The butterfly is a flying flower, The flower a tethered butterfly

Wednesday, 31 October 2007

Government reneges on training pledge

Channel 4:
Junior doctors face more uncertainty as the government cuts the number of places available for training. The two-year 'Foundation programme' is a young doctor's first job in the NHS after leaving medical school - what used to be called a House Officer post. It's an essential step on the pathway to becoming a fully qualified doctor. But an increase in the number of applications from medical students elsewhere in the EU combined with a reduction of the number of places on Foundation Programme courses, has lead to a shortfall of training positions. The doctor's union the BMA says this goes against government promises that every medical school graduate would be able to find a Foundation Programme place. They also say that the government has reneged on a pledge not to reduce the number of Foundation Programme places. The number of places is usually calculated from the total number of medical students graduating that year. Applicants from elsewhere in the EU can also do UK foundation programmes, so the government provides 12 per cent more places to accommodate them - the so-called 'headroom'. A would-be junior doctorBut this 'headroom' has been cut to below 5 per cent, despite assurances the BMA say they received from then health minister Lord Warner that cuts would not be made. Students were sent a letter late last week, informing them that due to the shortfall, some of their number would only be admitted to the first year of the programme. They would then have to reapply for year two. The result is considerable uncertainty for junior doctors, who have endured a series of bureaucratic fiascos over the past year, culminating in the collapse of the MTAS computer system set up to handle their applications. Many fear that they will be unable to find a second-year post, resulting in either an unplanned hiatus, or even a complete stop to their medical careers, after six years of training and around £250,000 of tax payers' money has been invested in their training. A would-be junior doctor told Channel 4 News that "the unofficial word from my local deanary that we'd better make our applications pretty fantastic, because there's likely to be a fairly serious shortfall, with little chance of 'plugging the gap'." 'On average, a graduating medical student is over £20,000 in debt, having dedicated five years of their life to train to be a doctor' Ian Noble, Chairman of the BMA's Medical Students CommitteeHowever, this headroom has been slashed to just five per cent this year. Since there is no legal way to prefer British trainees over applicants from elsewhere in the EU, many graduates from British medical schools will be squeezed out. Dr Hamish Meldrum, chairman of the BMA council, today sent a letter to the health secretary, Alan Johnson, to express the union's concern. Ian Noble, Chairman of the BMA's Medical Students Committee, said in a statement: "It is an absolute disgrace for doctors to be left in limbo in this way. On average, a graduating medical student is over £20,000 in debt, having dedicated five years of their life to train to be a doctor. "If the government refuses to open up sufficient training places for these young doctors, this will leave them unemployed, hugely in debt and wondering what on earth to do next." Conservative health spokesman Andrew Lansley told Channel 4 News: "The government said at the outset that it would be unacceptable for UK medical graduates not to have guaranteed posts for two years to establish their start of medical training. "So for us to be in a position where there might be hundreds of UK medical graduates for whom actually we have invested a great deal in their initial qualifications not to be able even to start their training is really a scandal."

There should be a new law to protect our graduates from this "attack!" This is bad, it seems that everybody in the whole world is entitled to British medical training posts but the British! This is beyond belief! :-(

“The abjection of our political situation is the only true challenge today. Only facing up to this situation in all its desperation can help us get out of it.”

The B ritish Medical Association!

“This and no other is the root from which a tyrant springs; when he first appears he is a protector.”

Modernising Medical Careers - Proposals for managing applications from medical graduates from outside the European Economic Area

Response from the British Medical Association
22 October 2007

The BMA believes that the timescale for consultation on this document has been insufficient and is extremely restrictive. On important issues such as these the BMA requires reasonable time to consult its members and conduct informed and detailed debate. Furthermore, the limiting nature of the questionnaire, which forces respondents to agree or disagree with questions relating to a narrow Department of Health agenda, is unacceptable and, instead, the BMA has given a more general response to the issue.

But this problem was identified early 2006! Still not enough time for the BMA to consult it's members?! How long does it take to send an e-mail? analyse the results? A month at the most?!

The BMA’s policy on doctors subject to immigration rules is already well established and consistent. All doctors who have entered the UK with a valid expectation to train or provide a service, and who do not require a work permit, should be eligible to apply for all posts on an equal footing with UK and EEA applicants.

If the BMA DID NOT consult its members, how can they make such a strong generalisation that will affect all juniors? Based on what then but the opinion of the few at the top of this organisation!

HSMP holders should be regarded in category one when competing for posts.

And the thousands of displaced UK graduates as a result, what category are they?

International medical students pay significantly higher tuition fees: £13,000 for their pre-clinical years and £23,000 for their clinical years. If the prospect of application to UK postgraduate training posts is removed, those who face returning to countries with low salaries will have immense difficulty in repaying any outstanding debts incurred during training. It would also be expected that when conducting workforce planning the number of UK medical graduates would not be assessed by immigration status and indeed up until this point non-EEA students at UK medical schools have been included in all workforce planning. These people are expected to graduate, work and train in this country.

???? What debt ???? How can a parent with an average income of, say, £2000 a year get, say, £100,000 loan to send their children to be educated in Britain?! Those are simply rich parents whose pockets will not be dented by UK fees! Of course, there are others who benefit from scholarships through The British council and other programmes and do not pay as they get sponsorships. Then again, our universities are full of overseas students studying all sorts of courses; finance, engineering, music .. the lot! They pay UK tuition fees plus their own living costs. Why don't we worry about where the parents of those get the money from then?! Or maybe The BMA will consider taking those under it's wings too?! Fight for their never aquired right to jobs after graduation as it fights so fiercely for overseas medics?

The BMA is also concerned that a change of status for these people would discourage potential international applicants from applying to medical school in the UK. This could have serious financial consequences for UK medical schools who reap the benefits of the high tuition fees. In this scenario it would be unacceptable to pass the financial burden on to UK students or to make significant cuts to UK medical school budgets.

