Tuesday, June 26, 2007

European Working Time Directive

Dr Crippen, the NHS Blog Doctor, has written this last weekend what has proven to be a controversial post, about doctors working hours, in response to a BBC report on a doctor “complaining” about long working hours. Dr Crippen has many good points to make but I tend to agree with Dr Rant´s commentary on his post.

As the debate evolved over the weekend, and of which I was unaware, I was drafting this post on the European Working Time Directive as it impacts on National Health Service employees and the proposed health service reforms in our local area.

The European Working Time Directive (EWTD) specifies how much time an employee can work. It is, to my mind, a good idea. In the developed world we accept the 40 hour working week as standard with some overtime, on occasion or even regularly.

I will not discuss nurses, midwives or other healthcare workers here … but I will discuss doctors.

There are many issues here, including:

a) our NHS has traditionally been under-funded and/or under-staffed resulting in high numbers of junior doctors having to work long hours;

b) at the same time these junior doctors are expected to undertake training during these hours.

c) doctor health and safety.

d) patient health and safety

When the EWTD, and its amendments for the medical professions were passed, junior doctors had their workload reduced to 56 hours per week by August 2007 and 48 hours in 2009. However, …

Fearing impacts on staffing levels that such cuts in hours might cause in the NHS, the government insisted that Junior Doctors could opt out of this on an individual basis. At an EU Council of Employment Ministers in November 2006 Spain, France, Italy and Cyprus wanted a deadline to be established to end this opt-out clause. The U.K. government objected. And a stalemate continues.

The Deanery of … has estimated that for 15 sites providing neonatal, children´s and obstetric services an additional 224 junior doctors – based on the EWTD requirements of 2004. That translates into 52 extra junior doctors under the first four options of the Making it Better plan, included in the plan´s Financial Assessment. I do note that Rochdale council`s consultant has not given us estimated doctor shortfalls for the “Do Nothing” option.

First some comments to the doctors …

You may be the only people to cut people open, administer otherwise life-threatening drugs but at clinically useful dosages … but you are not the only people to put themselves and the public at risk, whom I and you depend on to provide safe services - God Forbid if the hospital´s electrical sub-station failed - and who often have been or are required to put themselves or the public at risk through working long, albeit possibly illegal, hours.

Second some comments to the Health Secretary …

Our Rochdale report correctly highlights the error of basing training requirements on the volume-outcomes measure. Dr John wrongly equates hours worked with patient outcomes … but what else does he use? Volume by hospital outcomes or volume by physician outcomes - in the light of the paucity of research into the latter? Methinks the DoH needs to commission some serious research into the latter.

Make EWTD predictions for 2009.

And … given your predicted shortfalls of junior doctors, isn´t it about time you got MTAS/MMC right?

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