The Modernising Medical Careers (MMC) programme of work was established in 2003 to address difficulties in poor training and indifferent career prospects experienced by some doctors at Senior House Officer (SHO) level and by many of those in Staff Grade and Associate Specialist (SAS) posts. A new Foundation programme was introduced in 2005, the Specialty Training system was reformed and the SHO grade scrapped in 2007. As a result of inadequate preparation during the implementation of the reforms, in 2007 the MMC programme plunged into crisis. The new centralised recruitment system, the Medical Training Application Service (MTAS), proved highly unpopular with both candidates and assessors. A major inquiry, led by Sir John Tooke, examined the 2007 crisis and called both for major changes to the structure of training and for the creation of a new body, NHS Medical Education England, to oversee medical education. The Committee's investigation finds that a divided and inappropriate governance structure, flawed project and risk management and poor communication with junior doctors were the most serious failings. Co-ordination between the Department of Health and the Home Office on restricting medical migration was inadequate. These practical shortcomings were responsible for some of the direct causes of the 2007 crisis, including the defective application form and other aspects of the short-listing process, the unsafe computer system and the failure to limit the number of applications from overseas doctors. The leadership shown by the Department of Health was inadequate. The Chief Medical Officer chose not to take on a clear leadership role and thus did not accept responsibility for the 2007 crisis. The Committee makes a number of recommendations for change and improvement to achieve a more flexible training system, and calls on the Department to address policy issues relating to the wider medical workforce.