Adios .....

"I think the medical profession is a very difficult group to unite and HMG knows this and takes advantage. It’s sometimes remarked that doctors behave as cats - they won’t walk to heel and yet they can unknowingly be swept along with government reforms. A strange paradox." ... The Witch doctor


... Time to go now.. at last, 'Novo' is leaving it to the professionals, they know best ...

... too many mistakes , I think I am now doing harm and not the good I intended

... Best wishes to all of you young doctors, I sincerely hope you prosper always

... and to the seniors too, don't forget your duty; to hand down the heritage, shinning bright, as it was handed down to you

And doctors, remember, the woman in the office, the one polishing her nails and watering her plants, she has no idea who 'Nobel' is or why he has a prize ... she, does not do prizes ... ignorance is sometimes a blessing but always dangerous

... Special wishes to you Fiona and Your son, also to you David and your son and to all of you parents and friends who visited me here

and a very special thank you to the Witch doctor who has been very kind and encouraging to me. I do not think I will be able to keep away from black cat and the treasures she finds for long so, tell her to watch out for me .


Forward Remedy UK -------> Always


Sincerely,

Sam



"Remember black cat; From little acorns, grow mighty oaks ... Cats never cease to surprise me ... they are amazing .. and .. they have nine lives ... Lucky! .. always .."

... Could it be true?

A person so dear to me now looks very much like the photo below ... Every minute, every hour and everyday, I hope and dream that one day ... he too will be like the professional in this photo above.

I was left a comment here by 'Lord d' and, of course, straight away I thought it can't be possible, It must be that someone is just having a little joke :-) This is why I answered the way I did. But, it's been on my mind since. I am not sure anymore. I have been asking myself, is there a little chance it could really be 'him?' Is it possible?! Maybe just is a 1% chance? I suppose, yes, it can be! A good sign of a good honest man and why not?!

If it is really you Lord d, then I salute you for visiting people like me to get a feel of the real opinion at grass roots. I suppose, everybody, including myself, are just not used to that and so, excuse the way I replied to your comment.

If it is indeed you, then, I suppose, you must have looked around and have a little idea why I am here and why this site exists. Me writing about things I don't really know much about but trying all I can to learn. Sometimes with little success and perhaps, most of the sometimes not. You must have noticed that some posts appear then disappear regularly, the sign of a basic level learner.

You probably also saw this here and maybe smiled. Perhaps you asked yourself why is she picking on me? .. But, I think perhaps you know why ... because Professor D, I dream everyday that one day, my children will be like you, the professional and, if it is really you who left me the comment, then the man too. I am sure all the parents who come here would be feeling the same as me. I hope you also got a feel of the helplessness we feel trying to make sense of policy that is hard to comprehend, stomach or understand. Believe me, this is not a very nice thing to feel ....

Of course you know what is going on with the juniors, so, you also know why we all feel like we do. So, no need for me to explain. Except maybe, since you have already come here, that I sincerely hope you appreciate the unprecedented impact of last year's MTAS/MMC debacle on the juniors and their families. This hurt was and still is unparalleled because the injustice is so great. This is why we meet here, we have a need to huddle together to gather the strength to help our children to cope. To also cope ourselves with the puzzle of why things are happening the way they are? And maybe help those passing through same dilemma this year.

I suppose you realise how we must be feeling; we've handed over our most precious asset to you and your colleagues. We parents worked hard and made many sacrifices on the long way then handed over the fruits of our whole lives, our sons and daughters, good young doctors, men and women who want to give their all to the NHS as well has help themselves. Please tell your colleagues that we entrusted you all with our children so, please keep the trust and do right by them. Give them the chance to aspire like you did and to help themselves as well as you did ... This is your duty, all of you. This way you would also be doing right by the our young doctors and their very worried parents, the good people who come here.

What do you think everybody? Could it really have been 'him?!' .... If not, who? ... please


“The role of the teacher remains the highest calling of a free people. To the teacher, we entrust our most precious to you, our children; and ask that they be prepared... to face the rigours of individual participation in a democratic society.”

Workforce? Or .... force works?!

“Force is all-conquering, but its victories are short-lived.”

I am still waiting for the first part of the HSC's fifth session attended by 'Douglas.'It is not on the government site yet, not even as audio!

The second part of the session was attended by the workforce planners, Anne and Moira (Because I am friendly like that :) and Sian Thomas of NHS employers.

Remember, when Professor Liz Paice attended the third session and gave her evidence, she said that '2007 was the one opportunity that will never happen again' or something else meaning the same. If you bear that in mind while listening to the 3 ladies in the fifth session, the future of postgraduate education becomes clear, if the current policy is left to continue.

Was 2007 a disaster in workforce planning? No, said the planners and all the three ladies agree with the CMO's earlier evidence (session 1.) It was the IMGs, not us, says Anne and Moira. Sian mentions the 'good' things about MMC but agrees with the CMO that the IMGs were the problem and adds that it was due to high volume of applicants and the lack of a transition period and a big bang approach caused the 2007 mess.S ian then said that continuing with round one was what the employers said they wanted because there were only a few weeks to August 1st when doctors had to be in posts for the 'sake of the patients', hence, it was the right thing to do to continue with the deeply flawed round 1.

I don't think so Sian, there were around 5 months left till August first! Round 1 could've been easily scapped and a fairer way to select introduced! My proof, round 2 was introduced and managed in three weeks! Therefore, the quality of the recruits was never really a priority! Why?! .... but, forget about this for now ....

There were hardly any cuts to educational budgets said Anne, except for a year in London where study leave money was affected, actually more money was invested to ease the 'bulge' to help transition. The workforce ladies think 'Doctors' aspirations need to be looked at.' Moira then goes on , with lots of 'employee circular' jargon about her 'effective workforce planning' using words like 'positive', 'flexible', 'quality, effective, robust, full consultation, exactly what we should be doing .... etc. A load of dressed up to 'mock' hot air!

