Medical Training (Prioritisation) Bill
I will start with what is now a traditional declaration: I am a non-practising doctor and my wife is a doctor. I thank the Secretary of State for his comments, and for thinking through the content and merits of my new clause 2, on allocation based on merit. I hope that, as the Bill proceeds through this place and the other place, he continues to focus on that, because it is a very important point. For my Second Reading speech, I am not going to focus on the details of new clause 2—I will hold that back for Committee. Instead, I want to make some general comments. In a sense, the Bill treats the symptoms of what has been happening in the medical workforce. I do not think it is a cure for the fundamental disease or the problems we have had over the years, which are in part down to a creeping de-professionalisation of the medical profession. I also think they are down to the way we have approached doctors’ appointments to placements, and how we assess their skills and CVs, and how that then leads to different appointments and places. Doctors are thrown from pillar to post, subject to the whims of a computer or a training programme. It has been shown time and again that one of the most important things in people’s eyes, or at least what gives most work satisfaction, is autonomy. Unfortunately, we have sleepwalked into a situation, in pursuit of a weird type of fairness in the allocation of jobs, that works towards equality of outcome as opposed to equality of opportunity. Doctors have found themselves unable to compete or have control over their lives. Where they are allocated to their foundation school or their specialty training has a real, material impact. Crucially, within allocations, the geographical regions are huge. That means uprooting: moving your family and your social network. In the training scheme there really is no power that a doctor can exert in terms of choice or preference. My understanding—I am a creature of the Nursing and Midwifery Council and the Medical Training Application Service, when I was coming through and applying for posts—is that we just used to let doctors competitively apply for different posts and put together a sort of portfolio CV. That has all changed. There is now the allocation to training programme schemes and national contracts, which is something I have been campaigning about for quite some time. Do not get me wrong: I think the way the BMA has behaved is absolutely appalling. I categorically and unreservedly condemn the approach that it has taken, and not just under this Government but under previous Governments over various disputes concerning junior doctors. But the fact that doctors have found themselves in a situation where they need to have a militant trade union is a consequence of the training schemes, programmes and national contracts not treating doctors as professionals when it comes to applying for jobs. It also means that the training providers, the trusts and the integrated care systems, cannot provide options that doctors might want to compete for. They cannot say, “Well, we’re a really good research unit, so we’re going to have an offering that pursues a certain type of doctor who wants to go down the academic pathway.” We do not have trusts or regions that can say, “Actually, this is an area where there is quite a lot of social and economic deprivation, so we want doctors who are interested in certain specialties.” For all sorts of different reasons, there are parts of the country that are oversubscribed and parts that are undersubscribed. We cannot use what we use in every other walk of life, which is changing remuneration to encourage people to go to other places. We cannot say, “You know what? Let’s look at flexible working arrangements.” As part of my medical school rotations, I was in Barnstaple. I can only imagine that if the trust for Barnstaple had recruitment challenges—I do not know if it does or does not—then it could look at whether people are into surfing or ensuring they could get involved in other activities outside of medicine. Dare I say, as a former doctor, that medicine is important but there are more important things than people’s careers, in particular their work-life balance. We have a system that does not enable that to happen. The behaviour of the BMA is, in a sense, a consequence of dismantling the normal human experience in the approach to the selection and allocation of jobs. That has real consequences locally. Ashford and St Peter’s, my local trust, struggles to recruit because of the proximity to London, which has London weighting. Since we are on the border of London, to look at it purely financially—if that is the main priority—it makes more sense to pop into London and work than it does being employed in my area. Runnymede and Weybridge, by the way, has house prices and a cost of living that are equal to a big chunk of London, but there is no approach to regionalisation. I am really glad that the Secretary of State is in his place to hear my contribution. I will say to him something that I have said to many previous Secretaries of State. When he is in those difficult negotiations with the BMA and hears from doctors about the workforce experience challenges that they have, would it not be better if we trusted doctors—and, for that matter, anyone who is subject to a national contract—to make decisions for their own lives, and that we devolve decision around pay and terms and conditions to some form of regional unit? For medicine, the obvious solution would be the integrated care systems, but there could be different solutions and ways of approaching it. I think ICS devolution would make the most sense, but there are other opportunities to do it. That way, it moves from the Government essentially getting stuck in the middle of doctors, who are making difficult decisions about their careers and having to balance and judge different T&Cs of work, and the employers, which are different NHS trusts, being unable to use the normal mechanism that any other employer would use to recruit and incentivise people. If we do not do that, unfortunately the consequence is a Bill like the one we are debating: ever-increasing state intervention to try, in the absence of a market system, to impose a command economy. The Secretary will have seen the issues dealing with local doctor prices. The fact that we have struggled with high locum payments for so long is because we do not allow the doctor employment market to resolve itself for adjustments in contracts. The system would save a huge amount of money overall if, rather than having a huge amount of money going to locums and a national contract system for doctors, we let the market sort it out. I will support the Bill, but I see it more as palliation than the definitive treatment that we need to solve the workforce problems for the NHS going forward.