Hospital Dr News

Working Time Directive is “spectacular failure”

Surgeons’ representatives have called the working time directive “a spectacular failure” following new research suggesting care has deteriorated since its introduction a year ago.

Eighty per cent of consultant surgeons and 66% of trainees say that patient care has deteriorated under the working time directive.

The Royal College of Surgeons, Association of Surgeons in Training and British Orthopaedic Trainees Association are all campaigning for a 65-hour week, which they believe offers the best balance between adequate training opportunities, good patient care and work-life balance.

The survey’s results – taken from 980 surgeons covering all nine surgical specialties in England as well as those based in Scotland, Northern Ireland and Wales – compare unfavourably to a similar research undertaken last year.

Sixty five per cent say their training time has decreased – a quarter more than in October 2009.

More than a quarter of senior surgeons are no longer able to be involved in all of the key stages of a patients’ care, compared to 18% in 2009.

Two thirds of trainees have reported a decline in training time in the operating theatre and 61% of consultants report that they are operating without trainee assistance more frequently since the directive was introduced in August 2009.

Forty one per cent of consultants and 37% of trainees reported ‘inadequate handovers’.

This follows Hospital Dr research which showed that shift working and multiple handovers top the list of problems doctors face in delivering good care.

Almost three quarters of trainees and two thirds of consultants are consistently working more than the permitted hours. Over half of trainees say they cover rota gaps which result in them working in excess of their contracted hours, compared to 44% in 2009.

One consultant surgeon, who responded to the survey, said: “The European Working Time Directive has been a training disaster. We are raising a generation of demotivated, demoralised and poorly trained surgeons. The UK will pay for this and regret it for at least 30 years.”

Mr John Black, president of the Royal College of Surgeons, said: “To say the European Working Time Regulations has failed spectacularly would be a massive understatement. Despite previous denial by the Department of Health that there was a problem, surgeons at all levels are telling us that not only is patient safety worse than it was before the directive, but their work and home lives are poorer for it.

“The new government have indicated they share our concerns, but there is not a moment to lose in implementing a better system which would enable surgeons to work in teams, with fewer handovers and with the backup of senior colleagues.”

Mr Charlie Giddings, president of the Association of Surgeons in Training, said: “The survey shows that 12 months after the full implementation of the WTD there has been little progress with improvements to quality of training or to the quality of life of trainees and the subsequent impact on patient safety.

“New innovative solutions are required rather than the minor short-term tweaks that artificially produce compliance at the expense of training and patient care, which trusts have attempted so far.”

A spokesman for the Department of Health said: “The health secretary will support the business secretary in taking a robust approach to future negotiations on the revision of the European Working Time Directive, including maintenance of the opt-out.

“We will not go back to the past with tired doctors working excessive hours, but the way the directive now applies is clearly unsatisfactory and is causing great problems for health services across Europe.”

Meanwhile, additional RCS research suggests that the proportion of NHS patients having to wait longer than the 18-week target for non-emergency surgery had almost doubled from 1.5% 18 months ago to nearly 3% in March 2010. It blames the WTD.

Commenting on the findings, Royal College of Physicians president Sir Richard Thompson said: “We are not providing the service or the training that we require. I cannot over-emphasise the damage to service provision and to training.”

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5 Responses to “Working Time Directive is “spectacular failure””

  1. Dr Scott says:

    Couldn’t agree more. On-going patient care has been adversely affected, because an alternative trainee who has to cover the absence if his colleague does not have the same sense of ownership of that Consultant’s patients, nor the same level of responsibility, to ensure that care requirements are delivered appropriately and on time. I am more frequently operating and running clinics with junior staff who do not normally work for me, or no junior staff at all.

    The trainees are currently having much less exposure to the basic experience they need, and no amount of reorganisation and efficiency can make up for lost time – if the trainee isn’t there (e.g day off after night on call; 1 in 7 rotas), their exposure even to common conditions is becoming increasingly limited.

  2. Orthopod says:

    Surprise, surprise. Perhaps the BMA will now finally listen to its members instead of following its tedious mantra of ‘long hours bad, short hours good’.

  3. Paediatric Intensivist says:

    Please can we have a grown up debate about this and please can the colleges and the BMA support and represent their members for a change. The EWTD, New Deal and Immigration Law change have all been a disaster for patient care and training in the UK.

  4. pete says:

    There are some very culpable people here who need to stand up and admit their role in the damage done to British surgery…….principally the BMA with their whinging about poor little tired doctors, secondly the Royal Colleges themselves whose leaders had their mouths stuffed with promises of knighthoods (perhaps excepting Mr Black) if they kept quiet, and at ground level a whole raft of Medical Directors in individual hospitals who, wearing their management caps and anticipating CEAs, connived with senior administrators to drive through rotas including such nonsense as ENT juniors covering for abdominal emergencies and which did nothing either for patient care or for the training of doctors.

  5. Malcolm Morrison says:

    The EWTD was never designed for the professions. ALL professionals I have ever known have worked more than 48 hrs – especially when they were in training (‘on the way up’). Medicine cannot be practised in a ‘clock-watching’ manner – and it is a tragedy and a disgrace that some senior members of our profession acquiesced in the concept that it could. ‘Continiuty of care’ is an important matter – both for the patient’s safety, for training and for the professional satisfaction of all doctors; it is the basis on which the ‘doctor-patient relationship’ is built. We reject, or ‘let go’, these basic concepts at our peril.
    It is time for the profession to wake up, and stand up, for proper professional standards to be applied to all care of patients and for the proper training of the future generation.
    Retired Orthopod

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