The only way to get through life is to laugh your way through it. You either have to laugh or cry. I prefer to laugh. Crying gives me a headache

Wednesday, 9 January 2008

Innocent till proven guilty

“When in doubt, don't.”

I believe in always striving for justice and that it is the duty of every principled human being to raise their voice to fight same. Indeed, this is why I am here, because of the terrible injustice of the MTAS debacle and it's effect on a whole generation of young doctors. I had to raise my voice loud during 2007 and if anyone who visits here remembers, I did and still do so on the Remedy UK forum since that forum was started, as well as here when I learned about 'blogging' then started this blog to voice my opinion. I fight the MTAS injustice by pointing to what I believe is the real reason for the sorry episode of 2007 which, sadly, still causes trouble to this day. I have never changed my mind despite the opposition I faced. So, I am never afraid to voice my opinion so long that it is well informed and is voiced to correct an injustice.

That said, please imagine, if we were invited to sit on the jury of the trial of the CMO for England and if we know that the punishment may be 'rolling some heads", what would our decision at the end of this trial be like? Innocent or guilty?

'off with his head?!'

To do this, we must look at the evidence and and if we can prove, beyond reasonable doubt, that he is 'guilty' then be it! Off with his head! But since there has been no real trial up till now, apart from that HSC session during which, he insisted on denying sole accountability for the current mess, I feel that he has the right to be 'innocent till proven guilty!'

So, please consider yourselves members of this jury and let's look at the evidence now that Tooke's final report has been published.

The line of events:

  1. Britain is short of doctors, open doors policy begins.
  2. Aim for self-sufficiency. Increased intake with 4 new medical schools to produce doctors for this purpose.
  3. CMO rights his report 'unfinished business' aiming to modernise the SHO grade. In it, he suggests a more structured approach to their training thus ending the 'lost tribe' stigma that was being attached to this group of doctors and provide ways for them to go up the training ladder
  4. Medical profession unanimously welcomes the recommendations of 'unfinished business.'
  5. The MMC board is set up to decide on how to implement unfinished business and the curriculum for such structured training. Prof Crockard joins at an early stage.
  6. Professor Heard is assigned the design of the first two years of post graduate training.
  7. While steps 2 and 3 were taking place, the government releases the NHS plan 2000, in which, it announces the reform of the whole of the NHS including the roles of all front line staff including doctors in all levels of service.
  8. A vaccum exists here as no one knows (Or I don't know) what happened that influenced then ordered the MMC board to restructure the whole of medical post graduate training instead of the lost tribe only!
  9. The MMC board proceeds with the task reporting only as high as the deputy CMO. Some consultation with different professional groups takes place but their opinion does not carry much weight.
  10. The government recognises the 'bulge' due to the still running 'open door' policy but expects the IMGs not to apply to training since they are already working for the NHS mainly in trust grades.
  11. Based on 10, government decides on MTAS despite warning from the MMC board that the system is being rushed without being validated.
  12. Government insists and the robot monster MTAS rolls.
  13. Seeing IMGs changing behavior, government imposes restrictions, IMGs take legal action but lose then appeal
  14. Robot messes up due to being overwhelmed by number of applicants
  15. Hopes and careers of thousands of British graduates mercilessly crushed by the dum robot MTAS
  16. Remedy UK is born and the March in March takes place
  17. Crockard and heard resign
  18. Calls for the CMO to resign but he does not
  19. Remedy goes to court but loses because of technicalities
  20. Head of BMA, James Johnson, resigns after standing against Remedy UK in court and after defending the CMO in his letter to 'the times', the letter co signed by Dame Carole Black was in defence of the CMO because, as Mr Johnson said, the CMO, a civil servant can't defend himself.
  21. More calls for the CMO to resign but he appears on TV to deny 'sole' responsibility for the mess, however does not give any indication on who is also responsible.
  22. Tooke begins review, his interim report finds serious faults with the whole of MMC and recommends a 180 degree reverse (IMO)
  23. CMO attends the HSC meeting and again denies sole responsibility
  24. Tooke's final review is out condemning the government and recommending the the responsibility for post graduate training must be removed from the 'government's hands.
This is a very brief summery of what led to the debacle and the role of CMO as known to me. I had myself anticipated that the Tooke report will condemn the government because of the points above, hence, a few days ago, I removed all the not so nice posts I wrote accusing the CMO and joining the majority asking him to bear the responsibility and leave but in view of the latest report, I think that he he did make mistakes but do these warrant a call for his head? To decide, he has his right to a 'fair' trial and since he can not tell his side of the story, let's give him this right to a trial by jury; us here, before we condemn him ...

