Posts Tagged ‘Equality’

Consultant “didn’t break data protection rules”

By Francesca Robinson - 28th August 2010 8:20 am

A senior diabetes consultant who was sacked for gross misconduct after faxing patient records from her hospital to a community clinic has been exonerated by the GMC.

The South Warwickshire General Hospitals Trust (SWGHT) accused Dr Shirine Boardman of breaching patient confidentiality when she sent the names and contact details of more than 80 diabetes patients to her secretary at the Apnee Sehat NHS clinic in Leamington Spa.

Boardman’s aim was to invite the patients to a structured education programme to help them manage their diabetes. She was acting in according with NICE guidance. At the time all trusts had a statutory requirement to provide this patient education.

The award winning Apnee Sehat clinic (meaning “our health” in Punjabi) was a pilot service set up by Warwickshire Primary Care Trust to provide clinical care and help to disadvantaged members of the Asian community. Boardman led the establishment of the project in 2007 as part of her employment contract with Warwick Hospital.

But the SWGHT complained that Boardman made an unauthorised transfer of confidential data from the trust in breach of GMC guidance, the Data Protection Act and the trust’s data protection policy.

The case was sent to the Information Commissioner for an alleged criminal breach of the Data Protection Act in July 2008. Shortly afterwards Boardman was sacked. The decision was later upheld by an employment tribunal.

But the Information Commissioner dropped the case and the GMC has now scrapped a fitness to practise hearing saying that Boardman acted “solely to benefit patients”.

Dr Keith Brent, deputy chairman of the BMA’s consultants committee, said: “There seems never to have been any question that Dr Boardman was anything other than a good clinician providing good care to her patients.”

Dr Sue Roberts, former government diabetes tsar, comented: “The dismissal of Dr Boardman was fundamentally unreasonable in that it disregarded good medical practice in the treatment of diabetes.”

Boardman, who has four clinical excellence awards and has won four national awards for her work, said she had been shocked by the speed with which she had been sacked.

It has taken her two years to do the research to understand the NHS data protection laws, to obtain information from the trust through Freedom of Information requests and to get the right legal experts and witnesses to help her fight her case.

“I don’t think in medical school or specialist training anybody ever told me the kind of trouble we could get into as doctors. The minute something goes wrong it’s enormously important to get the right advice from the right people because a lot could have been done to save me before I was dismissed,” she said.

Peter Bottomley, the Conservative MP for Worthing West, has raised Boardman’s case in Parliament and is calling for the individuals at SWGHT who made the complaint to account for their actions. If this does not happen he says he will be pressing health secretary Andrew Lansley to conduct a review.

He would also like the case to be investigated by the Equalities Commission. He said: “It is now clear Dr Boardman was right and they were wrong and their allegations and smears were unjustified. In my experience no male or no white consultant has ever been treated like this.”

A trust spokesman said: “The trust’s actions were in the best interests of patients as the breach of patients’ confidential information is a serious matter and one which patients themselves also take very seriously.”

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Medical students burdened by 23 grand of debt

By Mike Broad - 12th April 2010 9:08 am

Many families have to find over £3,000 a year to fund their children through medical school, a report reveals.

The BMA research says that two thirds of medical students are now relying on parental support while they study, with the average amount being given in a year standing at £3,123. This equates to over £15,000 during the course of a five-year medical degree.

The report, which surveyed nearly 2,000 students, also finds that juniors who graduated in 2009 left medical school with an average debt of £22,851 - a fifth higher than in 2008.

The number of students entering medicine from low income groups remains poor, with just one in 20 medical students coming from the lowest two income groups.

Louise McMenemy, the BMA’s student finance lead, said: “The UK is facing a growing crisis in medical student finance that many policy makers appear unwilling to address.

“It is vital that these huge financial burdens are tackled, especially by the current higher education funding review, and not exacerbated by any further rise in tuition fees. This move would be a disaster, as we are already facing a situation where the NHS risks being denied the services of talented individuals with the ability, but not the bank balance, to get them through medical school.”

Read the full report.