Overseas students doing other courses are not discouraged because of the fees! It's the "British certificate and education" they are after! Because it opens the doors to a very bright future for them! British education is very valued abroad, see!

Then again, what about the cost of a minimum of 5 years PAID medical specialty training? What about the lost cost of training for the thousands of UK doctors who will definitely be displaced? What about the psychological costs for those doctors and their families?!

How much is the ruined career of a talanted young British doctor?!

The BMA is opposed to restricting doctors subject to immigration rules currently in the UK to apply only for short-term training grade posts, such as FTSTAs. Such a restriction would run the risk of exploitation and stigmatisation of this group of doctors.

?????!!!!! Gobsmacked!


The BMA maintains that doctors subject to immigration rules who are currently in the UK with a valid expectation to train or work in the NHS should be treated equally with UK and EEA nationals.

Was The British Medical Association able to convince the government to create training posts for all?!

Why isn't the BMA fighting for those who were 'commissioned' by the NHS to become doctors and serve the NHS and will face ruin if they do not?!

“The welfare of the people in particular has always been the alibi of tyrants, and it provides the further advantage of giving the servants of tyranny a good conscience”

Tuesday, 30 October 2007

Confused?! ..... So am I

“Confusion is a word we have invented for an order which is not yet understood”

UK medics should not get priority

Wednesday October 10, 2007
The Guardian

Proposals aimed at making it harder for international medical graduates to get a training post in the NHS (British medical graduates may be given priority on jobs, October 9) are not only short-sighted; they are extremely unfair to those graduates who gained a medical degree at a UK university.
These students came to study medicine in this country in good faith, expecting to see their training through. They pay more than four times the fees of UK and European students - an average of £13,000 a year in the pre-clinical years and £23,000 in the clinical years. Preventing them from continuing their postgraduate training in the UK is grossly unjust.

It could also have serious ramifications for medical education as these proposals will deter international graduates from studying in the UK and universities will lose the extra funding. Inevitably it will come down to UK students to stump up that lost money in the form of higher top-up fees, putting a medical education even further out of reach for the less well off in our society.
It is simply wrong for the Department of Health to seek to redress its own errors by disadvantaging these graduates who have racked up huge debts, often over £100,000, studying and training to be doctors in the UK. They must be allowed to compete fairly with home-grown graduates, otherwise we risk ending up with a two-tier medical education system, and that would be nothing short of a disgrace.

Ian Noble

Chairman, BMA medical students committee

No comment!

“Confusion now hath made his masterpiece!”

Monday, 29 October 2007

Justice for all? Is it possible?

“I can never fear that things will go far wrong where common sense has fair play.”

The Tooke Review acknowledged that the reason for the debacle of the 2007 specialty training application process for junior doctors was due to IMGs applying directly against UK graduates as more than 50% of all applicants were from overseas. The review said this behaviour by the IMGs was not anticipated and that the DoH was on "red alert" as a result. Near enough to 5000 training jobs out of a pool of 23000 were secured by IMGs. The DoH was forced to create more jobs to rescue as many displaced UK graduates as possible, however, many UK graduates will suffer unemployment at the end of this year as a result. Not forgetting those who may have left medicine altogether or travelled across the globe to save their careers. The majority of the "rescue" jobs are dead end posts that lead nowhere but British graduates had to accept them to save themselves from total ruin.

Has the 2008 job pool been raided to provide "rescue" jobs for juniors who would have been displaced by this year's shambles?

The DoH said that it was impossible to create enough training posts to accommodate all applicants because the NHS can not absorb this number of fully qualified doctors. To protect UK graduates from this unfair competition in future years, the DoH has started a consultation on whether UK graduates should have priority of application.

Bapio took the government to court last June on the basis that new visa regulations to stop IMGs applying to specialty training were discriminate and, hence, unfair. They lost the case but because they decided to appeal, IMGs were free to apply this year resulting in more than 50% of all applicants being from overseas. Bapio is now going to the High Court tomorrow 30 and 31 Octber 2007 to hear the result of it's appeal against the DoH. Bapio argues that giving priority to British graduates is illegal because this, it claims, would be a violation of their members' human rights.

The BMA does not agree that British graduates should have priority to training either. Surprisingly, Remedy UK is also taking the same stand! Of course both have always called for more training jobs to accommodate all which is impossible as the DoH have said. Another reason maybe that if the IMGs succeed in their appeal, then both the BMA and Remedy UK would not want to look as if they approved of discriminatory measures being applied to IMGs. That however, does not justify their current stand as both are supposed to be protecting UK interests first and foremost IMO.

I do not believe that the DoH would have started its consultation without seeking legal advice first. The same goes for the findings of the Tooke Review too IMO. Of course Bapio lost it's first attempt, hence decided to appeal. That said, no one is denying the role of IMGs since the NHS started nor did anyone say that all IMGs should not be employed in the NHS. Of course, there are still opportunities to fill gaps as well as the route 14 to full accreditation to fully qualified consultant level, on merit of course. So, why is Bapio going to court?! Can Bapio name another country, including it's own country of origin, that allows it's own to be displaced by overseas workers?

This current mess was caused by bad work force planning and no co-ordination between the DoH and the Home Office. However, this is not an excuse to sacrifice the careers of thousands of British graduates as a result. We have seen the suffering endured by junior doctors and their families this year when competition ratios were 2:1. What will it be like in 2008 and beyond when competition ratios will reach at least 3:1, if this problem is not resolved in favour of British graduates?

Would compensation resolve this problem? Is there a miracle cure?

Should the right to specialty training be part of the package for all UK medical students when they first start Medical School?

What about the British graduates human rights?

I hope that a solution that is fair to all will be found in court tomorrow.

