A defender of the indefensible

The chairman of the British Medical Association, James Johnson, has resigned after a letter he wrote to The Times defending the failed medical application system caused widespread fury and led to a number of doctors resigning from the BMA in protest. Mr Johnson, a surgeon, wrote yesterday to the BMA tendering his resignation. “My letter caused an absolute furore,” he admitted. But he was unrepentant about the letter, signed jointly with Dame Carol Black, which defended the Chief Medical Officer, Sir Liam Donaldson, regarded as the chief architect of the new medical training system.

Since the letter appeared on Wednesday, in response to one from Professor Morris Brown of Cambridge University and colleagues, a wave of anger has engulfed Mr Johnson. There has been no opportunity for the Council of the BMA, which he chairs, to meet since the letter appeared but opinions expressed on medical websites and in Times Online made clear that he had lost support. On Times Online there were by early yesterday afternoon 496 reponses to the letter, universally critical of Mr Johnson and Dame Carol, who is chair of the Academy of the Medical Royal Colleges. Many called on them both to resign.

The day after the letter appeared, a meeting of the Scottish hospital consultants condemned it unanimously. Other comments on the website include one from Richard Sidebottom, a junior doctor from London, who says: “I see the BMA and the royal colleges as traitors to those they should be looking after.” Others say that the letter is “arrogant, deluded and out of touch” while Chris Twine, a junior doctor from Cardiff, says the views expressed in it are “totally at variance with those of doctors dealing with the Medical Training Application Service (MTAS) in any capacity”.

What appears to have caused the greatest offence is a sentence in which Mr Johnson and Dame Carol “restate our support for the Chief Medical Officer and his role in improving junior doctors’ training”. Yesterday Mr Johnson was unrepentant over his defence of Sir Liam. “He’s a civil servant, he can’t defend himself,” Mr Johnson said. But his view of Modernising Medical Careers (MMC), Sir Liam’s creation, is not shared by the bulk of junior doctors. Nor, apparently, is it shared by Dame Carol’s successor as President of the Royal College of Physicians, Ian Gilmore, who last week wrote an open letter to Patricia Hewitt, the Health Secretary, saying that MMC needed to be reconsidered along with the failed application system.

A member of the BMA Council said yesterday: “Jim’s position became untenable when his letter to The Timeswas published. He did not consult senior BMA colleagues before sending it, and the letter caused substantial damage to the reputation of the association.”

Mr Johnson told The Times yesterday that he had planned to give up office at this year’s Annual Delegate Meeting in Torquay next month. The council will be chaired in the meantime by Sam Everingham, the deputy chairman. A new chairman will be elected at Torquay. Mr Johnson’s is the third resignation prompted by the MTAS fiasco. Previously two officials at MMC, Professor Alan Crockard and Professor Shelley Heard, resigned in protest at how, in their view, the MMC process was being subverted by efforts to repair the damage done by the computer failure. The High Court has yet to give judgment on the case brought by RemedyUK, the junior doctors’ pressure group, against MTAS. That is expected on Wednesday.

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Australia: Some attack on bloated hospital bureaucracies at last

QUEENSLAND Health does not have enough money to fund over-budget hospitals requiring key staff. Director-general Uschi Schreiber has imposed a staff freeze on districts that have blown their budgets, despite admitting the personnel were needed for "effective health service delivery". A cap has been placed on theatre-booking clerks, radiology/medical imaging clerks, ward receptionists, human resources officers and indigenous liaison officers.

Ms Schreiber has told her district health managers that the freeze would remain until the end of the financial year. In a memo obtained by The Courier-Mail, Ms Schreiber said: "I would like to bring to your attention consistently strong growth in administrative staff numbers, most notably at district level. "Whilst appropriate staffing levels for both clinical and administrative employees is a key component of effective health service delivery, this must continue to be balanced with the need for budget integrity."

The correspondence said districts, area health services and divisions would be banned from hiring any more administrators if they were above "affordable levels". She said if the extra staff was for essential, day-to-day activity, approval would have to be sought from an area general manager or an executive director.

Peter Forster's Queensland Health Systems Review, which evaluated the department in the wake of the Jayant Patel scandal, found that the department was putting budgets in front of patient care. It also revealed that the department was overburdened with bureaucrats, and recommended central office be cut to 644 positions. More than 160 had been identified as surplus.

In a statement to The Courier-Mail, Ms Schreiber's office said the 644 cap was an "annualised figure and the actual number fluctuates slightly throughout the year". There were 657.65 positions in February this year. Eleven positions were child and youth health positions "transferred to corporate office pending machinery of Government changes" and 31 were special project positions with a "set life span". "Queensland Health is actively managing administrative staff numbers and maintaining a lean corporate office," the statement said. "Administrative staff positions are established only where a strong and compelling need can be demonstrated and at the district level such positions must support clinical services. "The director-general has issued a memorandum to ensure active management of administrative staff numbers continues and appointments are linked directly in the districts to the support of clinical services, rather than an increase in bureaucratic positions."

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For greatest efficiency, lowest cost and maximum choice, ALL hospitals and health insurance schemes should be privately owned and run -- with government-paid vouchers for the very poor and minimal regulation. Both Australia and Sweden have large private sector health systems with government reimbursement for privately-provided services so can a purely private system with some level of government reimbursement or insurance for the poor be so hard to do?

For more postings from me, see TONGUE-TIED, GREENIE WATCH, POLITICAL CORRECTNESS WATCH, FOOD & HEALTH SKEPTIC, GUN WATCH, EDUCATION WATCH, AUSTRALIAN POLITICS, DISSECTING LEFTISM, IMMIGRATION WATCH and EYE ON BRITAIN. My Home Pages are here or here or here. Email me (John Ray) here. For times when blogger.com is playing up, there are mirrors of this site here and here.

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