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Comment
David Fisher
Guest Writer
Titanic NHS reforms
The NHS is steering towards an iceberg
of ill-conceived change. Unless it recalibrates
its compass it is going to sink. The
Government is under pressure to solve
two problems: to cut the budget deficit,
and to improve healthcare services in
the NHS. Both are colossal issues and
demand an overhaul of the system. The
proposed answer is to dissolve primary
care trusts, a mistake Unison has described
as, “of Titanic proportions.”
The proposed changes will shift accountability
for purchasing £80 billion
of healthcare to competitive markets,
freeing fiscal forces to save money. GPs
will supervise, ensuring appropriate allocation
of resources. There are many
services that could be improved or become
more widely available - if competition
were injected into the system.
Currently few incentives exist to shorten
waiting times for scans. Drugs, such as
Avastin are denied from NHS patients,
but can be purchased privately. The
government believes engaging with the
private sector is the way to rectify this.
However an outcry of opposition
from the medical profession has met
the recommendations for reform. They
are nervous about a conflict of interest
Imperial versus the Daily Mail
Guest Writer
Odhran Keating
As some of you may be aware, the Daily Mail
published an article entitled “Pass the sick bag:
Students have always got drunk, but the nihilistic
antics of these Imperial College medics
should worry us all”. Purporting to reveal the “sickening”
behaviour of some members of ICSM sport clubs, reporters
infiltrated the Reynolds Bar. Traditional home of
‘Sports Nights’, members of the clubs congregate and celebrate
or commiserate over the day’s results. What caught
the Mail’s attention was the provision of orange buckets in
case of student vomiting. They condemned these drinking
habits, labelling them incompatible with a medical career.
Imperial College took swift action, releasing a statement
that it “does not encourage or condone excessive drinking”.
Furthermore, students are no longer allowed to buy alcohol
in jugs and the provision of orange buckets is banned.
The Imperial College Union will also be organising campaigns
to remind students of the risks that excessive alcohol
consumption holds for their health and their careers.
where they must decide which treatments
should be made available to their
patients, balanced against the cost. They
also believe that dealing with an establishment
the size of the NHS in such a
rash way is negligent and potentially
destructive, protesting that it is unrealistic
to reform the NHS as a means
to cut the deficit. Healthcare quality
should not be sacrificed on the altar
of economic recovery. A more longterm,
considered approach should be
able to preserve standards in the NHS,
whilst providing economic return.
“If the system fails, it
will be virtually impossible
to reverse the
changes”
The rush to implement these changes
is also worrying. The Bill was only
introduced to Parliament on 19th January,
yet primary care trusts are already
being scaled down. Unlike the rest of
the Government’s plans, the NHS proposals
were not included in the election
manifesto. The House of Commons
Health Committee published a report
on 18th January 2010 examining the
proposals. They concluded that institutional
reorganisation was “subject to
little prior discussion and not foreshadowed
in the Coalition Programme”.
Surely it would have been prudent to
have had a few consortia test the system
before the rest of the country implemented
the changes. 141 consortia have al-
ready entered the “pathfinder scheme”,
representing half the country. Consequently,
if the system fails, it will be virtually
impossible to reverse the changes.
It would appear the Government has
performed inadequate research about
the ramifications of their plans. We are
left wondering what else they may have
overlooked, and whether the fast pace of
headstrong change will leave no time to
rectify mistakes. In particular, it is unclear
how the system will work during
the transitional period, between the closure
of primary trusts and the finished
opening of GP consortia in April 2012.
Undoubtedly, the economy needs
to be improved, and the NHS needs
reform. The National Health Service
Act in 1946 expressed the duty of the
Government, “to provide or secure
the effective provision of services”. A
commission ought to be appointed to
investigate whether the private sector
renders better healthcare than the
public sector. Conceivably, introducing
market forces to the NHS will be the
most efficient way of achieving this. It
will cost money to undergo this transformation,
but the current economic
climate should not frighten us from
what will inevitably be a cost-cutting
exercise. Now is the time to begin the
process of reforming the NHS, but it
should not be initiated rapidly under
pressure to save money. Unlike the
current plans, it would not imminently
save billions from the budget, but in the
long term it would assure us of much
higher care standards that are simultaneously
economically sustainable.
