Medical Education must be accessible to all who are suitable to become doctors

For too long training to be a doctor has been the preserve of those from more affluent backgrounds with a more privileged schooling, more likely to achieve the A level grades required, write a good personal statement, have access to relevant work experience or internships, to perform well at interview and to receive financial support from their families. This has meant that doctors are not representative of society and are often ill equipped to appreciate cultural differences.

Good A level grades, personal statements written with intensive support and a slick interview technique do not necessarily predict who will become a good doctor and serve their patients well.

Fear of the debt incurred while training to be a doctor is a huge disincentive to application and once qualified may send some doctors into the arms of the private sector, robbing the NHS of valuable workforce.

Many young people who would make excellent doctors are excluded from medical education due to discrimination.

The Race Inequalities Commission in Tower Hamlets has shown that even in areas, such as Inner London, where comprehensive education is good and less privileged students achieve high grades at A level, they are far less likely to be able to progress to higher education and beyond.

https://www.towerhamlets.gov.uk/lgnl/community_and_living/Inequality-Commission/Black-Asian-and-Minority-Ethnic-Inequalities-Commission.aspx

Racism is a well evidenced source of discrimination against entry to medical school. https://www.bmj.com/content/317/7166/1111

Covid has shown how understaffed the NHS is with respect not just to doctors but to nurses and all health professionals. Workforce planning is too interlinked with the short-term electoral cycle and does not meet the needs of the NHS and the patients it serves.

Governments try to cut costs by creating lesser paid workforces such as Physicians Associates, or diverting patients to existing health professionals who are not trained to deal with their problems, such as pharmacists and paramedics. Alternatively, they propose medical apprenticeship schemes for which the funding is unclear and which could lead to a hierarchy of medical degrees with these “second class” doctors sent to under-doctored areas and unable to get onto the more prestigious post graduate rotations, perpetuating inequality.

UK Government cuts the costs of training by poaching health professionals trained in other countries. We are in support of opportunities to work abroad and the sharing of ideas and cultures enriches us but this exodus poses a particular problem for the third world who lose very valuable personnel.

Training of health professionals is too segregated into unhelpful silos. Many tasks are carried out across professional boundaries.

Medical schools are vastly oversubscribed, there is plenty of opportunity to train more doctors.

Doctors in Unite demand:

Free medical education with the abolition of tuition fees and proper cost of living grants to allow young people from all backgrounds to access places at medical school.

Racism in the selection process is particularly pernicious and must be robustly challenged.

Pre-clinical courses should be set up which act as a gateway to young people from less privileged backgrounds into medical school.

Medical Apprenticeships could be an entry point to traditional medical education for young people from less privileged backgrounds in a similar way to pre-clinical courses, but must not be allowed to perpetuate inequality and lead to a tier of “second class doctors.”

There must be proper, long term workforce planning removed from the short termism of the electoral cycle. An independent commission should be set up which looks at need across the country and sufficient numbers of health care professionals must be trained.

Health professionals from abroad are welcome but there must be recompense to their countries of origin.

Barriers between professions should be flexible giving Physicians Associates, nurses, paramedics and pharmacists an entry into medical education to train to be doctors should they so wish.

We support graduate level entry into medical school, especially as this may allow young people who did not acquire the necessary A level grades to access straight from school. We acknowledge that funding would be an issue for many young people under the current system and would support the introduction of bursaries for this level of entry.

There should be core joint education with multidisciplinary training where appropriate to share skills, break down barriers and encourage teamwork.  

Decisions on access to medical school must involve some democratic, community input to ensure that doctors represent the communities that they will serve.

unite legal support

In terms of legal representation, DiU members receive this in the same way as all other Unite the Union members do for employment related matters (this includes members employed by GP’s practices). A DiU member should inform their Unite District or Regional Office via their workplace representative, where they have one, to follow the process of applying for legal assistance for an employment related matter.  There is a form to complete and the relevant information and evidence would need to submitted to allow us to assess what sort of legal advice is necessary. 

Legal advice does not necessary mean representation and there needs to be an assessment of this to determine if the union will provide legal representation at an employment tribunal, so the correct deadlines need to be adhered to.  In some cases there may not be a Unite representative in the workplace though, so support would be provided by the appropriate Regional Officer or Accredited Workplace companion.