Moira on commissioning the trainees evaded the question, using lots of jargon ending with the words 'positive step!' ... :-) Sian evaded a few questions herself using the same technique! The 'dence' use of jargon worked and the panel did not enquire further when questions were evaded! Of particular note, was when Sian spoke about international competition post CCT .. It was just left at that! Amazing. Again, when she said that 70% of medics are now female. Very good! Said Richard, the panel member ... No quizzing on why this is, nothing!

Sian talks from the point of view of her 500 or so employers It was very clear they were mainly after a cheap workforce in the future, regardless of the dire consequences on patients. All three women 'firmly' believe this is the way to go! Cheap, cheaper and cheapest! ... cut training numbers further, cut training times further! EWTD implications on the hours does not mean more training or training posts, it just means more nurses doing doctor' jobs, says Moira and agrees the rest!

With less training because of the EWTD, it simply means you have to re-evaluate the doctors at CCT level and classify them accordingly on the 'level escalator', or so implies Sian. Redefine the doctor's role, she adds but I don't think she means it the way Professor Tooke meant. I think what she wants is to 'downgrade' them! Afterall, the system for appointing consultants no longer guarantees a job at the end of training! But Sian wants more! She wants international competition for post CCT, even 4 years after graduation, at the end of core training! For the sake of the patients Sian? I don't think so! This is break neck competition! It's all about money! All about cheap, cheaper and cheapest!

It's about completely 'disarming' doctors! Forcing the medical profession into submission! ... It's WAR!

Can you now guess how the session will proceed to the end? The workforce planning ladies intend to wriggle out of responsibility and through the use of unfamiliar to the panel jargon entwined with carefully chosen 'positive' words. They will be evade answers when they it suits them. They will also make bad news look pretty!' Pchycobable, used on an investigative 'government' panel! Oh, please! I tell you, these ladies would have no trouble filling the 'white boxes of MTAS!' As for the above, I don't believe you ladies! Your ways have now prepared and put me in the mood for the remainder of the session! From this point, I could even have predicted your answers to the remaining questions! I knew you were going to also blame it on the seniors and their organisations, on the medical profession! No consensus, hey! Fiona sums up the session brilliantly below

Let's now go back to Prof Liz Paice and the 'one' opportunity of 2007 and see why she said so.

Here is the future of medical training in Britain:

Training posts will reduce year by year

Possible protection for the Brits till the end of core training for the lucky ones with training numbers

The rest will be forced into trust grade service or just leave medicine

Cut throat competition for jobs post core training

More and more doctors forced into trust service or leave medicine

Of those lucky to get jobs post core training, proceed to gain CCT

Again, cut throat competition for 'specialist' level posts based on the 'new' definition of the doctor's role, the way 'employers' see it and not the medical profession

Not much difference between CCT, trust grade or, indeed, quactitioners at this level either in expertise, money wise and, of course, 'standing' wise

Work in teams of bring them in, churn them out for safety

Select a handful to train to real consultant level ... no power, you're the flying consultant .. nice and placid ... and does 'exactly' what s/he is told!

Bye bye profession, hello levels escalator!

Welcome to Unison doctors!


“There are only two forces in the world, the sword and the spirit. In the long run the sword will always be conquered by the spirit.”

... Out of this world!

“Hold back the edges of your gowns, Ladies, we are going through hell.”

Speechability! Oh, say that again! They were out of this world! Literally, I think! They don't speak like us, ordinary folk but had their very own special language. Where do you learn to speak like this, otherwise?! A unique continuous speech made up of selected 'employee circular' style phrases and expressions simply joined up together ... and they flaw, circular style! ... :-) Every word calculated, every expression put in the right place .. circular style. One tone, one rhythm ... almost synthetic! Hearing them is like hearing a record repeating and repeating until you can't follow no more, you just simply hear the sounds ... (When you hear or watch the video, Pay attention the 'Richard', the panel member .. ;-) You know, I was once challenged to read a book called Fermat's last Theorem and I did, all 314 pages of it, in a day. Despite all expectations, Once you have started, it was so boring, you had to finish it or never be able to forgive yourself you wasted time reading the first page! ... Bears resemblance ... I sat through and heard the whole of the second part of the HSC 5 session, twice! Exactly like Fermat, there were little bits you wanted to know where they were intended to lead to ... you had to keep on reading .. or listening ...

They hit and ran, b*ched about each others and about everything else including Tooke's 87% support! The figure needed analysing! ... His 'aspiring to excellence' needed defining. Ring fencing money for doctors' training was not right, nor was the idea of a new body to be in charge of doctor training! Tooke was taken apart! ... A bit OTT ladies!

Yet ... there was absolutely nothing wrong with workforce planning! That is, of course, the part two of the ladies do! Their job. The mess is not their fault! Blame it on the IMGs ... Remember ladies, the IMGs have always been here when medical school intake was increased. Where were you then? Why didn't you warn the government? Instead, they say, the government told us that the IMGs will not be included in the selection! If this was not the job of the planners, whose job was it?!

Fiona heard that session and left this comment here

Hi Sam, I only got to hear the 2nd session with Sian Thomas et al. There was some real scary stuff, e.g. huge oversupply of doctors in 2007; 60% expansion in medical trainee numbers so this problem is not going to go away; 70% undergraduates are now female and implication that training numbers will be kept down and non-career grades will persist or even expand; no consensus with employers that UK/EU graduates need to be prioritised; detailed discussion about which point do you want the oversupply to kick in - at core training, at higher speciality training or at consultant recruitment!!

(And BTW, should we give full training to IMGs and then tell them to go away? Moira Livingston avoided answering this directly.)

It seems that Foundation Trusts want to be able to have international recruitment at post CCT level and at one point Sian Thomas seemed to be supporting full training for (?all) UK graduates - interesting discussion on how to get UK graduates trained to a level that would make "the barrier high enough for eligibility". There was a belief that EU applicants would increase and why not - free postgraduate training and one of the best pay scales in the EU!! So let's manage this increase by examination!!

