The Commons health select committee has described the Department of Health’s management of the introduction of a new system of medical training as “inept” and criticised both its leaders and the heads of the medical profession for failing to take responsibility for it.
In a strongly worded report, the committee identifies failings at every stage in devising and implementing Modernising Medical Careers, one aspect of which, the online Medical Training Application System, collapsed spectacularly last summer.
The report says that “key policy decisions and the processes for making and documenting them were ineffective and the medical profession, while frequently consulted, rarely influenced critical decisions.
“The governance systems for the programme were far too complicated, roles and responsibilities were ill-defined and lines of accountability were irrational and blurred.
“Project management for the introduction of changes to specialty training was equally poor. Much of the key planning for the 2007 changes took place in a mad scramble at the end of 2006. The ‘big bang’ approach and the failure to pilot any of the new arrangements proved particularly serious errors.”
The “mad scramble” affected the MTAS system in general and the website through which junior doctors had to apply for specialist training places. Towards the end of April, Channel 4 and ITN discovered a security breach that meant the private details of applicants were generally available.
The website provider was Methods Consulting, whose managing director, Mark Johnston, blamed the security failure on human error.
“Through a very untypical mistake, a senior member of my team put [files containing personal details] in place in a way which was not secure enough… It was a simple mistake… he made a call in doing something, which was very untypical of him. He was very tired from working very hard, and that is what caused it,” he is quoted as saying in the report.
The site was suspended following further security concerns, by which time junior doctors were complaining that the system was over-subscribed and consultants were complaining that the new system put too much emphasis on “white space” answers and not enough on CVs and other evidence of skills and experience.
The report says that communication with junior doctors during this critical period was “appalling” and that the leadership shown by the DH was “totally inadequate.” It singles out the chief medical officer, Professor Sir Liam Donaldson, for particular criticism and says his role should be more clearly defined.
But it says new arrangements are needed for managing MMC more generally, while rejecting the key recommendation of the earlier Tooke Review of the fiasco that a new body called NHS: Medical Education England should be created.
The report also says: “The leaders of the medical profession itself were ineffective, divided by factional interests and unable to speak with a coherent voice” and that the Academy of Royal Medical Colleges should be replaced with an executive body with the power to speak on behalf of the profession.
The British Medical Association said: “We completely endorse the basic analysis [in the report] that there was a massive systems failure. It is crucial this disaster is never repeated. This year’s recruitment process will, in some ways, be even more challenging, with severe competition in some specialities.”
A spokesperson for the DH said it would be studying the findings of the report, but that: “We understand and have apologised for the problems that the 2007 recruitment process created."
The extremely detailed, 140 page report on MMC makes almost 40 recommendations on everything from workforce planning to the detail of some training posts. Overall, however, it says MMC shows up systematic failures in government.
“The causes of and responses to the crisis of 2007 provide clear evidence of widespread failure to co-ordinate thought and action,” it says. “The secretary of state attributed the breakdown of the MMC programme to a ‘systems failure.’ We agree.”
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