MMC: “giving cholera to cure dysentery”

Abstract

“The reputations of both the Department of Health and the leaders of the profession were severely diminished by the events of 2007”. So concluded the UK House of Commons Health Committee's inquiry into Modernising Medical Careers (MMC). The universal judgment is that MMC was an unmitigated disaster. But it is worse than that. MMC signified a critical breach of trust between the medical profession and the Government.There is no agreement about why MMC failed. Mission creep? Complexity? Overambition? Fundamental flaws? Weak project management? Lack of clear lines of accountability? Postgraduate deaneries that elevated incompetence to a new art form? What is clear is that the MMC team was not up to the task. Reading through two volumes of evidence, there is a perversely inhuman quality to the excuses offered by the main parties—the MMC Strategy Group, MMC Advisory Board, and MMC England Programme Board. Young trainees were treated like expendable widgets in a bureaucratic machine, not cherished professionals in a caring health service. Many of those responsible for MMC still fail to appreciate the human damage caused by their “inept” decision making. Several organisations—in particular, the Postgraduate Medical Education and Training Board and the deaneries—continue to display an extraordinary and inexplicable self-delusion about their own responsibilities for a debacle that has destroyed morale among a generation of doctors.Especially damaging has been the harm caused to academic medicine, the engine that drives quality improvement and innovation throughout the NHS. The collective wounds to medical training make the creation of a new independent body—NHS Medical Education England, as proposed in John Tooke's Aspiring to Excellence—an urgent priority. The Health Committee has made a surprising error by calling Tooke's proposal “a step too far”. Only by separating medical education from Government will public trust in medical training be restored and professional morale strengthened.The Health Committee poses an additional important and troubling challenge. The medical profession repeatedly declared a lack of confidence in MMC during its planning and implementation. But professional leaders themselves lacked the confidence to say so decisively and publicly. The Royal Colleges are immensely valuable assets to the NHS, but they need to reflect carefully about their purpose, voice, and unity. It is on these questions of professional leadership that the future quality of patient care in the NHS depends. “The reputations of both the Department of Health and the leaders of the profession were severely diminished by the events of 2007”. So concluded the UK House of Commons Health Committee's inquiry into Modernising Medical Careers (MMC). The universal judgment is that MMC was an unmitigated disaster. But it is worse than that. MMC signified a critical breach of trust between the medical profession and the Government. There is no agreement about why MMC failed. Mission creep? Complexity? Overambition? Fundamental flaws? Weak project management? Lack of clear lines of accountability? Postgraduate deaneries that elevated incompetence to a new art form? What is clear is that the MMC team was not up to the task. Reading through two volumes of evidence, there is a perversely inhuman quality to the excuses offered by the main parties—the MMC Strategy Group, MMC Advisory Board, and MMC England Programme Board. Young trainees were treated like expendable widgets in a bureaucratic machine, not cherished professionals in a caring health service. Many of those responsible for MMC still fail to appreciate the human damage caused by their “inept” decision making. Several organisations—in particular, the Postgraduate Medical Education and Training Board and the deaneries—continue to display an extraordinary and inexplicable self-delusion about their own responsibilities for a debacle that has destroyed morale among a generation of doctors. Especially damaging has been the harm caused to academic medicine, the engine that drives quality improvement and innovation throughout the NHS. The collective wounds to medical training make the creation of a new independent body—NHS Medical Education England, as proposed in John Tooke's Aspiring to Excellence—an urgent priority. The Health Committee has made a surprising error by calling Tooke's proposal “a step too far”. Only by separating medical education from Government will public trust in medical training be restored and professional morale strengthened. The Health Committee poses an additional important and troubling challenge. The medical profession repeatedly declared a lack of confidence in MMC during its planning and implementation. But professional leaders themselves lacked the confidence to say so decisively and publicly. The Royal Colleges are immensely valuable assets to the NHS, but they need to reflect carefully about their purpose, voice, and unity. It is on these questions of professional leadership that the future quality of patient care in the NHS depends.