The Guardian and the the BBC have both recently written on the subject.

May justice prevail

“There is no crueler tyranny than that which is perpetuated under the shield of law and in the name of justice.”

Saturday, 27 October 2007

In search for a new chief?

Save the Chipmunks

ONCE there was a peaceful and happy village, and in it lived a Chipmunk and his tribe. They were very noisy little Chipmunks, and grandmother used to say:—

"My Grandchildren, when you are out in the woods, you must not make so much noise, or something will find and catch you."

But they did not mind her, and every morning they took all brothers and sisters and went to the woods, and ran about until they found some berries. Then they climbed a tree, and sat on a limb, and while they ate the berries they made all the noise they could.

In the evening their grandmother always told them stories and their elderly were listening but some could not hear, and once she told them about a Giant who wandered about the woods chasing Chipmunks and other creatures. He had a bag full of red-hot stones, and whenever he caught a small animal he popped it into the bag and cooked it.

"I do not believe that!" said a little Chipmunk, "for I have roamed the woods for two or three years, and have never heard nor seen the Giant."

"Nevertheless," said his grandmother, "if you make too much noise, the Giant will come and catch you."

Well, one day the little Chipmunks went out as happy and mischievous as ever. They scurried along looking for berries, and then one thought, "I'll go as far as I can, for I wish to see that Giant."

So he took some more chipmunks with him and went on and on, till they came to a high bluff, and on it they found a quantity of berries. So they sat on the top of the bluff, and while they ate, they tried to make as much noise as they could, for they thought, "Maybe the Giant will hear us and come." Brothers and sisters and some of their elderly who could hear followed him of course.

And the Giant did hear them and come; for he lived under the bluff. He heard all the noise that the little Chipmunks made, and he came creeping quietly, but he was not able to reach the Chipmunks, because the bluff was too high.

"Come down, little ones," said he, as pleasantly as he could, "and I'll give you a heap of fine berries."

But one little Chipmunk said, "No! If I do, you will catch me and make a fine meal for yourself!" So they stayed up on the bluff.

Well, it got to be evening, and the little Chipmunks were tired of waiting for the Giant to leave, and tried to think of a plan to get away. So they and their elderly who could hear broke off some branches from a bush, and threw them down. The Giant heard them fall, and thought it was the little Chipmunks, and sprang on top of them. But it was not the Chipmunk at all, only branches of bushes, and when he looked up to the top of the bluff, the little scamps were gone!

Then the Giant ran, and he took such long strides that soon he saw the little Chipmunks leaping home as fast as they could. And the Giant ran and ran, and just as the little Chipmunks were about to spring into grandmother's house, the Giant overtook them and grabbed their back. But most of the little Chipmunks slipped away, and jumped into the house. So they were safe, and the Giant, grumbling with rage, had to go home with only a few for supper. The giant is still very hungry!

That is why all Chipmunks who were saved have white stripes on their backs. The marks of the Giant's fingers. The giant went back to his hiding place under the bluff and has been there for nine whoooole months! No one ever saw him again except for one time when he came out to wee then he went back under the bluff and was not seen or heard again to this day.

The little chipmunks are still very afraid because the giant is still hungry and will come back to eat them and their elderly are not so big to fight him especially many of them can not hear him coming and some are afraid they pretend they do not care. They all know he will come back soon and when he comes he will eat as many as he can because he is now very hungry, starving! :-(

That is why New wise Medicine Man is desperately wanted by all chipmunks to be their Chief. Must be very strong and magical to put a spell on big hungry giant and drag him out of hiding under bluff and send him far away (down under perhaps?) and save all chipmunks and their grandmother and wipe all nasty stripes off their backs and make all elderly hear again and save their now not so peaceful and not so happy village!


Link originally provided by The Witch Doctor

Chipmunks much happier before nasty stripes

Nurses to decide on resuscitation

Front page news in most major papers today; The Telegraph, The Guardian and The Times as well as on the BBC and other TV stations

This comment from The Telegraph's page sums it up for me:

Euthanasia should be a matter of personal choice, not an arbitrary, third party decision.

Somebody once said that it's not where you were born that matters, it's where you choose to die. I therefore decided several years ago not to die, or rather be put down, in the UK.

Posted by O Zangado on October 27, 2007 11:03 AM
And this one:

New local hospital sign:


Posted by Better die with dignity at home on October 27, 2007 11:27 AM

Should somebody who passes a driving test on a 150cc scooter be able the next day to drive a double-deck bus in London?

Of course not - and the same answer applies to the question you pose.

Posted by Morris Hickey of Chigwell, Essex on October 27, 2007 11:41 AM
And this:

Phew~ I'm glad I got sick and treated in Thailand!
Posted by pauline on October 27, 2007 10:48 AM


And this doctor commenting:

It will be very difficult to convince a doctor on DNR of a particular patient just 'because' the protocol says so. A doctor will go by the books than by protocols... and this will prove costly to the NHS.

By giving nurses the power, they can work their way around doctors, and let patients die quickly.

Countries that have the best quality of medical care do not have nurses involved in such decisions.

The arguement of 'non-availability' of doctors is wrong, as these decisions are often made well over 24 hours before death occurs. If the converse was the case, where a patient suddenly crashes, an on-the-spot decision to DNR is a very tricky situation and usually made by a senior doctor.

I have worked as doctor in NHS, and have decided to leave the NHS once and for all. The prime reason... NHS cannot distinguish between a doctor's, nurse's role and manager's role in the clinical management of patient.

The purpose of these people are to assist doctors in their functioning.... and not as a substitute or take over.

Any such move by higher bodies, on the false belief that they can save money, will turn out to be a very costly both in terms of life and money.