Members should approach their Regional or District Officer if they have an employment or profession related issue which may require legal advice and the Regional Officer will be able to advise on the appropriate course of action. Individual circumstances will determine when legal advice is necessary, but as a trade union, our emphasis is to resolve matters in the workplace rather than through the courts, though we know sometimes this is necessary. 

There is a qualifying period for Unite members to receive legal support for employment related matters, this is usually 30 days of membership and the matter should not predate membership. In addition, we provide support to members that face industrial and occupational injury at work.  This is available to DIU and Unite the Union members from day one of membership and related to accidents at work or away from work. 

For more information contact your Regional or District office on call the legal support helpline on 0800 709 007 or check out the website. For non-employment related matters (including non-employment related issues concerned with HEE and the BMA), Unite has a 24 hour legal helpline  0800 709 007 to support member on any non-employment matter. Through our legal services package, Unite members are entitled to free initial legal advice on any matter which is non-work related from a Unite solicitor. This service entitles you to receive a 30-minute phone consultation with a solicitor, free of charge.   Do check out the for 24 hour non employment legal services website for this.  As DiU is part of Unite the Union, members are already part of a trade union.

A Letter from Gaza: “This Must End”

Dr. Yasser Abu Jamei is a psychiatrist living and working in Gaza, and is Director of the Gaza Community Mental Health Programme, a leading mental health provider in Palestine. He was the keynote speaker at our AGM on 7th February this year. He wrote this letter on 13 May 2021.

“I am writing this letter looking at my terrified 6-year old son, who keeps putting his hands over his ears trying block the sounds of Israel’s bombardment, my two daughters, aged 13 and 10, and my wife. These faces show the anxiety of not knowing where they can be safe now. My two older sons, 16 and 15, sit stunned and silent and I know they are reliving the memories of the previous three offensives on Gaza Strip and the family members we lost. These are the feelings that every family in the Gaza Strip are living through.

We Palestinians have lived decades of humiliation, injustices, and maltreatment. In 1948, we were expelled from our land; over 600 villages were fully destroyed, hundreds of thousands of us were killed or uprooted. Nearly eight hundred thousand ended up living as refugees in different places around the globe.

This happened under the eyes of the International Community, who have promised us a sovereign State over about one fifth of our original homeland. That decision was only accepted in the 1990s by Palestinians believing in a two-state solution.

Twenty-six years later, we look at the conditions in the promised State of Palestine and we see a West Bank divided and occupied by hundreds of thousands of settlers living in settlements built on the rubble of Palestinian homes, and who are making the lives of the Palestinian people living hell.

We see the Gaza Strip under blockade for more than 14 years, leaving us deprived of basic living conditions. Not only that, but having suffered three large offensives in this small area which killed, destroyed and traumatized thousands of our people.

And we see East Jerusalem, with its holiest sites for Muslims and Christians alike continuing to be under constant threat as settlers take over Palestinian homes and neighborhoods.

A week ago, Israeli settlers started to attack Sheikh Jarrah trying to seize more homes of Palestinian families. Everyone saw it. No one intervened.

In one of the holiest Ramadan evenings, Israel decided to evict tens of thousands of worshipers who were just praying at Al-Aqsa. These were mostly Palestinians who live in Palestine ‘48 – now Israel. Everyone saw the brutal use of military power by Israel. No one intervened.

The violent scenes in Sheikh Jarrah and the Al-Aqsa compound have lit a fire in Palestinian hearts not only in historic Palestine, but also everywhere in the world.

While we demonstrated in Akka, Jafa, Nazareth and the West Bank, rockets were fired from Gaza demanding an end to the atrocities in Jerusalem.

The Israeli army response was to attack Gaza with even more violence than in the terrible days of previous offensives. This time causing the deaths of more than 80 people including 17 children and 7 women. Bombardments hit tower blocks, apartments, governmental and police buildings and even whole streets. Everyone is seeing it. No one intervenes.

How long will the world just sit idly by while we here in Gaza suffer like this? The people of Gaza need more than just statements and resolutions, while Israel receives the arms which are killing and terrorizing us.

