A bewildered profession is bearing witness to frenzied debate, speculation and disagreement over the implementation of a 48-hour week for juniors on 1 August.
As the seconds tick away towards the deadline, a simple question is left hanging in the air: “Why now?”
Leaving aside the questionable timing, the debate boils down to two fundamental questions:
• Can we be sure that all affected services can cope with a 14% reduction in working time?
• Is the cost of a more palatable trainee lifestyle a consultant body with significantly less experience in the future?
The consequences of a chronically understaffed, stretched service are fresh in the public consciousness; look no further than the recent reports on the Mid-Staffordshire NHS Foundation Trust and the Birmingham Children’s Hospital.
It’s is arguably a brave stance for the Secretary of State Alan Johnson to dig in his heels on the EWTD in light of these events. You hope that the alarm raised by key members of the profession about service shortages in August is ringing around in his head right now.
But the question of training always attracts less media attention. With a cause and effect lead-time of 10 to 15 years the reasons are obvious. It was therefore good to see training raised as a central issue in the March debate on EWTD in Parliament by the shadow health minister.
Not so encouraging was the response from the Secretary of State for Health as to why trainees no longer need exposure to patients. “Developments in new technology such as virtual reality surgical simulators mean that there is increasingly, and thankfully, less need for inexperienced trainee surgeons to practice their skills directly on patients,” he declared.
This cynical abuse of logic was trawled out during the roll out of MMC as the fundamental reason why the progressive reduction of surgical training from 30,000 hours to 6,500 wasn’t going to have an impact on patient care.
It bubbled up from a few scattered developments in training technology (which have almost zero impact on the broad base of current trainees) and was inflated into a concrete fact to prop up policy decisions in the Department of Health.
It should be resisted as an idea at all costs, unless you know more about the advance of technology than I do and have already pre-paid for your ticket to the moon and can guarantee that you won’t be requiring surgery in the UK in 20 years time.