Posted by nmp on October 27, 2007 11:16 AM

And this:

Even if they are well qualified senior nurses, they do not have the depth of scientific knowledge doctors spend years and years learning and practicing, hence, conditions that can be treated maybe and will be overlooked. No, no

I had no idea the British "Medical" Association made decisions for nurses now! Roles are more blurred by the day, dangerous, no, no
Posted by A J Carr on October 27, 2007 11:04 AM


And my own comment:

Dangerous stuff as doctor's duties are erroded by the day! Not that we do not have enough doctors! We do. This year, we had 34000 young doctors applying to 23000 trining posts! Why assign such difficult decisions to nurses and pay them more than doctors to do it then?! Why train doctors at £250,000 each only to throw them to the skip afterwards and give their work to unqualified for these roles nurses?!

Professor Tooke reviewed the fiasco of doctor training 2007 and recommends that "The role of doctors as well as other health professionals should be redefined" instead, the roles are blurred further by stubid and potentially dangerous decisions like this one!

Our hospitals are now like battle grounds where nurses take every opportunity to bully our young but very well educated and qualified doctors as they are assigned more and more of doctor's traditional work! This is not right

Nurses now graduate not to nurse but to work towards becoming unqualified mini doctors while patients are told to "Go soil their beds" because the nurses are busy doctoring! No one seems to draw the line while super bugs are killing patients as nurses are "made" busier to nurse. when will policy makers wake up to the fact that this blurring of roles is dangerous to patients as well as lots more expensive in the long run? When a Cholera epedimic breaks in our filthy, bed-soiled hospitals?! When they will be forced to pay the cost of rectifying all the mistakes as well paying for all the legal compensations and costs which are inevitable?

"If you think hiring professionals is expensive, try hiring amateurs!"

Posted by Sam on October 27, 2007 10:47 AM

However, this comment from The telegraph gives away the reason why such stubid and dangerous decisions are made:

I shall most certainly continue to pay my vastly expensive BUPA subscription. At least you know that there will ALWAYS be a doctor available to you 24/7

Posted by Janie on October 27, 2007 12:20 PM

“Status quo, you know, that is Latin for ''the mess we're in.''”

Friday, 26 October 2007

The BBC's Interview with Sir Tooke

Sir Tooke and Sir Donaldson

Sir Tooke was interviewed by the BBC Radio on 8 October 2007 on "Why doctor training 'failed'" Hear the programme here

“This is my wish for you: Comfort on difficult days, smiles when sadness intrudes, rainbows to follow the clouds, laughter to kiss your lips, sunsets to warm your heart, hugs when spirits sag, beauty for your eyes to see, friendships to brighten your being, faith so that you can believe, confidence for when you doubt, courage to know yourself, patience to accept the truth, Love to complete your life.”

What is the solution Remedy UK?

Remedy Uk had conducted a survey re the position of International Medical Graduates. (Please click on Remedy reports then overseas graduates to read the full report)

Executive Summary

RemedyUK, and 73% of respondents to our survey, do not support the Department of Health’s
proposal that non- EEA graduates already in the UK should be considered for training only after UK and EEA applicants.

RemedyUK, and over half of respondents to our survey, believe there are other options to consider

73% of respondents believe that if this policy was implemented, non- EEA nationals graduating from UK universities should be exempt, and that non- EEA graduates should be allowed to compete openly for LATS and FTSTA’s.

69% of respondents support limiting further recruitment of overseas graduates to the UK. Only 12% of respondents believe the Departments favoured policy is well thought through, with 73% believing that the Department should not implement it.

RemedyUK recognise that overseas graduates have been crucial in supporting the NHS for decades.

As recruitment into medical school has increased, and the Government moves away from a
commitment to a consultant delivered health service, a surplus of trainees has developed. The
systematic changes associated with MMC and the failures of MTAs have compounded and
precipitated this problem.

The current state of medical recruitment and training is a result of poorly implemented government policy. Indeed, only a year ago the Workforce Review Team were recommending and expansion of training posts

The RemedyUK committee believe that the proposed policy to exclude non-EEA graduates already in the UK from competing for training posts is morally reprehensible. Thousands of doctors, regardless of origin, have been subjects of the most appalling failures of Government policy. Approximately 14,000 doctors have been forced out of training this year alone. This is a failure of Government, not the responsibility of overseas graduates. We believe that a thoughtful and considered immigration and employment policy is required, in conjunction
with solutions to the failures of MMC.

But, as Remedy's analysis shows, of those who participated in the survey, 275 + 18 were UK and EEA graduates, while 365 were IMGs. Of course all the IMGs who participated do not want to be excluded while the Brits get priority to training, hence the survey results were biased and Remedy UK should not build opinion based on biased results IMO.

As you can see above, Remedy UK has concluded that it does not support the government proposal that priority should be given to British graduates when applying to specialty training! Remedy does not propose any alternative solutions to the IMG bulge!

While I sympathise with the IMG situation, I do not believe that UK graduates should pay the price with their livelihoods and their careers for the mistakes of others in charge of work force planning. Those are the ones who need to be held to account and to rectify the consequences of their own mistakes without harming British graduates in the process.

I have been and still am a staunch supporter of Remedy UK since it's inception. Remedy came at a time when junior doctors suffered at the hands of MTAS and MMC when no one cared or stood up for the juniors right to justice. Remedy UK took an honourable and courageous position from day one and fought with honour and without fearing the personal consequences that may affect it's members who are junior doctors themselves. A noble mission that achieved a lot in such a small period of time.

Remedy has always rightly called for unity amongst it's supporters, whether members or not. It is now time for Remedy to take a more practical stand and call for UK unity to face the looming disaster;

Based on government statistics, time to realise that there is no UK "Bulge", that this "artificial bulge" is caused by IMGs in direct competition with UK graduates.