There were some frightening comments about the need to get all UK graduates into FY1 training posts, so that they get full GMC registration, but by so doing we could be contravening employment law. Sian Thomas suggested that we need to change the Immigration Laws!!

There was an interesting comment from one of the panel members that flooding the market with too many doctors would drive costs down! Sian Thomas could not disagree.

Note that at times they talked about a post-CCT doctor as a "specialist" not a consultant. Clearly NHS Employers, SHAs and Trust Chief Executives have a quite different agenda to the medical profession!

One of the scariest bits of the discussion was when they were talking about the EWTD and the panel member suggested that surely with a reduction in hours we will need more trainees.
Answers:
1. MMC is part of the solution to create doctors fit for purpose as a specialist (i.e. sub-consultant)
2. There are different models for delivering the service and the multi-professional approach is very attractive to employers, i.e. don't increase the number of doctors but change the make-up of the workforce!!! They mentioned in particular the (less attractive) specialities of O&G, Paediatrics and Anaesthetics!!!!!
My response to this: NO NO NO. This is a very high risk strategy in some of the most high risk specialities. They need to ask themselves WHY these specialities are less popular. There are a number of reasons but IMO one of the main reasons is because these are DIFFICULT HIGH RISK specialities.

It will be interesting to see what the HSC make of all the evidence that has been put before them!

...... The session with the ladies is to be continued ....

“If particular care and attention is not paid to the ladies, we are determined to foment a rebellion, and will not hold ourselves bound by any laws in which we have no voice or representation”

Health Select Committee meeting (5)

House of Commons, Portcullis House

The Health Select Committee's fifth session, held on 24 January 2008, attended by:

1. Professor Peter Rubin, Chair and Professor Neil Douglas, Board member, Postgraduate Medical Education and Training Board, and Professor Sir Nick Wright, Warden, Barts and the London School of Medicine and Dentistry
2. Anne Rainsberry, Director of Workforce, NHS London, Dr Moira Livingston, Strategic Head of Workforce and Deputy Medical Director, NHS Northeast, and Sian Thomas, Deputy Director, NHS Employers.

Very interesting lot! ... The final pieces in the jigsaw? ....

Audio now available, No video yet .. Keep trying :-)

Who can we blame?!

“We believe that to err is human. To blame it on someone else is politics.”

Since the 2007 MTAS disaster that caused unprecedented distress to the majority of our junior doctors, there has been very loud calls for heads to roll. Those doctors involved and their families wanted to see that those who were responsible for the mess doing the honorable thing and resigning. We had no idea who was responsible for which part of the 2007 mess so, as far as I recall, we all wanted the resignations of everyone who had a hand in the design, project management and implementation, first of MTAS and then for MMC. Since then many of those who were involved left on their own accord; The previous Secretary of State for Health, Patricia Hewitt, Professor Crockard, Professor Heard, The previous head of the BMA, we now hear that the deputy CMO has also left ... etc, etc

Since the MTAS debacle, the government ordered two reviews, the second of which; the Tooke review blames the government for what happened at 2007. No particular names, it is just this; the government. However, people kept on calling for more resignations and they still do. Of course, those who can be proven to be at fault should take the honourable way out and resign to allow for repair to effectively take place this year and in the future.

Thus far, there has been 4 sessions of another investigation into Modernising Medical Careers by the Health Select Committee, the fifth will be held on the 24th January 2008. I have already commented on the first three sessions here and Remedy UK summerised the 4th session here.

IMO, the fourth session in particular was very rich, maybe because it was attended by Dame Carol Black, chairman of the Academy of Medical Royal Colleges (RCS), and Mr Bernard Ribeiro, president of the Royal College of Surgeons of England and Dr Bill Reith, chairman of the Royal College of General Practitioners and for the second part by some of the heads of deaneries who were involved at dealing directly with the applicants; Prof Elisabeth Paice, dean of the London Deanery and chairman of COPMeD (Responsible for co-ordinating all UK deaneries), Prof David Sowden, dean of the East Midlands Deanery and Prof Sarah Thomas, dean of the South Yorkshire and South Humber Deanery.

To tell you the truth, after watching this 4th HSC session twice, I can no longer pin the blame on any of those who attended either in the meeting or even in the previous ones. I now share Professor's Tooke's view that the government is the one to blame of the happenings of 2007. IMO, the mistakes that each individual/group did was because they were simply overwhelmed by the unexpected number of applicants when they were assured by the DoH that only British graduates will be allowed to apply to round one. That all everybody had to do was to simply match places to applicants. Following this, it was expected that there would still be some positions remaining which were then to be offered to overseas graduates in round two. If only this had happened instead!

Can you imagine?! No mess, no debacle, no saga? No march, no judicial review or any other review, nor reports, nothing .... just plain sailing and everybody would have been in position and happy now! ... Including the overseas doctors, as those would have known, at an early stage, where they stand and would have had the choice to either take it or leave it! Fair! ... For everybody concerned! ... no humiliation would have taken place for everybody concerned either! ... So,

what went wrong and why?!

Everybody involved with the 2007 doctor recruitment to speciality training new that if the International Medical Graduates currently working in Britain were to apply, there would be a problem, simply because there were not enough training jobs to accommodate them as well as British graduates. But, the DoH assured all those in charge of recruitment, as well as the Royal Colleges, the Academy of RC .. etc, that 'they' will not apply. Actually, a DoH 'assurance' was given to all parties that they will be stopped from applying to round one. But, for some reason, thus far still very unclear, the DoH did not say what it intends to do , exactly, to achieve this and whether there was a plan B if plan A did not work. Regardless, the assurance was given and MTAS rolled ... and the government lost against the IMGs in court and the IMGs applied in thousands! Even in greater numbers than the Brits! As far as I know, from MTAS 2007, more than 50% of all applicants were from abroad! Quite a percentage of those were not even in Britain or working in the NHS!