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New aptitude test for medical school shows bias

By Mike Broad - 22nd February 2010 10:44 am

A new aptitude test, aimed at increasing diversity and fairness in selecting school leaver applicants for medical school, still has inherent gender and socioeconomic bias, a study finds.

The UK Clinical Aptitude Test (UKCAT) was first used in 2006 as part of the admissions process by a consortium of 23 medical and dental schools. UKCAT’s aim was to make selection to medical school fairer and more transparent. With A Level grade inflation, discriminating between large numbers of highly able applicants on their academic achievement alone has become increasingly difficult, and participation in the profession needs to be widened.

The test is an appraisal of skills such as verbal reasoning and decision analysis, and is designed to ensure that candidates have the most appropriate mental abilities, attitudes and professional behaviours to be successful in their professional careers.

To determine whether this test provides a more equitable assessment of aptitude, Professor David James and colleagues, at University of Nottingham Medical School, analysed data from the first group of applicants who sat the UKCAT in 2006 and who achieved at least three passes at A Level in their school leaving examinations.
They found a modest correlation between A Level and UKCAT scores, which confirms that the test can be used as a reasonable proxy for A Levels in the selection process.

However, the test had an inherent favourable bias to male applicants and those from a higher socioeconomic class or from independent or grammar schools.

“These findings lead us to be cautious about use of the UKCAT and the value of any one specific sub-test within an admissions policy,” conclude the authors. They also call for further research to clarify the practical value of the UKCAT in a wider range of applicants and, importantly, its predictive role in performance at medial or dental school.
In an accompanying editorial, in the BMJ, Professor David Powis, from the University of Newcastle in Australia, says that measuring cognitive ability is a step in the right direction, but it doesn’t tackle “widening participation” - the admission of people from lower socioeconomic groups or those whose education has been compromised by attending poorer schools.
And neither does UKCAT yet provide selectors with information on the non-cognitive characteristics and personal qualities that are fundamentally essential (and those that are undesirable) in the generic good doctor, he adds. This challenge remains for the future.

Read the full paper.

Read more on improving access to the profession.

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New plan to improve access to the profession

By Mike Broad - 18th January 2010 4:08 pm

Labour claims a new plan to promote social mobility will, for the first time, open up the medical profession to people from less privileged backgrounds.

In a comprehensive response to Unleashing Aspiration, the final report from the Panel on Fair Access to the Professions, the government has agreed to implement the vast majority of its 88 recommendations.

The government has promised additional support to 130,000 of the “brightest” young people from poorer backgrounds to help them secure a place at college or university.

One of the key proposals is to re-launch a forum which promotes access to the professions. The forum, chaired by minister of higher education David Lammy, will implement recommendations and ask professional organisations to report on progress.

Many of the recommendations involve improving and extending careers advice, professional placements and work experience for school children and students.

Nick Deakin, co-chair of the BMA’s medical student committee, said: “There is a great deal in this announcement which is positive, but ministers have sadly ignored the elephant in the room - tuition fees and student debt.

“A guarantee to look at how to help students from low income families at secondary school level is extremely encouraging. Research has shown that poor career advice and an absence of encouragement in the classroom are key barriers to professions like medicine. Many children in less well off areas discount medicine as a career because they regard it as a goal they can not reach. We will await the detail of these proposals with interest.”

The influential report of former health minister Alan Milburn said that careers such as medicine and law were dominated by people from affluent backgrounds.

A new Social Mobility Commission will provide expert evidence on trends and policy in social mobility and produce an annual report on progress. Professor Sir John Hills, director of the Centre for Analysis of Social Exclusion at the London School of Economics will be the chair.

In a 55-page document on social mobility, the government only mentions tuition fees once. It says it will review ‘the impact of variable tuition fees to consider a radical reshaping of the student support system’.

Deakin commented: “All the good sentiments in this announcement could be washed away if politicians decide to lift the cap on tuition fees. Just one in seven of those at medical school are from the lowest income groups, partly because of the huge debt they incur and the pressure it places on their families. Estimated debt stands at £37,000, while parents have to find £3,000 per year to support their children.