Time to unite and stop the abyss caused by the one way uncontrolled medical migration
into Britain that already has and will engulf and devour thousands of our best UK graduates soon when 2008 recruitment starts. The effect of which will remain thereafter for many years to come, if the situation with the "IMG bulge" presists.

“Practical wisdom is only to be learned in the school of experience. Precepts and instruction are useful so far as they go, but, without the discipline of real life, they remain of the nature of theory only.”

Thursday, 25 October 2007

2008 troubled waters ahead!

The debacle of junior doctor recruitment to specialty training of 2007 is still ongoing but will finally finish at the end of this month. To save face, the Department of Health has "created" more and more jobs to save bright young doctors from total ruin if they do not secure a training post at by then. The Department has already identified that the competition ratio of 2:1 for this year was because applicants from overseas outnumbered UK applicants, hence, although there was sufficient training posts for UK applicants, near enough to 5000 posts went to doctors who graduated overseas. As a result, many talented UK doctors would have been displaced had the department not create more than 2000 jobs to save them. Of course, there are many doctors who have either gone abroad in search of opportunity or will still be displaced at the end of this month. Not forgetting those doctors who were able to secure posts but would not have accepted them had there been fair competition; those range from One year dead end posts, far away from family and loved ones posts, different specialty posts .. etc

But, where did all those new jobs come from?! How did the DoH manage to "Create" new jobs?! Well, it didn't IMO! I think the department just simply raided the 2008 pool, that is why competition ratios for 2008 are averaging 3:1

Impact of competition on recruitment to specialty training in 2008 onwards:

3.1.12 The working assumption for 2008 is that competition will be even higher with a forecast competition ratio of 3:1. Over half of applicants are likely to have trained outside the EEA. In open competition for places around 1,000 to 1,500 UK medical school graduates are likely to be displaced and unable to secure to a training place. There are likely to be similar levels of displacement in future years.

The paper in the link is a consultation to favour the obvious! British doctors should have priority to British training! It is "nearly" agreeing the very simple but fundamental Principal! Common sense since UK graduates want to remain in the UK besides the UK has already spent so much to train them!

What I find baffling is the resistance to this proposal by those who represent our young doctors! Their reason, overseas doctors have always "helped" the NHS since its inception! Fine, they did ... but greatly benefited themselves on the way too; secured well paid jobs in one of the best medical training systems in the world! But things change! And they did! Now we have many bright young doctors graduating from our world renowned schools! They were hand picked and "commissioned" to work in the NHS, no where else is open to them; too young to start in private practice and language barriers limits where they can work worldwide! ... Unlike IMGs who can speak English so have the advantage of being able to work here and while our graduates can not work in their countries!

Can those please explain why they do not support the idea that British graduates should have priority to UK training?! Can you please provide an alternative solution to solve the artificial "bulge" problem?!

Haven't our young doctors suffered enough in 2007?! The unprecedented choas was because competition ratios were 2:1, now, what will it be like in 2008 with competition ratios of 3:1?!

Please see the obvious or there will be blood on your hands in 2008 as mayday looms! Please avert the catastrophe of 2008 and beyond!

“Sometimes I'm confused by what I think is really obvious. But what I think is really obvious obviously isn't obvious...”

Saturday, 20 October 2007

The Age of Outsourcing?

With the NHS in such troubled state, More and more people travel abroad to have their cataract done quickly and on the cheap in places like the Middle East and India. OK, if it suits them. They "choose" to do so and pay for the operations as well as travel expenses themselves. Their eyes, their money, their business IMO!

What if there is no choice? You have no say! You, or confidential information about you is sent abroad for treatment or have tests analysed?! ... I must admit, I would not like it at all! The USA is leading the trend in outsourcing as a good number of patients travel abroad for their cataracts or hip replacements, heart operations ..etc. Digital technology has made it possible to have X-ray imaging sent abroad to be examined and reported on by doctors who have never seen the patient! The images get sent across the world in a flash and return the same way without those whose imagery and confidential information ever knowing about the event and without those patients consent! Do those who started the outsourcing trend, the Americans know that such vital information about themselves is being sent outside of the USA without their prior approval? Then again, what are the consequences for American medicine?

Us doctors are already beginning to feel the bite!:

A FEW years ago, stories about a scary new kind of outsourcing began making the rounds. Apparently, hospitals were starting to send their radiology work to India, where doctors who make far less than American radiologists do were reading X-rays, M.R.I.'s and CT scans.

It quickly became a signature example of how globalization was moving up the food chain, threatening not just factory and call center workers but the so-called knowledge workers who were supposed to be immune. If radiologists and their $350,000 average salaries weren't safe from the jobs exodus, who was?

On ABC, George Will said the outsourcing of radiology could make health care affordable again, to which Senator Charles E. Schumer of New York retorted that thousands of American radiologists would lose their jobs. On NPR, an economist said the pay of radiologists was already suffering. At the White House, an adviser to President Bush suggested that fewer medical students would enter the field in the future.

Then I saw this reply from a doctor in India: Scroll down to the comment

All of us have been laughing away in India anyway...we've known all along that there is only one company. The reason is that you have to be board certified to be able to read outsourced images and why would anyone want to leave a cushy 350000USD job to come back to India? Arjun had family reasons, so he came back and started his company. A few others work as sweat-shop agents, reading for companies that have radiologists back in the US who sign-off without looking and make the most money, while those who actually report make around 10-20USD per scan. This also seems to be going down. Just goes to show what hype can do. The same is happening with the word "Medical Tourism" in India.

I heard Britain is beginning to outsource medicine to India too "because it is cheaper to do so!" The owner of this ONE company in India must be getting very rich! But, is it really cheaper to do so? I think not; Not if you add on what you would pay for the consequences of whatever mistakes that may happen plus the lost monies spent on training our doctors only to throw them to the skip when they are able and fully qualified! Foolish or what?!

