NHS hit by crisis over doctors' hours


Artykuł pochodzi z pisma "Guardian"

John Carvel, social affairs editor
Friday July 30, 2004
The Guardian

Most NHS hospitals in England will find it difficult to operate legally from Sunday when a European directive comes into force limiting junior doctors' hours, a Guardian survey has revealed.
Written replies from 75 NHS acute and specialist trusts showed 53% expect difficulties in cutting the juniors' hours to less than 58 a week, as required by the new law.
Although most have tried to organise shift systems to comply with the directive, many cannot find enough qualified house officers and registrars to staff them. The survey identified particular shortages in paediatrics, anaesthetics and maternity services.
It found 13 hospitals - 17% - admitting openly that they could not comply fully by the Sunday deadline. But many more gave answers raising suspicion that they will also be operating outside the law in two days' time.
If the NHS trusts do not comply they could be prosecuted by the Health and Safety Executive and fined or - in extreme circumstances - forced to close down overworked departments.
But the executive said it would wait for evidence of malpractice over several months before initiating proceedings and the first legal action is likely to be launched by the British Medical Association in local employment tribunals. It said it will "name and shame trusts which allow the new limits to reduce the quality of training".
Simon Eccles, the junior doctors' leader, said: "The Guardian survey offers comprehensive evidence of the confusion felt by hospitals and doctors in training over compliance with this directive. We believe many trusts that are indicating compliance will have real difficulty due to inability to recruit the extra numbers."
He said the BMA has already targeted six trusts where it may intervene to protest at the hours worked in one or more specialties. "They are the ones that are showing a cavalier disregard for the law and its intention to make junior doctors' hours safe," he said. The BMA is not naming the six at this stage.
Its spokesman added: "Each time hospitals breach the directive for individual doctors, they will be liable to fines of up to £5,000 from the Health and Safety Executive. They could also be taken to employment tribunals by junior doctors."
The directive was passed in 2000 in an attempt to stop the long-standing practice in many member states of overworking doctors during their period of training to become consultants.
For many years the medical establishment argued that long hours were necessary to give the juniors enough experience. More recently the royal colleges accepted that juniors working 80 or 90 hours a week were too exhausted to work safely and the shifts have been getting shorter.
But the 37,000 juniors in England - including house officers, senior house officers and registrars - have not been entitled to the rest breaks required under European law.
The directive requires 11 hours' rest in every 24 hours, breaks during shifts and a maximum of eight hours' work in every 24 for night workers. Other groups of employees have a maximum working week of 48 hours and this will apply to junior doctors from 2009.
Most hospitals were preparing for the change but were caught by surprise by recent rulings from the European court that made compliance more difficult.
John Reid, the health secretary, has been trying behind the scenes in Brussels to get the legislation amended and the commission has ordered a review. But he has told trusts that they must for the time being obey the law as the court interpreted it.
A Department of Health spokeswoman said: "We don't have figures on how many trusts will not comply... We anticipate that a handful of trusts have teething problems securing compliance."
The Royal College of Nursing said the Guardian survey showed the problem was more serious. Beverly Malone, the general secretary, said: "It is shocking that half of trusts admit that as of next week they will have difficulties operating legally.
"The RCN is calling on all trusts to put nurses at the heart of the solution in providing continuous patient care. We believe that expanding nursing roles offers a better way in safeguarding patient care." Nurses could take over work previously allotted to junior doctors, she added.
The Guardian received emailed replies from 75 of the 173 acute and specialist hospital trusts in England - a high response for this sort of survey. It may have underestimated the scale of the problem since those able to comply with the directive without difficulty might have found it easier to identify themselves.

Acute – ostry, poważny
to allot – przyznawać, przydzielać
amended – poprawka
to apply – mieć zastosowanie
to breach – naruszać umowę
cavalier – nonszalancki
circumstances - okoliczności
to comply with – stosować się do czegoś
comprehensive – pełny
deadline – nieprzekraczalny termin
disregard – lekceważenie
inability – niemożność
liable – narażony na
malpractice – nieprofesjonalne zachowanie
maternity - położniczy
proceedings – postepowanie prawne
to prosecute – wnosić oskarżenie
registrar – lekarz specjalista
Required – wymagany
ruling – orzeczenie (sądu)
shift system – system zmianowy
Survey – badanie, pomiar, ekspertyza
teething problems – początkowe problemy
Trust – koncern, trust (rodzaj angielskiej kasy chorych)
underestimated – niedoceniony


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