So, who do we blame?

The IMGs? No! There was nothing to stop them from applying. As per human nature, they saw the opportunity and they took it.

The IT company responsible for MTAS? No! Because the system was designed for a number of applicants equivalent to the number of British graduates only. When the scale of the problem became apparent, the IT company was quickly asked to increase the capacity of the system. the company did all they can but there was not enough time to do it properly, resulting in the system going absolutely crazy .... The IT company was overwhelmed and the system was also overwhelmed! Would it have worked well had it just been asked to do what it was designed to do only? ... Who knows!

Blame those involved in devising MTAS? either the application, shortlisting, interview and selection? No! .... Everybody was 'assured' their role will only be to match doctor to position, nothing about matching tens of doctors to one position, which is what in reality, were required to do! Actually, those who did not resign are brave, because they stayed and tried to do everything they could, to help sort out the mess as best as humanely possible, even though .... they too were overwhelmed! Shall we accept that they could not suit the Brits first in round one instead of suiting thousands of IMGs instead? Professor Paice said she had no idea about the legality of doing this and there was no other option. Of course the fact that the IMGs won the appeal means she was right to be cautious.

Blame Dame Carol Black for that letter signed with James Johnson, previous head of the BMA supporting the CMO? ... I don't know .. she said they were both asked to show 'unity' of the medical profession in supporting the Douglass Review, they both then supported the CMO as a symbol of same. Of course, the juniors went to court because they thought the review's findings were 'an abuse of power' to allow the flowed round one to continue and they were right; it was flawed and very unfair.

Dame black thought she was doing right but admits it maybe wasn't a good idea... so, blame her? .... I don't know because, she too was overwhelmed by the situation. How can you think clearly and make the right decision when everyone around you seem to have gone totally insane?! ... :-)

Blame the CMO? For MMC itself? But, we have no idea how MMC would have turned out had the original plan of suiting all British graduates to run through training would have worked out! Would everybody have been happy never to apply to find a post again? Would they have been contented in the knowledge that they were 'guaranteed' continuation of training and never having to compete again until they reach consultant? Would this peace of mind been one of the tools that would have helped, rather than hindered, the young doctors' aspiration and reaching excellence? Is this why the CMO insists to this daythat his underlying principles of MMC are sound? Is this why Dame black, the heads of the deaneries as well as Mr Ribiero signed up to 'unfinished business?' Of course, Ribiero does not like run through because of the 'craft' qualities of surgery and having to ensure candidates possessed them. But, would he too have objected if all the Brits were suited, flexibility would have been easily introduced too! ... Think about it! So, what shall we blame the CMO for? Not managing the mess? .. Could anybody have been able to manage the mess?! :-) This grandeur was not within the grasp of humanity to manage it. So, I am of the opinion, this far, that I can not find enough evidence to blame the CMO, but I do not think he qualifies as a saint either.

To conclude, Sir Tooke said it! Blame the government ... who? .. your choice. The government is full of men and women who make decisions ... and women and men who implement them ... then they go and more men and more women take their place and ..... Important to decide; who makes a decision and who is 'ordered' to implement.

Well, we know who liked IT so much ... but ... Did Hewitt order MTAS to run despite her later knowledge of the numbers problem once this was confirmed? Run it regardless so that it's money can be accounted for? I have no idea! Let's wait for the fifth session .. Or wait forever .. who knows ..

..... Enough ... I need to go to 'Boots' now ....


“A boss creates fear, a leader confidence. A boss fixes blame, a leader corrects mistakes. A boss knows all, a leader asks questions. A boss makes work drudgery, a leader makes it interesting.”

'Empowering the ignorant' kills!

“The error of one moment becomes the sorrow of a whole life”

A year and a half ago, a healthy 30 year old woman went into hospital to deliver her first child. Three hours after the delivery, she suffered a massive heart attack and died! An inquest was then held and found that the woman was given an epidural in her arm instead of her back. The woman was cared for by the midwife who was in charge of her during the delivery. No doctor was called to assist.

"Honestly speaking, because of what happened and the way it happened this will be engraved in my mind and my heart till the day I die and in the afterlife." Mr Cabrera, the husband.

The result of this tragedy is huge for, as well as the wasted life of this young healthy woman, there is the orphaned child who will never know his mother, as well as the devastated husband who lost a loving wife for reasons that were totally avoidable. To add insult to injury, the husband is also now being deported because it was his wife who had the right to stay and work as a theater nurse in Britain! He has no rights!

The inquest found that a succession of drugs mix-ups by midwives led to the woman's death.

Doctors on the net have been voicing their 'professional' opinion on the dangers of assigning doctor's duties to nurses and other health workers, who's traditional duty is to support doctors. They keep warning that those 'allied to medicine' professionals are now being empowered to do work way beyond their abilities, resulting in tragedies like the above! No one seems to listen! This incident above resulted in the death of a young and healthy mother as well as the devastation of her whole family. If a doctor was called to administer the needed drugs, this tragedy would never have happened! ... But it did!

I wonder about the midwife too, how she must feel now! How she will have to cope with the death of her patient in this way! She was wrongly 'empowered' and, for that, she will be tortured for life! ... No winners here!

How many other incidents similar to the above go unreported and/or covered up?!

We know the human cost of this tragedy which can not be measured in pounds and pennies, but how much is the cost, in hundreds of thousands of pounds, if not much higher, of investigating as well as compensating for this tragedy?!

Britain is now producing 70% more doctors but does not want to provide enough training opportunities for them! Instead, the money is being spent on mini courses for nurses to skim a tiny bit of the surface of medicine. Euphoric with their 'acquisition' of 'knowledge,' they are then let loose to carry on duties way beyond their abilities. "Not me gov" is their excuse, when the results of this empowerment causes tragedies like the above! The trend in this madness is continuing while our doctors fly away to serve others and save themselves. The money is still being spent on spreading the ignorance so, god helps us all, the 'empowered patients of Britain!

