Nigel 
August 1st,2009
But I've barely got to sleep
There’s been a fair bit of comment on the media today about junior doctors’hours being capped. Here’s a sample report.
Today I have read and heard only criticism of the change. There will apparently now be insufficient time to include proper training for junior doctors. We will not be able to cope with the flu pandemic. The NHS is simply not ready for this change.
Such comments are alarming in what they say about the commentators,but not surprising. Human beings (including me) are very bad at seeing both sides of an issue. We love to take sides. We love to ignore anything that doesn’t agree with our view. It takes education and an effort of will to look at and absorb the full picture.
Let’s take a historical perspective on this one.
A mountaineering friend called Hugh retrained as a medic in the eighties –not easy with a wife and baby daughter. After the main training he did the usual series of six-month placements as a Houseman (intern,junior doctor). Two of these were based at Bangor Hospital in North Wales. He enjoyed living on the edge of Snowdonia,getting involved with the Ogwen Valley Mountain Rescue Team,flying with RAF Valley rescue helicopters.
I don’t know how he fitted any of that in.
Many weeks he was on call for 100-120 hours. That’s more than 14 hours a day if you spread it over seven days. ‘On call’sounds easy,but he could never predict when he’d be called. Sometimes he’d make it the few miles home to briefly see his family before being phoned again. There was also a room at the hospital where he could get his head down till the next summons. Trouble was his sleep cycle was shot to ribbons. When he had time to lie down he couldn’t sleep. He once told me that the primary function of the duty nurse was to stop the Houseman killing patients. He was often so tired that a faulty decision was inevitable at some point in the day. Some medical mistakes are fatal. Maybe he was exaggerating for effect. Maybe not.
Later,once established as a GP (family doctor) he got involved in pushing for junior doctors’ hours to be made less punishing and more safe.
There were two problems. Firstly,the system was controlled by senior doctors,and many of them (apparently) took the attitude that they had coped with it so what was the problem? Secondly,the NHS (UK National Health Service) was run on the basis that junior doctors would work long hours for low pay. They were one of the very few groups of workers who received less per hour for overtime than for their basic hours. It kept the NHS going on artificially reduced labour costs.
The system may have been right or wrong –there are arguments on both sides –but nearly eleven years ago we were told we had no choice but to reform. In October 1998 the EU published its Working Time Directive. We have had eleven years to make sure the transition is as smooth as possible. The day the final stage of these changes becomes law is not the time to be complaining. That time was twelve years ago. Now is the time to get stuck in and make sure things do work.
Individual doctors can choose to opt to work more than 48 hours in a week,but they must take at least 11 hours continuous rest in any 24,and at least 24 hours continuous in any seven days. If they need more training hours within this then we have to continue changing the system so that they don’t need to spend so much of their work time on the job. This would cost money. If we think it matters enough to do it then we need to identify what else (probably outside Health) to spend less money on.
But why are we hearing so much complaining today,unless the media are distorting what’s being said? We’ve had eleven years to make changes. The new hours make sense in terms of safety and of quality of life for doctors. Of course there are knock-on effects,but let’s deal with those problems rather than whingeing that they haven’t already been dealt with.
If change is inevitable why don’t we ensure it works as well as possible rather than complaining it’s wrong. And why do we so rarely look beyond our own hands-on experiences to the wider picture. There’s a world-wide recession in progress. Businesses are going bust. Many people are losing their jobs and not being able to find anything else to bring in money. People are losing their homes. This is not the time to put more money into the Health Service. It’s the time to chill a bit,accept inevitable limitations,and do what can be done with what is available.
(There’s additional information about the European Working Hours Directive at this web page.)
