Prof Alan Crockard's letter of resignation

The MMC/MTAS debacle of Junior Doctor's Training in the UK looks to have seen its first senior Resignation, Professor Alan Crockard has apparently resigned from his position as National Director for Modernising Medical Careers. Confirmation of the resignation or reporting of it in the mainstream media appears to be thin on the ground and even the Telegraph does not actually have a report on it , just the letter. Various Blogs by Health Professionals have the story from early this morning.

UPDATE: Telegraph appears to confirm story here:

Alan Crockard is an eminent neurosurgeon, and has been the national director of the Department of Health's programme, Modernising Medical Careers (MMC) and its online application service, the Medical Training and Application Service (MTAS), since 2004.

One paragraph from the letter is very interesting:

From my point of view, this project has lacked clear leadership from the top for a very long time. Moving to the last few weeks, I have become increasingly concerned that the well intentioned attempts to keep the recruitment and selection process running have been accompanied by mixed messages to the most important people in the whole process - the young doctor applicants.

I assume that this is a dig at Patricia Hewitt. We can only hope that she has got the idea and will follow Alan Crockard's example. This is however unlikely bearing in mind Labour's normal mode of operation of promotion on failure.

It was earlier reported today that he was being reported to the GMC by Lindsay Cooke, who founded Mums4Medics - a family support group for people caught up in the jobs fiasco, who wrote to the GMC naming Prof Crockard as he was

"ultimately responsible" for the MMC and its implementation.

"I respectfully ask the GMC to examine the conduct of Prof Crockard in this matter and, if it is found wanting, to consider disciplinary action,"

Full text of resignation is as follows.

Dear Liam,( Sir Liam Donaldson chief Medical Officer at the NHS)

I wish to resign from my position as National Director for Modernising Medical Careers with immediate effect. I am increasingly aware that I have responsibility but less and less authority.

I care deeply about medical education and training. In 2003 I moved from the College of Surgeons where I was Director of Education to join the MMC team. At the College we developed a competency based curriculum. These ideas rolled over into MMC where the team put together the Foundation Programme which was launched in 2005.

It also involved coordination of the stakeholders in curriculum development, training the trainers and carrying out numerous road shows to set the scene for consultants and trainees. It is now considered successful and fit for purpose.

In addition the doctors completing the Foundation Programme this year seem as if they will match well into the new Specialty Training Programmes. As a prelude to new Specialty Training, MMC worked closely with PMETB and all the stakeholders to facilitate the new competency based curricula and set the scene for such a radical change in training.

Manifestly, specialty training is an order of magnitude more complex than Foundation, but it became obvious that the MMC team's expertise was less used in planning of specialty rollout. MTAS was developed and procured by DH outside my influence.

An email (12 October 2005) to our team made it abundantly clear that "Debbie (Mellor) has been tasked with delivering a recruitment system to recruit junior doctor posts specifically FP's and ST's .......I am not clear how far you should (or want) to be involved in this. We don't want to tread on any toes, but equally we need to be clear about what level of autonomy this Programme has".

The MMC programme has been the subject of an OGC Gateway Review in September 2006 (DH331), they concluded "that the programme has made significant progress since the OGC health check in August 2005".

The report overall was supportive of MMC, but there was one serious red risk. This was to "identify a clear break point for the MTAS project beyond which the contingency arrangements should be activated". It also commented on the unclear leadership between DCMO and two senior responsible officers.

From my point of view, this project has lacked clear leadership from the top for a very long time. Moving to the last few weeks, I have become increasingly concerned that the well intentioned attempts to keep the recruitment and selection process running have been accompanied by mixed messages to the most important people in the whole process - the young doctor applicants.

I realise that the service must continue to allow patients to be treated and I know little of the law, but it seems to me basically unfair to advertise the possibility of four interviews and then suggest that these might not be honoured.

Equally devastating would be the suggestion of some stakeholders, that the completed interviews be discarded and the process be rerun.

I accept that in many areas and in many specialties, this round of recruitment and selection has been acceptable. But the overriding message coming back from the profession is that it has lost confidence in the current recruitment system.

With my very best wishes.

Alan

Prof Alan Crockard's letter of resignation

Computer therapy access 'for all'

According to the BBC our esteemed Health Secretary Patricia Hewitt said:

"On 1 April, we will reach the first milestone in our drive to provide choice - namely quicker access to computer-based self-help services to stop mild mental health problems becoming worse.

"Clinical evidence confirms that counselling and therapy are just as effective as medication in helping to treat most cases of depression."

Now what she knows about clinical evidence could be written on the back of a stamp. In fact what she knows about anything could be written in a large font on the back of stamp.

I thought for a moment this was a joke for April 1 just being released a bit earlier by error as is normal by Patricia (Best year so far) Hewitt. This is not so much about choice as about cost and lack of resources. I have no doubt that the computer therapy may be a somewhat useful tool in the box but it is no replacement for face to face therapy. A few others have much the same opinion and they should know better than me.

Paul Farmer, chief executive of Mind, said computerised CBT was an important addition to the range of treatment options available for people who suffer from mild depression or anxiety.

But he added:

"This method of delivery will not suit everyone.

"Some people will prefer face-to-face contact and this electronic therapy must not be a replacement for CBT."

Dr Richard Vautrey, GP negotiator for the British Medical Association, said it was helpful to have a range of options for treating depression and computerised CBT had proven to be useful in some areas of the country.

But he added:

"Many patients still struggle to get an appointment with a therapist and it is key that it doesn't replace the pressure to invest in trained therapists."

Marjorie Wallace, chief executive of the mental health charity Sane, said:

"Evidence from several hundred thousand of our callers shows that of those reporting depression or anxiety, while 83% are being treated with medication, only 2% are receiving cognitive behavioural therapy.