When will the 'role of the doctor' be redefined sir Tooke? When will the role of other health workers be redefined too? When will everybody know exactly where they stand to assure the public that incidents like the above, will never happen again?

It it possible?

I would say yes, very possible, we are on the wrong path so, regardless of the financial costs, this dangerous blur needs urgent attention, needs urgent repair, before more and more tragedies happen.

Life can not be measured by money!


“Compassion is not religious business, it is human business, it is not luxury, it is essential for our own peace and mental stability, it is essential for human survival.”

The Health Select Committee meeting (4)

The Health Select Committee met on 17th January 2008, watch the session in the link. The meeting was attended by Dame Carol Black, chairman of the Academy of Medical Royal Colleges, and Mr Bernard Ribeiro, president of the Royal College of Surgeons of England. Prof Elizabeth Paice, head of the London Deanery, Prof Thomas .. etc

.... Remember this letter to the Times! The one that caused the resignation of the head of the BMA in 2007? For some reason, it 'had' disappeared from the net for many months now but, I found it! ... :-)

"May 17, 2007

Junior doctors

Sir,

We understand the deep concerns of Morris Brown and his colleagues but cannot support their proposals (letter, May 14). The Review Group examined all the options available to remedy the failings of MTAS. They concluded that withdrawal from the process was simply not an option. We accept that the Review Group’s recommendations, while falling short of the expectations of many doctors, do offer the best available solution. The solutions favoured by Professor Brown would mean writing off interviews that have already taken place and risking either posts not being filled, or shunting doctors to nontraining posts. We agree that a better system is needed, but believe that it should be achieved through argument and negotiation, not action that could risk harming patients, the NHS or our colleagues. Doctors who only obtained one interview in the first round will, if unsuccessful, have further interviews in the second round.

We restate our support for the Chief Medical Officer and his role in improving junior doctors’ training. He pioneered the principles underlying the reform programme. Serious though they have been, it would be a far-reaching shame if those principles were obscured by recent problems with the online application system. The mood of our institutions is not one of resignation. We are clear that our responsibility is to ensure that the underlying principles for modernising medical careers are properly met. It is vital that the profession is united to lead a way out of this crisis, and on all issues related to the future development of training. We are also actively designing a better process for future years.

CAROL BLACK, Chairman, Academy of Medical Royal Colleges

JAMES JOHNSON Chairman, Council, British Medical Association"

http://www.timesonline.co.uk/tol/comment/debate/letters/article1800798.ece

See, it's true, where is a will, there a way ... to find things .... ;-)


Prof Brown was there! See him talking to Dame black at the interval

The history file ... :-)

"Unless you understand the past, you can not prepare for the future"

I found the old Remedy UK forum, intact and fully accessible ... Brilliant! ... :-)
Full of information on what happened last year during the 2007 recruitment! Have a read, it is amazing. I wish Remedy UK would keep a permanent link to it on its site as this was the beginning of the 'struggle.' ...

And I also found Dr Clive Peedell's warning to the profession, One of the earlist but not many people paid much attention. He is still not properly recognised for his contribution.

And .... ! Le voila! Are we on the road to 'doctors chambers' soon?



"History will be kind to me for I intend to write it .."

In the media ....:-)

“There is not enough darkness in all the world to put out the light of even one small candle”

Last year, when Remedy UK first started, I sent them an e-mail suggesting they should open a forum on their site because the doctors.net site was only open to members who must be doctors. Times were so hard on all the doctors caught by MTAS as well as their families and loved ones, there was a strong need for communication, a forum that did not need membership and was open and available for everybody to use. A place that doctors as well as their parents as well as families can meet and support each other, after the extend of the MTAS saga became apparent. Remedy then started its forum but. Of course, I have no idea whether they considered that mine was a good suggestion or they thought about the same idea at the same time as myself, more important, the forum is there and it is a great success. Either way, thank you Remedy UK, your forum is a life line for doctors as well as parents and families.

The most important thing is that this forum has become a much needed communication tool for everybody concerned, either the doctors themselves, their parents, other family members, even journalists, educators and, of course, the government. It has now developed into an essential tool for doctors caught in MTAS last year or those applying this year, to communicate, discus, even vent a little and get some support from Remedy and the other members, or just to write about their personal experience as a way of giving advice to other applicants.

During 2007, a much needed support group was just accidentally formed, particularly amongst the parents who were themselves very worried about their own sons and daughters's treatment at the hands of the monster MTAS. Those parents visited every day, to support the young doctors and support each others too. The same group of parents still meet there on regular basis to support the 2008 applicants and their families. Keep up the good work everybody.

The forum then became a tool to inform the media of the situation. Of course reporters must have accessed the forum on regular basis to get the feel as well as the facts about the MTAS situation and, after a very long time of not giving much attention to the growing problem, they began to understand and report. Then there was an explosion of reporting and the MTAS issue was front page news on many a newspaper as well as TV, most notably the Telegraph and channel 4. Others, such as the times and the guardian then followed suite. The media is now very aware about doctors recruitment and unless solutions are found, I expect another explosion of reporting once the results for 2008 are known as, this year, around two thirds of all applicants will be disappointed!

Of course, ery early on last year, I also started a thread on the same Remedy forum to link to any piece of reporting about junior doctors that I found in newspapers. Since I do not sleep early, it was easy for me to find the news as soon as it became published and add a link to it on that thread. Other parents contributed too whenever they found something themselves. Remedy then changed the forum software but I have no idea, whether the old software containing the 'on the news' thread' is archived or was just disposed of with the old software.

As soon as the new forum was up, I started the thread again, now called 'In the media.' The contains most media reports that appeared in the UK, and sometimes abroad, on the subject of junior doctor recruitment to speciality training, MTASS and MMC. The hread has thus far had more than ten thousand hits! I still search for news every night and add whatever I can find and Other parents do the same too.