“If we are truly to get talented children enthused about medicine, we must stop pretending that financial barriers don’t exist.”

The Conservatives questioned why Labour has not done more to improve social mobility after 12 years in power.

Read a blog on the issue.

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Encouragement will widen professional access

By Liz Denny, medical student in Liverpool and the BMA's lead on accessibility - 18th December 2009 1:34 pm

There will be many of you who will approach yet another report about equality and widening access to medicine in the same way that I approach the Peter Andre and Katie Price circus.

I don’t understand it, I don’t care about it and frankly I wouldn’t be that fussed if a gigantic foot dropped down on top of it.

I sympathise with this reaction as in recent months we have been deluged with reports, pronouncements and initiatives on this topic, not least from Alan Milburn’s summer report on widening access to the professions. Unfortunately much of this has been wrapped in the overbearing language of political correctness which makes you want to pull your hair out.

But, buried beneath this mountain of political spin lies a couple of serious points. It is true, as the BMA’s new report into the make up of medical school demonstrates, that as a profession we have an appalling track record of recruiting students from low income backgrounds.

Just one in seven medical students comes from this group, despite the government pouring £392 million into widening participation schemes in recent years. The glut of spending has resulted in an increase from the lowest groups of just 1.7% since 2003. Not exactly time for the party hats and the cava.

I imagine though that many of you again would have been left unmoved by this last paragraph, possibly because you suspect that what is coming next is a call for positive discrimination. Certainly our report suggests this view is filtering through to students, with a rising rate of applicants refusing to answer questions about their social status, possibly due to a fear they could end up being penalised if they are judged to be too wealthy.

Well, this isn’t what the BMA or I believe in. Positive discrimination is as unfair as it sounds - there is nothing positive about discriminating against anyone.

What instead needs to happen is for us to remove the barriers holding back low income students. Many of these lie at school level, well before application forms are even filled in.

Pupils from low income areas receive worse grades than their counterparts in more affluent districts and, perhaps linked to this fact, many automatically think a career in medicine isn’t for them. Another issue may lie in the career advice students get, as there is evidence of an inconsistency in the quality of these services.

Certainly, in my own experience, I didn’t feel I got much encouragement to go for medicine despite my grades. There of course other barriers, not least the increasing cost of a medical degree which all politicians appear to have genetic pre-disposition to ignore - despite medical students now facing a £37,000 debt bill after graduation.

To tackle these problems we don’t need phony positive discrimination schemes. We need to look at the school system and how it interacts with medical schools, especially in terms of career advice services. We need no more increases in tuition fees and someone in Whitehall to wake up to the debt problem that threatens to bury the ambitions of thousands of students with the brains but not the wallet to get into medical school. And we also need a proactive set of mentoring schemes - an area the BMA is looking to work on - aimed at raising the sights of children so that they believe a career in medicine is within their reach.

Tackling the under representation of low income students is therefore not a flag to be raised in the cause of political correctness. It is about something more real, more practical and more important - making sure we get the best talent into our hospitals and that everyone gets the chance to fulfil their potential.

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“Only the wealthy can enter the profession”

By Mike Broad - 16th December 2009 2:25 pm

Medicine continues to be a closed shop to students from low income families, a BMA report finds.

The study, called Equality and diversity in UK medical schools, reveals that only one in seven successful applicants are from the lowest economic groups, despite them making up nearly half of the UK population.

In the past five years, there has been an increase of just 1.7% in students coming from low income backgrounds, despite £392 million being poured into widening access schemes across the higher education system since 2001.

Professor Bhupinder Sandhu, chair of the BMA’s equal opportunity committee, said: “Medical schools are still not recruiting enough students from low income backgrounds. There is evidence of a drastic gap in acceptance rates. Fifty eight per cent of applicants from the top socio-economic group obtained a place at medical school, but only 39% of applicants from the lowest group were successful - a gap of 19%.

“A combination of complex problems lies at the heart of this failure. There are clear underlying issues within education at school level, not just in the poor academic performance amongst low income students, but also in low aspirations, with many seemingly feeling a career in medicine is simply unattainable.”

