Re­vealed: ju­nior doc­tors work­ing 90 hours a week

Health boards flout spirit of Euro di­rec­tive

The Herald - - FRONT PAGE - HE­LEN PUTTICK HEATH COR­RE­SPON­DENT

JU­NIOR doc­tors are hav­ing to work more than 90 hours a week in some Scot­tish hos­pi­tals de­spite Euro­pean laws to tackle ex­haust­ing shift pat­terns that medics claim risk pa­tient safety.

An in­ves­ti­ga­tion has found young doc­tors rou­tinely clock up more than 87 hours per week even though the UK has adopted rules that state staff should work no more than an av­er­age of 48 hours un­less they choose to do so.

But ro­tas im­posed by many health boards mean doc­tors are clock­ing on for an en­tire week of back-to-back shifts of at least 12 hours.

The Bri­tish Med­i­cal As­so­ci­a­tion (BMA), which rep­re­sents ju­nior doc­tors north of the Bor­der, warned that al­though the shift pat­terns did not breach the Euro­pean Work­ing Time Di­rec­tive (EWTD), they went against its spirit.

Dr David Reid, chair­man of the BMA’s Scot­tish Ju­nior Doc­tors Com­mit­tee, said: “If you were a pa­tient you would not nec­es­sar­ily want to be treated by some­one who has been rotared for 90 hours, who is com­ing to the end of a seven-day run of long shifts.”

NHS man­agers are al­lowed to do this within the law as long as they can show av­er­age work­ing pat­terns are be­low 48 hours per week over a pe­riod of six months.

All Scot­tish main­land health boards, with the ex­cep­tion of NHS La­nark­shire, pro­vided de­tails about the hours worked by ju­nior doc­tors un­der free­dom of in­for­ma­tion leg­is­la­tion, as re­quested by The Herald as part of our NHS Time For Ac­tion cam­paign.

Ayr­shire and Ar­ran, Fife, Forth Val­ley and Grampian and Loth­ian ros­ter some doc­tors to work 87 hours or more a week. In Ayr­shire, the max­i­mum work­ing week is 91 hours, com­pris­ing seven con­sec­u­tive day shifts of 13 hours.

Tay­side also in­di­cated ju­nior doc­tors were work­ing a 91-hour week un­til this sum­mer, when the max­i­mum dropped to 71 hours. Other boards had more rea­son­able shift pat­terns, though five out of 11 health boards ad­mit­ted ju­nior medics still work seven nights in suc­ces­sion.

Dr Reid de­scribed 85 to 90-hour weeks as ex­haust­ing, adding: “It is not just the time you spend at work. By the time you get home af­ter a 12-and-a-half hour shift you can­not just switch off, you need time to un­wind. Par­tic­u­larly on night shifts, you do build up a sleep deficit as the week goes on.”

Dr Reid said: “There is re­ally good ev­i­dence that you make more mis­takes if you are work­ing a lot of night shifts in a row and be­come more fa­tigued. If some of the big­gest health boards in Scot­land can sort this out, I am sure the oth­ers can do that too.”

The BMA has gath­ered ev­i­dence that med­i­cal er­rors, in­clud­ing in­cor­rect di­ag­noses, in­crease ex­po­nen­tially over the course of one night-shift and even more over con­sec­u­tive night-shifts.

Last week, the largest study of its kind in Scot­land re­vealed 8.5% of pre­scrip­tions writ­ten by ju­nior doc­tors in their se­cond year af­ter grad­u­a­tion con­tained a mis­take. When re­searchers asked staff about the causes of their er­rors they cited work­load, time pres­sure, tired­ness and stress as key is­sues. Ian Ritchie, pres­i­dent of the Royal Col­lege of Sur­geons of Ed­in­burgh, said: “It is dis­ap­point­ing that af­ter so many years of the New Deal and Euro­pean work­ing-time reg­u­la­tions we still have ju­nior doc­tors work­ing very long hours when we know that is not the safest thing to do.”

He noted the NHS has had to cope with many ma­jor changes and that con­sul­tants who used to work 100-hour weeks felt there had been im­prove­ments.

Mr Ritchie called on med­i­cal col­leges, NHS chiefs and the BMA to con­sider what train­ing ex­pe­ri­ence they wanted to of­fer the next gen­er­a­tion of doc­tors.