This thread IMO, has become a valuable historical document and a record of every step that took place since the start of the Remedy forum after the junior recruitment result 2007 were out. It's also a very rich resource for those researchers who may have decided/decide to tackle the subject of MTAS/MMC as a research project. To complete this resource, I just hope that Remedy would transfer the earlier links from the 'In the news' thread of the old forum so that this historical document is complete.

Of course, Remedy is now growing bigger and better, they probably have their own staff who now do the job of searching for news, then publish it on the front page of the Remedy site, but I still add to my thread, even that news that appear on the front page of the Remedy site itself. I do so because I want to keep this document complete and up to date.

I have no idea whether I should stop or continue, now that Remedy are growing and have their own staff. It would be nice to know because I wouldn't want to be seen as interfering.

Forward Remedy UK -------> Always :-)


“Life is no brief candle to me. It is a sort of splendid torch which I have got a hold of for the moment, and I want to make it burn as brightly as possible before handing it onto future generations.”

To be or not to be ....

“Love wasn't put in your heart to stay. Love isn't love until you give it away.”

That is the question, to be an organ donor or not to be an organ donor? A big question specially if you have no say! Especially when only a day after our PM decided to back the idea that hospitals can harvest our organs without explicit consent from the person or their families. Only the following day, heart specialists and scientists find a way to 'refurbish' dead hearts and use them again! They've done so on mice already so, I imagine, it won't be long before human organs are refurbished and used again. If so, scientists expect that this is the first step to doing away with donated organs completely!

Good news for the future but, until this happens, who has the right to our bodies? Us or the government? Well, IMO, my body is the only thing that I really own, so, I have the right to take it with me to the grave ... whole, if I so wish. Governments have no right to interfere or molest or impose that the only thing we own can be cut and distributed without permission. Spain has done that and Spain is wrong IMO.

So, what do you do about the thousands of lives that are lost because of lack of replacement organs?

I'd say, don't allow those who don't give permission to their own bodied access to organs from those who do!

This will make more people either carry donor cards or willingly give permission without being forced to do so by the state. And, the state will have every right to impose such rule instead of forcing grieving families to endure yet more suffering at a time when they should be helped rather than tortured further.

Will medical ethics approve? Well, if you deny the obese the chance to fertility treatment until they lose the wait, following the same principle, you won't get an organ yourself unless you are prepared to give yours too.

A simple give and take idea.

What do you think?


“The quickest way to receive love is to give; the fastest way to lose love is to hold it too tightly; and the best way to keep love is to give it wings”

Child play ...

“A hidden connection is stronger than an obvious one.”

An article in The guardian today claims that doctors lack training when prescribing medicines for children. They back their claim by a research conducted by the school of pharmacy at London University and the Royal College of Paediatrics and Child Health.

'The research, backed by the school of pharmacy at London University and the Royal College of Paediatrics and Child Health, sent questionnaires to 319 centres in the UK. It found that junior doctors get no more than a 30-minute or 60-minute presentation on the issues, although some have workbooks, and some computer-based training and practice questions.

There is very rarely an assessment of understanding and skills, including the mathematical competence to calculate an age-appropriate dose.

The article does not say whether the research included statistics to show the percentage of junior doctors who made errors in calculating child dozes and how many children were harmed as a result. But, it includes this statement instead:

"Before a nurse can give a medicine to a child they have to pass a test"






















I wonder what are they trying to say here exactly?

I do not understand the comparison here, are they saying a nurse is more efficient in describing medicine than a doctor? Was this part of the research? Or, the paper just included it for some fun?

We were promised a "consultant led health service" but then this was changed to a "patient led health service", but the reality is, its ...

... a " nurse led health service" ...

... and its time to be very afraid ...

... now, the health service is just child play, a playground ...

... why Mr Blur? ....

... was this too, doing the right thing? ...

... I need to put my thinking cap on now ....



“Three things cannot be long hidden: the sun, the moon, and the truth.”

Time to make noise! Lots of it!

“Common clay must go through the heat and fire of the furnace to become porcelain. But once porcelain , it can never become clay again.”

I was wondering why things were so eerily quiet despite the current situation of application to speciality training 2008. Despite the predictions that this year will be much tougher than in 2007! One can not imagine that anything can be more evil than hurricane MTAS 2007! But it seems it is possible after all, nothing is beyond the ferocious furnace MMC!

But, it seems that all is not so quiet after all as today, four eminent doctors and heads of four Royal colleges decided to make 'some' little noise. The 'courageous four' sent a joint letter to the Times warning that unless training posts are increased, British doctors who are already mid-way in their training "will be unable to access specialist training this year" and that " the prospect of large numbers of UK doctors being unable to complete their training is now real. "

Now only! Why are they forgetting 2007?! All the excellent doctors who were either made redundant, flew to Oz or just left medicine! Those too ARE a reality! But, in the middle of current the deafening silence, this letter is very welcome indeed, at least someone is doing something. Albeit very 'mild' IMO, especially as the distinguished doctors already know that the problem is not about not gaining access to training this year, but about not gaining access to training 'ever!'

Why didn't the other heads of Royal Colleges sign this letter?!

Remember how many senior doctors signed with Professor Brown in 2007? See how this good Professor never lets go of his principles? This is a man who knows that it is the duty of the seniors to hand the profession down to the juniors in good shape, that, therefore, the seniors are 'responsible' for the younger generation of doctors because, those juniors have to be very well prepared for the hand over, if British medicine is to preserve and maintain its worldwide reputation as 'world class!' That in order to so, they MUST save the younger generation from the furnce that is threatening to eat half of them alive!

I am sure this eminent and respect worthy professor and his colleagues are watching from afar. They know their duty, very well.

