So, what a surprise. The Remedy survey of the first month of the WTD showed that many of the trusts that were compliant on paper were not compliant in real life.
Three reasons stood out for this. One was the widespread gaps and vacancies, which have encouraged and even required moonlighting and extra shifts. Secondly, there has been the effects on training, which mostly happens during the day. And, thirdly, there has been the dogged professionalism and committment to their jobs which baffles some of the bean-counters in Whitehall.
Many of the politicians hark back to a time during the last century, when doctors worked hundreds of hours a week. They use this as a pious justification of the new regime, invoking such arguments as “patients should not be treated by tired doctors”. They ignore the inconvenient fact that patients sometimes get ill at night.
The problems we have identified have been recognised for some time. Last year a pilot in Galway published in Surgeon showed that SHOs on a supposedly WTD-compliant rota ended up working more hours than they were rostered for, and they failed to comply with the regulations. The SHOs also noticed a deterioration in the quantity or quality of training, and 81% of them felt that patient care deteriorated.
The Royal College of Physicians also expressed concern. A survey carried out by them in February 2009 showed that two thirds of WTD compliant rotas for medical SpRs reported major problems, and that respondents reported significant reductions in the quality of patient care and in training. They also commented on the problems with locum cover. But, strangely, both of these studies showed an increase in the quality of life for doctors.
So why are the respondents so unhappy?
Medicine is not a normal job. Every sixth former is warned when they apply to medical school that medicine is a vocation, and that it demands a lifetime of commitment. Those that accept this particular gauntlet do so on the understanding that they will be treated by society as experts in their field. And here is where we have come unstuck. The WTD was intended to protect factory workers from exploitation. Was it ever intended to cover professionals?
Remedy believes that the WTD was always going to be bad for training and bad for health care, and should have been opposed more vigorously by the politicians. We put out a plan, the Barbados plan, which relied on doctors taking the voluntary opt-out. There is an element of sour grapes in our call.
We now get frequent emails from members who tell us that they are working longer hours than they should be, and are not being adequately paid. This is the worst possible position, and one may have been cynically exploited.
When the reduction in junior doctors hours was first proposed then it immediately raised the question of who would do the work that had previously been done by junior doctors? Would it be consultants? Would it be a sub-consultant or a staff grade, or an new-fangled rebadged middle-grade doctor? Or would it be nurses and nurse practitioners? As the years ticked away the answers to these questions remained unknown, and the career and manpower planning that was needed to implement one of these solutions fell by the wayside.
We now need an urgent answer to that question. Because the Remedy survey suggests that the work previously done by junior doctors is now being done by unpaid junior doctors.
Read the Remedy WTD survey in full.
