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In which our intrepid neurologist puts the question on every medic's lips to the Chief Medical Officer - why haven't you quit over the junior doctors' recruitment fiasco?

This week has seen the Government response to the disastrous events last year with the junior doctors training.programme, MMC.

Regular Stirrer readers will remember that the chaos of MMC led to Patricia Hewitt leaving the Department of Health as well as the head of the BMA being replaced.

As a result of the problems, the government announced an independent review of doctors training, led by Sir John Tooke. In all the mess of events last year, the Tooke report received overwhelming support from the profession with almost 40,000 responses.

However in all this time, some of the main architects of MMC have remained in post, such as the Chief Medical Officer, Sir Liam Donaldson - whose report led to the development of MMC in the first place. Sir Liam has remained in post despite calls from the BMA, doctors pressure group Remedy and even a former Health Minister that he should have resigned. Thus, it is perhaps no surprise that the Department of Health has declined to fully implement the Tooke Report with Liam Donaldson at the helm.

Dr Matt Jameson-Evans of Remedy stated “Of the 47 recommendations, less than one quarter have been accepted unconditionally, with another 25% being accepted ‘in principle’. A further 25% have been subsumed into the Next Stage Review, led by Lord Darzi of Denham.

Lord Darzi is a government minister and his panel operates under government direction. Sir John Tooke and his team were truly independent and have gained the confidence and respect of the profession while trust in the government is at an all time low.

The Royal College of Surgeons said “the commitment to many recommendations in the report is qualified and there is a lack of any commitment to many others. It is also disappointing that those recommendations the DH offer to support have no timetable for implementation. The problems that led to Sir John’s inquiry are fundamental and ongoing and the need for early solutions is paramount.”

Sir John Tooke himself said, "Whereas I welcome the positive response to many of our recommendations, reform of the first 4 years of postgraduate medical education and training (PGMET) is urgently required. Without it subsequent years cannot be effectively planned.

Even since the government’s recent changes in medical immigration, the minister responsible Liam Byrne, has recently confirmed that no central figures are kept both for what specialties doctors from overseas represent or whether they are new or renewal applications due to “disproportionate cost”.

Further, recent leaks from the Department of Health have confirmed widespread problems throughout England filling gaps with hospital locums due to the ‘boom and bust’ recruitment strategy. In the West Midlands, there have been problems covering “vacancies at medical registrar level”….and in “covering paediatrics at all levels”- similar problems have been reported in Wessex, the North East, the South East, the North West and London.

Thus Liam Byrne’s comments are all the more remarkable as it is clear that the NHS is facing disproportionate costs in terms of medical staffing due to the planning failures over the last 10 years.

All of this really does beg the question in all this madness, why is Sir Liam Donaldson still in his post as Chief Medical Officer when so many have asked for his resignation? Indeed the government response to Tooke has confirmed him as senior responsible officer for medical education in England.

Thus tonight, I had the pleasure of putting this very question to Sir Liam in front of 400 others at the Lunar Society’s annual lecture in Birmingham at his talk entitled “The challenges of medicine in the 21st century”. He spent his talk focussing on patient safety on how doctors could learn how the airline industry learns from risk and its mistakes to help improve medical care.

At the end of his talk, I asked him how he had learned from his own mistakes, given that MMC was a good example of a systems failure and how many, such as Lord Owen had suggested that he should have resigned over the matter. The room went very quiet, and to no-one’s surprise, he ducked the question saying that “no single person was responsible”.

Maybe the challenge of medicine in the 21st century or indeed any century is to be accountable when you make a mistake- that is a true sign of integrity. As a colleague said to me afterwards, “He is clearly coated with Teflon”.

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