The amazing thing is, despite our doctors now being called a 'glut' by foreign newspapers, despite the dire situation the juniors are facing. Despite around 14,000 doctors facing the threat of unemployment, Scotland is sending a delegation to recruit 'Physician assistants' from the USA!!! Men and women without a medical degree to work in Scotich hospitals! This makes me want to scream! ... What do we do? wish them happy holidays in the USA funded through the public purse, or ask them to stay in the USA with their beloved recruits?! ... up to you to decide.

The situation is very hard for our juniors this year, much harder than in 2007, judging by the competition ratios. No one will do anything unless the whole medical profession makes lots and lots and lots of noise! NOTHING will be done unless anybody and everybody who cares about Britis medicine SCREAMS and keeps on screaming until something is done to protect British graduates and save them from the abyss of 2008 and beyond.

Rest assured! The fire is there, despite the cool front ...


“Times of great calamity and confusion have been productive for the greatest minds. The purest ore is produced from the hottest furnace. The brightest thunder-bolt is elicited from the darkest storm.”

Ours are 'Gems!' A national 'treasure!'

Ordinary riches can be stolen, real riches cannot.

It seems that Britain is sending out signals to the rest of the world that we have a "glut" of junior doctors in excess to our requirements! Countries like Australia and New Zealand have a shortage and have been trying to entice our juniors to immigrate to their countries since the 2007 MTAS fiasco to the point that they sent teams of their representatives over to Britain, on a mission specifically aimed at targeting and recruiting British graduates. They have even changed some of their rules and regulations to help this recruitment drive.

They want to get British 'gems', British 'excellence' ... for free!

These countries have a 'problem', we don't. Their graduates fly away because of unsuitable work conditions, ours don't, they want to stay here and serve our people, serve Britain! ... and for this, we reward them by 'forcing' them to fly away! ... to the same countries whose sons and daughters deserted to go elsewhere, including Britain!

Despite the shortage they suffer, both countries will not give priority for training to UK graduates over their own graduates! Or to anyone else for this matter! Actually, other overseas graduates even find it hard to register with their medical councils as the article in the link says.

In an effort to achieve self-sufficiency, our government built new medical schools and increased intake by 70%. Had the government also protected our graduates, we would not have the 'excess' we have today and we would have had to employ more doctors from abroad to fill in gaps and 'work' in non-training posts too. So, had there been protection for British graduates, we would have had a 'shortage' if the 'excess' of overseas graduates was not here already. Those are at the moment happily working in the NHS and, us, happy to have their services, so, where is the problem?

The only problem is that there are enough training posts sufficient only for our graduates. That if the government does not succeed in guaranteeing them priority to training, British training posts will have to be shared with the whole world! And our graduates will be displaced! Then, our graduates will have to 'fly' abroad, in a hurry, to save their careers. If left to do that, they will be emigrating just to fill other countries 'gaps!' As far as I am aware, this does not happen anywhere else in the world but Britain! If anyone knows otherwise, please enrich me with the education!

So, what 'glut' are they talking about?! We have no 'glut!' We just need to protect our graduates so that everybody knows exactly where they stand.

Our juniors are the product of some of the best medical schools in the world, British medical schools. Our doctors were hand picked, 'commissioned' and expensively groomed from the public purse at a quarter of a million pounds each!

Our graduates are 'precious!' They are not for sale!

Protect the Brits and bring those who were forced to leave in 2007 back 'home', their families and loved ones are desperately waiting. We deserve them here especially that we now have a shortage of 'good' doctors ourselves.

Ours are the best in the world, a priceless national 'treasure' to be protected and cherished!

Believe it, it is true!


“He who finds diamonds must grapple in mud and mire because diamonds are not found in polished stones. They are made.”

Bullying!

An F1 doctor friend of my daughter has just started her A&E rotation beginning of last December. She was on a surgical rotation previous to A&E. On arrival to the Department one day last week, the nurse in charge, who is in her fifties, told her that the dept was very busy and that everybody will just have to work as best as they could and this young doctor agreed and promised same.

During the course of the day, a patient with an open wound on his shoulder returned to have it sutured after he was advised to take a course of antibiotics first 3 days earlier(Or something like that, I am not a doctor :-) As this young doctor has already done this many times before and has one of those new bits of competency papers to prove (DOBS), she told the patient that she would do the procedure herself. But as she was preparing to do so, the nurse told her, in front of the patient, to stop 'what you are doing' and called for the consultant who quickly came and did the suturing herself.

Terribly embarrassed, the F1 doctor did not say anything at all and just walked out of the room. She said the patient looked very surprised. As the consultant was very busy that day, , she did not get an opportunity to explain. Towards the end of the day, the nurse stood by the desk talking to the other nurses. This young doctor could tell they were talking about her as they all kept turning and looking at her!

She says that she felt humiliated, insulted and did not know what to do. So, when she returned home, she phoned my daughter ... but my daughter does not know what to do in such a situation either! .. I told my daughter that her friend should explain to the consultant and show her proof that she can do this type of work efficiently. But it seems that the consultant is not very friendly or easy to approach. Apparently she does not allow complaints and does not get involved in such 'little' things as another friend, who did A&E with the same consultant during his previous rotation, told this F1 doctor before.

Those young doctors are also under the impression that the consultants will always stand by the nurses who work with them all the time, rather than the young doctors who are only visiting for a four months rotation. ... Makes sense, who wants the headache anyway!

If this experienced and much old nurse suspected that this young doctor can not safely perform the task, does this give her the right to speak to the doctor in this way in front of the patient?

This is proper bullying IMO!

Any ideas?! What should this young doctor do?!



"I wish I was sixteen and know what I know now!"

My witching hour ...

