High quality medical training is the key to a sustainable high quality NHS. The motivating force behind my decision to become involved in NHS Survival is simple, like many patients and doctors I have become increasingly exasperated and frustrated at the way in which structures have been 'reformed' in a rather evidence-free and potentially dangerous manner.
My work uncovering the reality behind the GMC and the government's planned major structural reform of medical training has demonstrated many recurrent themes that it are worth summarising in this article, in order to get across just how things need to be managed better in the future if we are to optimise our health service of the future.
The Shape of Training review was methodologically flawed on a number of levels. Many straw man arguments have been put forward to justify the review’s potentially dangerous recommendations such as these words from Niall Dickson of the GMC:
“There is a consensus that more needs to be done to meet the changing needs of patients and to provide high quality care in the future.”Notably the Shape of Training evidence review stated:
“This search found little research evidence looking at predicted changes in patient needs and public expectations of medicine and their impact on postgraduate medical education.”This was one huge gaping flaw in the review, it never found an evidence based argument to justify its proposed major structural changes. It was simply poor methodologically to not demonstrate how patient needs would change in the future; after all, how could one then claim that the review could meet the future needs if one has zero evidence to suggest what these may be?
The review was non transparent and subject to the repeated influence of politicians behind closed doors. Not only did the GMC repeatedly refuse to release the documentation of several important meetings into the public domain, but when forced to release the documentation by court it was revealed that Department of Health Ministers were already setting the ‘strategic direction’ before the evidence gathering process has been completed.
The review also ignored the majority of its consultation respondents in recommending that the time taken to train a hospital consultant be shortened:
“Most individuals and organisations argued that generalists would require a longer training period or reconstruction of training to capture the breadth of experiences needed to provide competent general care”Niall Dickson of the GMC talks of a ‘consensus’, perhaps the Shape of Training was indeed a consensus in Whitehall? What it certainly was not was an evidence based consensus as the review’s recommendations ignored this majority of the consultation’s respondents by proposing to shorten consultant training time.
This Shape of Training case study demonstrates just how badly wrong health policy making is going at the moment. The process has been shown to be methodologically flawed and non transparent, while the outcome of the review appears to have been influenced by meetings which were not formally minuted or even mentioned in the review’s final paper trail. The problem areas in training today were never adequately analysed and the future needs of patients were never described based on evidence. While the review also overtly ignored the consultation response on the most significant issue. I could go on, but I hope you now see what motivates me to fight for change. If we are to develop reforms which actually improve our current situation, we need to get back to the very basics and do them right. We need a fully open and transparent process throughout, we need proper evidence based methodology and we need consultations that listen, not those that just pretend to listen. As things stand the Shape of Training promises to be another top down regressive step for medical training that appears part of the government’s shabby attempt to produce 7 day services on the cheap.
I think that you and I deserve better than this.
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