"While we applaud the secretary of state's announcement, we urge her to match it with a funding commitment to ensure that CBT can be a real choice, as she intends, for everyone who could benefit."

So whilst, it my be of some use, it is really just another case of Patricia trying to dumb down the NHS as usual. Medicine by Protocol, Medicine by numbers, Medicine by the untrained.

BBC NEWS | Health | Computer therapy access 'for all'

NHS cuts 'hit antenatal classes'

Why I should think NHS Cuts should be news anymore I'm not sure. The relentless cutbacks and dumbing down of the NHS continues from Cradle to Grave and even before and after each of them.

Now it's Antenatal classes that are being cutback.

Hospitals in parts of England and Wales are reducing or even axing services for pregnant women because of the NHS's financial problems forced on them by Patricia Hewitt.

According to the BBC, the National Childbirth Trust and Royal College of Midwives, told them that Antenatal classes and breastfeeding tuition are being affected.

Apparently a Department of Health spokesman said trusts should meet standards laid down by the NSF, and echoed by the National Institute for Health and Clinical Excellence.

"The soon-to-be-published maternity strategy will set out how we will achieve services that provide real choice and support for women in all settings, from antenatal care through to the early child years."

So that will be another strategy/protocol to follow which has plenty of paper but no action or money behind it.


BBC NEWS | Health | NHS cuts 'hit antenatal classes'

Dumbing down of the Ambulance Service

Across at Random Acts of Reality we have the story of the latest dumbing down of the NHS. This time it's the turn of the Ambulance Service and as usual it is being sneaked in below the radar, not only of Joe Public, but even of the employees. As Tom Reynolds says.

With the whole dumbing down of healthcare under this government, this hasn't come as a huge surprise, what has come as a surprise is that no-one is protesting it. It's a stupid, stupid idea and I'm dreading working with an ECA; it's nothing against the people who will be doing the job, but they won't have the training to provide the care that has traditionally been part of the ambulance service.

It's the sort of thing that will have me leaving this job that I love so much.

I picked this up from Dr Crippen who said in his article:

This, of course, is Hewitt dumbing down the service to save a few pence. Her mind works like that. Most of the patients who see GPs only have minor illness, so why not get a nurse to do their job? Most of the patients consultants see have predictable and easily treatable problems, so why not get a GP (with a “special interest” of course) to do the job? Most of the calls the ambulance service get, even the 999 calls, are breathtakingly trivial. So driving skills, even white van driving skills, will do nicely, thank you. Who needs a paramedic?

Most of medicine, like any other job, is humdrum. But when there is a serious problem, a really serious problem, you need trained personnel. You need experience.

If the paramedics are replaced by white van drivers, the really seriously ill patients will not get to hospital.

Perhaps it does not matter any more. You might as well die in the in the hands of the ambulance quacktitioner on your way to hospital as die a few hours later in the hands of the hospital-at-night quacktitioner.

Soon the NHS will be populated by the likes of Blue Peter's John "I'll have a go" Noakes and we will just be one big accidenttraining exercise for the NHS as they skill up. Remind me not to get ill/have an accident/get pregnant(?) again.


Random Acts Of Reality :: Changes, And Not For The Best... (Or - Reynolds May Lose His Job Again)

Death by 1,000 cuts: NHS budgeting laid bare

Tales of the destruction of the NHS by Patricia (Best Year so Far)Hewitt continue with this article in the Independent written by a doctor at an NHS hospital in the south of England.

In the article the doctor writes how the relentless pursuit of the false targets set by Patricia to make the NHS break even to some sort of mythological target are affecting an A&E department. One particular bit got my attention in particular and shows how the short term thinking of this budget is possibly causing lives to be lost

Training budgets have been cut back, or simply suspended. As a direct consequence, when our new defibrillator appeared, nobody had been trained in its use the first time a patient needed it. On another recent shift, of the three qualified nursing staff present, one was dealing with a man who had bled into his brain. Another was helping control seizures in a three-year-old, and the third one was transferring a patient to theatre whose thigh bone was poking out through his jeans.

Which left two unqualified assistants with three months' A&E experience between them, to temporarily look after 10 or so "trolley" cases, from backache to threatened miscarriage. They also had to make sure the department was clean to prevent the spread of MRSA, answer the phones that never stop and keep an eye on the junior doctors.

We must get rid of this women before she kills us all.

Death by 1,000 cuts: NHS budgeting laid bare

Lost in the Brave New World of NHS

Push for Personalised Services

Lost in the Brave New World of NHS

Have a look at the two posts above and contrast the difference between the Imaginary that Mr Blair thinks exists, because he would never have to do this himself, and the Reality that people are finding.

This is a minor example of what happens out there in the "real" world, not what the politicians think happens. In the Independent article Jemima Lewis says

Luddite though I may be, I am far more computer (and consumer)-literate than many of my parents' generation. It is the most fundamental principle of the NHS that it should be accessible to all, yet these well-meaning, sloppily executed reforms may create a two-tier system of access. The young, determined and scientifically minded will be able to find their way to the best care. The old-fashioned, impatient or technologically inept will give up in despair - myself included.

Whilst in the BBC article Mr Blair called for

"truly personalised" services with people given the information and power needed to choose a school or hospital.

This is typical of this government who thinks that everything is rosy out there as they regard us from their High Towers.

And as for the comment from Patricia (Best year so far) Hewitt that

Technology is really expanding what is possible.

She wouldn't know what "Technology" was if it slapped her round the chops. As the shadow Health Secretary put it

Rather than more warm words, what people want is for the government to trust the professionals.

Push for Personalised Services

Lost in the Brave New World of NHS