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Working Time Directive

Volume 712: debated on Monday 29 June 2009


Asked By

To ask Her Majesty’s Government what steps they will take to ensure that patient care will not suffer following the introduction of the new European Working Time Directive on 1 August.

My Lords, the NHS has made excellent progress in implementing this important health and safety legislation, which ensures that patients receive safe, high-quality care from staff who have not worked excessive hours. Only doctors in training remain to become fully compliant by 1 August and two-thirds of them are already working a 48-hour week averaged over 26 weeks. Our overriding principles are patient safety and the quality of care. This is paramount to all that we do.

My Lords, has the Minister noted the severe warnings from the president of the Royal College of Surgeons and bodies representing junior and hospital doctors who are far from pleased about the arrangements that have been made so far and who should know what they are talking about? They say that this diktat will mean surgeons not being properly trained, patient safety being severely compromised and hospitals closing. Does the Minister really think that the problem should continue to be met by junior hospital doctors being ordered by their NHS bosses to lie about the hours they work in order to keep to the restrictions? Why cannot the Government simply refuse to accept these rules or ignore them as other countries do?

My Lords, I am aware of these debates and refer to a publication from the Institute of Medicine in the US, which is the US academy. It stated that the surgery profession was concerned about the shift in work mentality, loss of professionalism and decreased access to quality surgical care; but that it was difficult to assess how much of the complaining represented rhetoric and resistance to change rather than valid criticism.

I am here to share evidence with noble Lords. The evidence is quite clear from the Institute of Medicine’s publication—the error is human. In 1999, between 44,000 and 98,000 people died in hospitals from adverse effects. The single and most important contributor is sleep deprivation and fatigue. The reduction to 48 hours a week is to enhance patient safety and, let us not forget, to enhance the social well-being of doctors, who have the highest rates of divorce, addiction and depression.

My Lords, will the Minister tell the House how many services requested derogation in January this year, and what has been set as the trigger for an extension of the numbers to request derogation for other services, given the anxiety that has been expressed by the Academy of Medical Royal Colleges?

My Lords, there have been 200 successful applications across 13 specialties, which represents about 3 per cent of all the rotas. I could write to the noble Baroness with details of which regions and what specialties. The 3 per cent is what we believe needs to be derogated by 1 August. However, if there are strains on services within a period of 26 weeks—we calculate the 48-hour week over a period of 26 weeks—the employing organisation could request further rotas to be derogated.

My Lords, I am sure that many of us in the House who have had medical training will welcome the introduction of the 48-hour week. I well remember the hours that I worked as a junior hospital doctor—they were the hardest times of my life. Will the Minister enlarge a little on what he has just said? Many hospital trusts are still not ready to introduce a 48-hour week for their junior doctors in training. Why is this so, when they have had 10 years of unprecedented increase in their funding? Will any action be taken against those managers who fail to introduce the directive?

My Lords, I am grateful to the noble Baroness for raising the issue. She is correct that we have had 10 years to get these rotas compliant. There are 200 rotas and, to be fair to the service—I am sure that the noble Baroness will agree—there are some sub-specialties for which we find it extremely difficult to make these rotas compliant: for example, transplantation in children and some neurosurgical disciplines. As a result, we have requested derogation for another few years. This is a health and safety directive, so if an organisation is not compliant, the accountable officer, who is the chief executive, will be accountable for breaking the law in relation to the 48-hour week.

My Lords, I am told that the directive was introduced in Europe at a time when impact assessment was not a part of the introduction of European legislation. However, I share the noble Lord’s concerns about its impact on the quality of training for the future generation of surgeons, which is an important issue. To address that, we need to start a dialogue not around the numbers of hours of training, but on how we can improve the quality of the hours of training. The noble Lord is well aware that some units across the country which have a dedicated curriculum may separate elective from emergency services or use simulation, all of which are training tools. Some organisations have different training cultures in addressing the quality of training. My right honourable friend the Secretary of State recently asked Medical Education England to look at the impact of the European working time directive on the quality of training.

My Lords, while the doctor’s clinical practice is obviously of great importance, also of great importance is the ability of the doctor to liaise outside the clinical practice—for example, in the social care arena. Will my noble friend assure the House that that side of the doctor’s practice will not suffer from the 48-hour directive?

My Lords, any doctor employed in the National Health Service who might provide services within an NHS provider or outside in social community services will be obliged to comply with the 48-hour working time directive.

My Lords, the Minister has concentrated on doctors and surgical consultants. What is the position for anaesthetists? I believe that the situation is likely to be fairly dangerous.

My Lords, I am grateful for the noble Lord raising that important issue. Anaesthetists should get more rest than surgeons. Some of us may enjoy the odd nap here, but it is a dangerous thing to do in an operating theatre. The answer to the question is valid: a number of rotas have been requested for derogation in anaesthesia, but we hope that within two years we will be able to resolve some of these issues.