Thursday, 21 May 2009

EWTD and the great deckchair rearrangement

The following description of the shocking state of affairs concerning the European Working Time Directive (EWTD) and the NHS has been largely stolen from a great piece on, given the enormity of the problem I just felt this needed airing to as wide an audience as possible.

After a huge amount of pressure, and only 12 weeks before the full weight of the Working Time Directive hits the NHS Alan Johnson has ordered an enquiry into the effect of EWTD on the training of doctors in the UK.

In announcing it Alan Johnson has tasked MEE (Medical Education for England) to commission PMETB to consult 'stakeholders' as to solution to the imminent changes. This ultra-arms-length approach hints at lack of foresight and planning - arguably not boding well for a quick-fire solution in the 12 weeks that remain.

The writing has been on the wall for some time, and those pushing the WTD agenda cannot fail to have heard the message. In a recent joint statement the Royal Colleges of Anaesthetists and Surgeons wrote "Both colleges believe that the implementation of the WTD is in serious danger of having a deleterious effect on medical training, patient safety and service delivery."
A pilot study from Galway last year found that "all [the SHOs'] reported a deterioration in training and 81% felt that patient care suffered".

A Royal College of Physicians study found that "...the new 48-h working week has resulted in significant reductions of not only the quality of patient care, but also of general medical and medical specialty training. In particular, continuity of patient care has been affected adversely." Two former Royal College Presidents wrote to The Times this week and argued that "It is evident from many sources that quality of care of patients and proper teaching and experience for doctors in training cannot be provided for adequately in many specialties within a 48-hour week. This is particularly true of acute medicine and surgery".

Yet the Chairman of MEE, Sir Christopher Edwards, claimed today that the Secretary of Health was being 'proactive' in ordering this enquiry. Bearing in mind the timescale behind the implementation we think this is a new meaning of the word 'proactive'.

Last week the Department of Health admitted up to 28% of rotas were not going to be able to comply with the WTD by August. Some of those which were ostensibly had plans were completely unrealistic and were dependant on recruiting large numbers of doctors over the next few weeks. In a presentation made last week by Wendy Reid, the National Clinical Advisor to the EWTD, she acknowledged "Its not wise to go for a ‘big bang’ approach on August 1st". She also highlighted that despite throwing over £150million at the problem there were still many unanswered questions.

Implementation of the WTD requires more than just a reshuffling of rotas. It requires a major rethink in the way clinical care is delivered in hospitals, with changes to staffing levels and work patterns. Such a 'whole systems' approach requires far-sighted planning, central coordination and clear leadership. The government have had years to look at this. Why have they only noticed the impact on training now? The words from the new chair of MEE also make this man appear either completely out of touch with reality or so far up the government's derriere that his job is pointless.


Witch Doctor said...

When was the first time I heard this problem raised at a committee?

Was it 10 years ago? !5 years ago? It might even have been 20 years ago. Is that possible? I have lost all concept of time.

Ali said...

I am currently a surgical houseman in a decent-sized teaching hospital.

I am working 55-60 hours in an average Mon-Fri week.

I don't mind, as I expected to work long hours when I got a place at medical school, and I don't think the patients would get a fair deal if I just walked out when I'm meant to.

I just wish it was recognised by the powers that be that a 48-hour week is, in many places, completely impractical.

Other departments in the hospital are now 48-hour compliant and the HOs have to be given random midweek days off to make it work - so you have to hand over all your patients, leave the hospital, and then get a handover back again 36 hours later. Continuity of care and safety are suffering badly. said...

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