From the above sequence, was the CMOs involvement enough for all of us to ask for his head? Bearing in mind that he is a civil servant?

What are we accusing him of exactly?

Please remind me if I have forgotten an important piece in the above sequence of events. Also, please let me know your opinion ... guilty or not guilty and why? Then we can pass judgment so long as it is,

Beyond reasonable doubt!

“Justice cannot be for one side alone, but must be for both.”


David L. Cox said...

Should one be fair to someone who by either his action or inaction has condemned unfairly so many of his colleagues, their familes and friends to such continued stress, and destroyed careers in infancy, barely acknowledging the problem?

Not withstanding the effects on those at the sharp end, who recovers the wasted taxpayer's money and how? It clearly can't be done, so somebody in authority should be held responsible.

Senior office brings its rewards - high salary, recognition and a voice that has real influence. Honour requires that those so blessed should meet their responsibilities!

If he was directly responsible then he should go or be fired!

If he was 'not the only person responsible' he should go for not doing his job properly - he should have had ultimate responsibility - he should be fired!

Sam said...

"somebody in authority should be held responsible.

Honour requires that those so blessed should meet their responsibilities!"

Absolutely, I agree with you David and if he was responsible, then he should be fired, not even given the chance to go on his own accord. But, in view of Sir Tooke's condemnation od the government itself, was the CMO himself responsible for the shambles or was he just a civil servant who was just following orders from above? Was MTAS 'his' decision? Was the still continuing 'open door' policy his decision? I believe those responsible must be held to account but no good to select 'one' scape goat then sit back and be happy.

David L. Cox said...

'Just a civil servant' Sam?

So was Eichmann!

He and many more need to go to ensure that they cannot corrupt the new order, assuming Tooke is accepted fully.

Sam said...

"So was Eichmann!"

Yes, he too was a civil servant and I suppose he too was following orders, although, unlike theCMO, Eichmann knew exactly what his actions would lead to, enjoyed the job and also gave the orders. He knew exactly what he was doing
didn't he?

I suppose based on this logic, one could say that the CMO was just following orders but did not give them as they came from above. He probably should have resigned when it became apparent that things were getting out of control, but he didn't.

"He and many more need to go to ensure that they cannot corrupt the new order"

But the more prominent ones have already gone or rather, ran away before they got properly found out. This is why I ask, was the CMO set up to be the escape goat?

Is it possible that he will do all he can to help this year? If only for the sake of saving his own skin?

David L. Cox said...

After his performance at the Commons Health Committee hearing, I won't hold my breath, Sam!

All 'work force' issues he avoided and landed on a junior! It is a trait of bad management to offload responsibilities in this way.

He either was responsible and therefore should resign for the failures, or was not in charge, in which case he should have been and should be fired for incompetence and negligence!

Let us not forget that not only is he a medic, he is a civil servant, who has presided over a massive waste of taxpayer's money.

Show him the door!

Sam said...

"or was not in charge, in which case he should have been and should be fired"

You see David, this is exactly the point when I started asking, what did he do and what didn't he do? If he was not in charge of some parts, surely, he shouldn't be penalised for them. And, if he wasn't in charge, how could he have forced himself to be in charge?! He doesn't own the DoH, he's an employee.

And, about "Presiding over massive waste of taxpayer's money."

I had no idea he was in charge of finance, unless you mean that money spent on training doctors whose careers was terminated. If so, we go back to square one.

I am not defending the CMO, I am just no longer sure that I have the right to call for his head because there are many grey areas and to be fair, you have to give him the benefit of the doubt until you can prove his guilt.

David L. Cox said...

I'm afraid that you are splitting hairs, Sam.

He is the CHIEF Medical Officer, not some minor player. He gets the benefits and plaudits associated with that. In such a position he is in place to strongly influence policy in wide ranging areas, and has absolute responsibility for others.