I am a father first and a psychiatrist second. My dream is for my children to live, to grow, to learn, in safety. This is the same dream as that of every one of the clients I see. There will be more of them today, and tomorrow. It is my job to give hope. I will tell them what I tell my children and my wife: “Because this injustice for Palestinians has gone on for seven decades, that does not make it normal. The world is increasingly full of people who do not accept it is normal. There will be change.”

Concrete political action is needed NOW to end not only the current deathly bombing raids, but also this illegal occupation and siege of Gaza by Israel, immediately.

Our current living conditions under the siege are an affront to human dignity. I tell my children and my clients, “We Palestinians have the right to live as any other people in the world: to live in peace, in dignity and to enjoy our rights. It will come.”

The International Community MUST NOW fulfil its promise of a sovereign Palestinian state. Respect for international law demands every civilized country must recognize the State of Palestine now.

After more than seven decades now of occupation and misery, we remain resilient and will never give up. But there is no father who can bear to see his children live like this.”

Integrated Care Systems threaten patient care, jobs, pay, working conditions and the integrity of the NHS as a public service. we oppose them.

Resolution on ICSs 9 May 2020

Doctors in Unite notes:

  • While attention is focused on Covid, the NHS in England is being rapidly reorganised into 42 regional Integrated Care Systems (ICSs). This will strengthen the role of private companies, including US health insurance corporations, in clinical services and management of the NHS. ICSs will mean more private contracts, more down-skilling and outsourcing of NHS jobs, reduced services and significant spending cuts.
  • The Government plans new legislation to turn ICSs into legal bodies. Their February 2021 White Paper “Integration and Innovation” is based on NHS England proposals, derived from a US model which aims to spend less on care.
  • ICSs will have fixed annual budgets based on area-wide targets, rather than providing the care needed by the individuals who live there.
  • NHS England has accredited 83 corporations and businesses, including 22 from the US, to help develop ICSs. The White Paper will allow private companies to sit on both tiers of the ICS Board: an NHS body including representation from a local authority and open to unspecified others, and a Health and Care Partnership including independent sector partners and social care providers.
  • ICSs will sideline local authorities, threatening the future integrity of social care and reducing local accountability to elected Councillors, let alone patients and NHS staff.
  • NHS providers will be bound to a plan written by the ICS Board and to financial controls linked to that plan.
  • Procurement will be streamlined, eliminating safeguards for compliance with environmental, social and labour laws and the ability to reject bidders with poor track records.
  • The White Paper proposes that unspecified NHS roles currently covered by professional regulation could be deregulated in future due to changing technology.
  • NHS England proposes agile and flexible working with staff deployed at different sites and organisations across and beyond the system.
  • NHS England calls for most NHS funding to be delivered through a fixed block payment, based on the costs of the ICS system plan, whose value is determined locally. Local funding levels could threaten national agreements on wages, terms and conditions. Local pay could lead staff to leave areas where funding is cut, further reducing care.

Doctors in Unite believes:

  • Integrated Care Systems threaten patient care, jobs, pay, working conditions and the integrity of the NHS as a public service. We oppose them.
  • After 30 years of marketisation, it is time to restore the NHS to a fully accountable, publicly run service, free to all at the point of use. As unanimously adopted at Labour Party Conference in 2017, full scale repeal of the 2012 Health & Social Care Act and new legislation for a universal, comprehensive and publicly provided NHS are required.
  • We need a separate, collaborative, publicly funded Social Care Service.
  • Genuine integration based on the wider determinants of health, such as housing, involves more input from local authorities not less.

Doctors in Unite resolves:

  • To immediately report these threats to the NHS and social care, to appropriate Union structures and to find out what action the Union is taking.
  • To press the Union to take urgent action, including using its influence with other unions, the Government and opposition parties, based on the following demands:
  1. An immediate halt to the rollout of ICSs,
  2. An extended and meaningful consultation with the public and Parliament to decide how health and social care services are provided in England.
  3. The introduction of legislation to bring about a universal, comprehensive and publicly provided NHS, free at the point of use and fit for the 21st century.
  4. New technology must be used to improve patient care, not to deskill or replace or performance manage staff, or to deprive patients of face-to-face interaction with clinicians and other care staff that they may want or need.

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