Ayr­shire and Ar­ran said it was re­view­ing ro­tas to en­sure that train­ing, well-be­ing and pa­tient safety were not com­pro­mised. A num­ber of health boards pointed out only a small num­ber of ro­tas en­tailed tax­ing shift pat­terns and that doc­tors were given time off fol­low­ing an in­tense pe­riod of shifts.

Boards also stressed they fully com­plied with the EWTD and “New Deal” rules, which cut work­ing hours for ju­nior medics in the UK be­fore the Euro­pean law be­came manda­tory.

OULD you want to be treated by a ju­nior doc­tor who had just come to the end of a 90-hour, seven-day work­ing week? As Dr David Reid of the BMA’s Scot­tish Ju­nior Doc­tors Com­mit­tee points out, there is ev­i­dence that doc­tors in such cir­cum­stances make more mis­takes, and who can blame them – any­one forced to work long night shifts for seven con­sec­u­tive days is bound to be tired and more prone to slip-ups.

What is frus­trat­ing is that such gru­elling work­ing weeks were sup­posed to have been ban­ished by the Euro­pean Work­ing Time Di­rec­tive, which states that no-one should be forced to work more than 48 hours a week. How­ever, fig­ures pub­lished by The Herald today as part of our NHS: Time for Ac­tion cam­paign demon­strate that ju­nior doc­tors are still rou­tinely do­ing much more than that. In hos­pi­tals across Scot­land, some are reg­u­larly work­ing 90-hour weeks.

The rea­son health boards can still get away with this is that ro­tas on some wards are be­ing or­gan­ised so that they do not tech­ni­cally breach the Euro­pean di­rec­tive, which is part of UK law. Some ju­nior doc­tors, for in­stance, will work a 90-hour week and then be given a few days off so that over six months their av­er­age work­ing week does not ex­ceed 48 hours. This means health boards can stay within the let­ter of the law while fla­grantly ig­nor­ing the spirit of it.

Such chi­canery has un­pleas­ant ef­fects for ju­nior doc­tors. It means that some are work­ing hor­ren­dous hours with very lit­tle sleep and that is un­ac­cept­able for the rea­son that Dr David Reid has high­lighted: it is dan­ger­ous for pa­tients and un­fair on doc­tors, who end up feel­ing like they have per­pet­ual jet-lag.

Ad­mit­tedly, there have been im­prove­ments in the work­ing hours of ju­nior doc­tors in re­cent years – as some older con­sul­tants are fond of point­ing out, there was a time when a 100-hour week was not un­com­mon – but that is hardly the point. How­ever much the sit­u­a­tion has im­proved, no doc­tor in the mod­ern NHS should be work­ing a 90-hour week.

So why is it still hap­pen­ing? Clearly, in some de­part­ments, as NHS: Time for Ac­tion has high­lighted, there is a short­age of ju­nior doc­tors. This is par­tic­u­larly the case in emer­gency de­part­ments and it is not just be­cause of tight bud­gets, al­though that is clearly a crit­i­cal fac­tor; it has also been hard for some hos­pi­tals to find the doc­tors they need with many trainee posts left un­filled.

Longer term, these short­ages will have to be ad­dressed if the work­ing hours of ju­nior doc­tors are to come down, but shorter term, there is some­thing else that health boards can do to im­prove the sit­u­a­tion. As The Herald’s fig­ures show, some health boards are do­ing bet­ter than oth­ers in con­trol­ling the max­i­mum num­ber of hours worked and the ob­vi­ous con­clu­sion is that if some can do it, so can oth­ers.

What this means is that, as a mat­ter of ur­gency, health boards should look at how their hos­pi­tal ro­tas are or­gan­ised to min­imise the chances of ju­nior doc­tors work­ing 90 hours. We know that some wards would be plunged into cri­sis if all doc­tors sud­denly had to work 48 hours a week or less, but the work­ing week ex­pected of some ju­nior staff is not only un­fair, it is un­safe. Health boards must do more to find a so­lu­tion.

WARN­ING: Dr David Reid, chair of the BMA’s Scot­tish Ju­nior Doc­tors Com­mit­tee.

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