As well as the USA, The UK is also being targeted by Medical "Tourism" from abroad! Globalisation at it's worst IMO; Call centres, secretarial work, insurance, banking, Steel for industry, our cars, clothes, food and now medicine, ie, our bodies, our livelihoods and our health .. Everything is going out ... Sad! (Watch the BBC video/s)

Medical outsourcing, is it cost effective, is it safe?

"Your life in their hands?" .... Whose hands?!

“Safe upon the solid rock the ugly houses stand: Come and see my shining palace built upon the sand!”

Understanding the BMA

First there was this:

Recruitment to specialty training: Proposals for improvements in 2008

25 September 2007

The introduction of MMC specialty training was a disaster in 2007. Morale in the profession is incredibly low as a result, and it is with this in mind that the BMA believes that solutions to the ongoing problems with MMC in 2008 need primarily to take into account the needs of the young doctors directly involved and the medical profession as a whole. The primary role of the BMA is to represent the views of doctors in the UK, and it is important from the outset that this position is clear. The quality of patient care in the NHS will be adversely affected if selection to specialty training is not improved in 2008, and again from 2009 onwards.

The BMA welcomes the opportunity to respond to this consultation and to engage in constructive debate with other key stakeholders in order to design a workable selection process for specialty training in 2008 that commands the confidence of the medical profession. However, the options available in ‘Recruitment to specialty training: Proposals for improvements in 2008’ are unsatisfactory.

The BMA is under no illusion about the need for compromise in designing selection to specialty training for 2008, but believes that all possible routes for selection should be explored. The Programme Board should strive to achieve the best solution possible in the existing context of gross mismatch between the number of junior doctor applicants and the number of training opportunities. The Board should choose the route that carries the lowest risk of worsening the morale of a group of doctors who, during the 2007 selection process, continue to feel badly mistreated and disenfranchised, and that there is a significant risk of many mistakes being repeated in 2008. In addition, selection must be designed to allow the best candidates to be appointed.

Then you read the BMA's reply to the Tooke review:

8 October 2007

”The report states that medical immigration is an issue that needs to be addressed if future training systems are to be successful. The Department of Health has issued a discussion document on managing applications from international medical graduates. The BMA is calling for greater clarity on doctors’ immigration status, and for overseas medical students currently at UK medical schools to be allowed to complete their full postgraduate training in the UK. Dr Meldrum adds: “The immigration status of overseas doctors during the recruitment process this year was extremely vague, creating the possibility of discrimination. Overseas medical students have come to the UK on the understanding that they’d be able to train and work in the NHS. They’ve often made personal and financial sacrifices to come here. It would be hugely unfair to deny them opportunities to work in the NHS."

BMA, You can't have your cake and eat it! Those two statements were made within less than a two week time span!

Simple mathematics, then the Tooke Review AND the government have acknowledged that the reason for this years debacle was because the number of applicants from overseas outnumbered those from UK graduates and that something has to be done to address this; either allow UK graduates to be displaced by overseas applicants or give priority to UK applicants first then allow applications from overseas to fill gaps.

Of course overseas graduates' contribution is acknowledged, valued and appreciated but no other university course guarantees higher training, paid or unpaid to its students, why should medicine continue to do so especially that this would adversely affect UK doctors trained and invested in through the public purse?! Everyone wishes their was enough training posts to accommodate all from UK AND overseas but this is an impossibility, What do you think should be done to solve this huge problem?!

The "British" Medical Association offers no solution to this conundrum!

"To be persuasive we must be believable; to be believable we must be credible; credible we must be truthful.”

Thursday, 18 October 2007

MMC, not all bad!

Traditionally and for centuries, Academic Medicine has always been able to attract the best and most able to join it's ranks and the fight for an Academic post was fierce, but recently, this is no more .....

Academic medicine: what's in it for me?

Not much! Not in its current dilapidated state, Now a very unattractive option for those young doctors who have always been "aspiring to excellence" academically as well as clinically and hoping to be the innovators, educators and the leaders of medical research in the future. For at least the past decade, Academic Medicine has seen a sharp decline in everything; not enough funding, no clear entry pathways, no flexibility, no clear exit points, no job prospects for many of those who complete their academic training and research and no parity in pay with their clinical colleagues. The reason why, despite the stampede for training posts this year, many of the small number of Academic posts remain unfilled! Such a shame if British Medicine is to "Aspire to Excellence" as professor Tooke rightly recommends in his review.

But, to those who are interested in academia but did not apply to clinical fellowships because of all the problems above, have you read what MMC intends for Academic Medicine? A solution to all the above problems so as to revitalise Academic innovation, education and research. There is better funding provision, also clear entry and exit pathways, opportunities to integrate Masters degrees into your clinical/academic training and parity in pay with other clinical only colleagues. For those who latter on decide to exit academia, they are guaranteed a return to clinical only run through training. Incredibly, there is flexibility, which is not an option if you in the clinical only "straight jacket" of run through training.

Have I got this right? :-)

I Love NHS Rally 3 November

A national march and rally to celebrate NHS achievements and to defend its core values.

Saturday 3 November 2007. Central London.

Assemble at Temple Place on Victoria Embankment (by Temple tube) at 11 am. March to Trafalgar Square for a rally, entertainment and a big screen celebration of the NHS.
Transport from around the country, and more details and publicity coming soon.

About the campaign

NHS Together brings together all the health service unions and staff associations together with the TUC.

It's a new campaign alliance of health staff. We want to raise the alarm at what is happening to the NHS and to press the government for honest and open discussion about its reform agenda.

The NHS has been getting better thanks to increased spending and the dedication and commitment of NHS workers to new ways of working.

But progress is under threat:

Health trust deficits are causing cuts in patient care and staff jobs
NHS staff support reform that delivers better patient care, but that has been replaced by untested rapid changes with no staff involvement.
the fragmentation of the NHS threatens the NHS values that bind it together.

