The cuts in funding for junior doctors' pay and study leave were very bad management and smacked of panic measures when they were announced half-way through the financial year.
The cuts left our trust with a significantly increased overspend, as well as the cancellation of all training study leave and all payments for travel for juniors. Our trust and our juniors debated these issues extensively with the deanery and the strategic health authority before involving local MPs and finally the media, as a very last resort.
These cuts demoralised the juniors and reduced their confidence in the deaneries and the NHS to provide proper training for them as they developed towards being consultants and GPs. The cut in study leave, for example, meant juniors could not go on advanced trauma life support.courses, essential to enable them to deal with trauma calls.
To find that the NHS had a.£500 million positive balance at the end of the year made a mockery of these cuts. Was it worthwhile alienating most junior doctors in England to meet Patricia Hewitt's promise to balance the NHS books for 2007-08?
Then came the introduction of the medical training application service. I fought this through every due process from 19 September 2006, and by December 2006 had to admit defeat and prepare my junior and senior colleagues for disaster, crossing my fingers that disaster would not happen. The disaster hit on 26 February. Again I involved local MPs well before going to the media.
I also fought for months on the patient safety issues around the national IT programme.care records system, taking matters right up to Whitehall before turning to the media.
We are meant to have an open culture for whistle-blowing on imminent disasters. This process does not seem to operate above local trust level. Our trust management has always taken seriously what I have had to say, listened and taken action.
Higher up above the trust, the attitude to my raising concerns seems mainly to have been a pretence of listening, no understanding and a denial of impending problems. Even now, the Department of Health.seems to be reacting as if the failures of MTAS are a minor set of ripples in a teacup, not a major disaster that will sap the enthusiasm of a generation of doctors, as well as put patients at risk.
Doctors are professional and do not rush to the media. The number of doctors breaking ranks from loyalty to the NHS and the profession to speak out in the media is a sure sign of major problems in the philosophy and implementation of central management in the NHS. [NHS chief executive David].Nicholson would do well to consider this to be an early warning of issues that could be deeply damaging to the NHS, and take steps to ensure that sober, prudent professionals are heard and understood, before they feel that they have to turn to Joe Public for support through the media.
Dr Gordon Caldwell is a consultant physician at Worthing Hospital.