To ask Her Majesty’s Government what action they are taking to minimise junior doctor staffing gaps on hospital rotas.

There are more doctors working in the NHS now than there have ever been in its history, and there are 49,000 junior doctors in training. Clearly, it is the job of trusts and clinical leadership to ensure that they are designing appropriate staff service rotas in accordance with the working time regulations and to ensure patient safety at all times, including cover for the inevitable gaps created by things such as annual leave, maternity leave and out-of-hours training programmes.

I thank the Minister for that reply. Does she recognise the results from the BMA survey which show that four in 10 doctors in training are working in understaffed rotas? In accident and emergency that figure is worse at one in six. I declare an interest as my daughter is one of those trainees. More than half of junior doctors reported pressure to work additional, unrecorded hours. They have to toss up between working more than their regulated hours and leaving patients, and they opt to stay with their sick patients. Does she also recognise the need for those trusts that secure derogation from the European working time directive to plan now to be compliant because that derogation period will run out?

My Lords, the survey by the BMA, which supports the implementation of the working time directive, is to be welcomed as a snapshot of the views of a relatively small self-selected number of junior doctors—1,500 out of 49,000. None the less, it provides us with some alerts and concerns, particularly about the training of those junior doctors. The vast majority of the NHS is now compliant with the working time directive and in accident and emergency we now have double the number of doctors and consultants that we had 10 years ago. The noble Baroness will know that patient safety is at the heart of the reorganisation that has taken place. Before the BMA produced its survey, we had recognised the concerns of trainee doctors about their training. My right honourable friend the Secretary of State has asked Medical Education England to review the impact of the European working time directive on doctors in training and the reduced hours that they are working. That will be completed next month and I will be happy to share that with the noble Baroness at that time.

My Lords, does my noble friend have any information on the impact of the working time directive on such matters as patient deaths, the length of stay or readmittance to hospitals?

My noble friend raises an important point. We all accept that tired doctors make mistakes and there is substantial evidence to support that. We believe that the working time directive is improving patient care, not damaging it. Trainee doctors in NHS North West recently conducted their own research, which has just been published. I should be happy to put that in the Library for Members to see because it is very interesting. NHS North West, which adopted the European working time directive a year earlier than the rest of the NHS, conducted a survey on whether this had a detrimental effect on the standardised mortality ratios—that is, the number of deaths in hospital—on the average length of stay and on readmissions. I am happy to report that it showed not only that it did not have a detrimental effect but that there were some signs of improvement. As I say, I commend that research to the House.

My Lords, the noble Baroness did not comment on one aspect of the Question asked by the noble Baroness, Lady Finlay, which was to ask what measures the Government have put in place to ensure that junior doctors are not pressurised by employers to work in excess of the 48-hour limit.

I apologise; I did not deal with that derogation. A very small number of 24-hour emergency care services have a permitted derogation to work an average of 52 hours a week rather than 48 hours. Health authorities have until 2011 to comply with the 48-hour working time directive and that time has to be spent sorting that out. In the department, through Dr Wendy Reid, our national clinical adviser, and her working team, we are providing those health authorities with support and we would be very concerned if there was any sign of doctors being bullied or pressurised into undertaking work that they should not be undertaking or of patient safety being jeopardised. We would want to know about that. In fact, we investigated some issues that had been raised and found that not to be the case.

The Minister spoke about the training review that is taking place. There is reason to believe that there may some suffering on that front. I agree entirely with her that a doctor being wide awake is very much in the interests of patient safety. However, there is another important difficulty with the rota changes: continuity of care.

Question!

If a junior doctor is covering many beds in many wards, continuity of care for patients is less. What is the Minister’s proposal to address that element of the problem?

The noble Lord raises a very important point. I was alluding partly to it when I said that this is an issue of clinical leadership and the reorganisation that is needed at a local level. It would appear from the evidence that is emerging that implementation of the working time directive is pointing to where there are gaps, where there is a need to reorganise and where better leadership is required. It is important to strike a balance between doctors not being exhausted, their being able to continue the care that is necessary and their being able to undertake the training that they need.

Does the Minister agree that if more care, including out-of-hours care, was provided by fully trained specialists, patient care would be safer? Does she further agree that the Government and the profession need to work together to achieve this within five years?

I thank the noble Lord for that question. I welcome his support. I hope that he may help us in taking forward those discussions with some of his senior colleagues in the royal schools. We know that Homerton Hospital has completely reorganised its training for its junior doctors. It offers a very good example of the handovers to which the noble Earl referred and of the need for doctors to have the necessary time to undertake specialist training without being whipped off to accident and emergency. The Homerton seems to have tackled those pressures very successfully.

My Lords, I remind all noble Lords, both on Front Benches and Back Benches, that, for an effective Question Time and for the Government to be held properly to account, we need short answers and short questions.