Charlotte Leslie is a member of the Health Select Committee and MP for Bristol North West.
What do the following all have in common? Overburdened A&E services; junior doctors working tired and unpaid in their own time; sudden cancellations of clinics; the tragic death of 22 year old Kane Gorny; never seeing the same doctor twice during your stay in hospital, and NHS staff run down by illness and tiredness. Give up? It’s a piece of legislation dreamed up by a political body that was never supposed to have any influence over our health service at all. It is the European Working Time Directive (WTD).
The WTD, which the EU forced upon us after the Blair Government pushed us into the Social Chapter in 1997, is not only damaging our NHS: it epitomises our frustration with the European Union. It suffocates British Businesses (95 per cent of which have no involvement with the Single Market at all), is estimated to cost the UK economy over £3bn per year, and is a ball-and-chain in our efforts to keep speed in the so-called “global race”. Little wonder Europe is the slowest growing region in the world.
And in the NHS, coroners are now suggesting it may be costing lives – Kane Gorny, who died of dehydration in hospital, suffered from an appalling lack of continuity of care, for which the WTD was “party to blame”. Like most things, the intentions behind this directive were good: limiting the working week to 48 hours, ensuring that workers have access to rest and holidays. Nobody wants to see workers doing 80 to 100 hour weeks, especially when your life may be in their exhausted hands. But with sour irony, a directive that was supposed to be making life better for junior doctors may actually be making it worse, and endangering patients at the same time.
Doctors have been worried about this for years, and I have also been campaigning on this for years (debates, reports, speeches, ten minute rule bills, Prime Ministers Questions, you name it). It is a problem that – hand in hand with Labour’s ”New Deal’, rigidly limiting hours to 56 per week – could be one of the most far-reaching and pernicious pieces of legislation in the NHS. If solved, it would bring about far-reaching improvements into the A&E challenge, patient safety and experience, and the expertise and professionalism of our future medical workforce. That’s a pretty big prize.
And now, thankfully, Jeremy Hunt, alone amongst Health Secretaries, has grasped this nettle. He set up a taskforce led by the Royal College of Surgeons to look at the extent of the problem and what we can do about it. Their report, a potential game-changer for medicine, went relatively unnoticed amongst the rest of the political froth of the day. Yet this was the first time the health sector – including royal colleges, NHS managers, patients, medical trainees, and trade unions like the BMA – unanimously agreed the WTD is having a negative impact on parts of the health service, including surgery and acute medicine. If you do nothing else this week, read the report and read the evidence that went into it on the Royal College of Surgeons’ website.
The report and evidence submitted to it highlights that 280,000 hours of surgical time are lost every month because of the WTD. The directive means that junior doctors are getting neither the amount nor the quality of training they need, and the majority are trying to make up for it, unpaid and tired, in their own time. In a recent GMC survey, 42 per cent of trainees said that their working pattern was making them tired at least monthly.
European Court of Justice judgements (the so-called SiMAP and Jaeger rulings) mean that all time a worker spends at the place of work counts as working time, even if they are asleep, and that if a doctor goes over his allotted hours because of a medical emergency, he must take immediate compensatory rest, even if it means cancelling a clinic the next day, for which the patient is already in hospital and medically prepared. Cue an epidemic of cancelled clinics. The Royal College of Physicians suggests that since the introduction of the WTD in full, there has been a rise in sickness and stress-related leave amongst its members.
No one suggests a return to the bad old days of hundred hour weeks, but the report leaves no doubt that drastic improvements are needed. It is also cold comfort that we are not the only EU member state to have real problems with this – France, Ireland and Italy have all ignored the directive with respect to their health services. Other countries have been trying to get around the regulations to safeguard the ability of their medical workforce and the welfare of patients.
Crucially, the taskforce report suggests allocating junior doctors protected training time, separate from working time to ensure that they get the training they need. The report recognises that the WTD presents different challenges for different specialties, and heard evidence a 60 hour working week would be optimal for some surgical specialities. Overall, the report calls for flexibility, and for medical professionals, not bureaucrats in Brussels, to determine how doctors get trained and work.
But outside the remit of what the report was asked to consider is the very concept of the EU intruding into our health system, endangering patients and de-professionalising doctors. The stakes are high. The short-term effects of the directive can be undone. But the long term effect is the most pernicious. As every generation of new trainee doctors passes under this directive, the ethos of ‘clock-on-clock-off’ medicine is further embedded in the minds of our future medical consultants. It is not heavily paid NHS bureaucrats and Department of Health Chief Executives and their world of complex systems that keep the NHS going; it is the people who work in them, and who every day go the extra mile to keep our NHS afloat. We currently take that professionalism, dedication and sense of vocation for granted. But if we lose it, and train it out of our workforce with this directive, the NHS stands absolutely no chance of meeting the already enormous challenges it faces in the future.
So Hunt must robustly act on the recommendations of the medical workforce in this report. But we must go further, even if it does mean upsetting our more EU-squeamish coalition partners. We must continue to challenge this directive, and the European madness it represents, at all levels. We are not alone in this mission: we have many allies in other member states who want the same thing. If Europe cannot demonstrate that it is able to adapt and even scrap a directive that is hampering healthcare, that is hated by its member states, and that is literally costing its citizens lives, then it really is time to leave.