Care will suffer unless NHS employers and employees are given more flexibility over how the WTD is implemented, the NHS Confederation has warned.
Its demand has been prompted by a European Commission (EC) review of the Working Time Directive. In a submission to the EC, the NHS Confederation’s European Office called for changes in the way time spent on-call is counted and more flexibility in the timing of compensatory rest.
The submission criticises the European Court for its narrow interpretation of the rules and suggests it has adversely affected staffing levels, costs and time available for patient care in the UK.
Hospitals have had to employ extra doctors and other staff, at considerable cost, it says. Many have had to rearrange working patterns completely to avoid situations such as cancellation of clinics and outpatient or inpatient procedure lists at short notice. Continuity of care can be badly affected if there are frequent handovers, and trainee doctors have less time to learn valuable skills, it adds.
The NHS Confederation calls for individual healthcare staff to be allowed to maintain the right to seek an opt-out from the 48-hour ceiling.
Elisabetta Zanon, director of the NHS Confederation’s European Office, said: “The European Working Time Directive needs a new approach which is realistic and fits in with the way our health service works. The quality of care patients receive is highly dependent on having an adequately staffed health service. NHS trusts ability to provide this level of care has been affected at times by this directive.
“We are keen to seize the opportunity we have now to influence the European Commission’s forthcoming proposals to change the existing working time rules. We want to work with the European institutions and workers’ representatives to come to a common sense compromise which delivers a solution for all parties.”
It wants a new definition of on-call time and more flexibility over the timing of compensatory rest. Currently, the whole of the resident on-call period is seen as working time whether or not the member of staff is working. And, compensatory rest, which must be provided when a worker’s daily or weekly rest requirements cannot be met, has to taken immediately after the end of the working period and be equivalent to the rest missed.
A consistent message in the consultation so far is the call for trainee doctors to be given more time to gain relevant experience and learn how to carry out procedures.
The Royal College of Surgeons, as part of its submission to the consultation, called for a new contract for juniors based on training rather than hours worked. It wants trainees to return to a system of working in teams on 1 in 6 rotas, and the new contract would specify that trainees would do a minimum number of operating lists, clinics and ward rounds. Hours would be mentioned only as a health and safety issue.
The EC has indicated that it wants to move swiftly on the issue and new legislation could be in force as soon as the autumn.
The NHS Confederation represents more than 95% of the organisations that make up the NHS. Its members include the majority of NHS acute trusts, foundation trusts and PCTs.
Tags: WTD
translation: the employers have done nothing for years because they banked on their ability to exploit staff to stay unchecked. the ewtd and the simap and jaeger judgement are smthg that disturbs their long established ways - now they leave no trick untried to get the ability to exploit employees at leisure back.
At least now ‘the managers’ have recognised there is a problem! The EWTD(R) was never designed for the professions, none of which can function properly if the rules are strictly obeyed! (Indeed, anybody in a supervisory capacity (which includes managers) is expected to, and does, work more than 48hrs). I would suggest that ALL professions should be exempt. Or, of course, we could leave the EU! I gather many countries in Europe just ignore the regulations - but then the British are law-abiding citizens! It is pointless having laws that cannot, or will not, be enforced.
I know the other side of the coin. Having no regulation could mean you spend 32 hours (up to 40 hrs) in hospital without any proper break or sleep. I did it in a country that just ignored (and ignores) the regulations. By the way, the idea of the EWTD is to protect patients!
Correction to ‘Kaplan’. The EWTD was a general ‘employment’ regulation designed to stop employers exploiting ’shop floor’ workers. It was not designed for doctors; but doctors (of ALL ranks) who are ‘employed’ are subject to it. Certainly no one would wish to go back to the so-called ‘good old days’ when juinors had only one half day off per week and worked alternate weekends. But I know of nobody, in any walk of life, who is regarded as even moderately ’successful’ who worked only 48hrs per week whilst training - and even worked more than this when they had ‘arrived’!
malcolm - the law will be enforced, it is just a matter of time. there will be the malpractice case were the plaintiff’s lawyer will successfully argue that wilfully ignoring fatigue and working during hours during which truck drivers and pilots are considered too tired (=dangerous) to work constitutes gross negligence. the doctor in that case will get crucified and that will be that because “the profession” is not willing to learn any other way and develop a safe way to work. the dinosaur attitudes of declaring ridiculous hours as “necessary for training” is so deeply ingrained that nothing anyone can say will make any impression. it will take an “hour junkie” to get slaughtered in court before the message gets through certain skulls.
Malcom - have you ever spent 30 hours in theatre and ITU without sleep and just junk food from the vending machine? It has nothing to do with training (I have already ‘arrived’), professionalism or what ever. And it was not paid.
EWTD is more important than ever now, especially with the pressure of all the extra efficiency savings on NHS management. What is needed too, though, is real punitive teeth to the directive.
As an example, over last 12 months, I’ve had my new job plan imposed on me (never agreed), O/C time allowance reduced by 2/3, SPA time cut in half, protected non NHS time taken over for audit etc etc. End result? Down £2000/month and averaging 17 PAs per week, over 16 of these DCC. Last week, put in total of 142 hours of work/on call. Back to work today. Safe to operate? Yeah right.
An NHS manager near you will be plotting similar unilateral changes to your contract. Expect sympathy? Family friendly/patient safety oriented attitude? How much did you see in the 80’s when we were doing 1:2s?
We need the EWTD, but we need it enforced too! And the very last thing that is needed is for it to be watered down at a time like this.
kaplan and marty are 100% right and i am delighted that more and more colleagues realise that the ewtd is one of the very few friends doctors have. it needs to be defended teeth and claws against john black et al. anyone who knows of a case that could be the one i mentioned in my previous post should think about getting the ball rolling.
Freedom of Information is your friend.
I made a FOI request for my rota. I was sent something different to what I was working as it was designed for 10 and there was only 7 FY2s.
I sent this to the EWTD officer in Scotland and out of the blue the rota was changed and I got 96 hours taken out the following 6 weeks.
I am in touch with a human rights lawyer that is certain what Chrissa said is true- a case will come along in which a doctor was breaking EWTD and will be crucified.
It is ridiculous that they understaffing rota’s yet turning away medical students saying that there isnt enough jobs! I believe the figure is only 69 now but that would be an extra junior on 69 wards making a hell of a difference.
Everyone must stand up, for themselves but most importantly, for patient safety.
I think there may be some confusion here. The EWTD(R) is different from the contract of empployment. The EWTD applies to ALL (not just doctors - but also doctors of ALL ranks/titles). It is illegal to have a contract that does not conform unless the individual has ‘opted out’.
I have written on many occasions about the failure of THE PROFESSION (i.e. our ‘leaders’) to get to grips with the proper training and supervision of juniors (which I believe should encompass ‘continuity of care’); so that the ‘out of hours’ care of patients should be covered by ‘trained’ doctors and any training should include the care of emergencies - but under proper supervision (rather than having the ‘juniors’ cover ‘out of hours’ and then try to fit in some training during ‘working’ hours).
I have never suggested we should go back to the ‘bad old days’ (of my youth when I had one half day and alternate weekends ‘off’!); but I maintain that the EWTD was not desigend for the professions and that ALL ’successful’ people work more than 48hrs per week