Q’aeda. Many people have been saying for many years that the individual hospitals and trusts need to behave in a more autonomous fashion. They should be set a target and left to reach it in whatever manner they see fit. Not unlike a terrorist cell.

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One thing I have witnessed “first hand” is the anxiety - nay, terror - induced by the shocking MTAS system for appointing junior doctors. Various aspects of the mis-management continue to be discussed in the blogs and in newspapers, including the dumbing-down of the profession and the fact that some people are having to take on lower grade positions.

So, while I can concede that there are dozens of political groups that I could campaign for, I’ve lent my support to the junior doctors at Remedy Scotland by setting up a campaign blog for them. They have quite a focused campaign, with an achievable reform agenda, in a single policy area, so I am hoping that it can be quite incisive. Since so many people in Scotland will be affeced, a fairly disparate group of people will need to be mobilised. I am planning to utilise the full arsenal of Web 2.0 technologies to help spread the message. Expect blog buttons and such things very soon.

Do please visit the site and sign the petition. There is also a protest march planned for mid-July, in Glasgow.

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Since Monday, when the Medical Training Application Service (MTAS) announced which doctors would be shortlisted for an interview in their new system, a tsunami of discontent has been rumbling on the horizon. It has taken until Friday for the full scale of the problem to reach the media: Under the guise of ‘modernisation’, the government has effectively culled 8,000 jobs at once. Predictably, this has inspired anger among doctors, especially since many of the applicants have found themselves off the shortlist for the post that they currently hold!

Many are considering leaving the country.

As one would expect, Dr Crippen has more information on how poorly the process has been managed. But a quote from a person named ‘fishgoth’, posting on the doctors.net.uk website, sums up the problem:

MMC is an ill thought-out wankfest, destined to destroy the careers of thousands of junior doctors. This shameful cuntathon of an online exercise in humiliation will leave large numbers of doctors, some with several years experience in a speciality, fighting over the crumbs of a few jobs that will ultimately produce ’specialists’ with fuck-all experience

‘Fishgoth’ is a surgeon, writing late at night after an exhausting shift. In addition to the problems raised, it is clear that the Modernising Medical Careers process has actually served to raise the blood pressure of doctors who we hope remain calm during a crisis, our crisis. He (I suspect it is a ‘he) rages on:

My future, my earnings and my ability to pay off a mortgage have suddenly been channeled into a two week wank-fest of an online application which kept crashing

It may be that, despite the MMC policy being so flawed, the fact that it is a government policy means that there is very little redress for juniour doctors who complain, or protest about it. All policies, after all, have winners and losers. However, I think that the problems with the MTAS website may be an achillies heel.

When many doctors found that, for one reason or another, they could not submit their application properly, they naturally asked for assistance from the MTAS team. MTAS recommendations were embarrasingly amateur. They suggested that all doctors log-in using Internet Explorer, and try submitting their application in the early hours of the morning. This is totally unacceptable, akin to shutting a government agency when it is supposed to be open.

What is more, it looks very much to me like maladministration (i.e. when a government agency has not applied policy correctly). All government websites must comply with accessibility standards, allowing a fair measure of the population to access any particular site. The MTAS site would fail even the least demanding of these standards. It is therefore in breach of the governments own legislation in this regard. Disappointed doctors may find that the most effective means of redress may be via the Parliamentary and Heath Service Ombudsman.

In the coming days, I hope to compile a more detailed post here, on what is meant by ‘accessibility’ in the web design sense of the word, and how the online application forms employed by MTAS fail accessibility standards.

NHS ‘moles’ are like the Malawian Orphans of the British blogosphere.

Doctor Crippen and Devil’s Kitchen think they are soooo clever with their inside information, don’t they? The Doc reports on the persecution of junior doctors, by revoking their right to prescribe drugs; while the Devil has a bizarre story about nurses secretly performing medicals on asylum seekers.

Well, I’ve got one too (actually, I have five or six, but let’s not be boastful). I’ve been forwarded a particularly amusing letter from Mr Mike Grieve, University Hospitals Division, NHS Lothian. He is leading a financial recovery team to reduce over-spending, which is currently running at £1 million per month.

Our immediate task is to return to a position of month-on-month income and expenditure balance … Much of this is incurred in four areas of expenditure namely, the cost of doctors in training, bank and particularly agency nursing costs, clinical supplies and some medicines.

So, they need to cut costs in the areas of: doctors, nurses, medical supplies, and medicine! Is that not, like, everything that goes into making a hospital a hospital!?

To be fair, at least they are on the case, and trying to get back on budget. My source is not impressed:

Without bank and agency nursing staff the service would collapse. There is a high level of sick leave amongst nurses, due to high levels of stress, low morale, poor pay, shift working etc.. A ward not well staffed by nurses is not safe.

What is interesting is there is no mention of managers, the ones who clearly fucked up in the first place.

That’s fine, but I can’t shake the worry that this would be not so different if the running of hospitals were sub-contracted out to private companies. What’s to stop them cutting the same costs and services to maintain profit margins?