The report finds, however, that medicine does attract a higher proportion of ethnic minority students when compared to the general university population, although there are large differences in acceptance rates between different ethnic groups. And women made up 56% of all accepted applicants to UK medical schools.

The study analysed the latest figures from 2008 on successful applications to UK medical schools from the Universities and Colleges Admissions Service.

Dr Vivienne Nathanson, head of science and ethics at the BMA, is concerned that lower income applicants could be further deterred by mounting levels of student debt, which are set to hit £37,000 for medical students.

She said: “The chancellor’s recent announcement of a scheme aimed at helping low income students gain exposure of medicine may help to address the fact that many do not feel a medical career is a possible career option.

“But this will not in itself solve this problem. The government must look at the cost of the medical degree and how we address the failings in our school system.”

Read the full report.

Read a blog on the issue.

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“Male doctors deserve to earn more”

By Francesca Robinson - 8th December 2009 6:50 pm

Male doctors should earn more than their female colleagues because they are more productive, claims a prominent health economist.

Professor Alan Maynard of York University said on average male consultants manage 10 to 15% more patients than their female counterparts.

The figures come from an analysis of consultants’ activity rates published last year.

He jokes that women see less patients because they spend more time listening to them - unlike their male counterparts: “Thus female consultants may process fewer patients but perhaps their diagnostic skills are superior and this may produce better outcomes for patients.”

Maynard’s comments are dismissed as “completely unhelpful” by Dr Helen Goodyear, a consultant paediatrician at Heartlands Hospital in Birmingham and president of the Medical Women’s Federation.

They follow a BMA report which reveals that men, on average, earn £15,000 a year more than women in medicine.

“There is no evidence for Professor Maynard’s comments. They come from one flawed study which had a number of misconceptions in it,” said Goodyear.

Women often earn less than men because they are not as forceful in their contract negotiations, she explained. “If a woman gets paid for seven sessions she will often actually do nine or ten. If a woman is on a full-time contract of 10 programmed activities her male counterpart will often be on 13 because they are not so shy in coming forward.”

If her pay was linked to productivity, Goodyear said her salary would immediately double.

The solution is for women to take more of the top leadership posts in the profession. “Women need more encouragement and mentorship to take on these roles. We need to do away with the old boys’ network where leaders who are stepping down nominate the next leader, as still happens in quite a number of posts within medicine,” said Goodyear.

But she said there is still a long way to go: “Although more women are coming in at the bottom in medicine, it is going to take at least 20 years for them to reach the top and to change the culture.”

A BMA spokesperson said there was no justification for a pay gap in the NHS of 2009. “Women doctors undertake the same training and perform the same tasks as their male counterparts - and should also receive the same level of pay.”

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“Hostile culture” creates gender pay gap

By Mike Broad - 11th November 2009 3:33 pm

Men are paid over £15,000 more than their female counterparts in medicine in the UK, a report reveals.

The research, by the BMA, shows that the gender pay gap widens as women’s careers progress.

Some of this pay gap can be explained by career factors, such as female doctors taking career breaks or maternity leave and men dominating the senior roles in the profession.

However, there is still an unexplained discrepancy of £5,500 between male and female consultants, and a £2,000 gap among juniors.

The report’s authors attribute this to discrimination and claim women face a “hostile culture” in medicine.

Dr Helen Goodyear, a consultant paediatrician at Heartlands hospital in Birmingham and president of the Medical Women’s Federation, said: “It’s endemic in the NHS - women not being paid the same as similarly experienced, similarly talented male counterparts.”

The report suggests that women with families are often at a disadvantage when applying for new positions or negotiating for pay because they often cannot offer to move jobs owing to their family commitments.

There is also evidence from the research that employers are unsympathetic to the pressures from family life, especially those relating to time off.

And the report suggests that NHS trusts are also not enforcing equal pay regimes at a local level.

A spokesperson for the BMA said: “A worrying pay gap continues to exist between men and women in UK medicine today. Some of this pay gap can be explained by the fairly recent influx of large numbers of women into the medical workforce and that many have not yet reached the higher levels of the career ladder.

