For years, Secretaries of State for Health have studiously ignored one of the most corrosive regulations to the NHS: the European Working Time Directive. Although the EU is not supposed to have any remit over health, this ‘health and safety’ directive limits junior doctors’ hours to an average of 48 hours per week, with added ECJ judgements imposing compulsory immediate compensatory rest time should hours be breached – and ‘on-call’ time classed as work, even if the doctor is fast asleep. This rigid imposition is neither healthy, nor safe; with junior doctors complaining that it has led them to do illicit work to get sufficient hours of training in, unpaid, less supervised, resulting in them being more tired and less trained.
It has resulted in more hand-overs (when vital patient information can get misinterpreted or misplaced), and lost the NHS approximately 400,000 hours of surgical time a month. The ECJ rulings on doctors having to take immediate compensatory rest if they go over their allotted hours has cancelled countless clinics as doctors have been ordered to rest instead of operating on patients ready and prepared for their surgery. For patients, it has resulted in hardly ever seeing the same doctor twice, and overall many senior doctors say it is eroding the concept of professionalism in the NHS, pushing a ‘clock on, clock off’ mentality on trainees.
Doctors, trainees, MPs like myself, Andrea Leadsom and organisations like Open Europe have been vocal on what can literally be a fatal directive – it has already been listed as a contributory cause of death on at least one coroner’s report.
And Britain is not alone; across Europe, countries with less compunction about breaking the Euro-rules have been trying to by-pass this destructive regulation.
But, thankfully, one secretary of state has at last grasped this toxic nettle. Jeremy Hunt bravely commissioned the Royal College of Surgeons to look at the impact of the directive, which was negotiated and introduced by Labour, and which has only recently taken full effect. The College came up with a number of recommendations. One of which, the Government has just embraced – encouraging junior doctors to exercise their opt-out from the directive.
The Royal College of Surgeons recommends an optimum of a 65 hour working week. No one wants a return to the 100 hour weeks of exhausted trainees; but that flexibility is vital.
The opt-out will help, but it is testament to the lunacy of the EU as currently articulated that a directive unpopular across Europe, which is costing lives, in an area over which the EU is not supposed to have a competency, can only be circumvented by encouraging junior doctors to opt out on an individual basis, and by trying to redefine working time and training time, as other countries have done.
Jeremy Hunt deserves full credit for listening to front-line staff and tackling this unsexy, but disastrous directive. When pen-pushing bureaucracy is literally fatal and a common-sense solution is almost impossible, you know that an organisation needs change. But how many coroners’ reports will it take for the EU to wake up to this reality?
Charlotte Leslie is Conservative MP for Bristol North West
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