How ‘liberating the NHS’ may damage medical training

Surgical trainee, Dave Riding, looks at the effects of Lansley's health bill and the idea of any willing provider on training and clinical excellence in the NHS

Andrew Lansley

Dave Riding is a General Surgical Trainee based in Manchester

The anxieties surrounding the escalating role of independent healthcare providers in Andrew Lansley’s ‘Liberating the NHS’ white paper are well documented. Patient groups and professional bodies alike have expressed concern at the speed and breadth of the changes, which will alter the structure of the health service for the foreseeable future.

Fears regarding the accountability and quality of these providers, and their effect on the role of the established NHS services, have been growing. However, the debate has not yet examined the potentially disastrous impact of the policy on the postgraduate training of junior doctors.

At present, NHS hospitals are the primary source of training opportunities for those doctors aiming to qualify as specialists. The hospitals have a responsibility to provide the ‘assured high quality of training, better formal supervision and continuous development of acquired competencies’ demanded by the present recruitment and training system to achieve the skills and experience required to practice independently as an NHS consultant. Lansley’s plan to outsource care to ‘any willing provider’ threatens the ability of the NHS to fulfill this responsibility.

Independent treatment centres are commercial enterprises and they will be reluctant to jeopardize their efficiency by allowing trainees to accompany their consultants into the operating theatre. A hernia repair is likely to take twice as long if the trainee is receiving instruction than if the fully-qualified surgeon is performing the operation.

In any case, junior doctors are employed by the NHS, are not insured to work anywhere else, and so have no opportunity to work in such centres. Accordingly, the young practitioner will have no access to the smaller procedures that develop the skill, experience and confidence required to perform major surgeries and to become a safe, independent practitioner.

There is a significant risk that the Tory legacy will be a generation of NHS surgeons that have had a far inferior standard of training than their predecessors, with the inevitable result that patient care is compromised.

These concerns are shared by Mr John Black, President of The Royal College of Surgeons of England, who emphasizes the need for “any willing competent provider able to achieve the highest standards of care including audit, research and training”.

Despite this, Lansley finds space for only one paragraph within his 184 page document for a comment on training within the new system, and he has yet to provide junior doctors with the reassurance that the quality of their postgraduate experience will not be tarnished.

No sensible analysis of the health service and its training systems could conclude that they are perfect, nor that the resources at its disposal are used with maximum efficiency.  However, Tory ideology is threatening to create a system where ‘any willing provider’ is able to offer diagnostic and therapeutic interventions without the same level of accountability demanded of their NHS equivalents.

The growing unease amongst health professionals betrays a fear that a lower standard of care may be the price to pay for this dogmatic privatisation. Should Lansley continue to ignore the adverse effect of his policy on the quality of surgical and medical training, then this is a certainty.

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