“People get nostalgic about a lot of things I don't think they were that crazy about the first time around”

Now that Sir Tooke is recommending the medical post graduate training should be removed from the governments hand, I find myself more and more on the Witch doctor's blog. She has accumulated probably the most comprehensive recent NHS policy archive on the blogsphere! And with her own interpretation too ... Although she says that, due to her work, she does not have enough time to read more ...hmmm! ... It must've been her black cat doing the 'extensive' sourcing and the reading then ... together with her when on her witchy midnight flights of course ... There you go, learn from the doctors about doctors and their business .. ;-)

So, since the Tooke report came out, I have been spending more time on her blog, looking at all the media reports on the NHS and the health modernisation programme that started in 1997 with the NHS plan 2000 and up to this day. Professor Tooke recommends that medical post graduate training should be removed from the hands of the government ... Reading about the health modernisation programme, it seems that you need much more than finance and management experts to run health. With the ongoing but totally unpopular privatisation, I think the whole of the Dept of Health should be removed from the hands of the government and given to the doctors if we are to save the NHS and the nations health! ... If only this was possible ...

Why isn't the Secretary of State for Health a doctor?!


“A question that sometimes drives me hazy: am I or are the others crazy?”

Time to 'hover' ... again

“Fair is foul, and foul is fair:
Hover through the fog and filthy air.”

Apparently, you are now considered to be a 'helicopter parent' if you do what the government wants you to do and get 'positively' involved in your 'child' education!

I admit, I was always been involved in my children's education until they started university but never beyond this point. I stopped because I decided they were adult enough to fend for themselves, experience the university of life .. etc, but I always encouraged them to seek my advice if they need to and they did. Although they came more when they were younger, bit by bit, they came no more or very rarely. Wonderful! It was time for me to relax a bit, pamper myself a bit, travel a bit, have a facial, meet friends to just relax and talk silly, care free .... at last! ... and I deserve it!

Can you imagine then how I felt when my eldest told me he never got any interviews in round one of the loopy monster MTAS?! I remember that for a very brief moment, I looked him straight in the eye as if he were 10 again .. and I remember him looking back with a 'no, no mum, not me' look on his face... For a moment, he was 10 again! This was the MTAS effect that he and I will never forget! Ever!

I don't know how to describe my feelings after the MTAS blow, confused, numb .. then guilt; I felt the rejection must have been because I let go of my duties as a parent too early. To my mind, there was no other reason, so, I had to get involved again! ... Sounds familiar?

For a moment, I doubted him; he must have forgotten to write about his prizes or made a wrong statement somewhere but he assured me he didn't and I did not believe him .. :( ... He then told me that there was now a possibility he would have to leave medicine or emigrate to New Zealand or Australia .. This is when I sat by my computer for hours on end staring at the screen, frantically trying to understand the whole of medical training in one sitting! I had to learn about, to read anything and everything that had the letters M.T.A.S in any order! .. I never sleep early anyway but at that time, I hardly slept at all! ... The rest is, hopefully, .. history.

















It feels a little better when you understand, even a little. Better still when you find out it wasn't your child's fault but it was some of his seniors that have messed up, those in charge of him and his generation. He was their responsibility now! But, see this picture above? This, to my mind, is what MTAS did! Rather than punishing the incompetents who devised it, it executed 30% of the creme de la creme of their generation ... My generation did that.







I have learnt my lesson, let them grow but keep an eye though you pretend you don't. Be a 'helicopter parent', or you will never forgive yourself, when our generation messes up!


Are you a 'helicopter parent?'

Time to do a bit of hovering now ... ;)

“And there, there overhead, there hung over Those thousands of white faces, those dazed eyes, There in the starless dark the poise, the hover, There with vast wings across the cancelled skies, There in the sudden blackness the black pall, Of nothing,”

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.”

Tooke's final report ..

Professor sir John Tooke has today released his final report and recommendations. The 75 page report addresses and amends the recommendations of the original interim report and condemns the government's role for the current debacle to the extent that his views now amount to a vote of no confidence in the government's handling of Medical postgraduate training. Therefore, one of his most important recommendations is, to 'ring fence' doctors' training monies and remove same from the hands of the DoH who keeps on raiding same whenever it is in trouble and wants to balance 'its' books. He recommends that a new body, NHS Medical Education England, should be set for this purpose alone. Brilliant move that is long overdue IMO.

From page 17 of the final report, he returns to addressing the very urgent issue of the redefinition of the role of doctors in training and emphasis the need to recognise the professionalism of these doctors at different stages of their training. He wants doctors to have a bigger role in management and be adequately prpared for involvement is such at all levels. He also, again puts emphases on the need to redefine the roles of other health professionals as supporters of doctors who are to maintain their roles as leaders of the 'team.' However, he recognises that other health professionals will have a bigger role and responsibilities but that they should be properly, through more training, be professionally prepared for such roles. He then leaves it to the different bodies controlling other health professionals to address this as part of their modernisation of their own professions, something which, IMVHO, will leave the door open as those other professionals are unlikely to agree to hand back some of their gains. I thought that Professor Tooke would recommend that a certain body, new or otherwise, would be in charge of seeing to the doctor's role definition against the definition of that of other health professionals. At least to ensure that this these roles are not confused again and/or overlap with that of other health professionals causing the current blur of roles.

Regarding the current 'bulge' Sir Tooke recommends that overseas students reading medicine in the UK as well as asylum seekers should be allowed to compete on equal terms with UK graduates. I can understand why he recommends this; as for asylum seekers, he has to comply with international laws governing their treatment. As for overseas students, I think Sir Tooke allowed them to keep international good will with other countries that need to benefit from the Brits 'world renown' expertise in medicine, so in a way, this aids his concept of 'aspiring to excellence.' And, since the numbers of those two groups are very small and since they too will compete on merit, it is unlikely they will cause any real displacement of British graduates.

That said, Professor Tooke recommends an urgent solution to the 10,000 IMGs who are currently working in the UK but have never been on the training ladder and intend to take the opportunity to compete head on with British graduates this year and for the foreseeable future if the situation is left to resolve itself. He does not make a specific recommendation regarding those but leaves it to the government to sort it's own mess IMO. I understand the government will take this matter to the house of lords next month. As this is identified as an urgent issue by the Tooke report, Wish the government luck.