But what have the Daily Mail actually exposed? An article
written in Felix, the student newspaper, interviewed
many students who felt that the article was sensationalist.
Professor Laycock of the Faculty of Medicine is quoted
saying “I certainly don’t think that our students are any
different from many of their peer group”. Indeed many
of the comments left underneath the online version of the
article seem bemused, with one reader posting: “It’s student
life, practically a right [sic] of passage. Get over it”
This would not be the first time the Mail has
courted controversy, notably with Jan Moir’s article
on the death of Stephen Gately. The paper has
also taken a recent swipe at Oxbridge students taking
part in the “Valley Rally” at Val Thorens ski resort.
Now if the students involved, their faculty heads, or
even the general public don’t see the article as indicative
of the moral collapse of 21st century medics, what
point is the Mail trying to make? It would seem the
Mail is generating acrimony merely for the sake of it.
Since its invention in 2005, the
selection process for the Foundation
Programme has been
dogged by criticism. While
completion of the foundation years of
training is a prerequisite for full registration
by the GMC, the 2010/11 application
cycle has seen 184 more applicants
than training posts available.
The foundation programme was introduced
to provide structure and uniformity
to post graduate training, and
to contain it within a finite time frame.
Although in many ways it has been
successful in doing so, from an employment
perspective a number of applicants
could be left without a post.
Derek Gallen, co-ordinator of the
programme, has justified not increasing
the number of places to accommodate
all graduates with reference to
the problem of under-subscription in
2009. Due to an unexpectedly low number
of applicants to the programme,
many deaneries were left short staffed.
“It is estimated that
10% of graduates will
be unplaced
until as late as July”
In light of the oversubscription expected
in 2010, the UKFPO implemented
a contingency plan, where they
placed applicants in batches according
to application score;; the most highly
scoring were placed on the primary
list and allocated posts before January,
the remainder on the reserve list,
placed in batches between March and
July.. The promise that 98% of eligible
applicants will be placed is encouraging,
however the time-frame over
which this occurs could be problematic.
It is estimated that 10% of graduates
will be unplaced until as late as July.
In addition a potentially unstable
variable has not been fully addressed;;
the number of international applica-
February 2011 medicalstudent
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Unsteady foundations
Zoya Arain discusses the difficulties of securing FY1 jobs
tions, which varies significantly from
year to year. In accordance with European
employments law, all eligible
UK, EEA and non-EEA applicants
with a right to work in the UK have to
be considered equally. Therefore little
can be done to curb a potential increase
in the number of eligible international
applicants. Criticism has been
voiced over this including a comment
from a previous national facilitator
and Obstetrician, Laurence E Wood,
“The suggestion that we regard a medical
degree from anywhere in the world
in any language to the bespoke uk 6yr
preparation to core training… sacrifices
any understanding of curriculum
on the altar of political correctness;; it
is not equal opportunity to substitute
a brief snapshot selection process for
6 or 9 years of education and assessment
in the practice of UK medicine”.
Ultimately the debate raises the
question of whether all UK medical
school graduates should be guaranteed
training posts if they wish to apply.
A strong case can be made for this:
UK taxpayers contribute £60,000 for
the training of each medical graduate,
meaning unemployed graduates
are economically wasteful. Furthermore,
as medicine is a vocational degree,
the training posts will be sought
after by the vast majority of its students
and hence should be provided.
In his inquiry into the MMC in
2008, Professor Sir John Took suggested
a direct link being established
between medical schools and FY1, in
contrast to the follow on between FY1
and FY2. Furthermore, FY2, ST1,
and ST2 would be combined to form
three further years of core training.
I for one think, that after having
completed 5 or 6 years of a rigorous and
intellectually demanding degree, medical
graduates do not appreciate this Russian
Roulette style selection process. It
is time for the parties involved to reform
the system to ensure that a training post
is guaranteed to everyone who applies.