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Making Ministers Happy

Posted by Dr No on 05 February 2015

dear_boy.jpgJust as forecasters talk of a ‘fog situation’ or a ‘snow event’, so do medical educators now talk of the ‘shape of training’. Why the accessory words are needed is beyond Dr No, but then again he is not all that surprised because the recent Shape of Training Review – hashtag ShoT or in this parish bashtag ROT – was led by a certain eminence situation, one Prof Sir David Greenaway, a distinguished looking egg-head and leading light from the science that makes astrology look good. The #ShoT review’s publication situation was treated by and large as a no news situation – maybe being #ShoT didn’t help - though for some reason the BBC did cover it, and of course our dear friend the Ferret Fancier has been poking holes in the review for some time. One of the Ferret Fancier’s notable achievements has been, on appeal, to get an order for the release of certain GMC minutes of #ShoT/DoH meetings, which the GMC had previously determined should most definitely remain as an ongoing non-situation.

The tenor of the few minutes that have so far been made public is warm, cosy, and upbeat. One noted ministers were ‘feeling happy’, the tone hinting in a light-headed laughing gas sort of way. Another noted ‘opportunity’ was in the air. We shall come shortly to what all this might mean, but before that, a little context. The Shape of Training Review is the Establishment’s latest attempt to dumb down medical training while at the same time pushing up GP and consultant numbers. Faced with the deleterious effects on morale and numbers caused by the GMC’s mounting interference with the profession, from mushrooming ‘guidance’ through revalidation to the chilling and killing effects of its fitness to practise squads, the Establishment now needs to get new sausages through the machine faster. The two chief proposals to this end are to shorten postgraduate training by about two years, and to remove the post-qualification pre-registration year entirely.

The medical curricula, both undergraduate and postgraduate, have for decades been over-filled balloons waiting to burst. Now the Establishment wants to sit on the balloon, to compress and so shorten it. We don’t need to be astrologers to predict this will soon cause a pop situation. Any new Mk 2 sausages that somehow do emerge intact won’t look too smart either. Only last month, the GMC aired its plans for military style thick-skin training for doctors, but what we are going to get, if the #SHoT proposals happen, is thin-skinned all filler and no meat bangers on the cheap, and we all know what happens to cheap bangers once they are exposed to the heat in the kitchen.

The Establishment has form on this. Modernising Medical Careers, or Mangling Medical Careers as MMC it is more popularly known, did to junior doctor training what mangles do to cucumbers. The change from what might be called an aspirational ethos, where junior doctors naturally aspired to be the best they could, to competency based tick-box training, brought about a fundamental change in the zeitgeist. It marked the first step on the road to zombie training, two dimensional training that teaches where the boxes are and which to tick, but lacks the crucial third dimension: what’s in the boxes. Thus MMC Mk 1 impoverished the depth of training. If MMC Mk 2 - #SHoT – is now allowed to shorten the duration of training, our once great medical postgraduate training will become little more that specialty speed-dating in white coats.

Yes, be afraid; but that begs the question why on earth mess so disastrously with medical education? This, as it happens, is where ministers feeling happy comes in. #ShoT was established by the four UK governments as an independent coalition of major players, including the GMC, in the medical Establishment. One might expect a medical leader, but instead we have a numerologist with, so far as his ongoing CV situation shows, no particular professional medical knowledge or experience, though he has held non-exec places on NHS boards. This modern habit, popularised of course by Mrs Hacksaw, of appointing review ‘heads’ with no relevant experience has always struck Dr No as appointing a captain with no seafaring experience to a ship, and then wondering why the ship hit the rocks.

Be that as it is a recipe for bizarre and usually misguided review conclusions, the #SHoT review is nonetheless meant to be independent of government and ministers. Though a long way from being infallible, one of the ways we attempt to show independence is by transparency: no secret meetings, no closed doors, no undisclosed minutes. Yet for a good year and a half, GMC goons – masters of candour that they are – refused to release minutes of high level #SHoT/DoH meetings which the Council had attended and minuted in its role as secretariat to the review. The goons averred that the meetings were informal, the minutes internal, merely aides to help ‘inform our thinking’, and so there was no need to place them in the public domain.

When, after a prolonged refused FOI request and subsequent successful appeal by the Ferret Fancier, a tetchy GMC did finally release the minutes, it became much clearer what ‘inform our thinking’ really meant: ministers telling an independent review what direction to take. The first clue is in the somewhat cryptic note that the review would provide ‘an opportunity for ministers to be radical’. By and large, and especially with the current lot, one prefers one’s ministers not to be radical. But the whopper is the one about ministers feeling happy, the fuller BBC quoted version of which reads ‘Ministers [are] setting strategic direction and feeling happy’. Setting strategic direction? No wonder they are feeling happy. Review independent? No way.

If you, be you patient or doctor, are alarmed at the prospect of further impoverishment of medical training, and want your voice heard, the Ferret Fancier has set up a petition you can sign here.


I don't think that is how to be such a problem in medical education. I say this because I do an extensive comparison between what I see in my country and the rest of the world, and your level of educational development seems to me excellent.

I think this isn't such a big problem as you picture it. As the comment before says, you are much better off than a lot of other countries. Of course, that doesn't mean that you shouldn't try to improve things even more. it just means that you shouldn't be wasting your time making problems where there are not any. alex

lol, what are politicians for? you think their role is to make the population happy? no! they just have to satisfy those who are above them. it's a vicious circle. Cosmin

I don't knw why, but im a little bit sceptical about this direction. I guess they will not improve nothing at all. They will fail again a because this is how they do. Saly

everytime is about making ministers happy. if the ministers are not happy you will lose your job, which is not good for you and your family. there is no concern for electorate. alex

Haha, Nice one. Intersting point of view. I m glad to see that somehow you are making a review of the actual situation. Cheers Lia

Why would we need to make ministers happy? I don't think they should be happy, i think they should just work and that's it.

I say this because I do an extensive comparison between what I see in my country and the rest of the world, and your level of educational development seems to me excellent. Laura

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