Publisize the rally and attend if you can :-)

Tuesday, 16 October 2007

Safety net extended

Good news! MMC: Extended employment commitment to 31 December 2007

Published: 11 October 2007
By: MMC Team

The Round 2 employment commitment has been extended to 31 December 2007

The Secretary of State for Health has agreed to extend the employment guarantee to 31 December 2007. This will ensure continued employment for all trainee doctors that are applying for 1,050 additional training posts that will be on offer after Round 2.

The original employment guarantee was announced in May 2007 by the previous Secretary of State to cover the period 1 August to 31 October 2007. This was to ensure continued employment for doctors whilst they competed for posts in Round 2 of this year’s extended recruitment process.

Since then, 1,050 additional training posts have been created as a transitional safety net, to be offered at the end of Round 2, which finishes on 31 October. The transitional training posts will be filled in November and December and the extended employment guarantee will ensure that doctors taking up one of the transition training posts will continue to be employed until their transition post is established.

Action speaks louder than words and this is a move in the right direction :-)

"Pay as you go" NHS?

Apparently, our NHS will be bankrupted unless we all looked like that soon! ;-)! The question that urgently poses itself here is; what if we can't manage to look like those two beauties above?! Will the NHS refuse to treat the consequences of our life style weaknesses and mistakes? Dentistry was capped not so long ago, then prescription charges went sky high.

Are we about to see the dawn of "Pay as you go" for the treatment of conditions arising from our life style? Type II diabetes, Gastrointestinal disease, clogged arteries and subsequent heart attacks resulting from smoking or frequenting Burger King and KFC? No more treatment of cancers resulting from same? No more treatment of liver conditions resulting from high alcohol consumption nor diseases arising from higher salt intake such as High Blood Pressure, Cardiovascular disease or Renal Failure? Not forgeting depression that results from the consumption of all of the above plus lack of proper exercise?

What is left?! ... Not much, apart from colds and flues, then again, if you wrap well, you may avoid those too (Although Medical research says otherwise!) So, are we about to see the dawn of "Pay as you go" for all treatment of all conditions soon? Is the end of the NHS, as we know it, neigh?! :-(

I hope not since I can't see why the NHS would go bankrupt if we are above weight! We'd die sooner than those lean, mean buggers above! Proven! ... Won't dying en Mass save NHS money? Be better than being lean and mean and living much, much longer at great cost?! :-) Of course, people die for many other reasons which also need to addressed.

When was the last time you saw a 20 stone 80 year old man or woman on the bus?

The paper doesn't mention this time that this is another one of the CMO's initiatives, well intentioned, of course

Now, back to my session of up n down the stairs 25 times :-)

"No Give and Take. No Exchange of Thought. It gets you nowhere, particularly if the other person's tail is only just in sight for the first half of the conversation."

Monday, 15 October 2007

Ibn Sina - The Prince of Physicians

Abu Ali al-Husain ibn Abdallah ibn Sina (980 - 1037) Also called Avecina. The man would turn in his grave if he read this! Would he have refused to treat patients for any reason?! Of course not, nor does his history contain any such despicable act! The article in my post below appeared on the 9th October and despite calls from those who posted a comment for the paper to give examples, nothing was provided by The Telegraph! Today, another article! Less than a week after the first one! This second unsubstantiated article by the Telegraph! Again, no examples and no names, not even where in Britain are those doctors/medical students! Mr O'Hagan wrote the first article, this time, no one knows who wrote it as no name is mentioned (The name Max Pemberton has been added as the writer of the article at 16.30pm today, article appeared unnamed early morning today! ;-))

The material is neither substantiated nor is it that big a headline or big breaking news, so, what is the purpose of such rushed repeat?!!

This time I have commented on the article asking the author to give examples and name names of those doctors/medical students who are refusing to treat patients with sexual diseases/women and/or refusing to sit exams containing such (Can any medic be so daft?!!)

If true, please name and shame them then remove them from medicine as they are not worthy of the honour of belonging to this most noble of professions. They should not call themselves Muslims either because their stupid actions goes against the values of Islam!

Name them and shame them please The Telegraph ... If you can!

"In a time of universal deceit telling the truth is a revolutionary act."

Friday, 12 October 2007

Tooke and the Super bugs

“By ignorance we mistake, and by mistakes we learn”

The Telegraph today:

The European Union, which is proposing to introduce Europe-wide hospital hygiene requirements next year, said yesterday that Britain should learn from countries such as Slovenia, which has reversed the spread of superbugs with a "classical" approach to nursing and hygiene.

On Wednesday, the report from the Healthcare Commission into the C.diff outbreak in Kent found a catalogue of failings. The hospitals had filthy wards and vulnerable elderly patients were told to soil their beds because nurses were too busy to help them.

I never heard of super bugs until a decade or so ago. Never thought they would exist in our hospitals so, correct me if I am wrong, but this must be a new phenomena; opportunistic bugs that saw an opportunity to attack the elderly and the vulnerable patients in our hospitals while the cleaners are busy nursing and the nurses are busy doctoring!

It may not be obvious but if The Tooke review is properly implemented, vulnerable patients with curable conditions would not be killed by super bugs that thrive in our, now, filthy hospitals. Professor Tooke wants the role of doctors and all other health professionals to be properly defined. In doing so, nurses would go back to nursing instead of meddling with doctors' classic duties and would not be too "busy" to the point of telling the poor, helpless patients they are supposed to be nursing back to good health to go "Soil their beds!"

It may sound a good idea and a cheaper option to blurr the roles of the health team but, watch my lips :-), this will be the most expensive mistake in the history of medicine if allowed to continue and if professor Tooke's recommendations are not implemented .. Fast!