His choices and decisions (or lack of them) heavily influence the policy of those he advises. His dogged persistance that MMC was (and is) the right way to go, despite valid constructive criticism from elsewhere in the profession (see Fidelio's comments for example), without real concern for the consequences until far too late, would be considered by many to be reason enough for him to go.

My comments on finance were to add the other aspect, beyond the medic's dilemma. Institutionalised waste of the public's money is rife in the NHS. Rarely is anybody called to answer. In the MMC case there has been collosal waste both financing the MTAS system, generating policy on the hoof as in the temporary contract extensions, to say nothing of the Douglas and Tooke Reports and the costs of the Commons Health Committee!

These costs arise from the mistaken policy and the abject management that tried to put it into place. In industry that management in all its aspects would be called to book.

Not just the CMO should fall. Many others should go too, but he's the best place to start!

Sam said...

Well David, the definition of his duties as on the NHS website is:

"The Chief Medical Officer (CMO), Sir Liam Donaldson, is the UK Government's principal medical 'adviser' and the professional 'head' of all medical staff in England"

I don't understand how, at the HSC meeting, he denied being the leader of the profession despite this being one of the definition of his duties as per the DoH as you can see?

And the 'adviser' role means that he can only suggest, not impose policy. This was, at that time, Alan Milburn's job. Was he the one who decided to modernise the whole of medical training rather than the SHO grade only? I actually think that he probably did and left (citing lack of balance with his family life ... ) But he then (rejoined it as Chancellor of the Duchy of Lancaster for oversight of Labour's 2005 re-election campaign..... In Parliament, Milburn allied himself with the Blairite 'modernisers' in the Labour Party .....)

Read his page on Wikipedia David. It is a bit puzzling that he left the DoH because of his family then joins in another job straight after!

David L. Cox said...

We get the politicians we deserve Sam, and thank God, we can remove them if they are incompetent at election.

The professional advisors hold major sway with them, and Donaldson certainly did that with Milburn (gone), Patsy (gone), Hunt(gone) and Warner (gone). Postman Pat remains, and though he isn't too bright, he has the political savvy to recognise danger to himself from other's incompetence!

Unfortunately the 'advisor' and his cohort of overpaid and underachieving managers at MMC and the DoH remain. I had hoped they'd leave honourably, accepting their responsibility for the MMC fiasco. I'd be content with a big swing of the clunking fist from his political masters if it achieves the same result!

Sam said...

"The professional advisors hold major sway with them, and Donaldson certainly did that with Milburn"

I wonder if this was the case. We had a PM who intiated the modernisation of the whole country, including health, hence, the Milburn appointment .. But, apart from his over inflated ambition, what did Milburn know about health to be appointed as minster?! He 'runs away' when the 'modernisation' began to spiral out of control and passes the buck to Hewitt. This is the point when 'things' needed repair, but with her background in management and finance,did she repair? You can 'predict' that everyone in the entourage was 'adviser' at this stage, inclusive of the CMO but, it was very apparent at the HSC that he did not take part in the decision the government made to take the opportunity of MMC and modernise the whole profession. It seems this was a decision from much higher above.

Didn't Blair say he did not want to leave office despite the calls for him to go, because he wanted to ensure that his modernisation programme was past the turn back point? He firmly believed this was 'doing the right thing.'

The CMO was 'servant of policy', not the maker of it. Even his 'advisory' role was not thought when MMC aimed at the whole profession, not just the SHO grade.

That he should have resigned when policy did not agree with his principals, as you always say, they don't nowadays, those captains just jump off the half sinking ships 'before' they completely disappear to the bottom, but the CMO did not. I feel maybe this is because he will try to 'mend' this year. We can only wait and see

Anonymous said...

Read this:,,2175838,00.html

Sam said...

I have a strong feeling the CMO is trying to resolve the situation somehow; protect British graduates, more posts, good trust grade contract ... etc or all. This, to my mind, is more honourable than jumping ship as the others did especially with the current calls for him to either resign or be sacked. Doctors have built in integrity and he is a doctor, hence, I feel that this silence is because he really is trying hard. I hope he succeeds, otherwise, he will seal his own fate IMO

I am hopeful. Let's wait and see