“Despite this, there is evidence of discrimination, especially in the continued failure of the NHS to provide adequate support to women with families. In particular, women with children often have limited room for manoeuvre when trying to negotiate new positions or pay levels because they have a settled family and are unlikely to be able to move jobs or change their working patterns. This restricts their ability to get a fair deal and leaves them at a significant disadvantage to men who often do not have the same constraints.”

The study examined the pay of 1,015 doctors working for the NHS, private healthcare providers and in academia, and was funded by the BMA, Medical Women’s Federation, the Higher Education Funding Council for England and Imperial College London.

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Us women have nothing to lose but our guilt

By Katherine Teale - 19th October 2009 10:43 am

I am sitting in Costa enjoying a quick cappuccino and doing what I do best - feeling guilty. I’m feeling guilty because it’s 4pm on a workday and I’m not at work. And I’m feeling guilty because I’m not with my daughter.

The fact is that being a female doctor is all about feeling guilty. Apparently we’re a ‘demographic time bomb’ because we all want to go part-time, added to which we don’t go into clinical leadership roles, and we reduce the standing of the profession. If I find this all a bit hard to take, it’s some consolation to know that I’m not alone (although that’s part of the problem, obviously) - medicine is now full of guilt-ridden women. 

Medical school intake is now 56% female, up from 24% in 1961. We were discussing this during my orthopaedic list this week (percentage of female surgeons in theatre 0%). I have to admit it doesn’t seem obvious to me why I should be responsible for reducing the status of medicine more than, say, Harold Shipman.

In my experience, medicine has become a much pleasanter profession to work in as the proportion of women has increased. When I started anaesthetics, in 1988, only two of the 12 trainees were female. In theatres, there were separate changing rooms for the female and male theatre staff, a palatially proportioned facility for the male doctors, but no changing room at all for the women doctors. 

The two of us had to use the cleaners’ changing room, which was the size of a small cupboard. Now, trusts are even having to provide special rooms for female doctors to express breast milk!

As to being part-time, I have to confess that when I first came back from maternity leave I worked a three-day week. But over the years it’s gradually crept back up to full time, mainly because of my pathetic inability to say “no”. I would be the first to admit there is a problem with part-time work and it’s this: once you’ve experienced life with less work, it becomes addictive. The less you do, the less you want to do.

Where once the odd half day off seemed like an unimaginable luxury, soon a four day week becomes an intolerable imposition on your time, and three days a week is only barely acceptable. I think the best arrangement would be to work just sufficient hours to break up the routine of lunches, tennis matches, manicures and whatever else non-working mothers fill their day with - perhaps about 15 hours a week.

Surely it’s not beyond the wit of the manpower (womanpower?) planners to factor all this in. We would still earn more than most of the population, and with current levels of unemployment the more jobs there are to go round the better.

So male doctors are going to find themselves in the minority - the good news for them is that there will always be plenty of jobs available in the fields to which they are perhaps more naturally suited (plumbing, car maintenance, etc).

Meanwhile, I’m going to stop feeling guilty every time I steal half an hour for myself, practise saying “no” when the trust piles on more work, and dream about the day when the poor old men have to get changed in the cleaning cupboard.

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Breaking down the barriers to female medical leadership

By Mike Broad - 16th October 2009 6:12 pm

A new report, called Women Doctors: Making a Difference, identifies the barriers preventing female doctors from reaching senior positions and sets out how to address them.

It’s been produced by the National Working Group on Women in Medicine, which was set up in the wake of the Chief Medical Officer’s annual report in 2006. Sir Liam Donaldson’s report identified a shortage of women in leadership roles in the medical profession despite outnumbering men as medical undergraduates.

Donaldson expressed support for the report’s recommendations and said the Department of Health would consider each of them. Here’s a summary of the key recommendations:

1. Improve access to mentoring and career advice

In the next round of contract negotiation there should be an explicit facility for appropriately trained and skilled doctors (usually consultants) to undertake mentoring or career counselling as a programmed activity within their job plan.