By the way Professor Tooke, you are not serious about the idea of "Hospital porters reaching consultant" are you??? (Tooke report)

“If you think hiring professionals is expensive, try hiring amateurs”

Tuesday, 9 October 2007

The Tooke review is out at last

Professor Sir John Tooke's much awaited review of the current mess caused by MTAS and MMC has finally come out yesterday. 190 pages of it. A breath of fresh air after all the confusion, the lies and the stress caused to our young doctors now ongoing for the past 9 months.

Sir Tooke and his team have done a good job and produced a comprehensive analysis of how and why the whole recruitment of junior doctors' speciality training has gone so wrong. Short of naming and shaming, he produced evidence, through logs, minutes and diagrams, spoke frankly about the failings of all officials from the Department of Health as well as the Royal colleges and those representing the medical profession. A damning report that finds for British doctors and the suffering they and their families endured this year. Although it did not name names, the evidence was presented in full allowing those responsible to think again and resign on their own accord. Will this happen? Let's hope since this would be the only honourable thing to do.

He acknowledges the unfair overseas competition suffered by British graduates which was the main cause of this years debacle. Recommends that British doctors be protected from same in the future; something that should have been done before the implementation of MTAS this year. Had British graduates been given priority applying to MTAS this year, none of the unfairness and heartache would have happened. Yet ministers knew and the the department was on red alert expecting such problems but no one understands why didn't those in charge of the content of the MTAS application not include questions about an applicants nationality of where they graduated nor did anyone suggest priority for British graduates! Everyone just hid their heads in the sand and hoped their failings would just eventually pass unnoticed but thanks to Professor took, it didn't.

He clearly does not approve of MMC as it stands, rightly recommends that British medicine should strive for excellence not just adequacy through competency. He wants the doctor's role to be redefined to reflect their abilities, attributes and the years of training doctors go through before they are entrusted with people's lives. No more meddling in doctors duties by other health professionals? Let's hope. Defined roles for other health professionals is a must too.

Like most doctors, the Professor doesn't like the communist style names given to doctors in training, so, no more FY1/FY2/ST1/ST2 .. ect. Instead, doctors are to be rightly treated as humans, as the high calibre respectable professionals they are; pre-registration doctor instead of FY1 and registered doctor instead of FY2/ST1/ST2 ( Sound like a 180 degree turn back to the old system of PRHO and SHO) Specialist or trust registrar at higher training levels (Familiar again but with more respect and appreciation for the role played by trust doctors in an effort to remove the stigma attached to them. Good move.)

However, the report did not suggest any solutions for those who will be left unemployed at the end of round 2 this year nor for those who had to leave Britain in search for opportunity nor for the many doctors who took speciality positions they don't really like or accepted far away jobs and have been separated from their families. The heartache for those continue! Maybe if his recommendations are fully implemented , which I hope will be the case, his recommendation for a more flexible system will help those trapped soon so, hope is on the horizon.

What a wonderful smile Sir Tooke; from the heart ... only an honourable man can smile this way. Thank you for taking serious steps to protect junior doctors and to stop the downgrading of this great profession :-)

“He has honour if he holds himself to an ideal of conduct though it is inconvenient, unprofitable, or dangerous to do so.”

Sunday, 7 October 2007

Best of the best

It seems that the tooke review, due to be published tomorrow will acknowledge that this year's medical recruitment to specialty training debacle was due to the uncontrolled medical migration of overseas doctors into Britain, something that I have been saying all along. Many excellent British doctors will be left unemployed at the end of round 2 and will be facing total career ruin as a result!

I hope this year's shambles will teach workforce planners a lesson and British medical graduates will be given priority when applying to specialty training over those who come from overseas who should be employed to fill gaps and not take over as is the case this year!

For those who argue that "British patients deserve the best doctors regardless of where they trained", of course "British patients" are the British public and based on this crazy notion, the British public should also have the best lawyers, engineers, architects, teachers, shoe makers, road sweepers ..etc, etc! So, what are those who support this argument suggesting we do?!

Then again, overseas doctors have contributed to the NHS since its inception but with opportunity being so tight nowadays due to the increasing numbers graduating from British medical schools amongst other factors such as the changing structure of the NHS and government policies, priority of employment should be given to our own while providing opportunity to fill gaps from overseas, on an as and when needed basis and mostly at more senior levels as, of course, there is benefit in employing "some" senior overseas doctors with vast experience in the management and treatment of conditions and diseases not seen much here in Britain. A system to monitor this should be put in place to ensure fairness for British doctors whether junior or senior.

However, this years debacle is nothing to do do with senior doctors but was wholly about juniors applying to start or continue their speciality training! The majority of those doctors who arrive from overseas to work and train here are juniors with limited experience seeking to train here! ie, they are trainees coming here to "learn" and have no more valuable experience than our British junior doctors so how can any of them be better than British junior doctors?! Why do overseas doctors bend over backwards to gain a training post in Britain? SIMPLE, because, apart from British medical education and training being the best in the world (Was? Thanks to MMC?!), it is the easiest to get into as no other country in the world will give training opportunities to those from abroad over its own as we do here in Britain! DAFT to say the least!

We do have the best medical education and training in the world, so, see, the "best" doctors are already here; home grown in Britain at vast expense! That's why countries like Australia and New Zealand are doing all they can, including changing their own regulations to get them .. for free! What a waste!

British doctors!
Bring those who were forced out of Britain due to uncontrolled medical migration resulting in lack of opportunity for them back to Britain! Protect our junior doctors from the current unfair unemployment and waste of careers and talent. They vowed to give their all to their patients so give them the opportunity they deserve and help them to prosper! Protect their rights, nourish and care for our own talent and you would be giving NHS patients what they deserve; the best doctors in the world!

Ours are "Best of the best!" .... Believe it, it's true!