To facilitate accessing mentoring or career management support, the future commissioners of medical education should maintain a register of all doctors who are skilled and are willing to undertake these tasks and make it more accessible to other doctors.

2. Encouraging women in leadership

Appointments to NHS, academic and clinical committees and boards should be advertised widely and have a transparent and democratic process rather than simply an appointment by nomination.

Committees should be encouraged to develop their ways of working to enable greater participation by doctors who are parents or carers.

There should be increased access for women to the committees and boards of major medical institutions, including the medical schools, postgraduate deaneries, medical royal colleges, NHS trusts and other NHS bodies. The Equality and Human Rights Commission should consider auditing the appointments process for all such posts.

3. Improve access to part-time working and flexible training

The postgraduate deaneries should maintain a list of doctors wishing to train part time in a slot‑share arrangement.

NHS Employers should develop guidance for meeting the costs of continuing professional development, including for those who are working less than full time.

The development of credentialling should be expedited, and there should be full recognition by the medical Royal Colleges that time alone does not indicate competence to practise independently.

The aspirational quota for part-time training should be abandoned in favour of a needs-assessed availability by strategic health authorities (SHAs). The newly formed Centre for Workforce Intelligence should be commissioned by each SHA to provide this needs assessment on a regional basis, and provision should be made to meet it.

4. Ensure that the arrangements for revalidation are clear and explicit

The GMC and the appropriate medical royal colleges should ensure that they have a clear set of re-licensing and recertification standards and assessment processes in place for doctors who have taken time out of training or the profession to return to work.

Responsible officers should coordinate refresher training for those who have taken time out of training to meet these standards. There should be funding for this within the NHS budget.

Trusts should offer ‘back-to-work’ and ‘taster’ sessions where those who have taken a career break can shadow working doctors to re-familiarise the doctor with procedures and work patterns, so that they are confident on return.

5. Women should be encouraged to apply for the Clinical Excellence Awards

The Advisory Committee for Clinical Excellence Awards (ACCEA) should provide greater feedback to applicants and advice as to where additional development might be necessary, and develop a network of mentors.

Selection panels should be gender balanced wherever possible; due consideration should be given to part time applicants, and ACCEA’s processes should be monitored for gender equality.

6. Ensure that the medical workforce planning apparatus takes account of the increasing number of women in the medical profession

NHS Medical Education England (NHS MEE) and the Centre for Workforce Intelligence should ensure that workforce models for the future clearly delineate the effect of a rising number of women in the workforce so that appropriate advice for the workforce planning apparatus can be given.

7. Improve access to childcare

The Conference of Postgraduate Medical Deans and the Department of Health should consider whether the model such as that in place in the North Western Deanery, which commissions a lead employer for all specialty trainees in the deanery, would be a practical and desirable model in the new education commissioner/provider landscape. The additional benefit of better facilitating access to government assistance for maternity benefits and childcare of this model is clear.

Postgraduate deaneries or their lead employers should plan ahead for the childcare needs of their trainees and facilitate arrangements between a trainee and the trusts during their rotation for access to childcare provision.

Trusts should appoint a childcare coordinator within their human resources department if they have not yet done so. Childcare coordinators should develop internet resources to act as both an information resource and message boards on local childcare options, including emergency cover.

Hospital-based childcare should move to extended opening hours.

The DoH should explore the costs and benefits of doctors who are parents paying for full-time or part-time childcare as a value-for-money solution for enabling doctors to progress their careers. On the basis of this analysis the DoH should submit a case to the Treasury to allow doctors to pay for childcare from their gross earnings. In addition, it should establish whether any central funding might be available for childcare assistance.

8. Improve support for carers

All postgraduate deaneries or their nominated lead employers and NHS trusts should have a lead person responsible for supporting carers.

9. Strenuous efforts should be made to ensure that these recommendations are enacted through the identification of champions

Trusts should identify a non-executive director to have responsibility at a local level for improving working patterns, giving advice and handling complaints. The director should work closely with a lead consultant for workforce planning.

Read the full report.

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