EU Working Time Directive (NHS)

Amber Rudd Excerpts

Thursday 26th April 2012 Westminster Hall

[Amber Rudd (Hastings and Rye) (Con)]

It is a pleasure to follow my hon. Friend the Member for South Northamptonshire (Andrea Leadsom) who, as always, speaks with such authority on the relationship between this country and Europe. I was particularly interested to hear the relevant experience of my hon. Friend the Member for Totnes (Dr Wollaston). Most hon. Members have said that we do not want to go back to 100 hour weeks; her rather shocking and frightening examples remind us all why that is so. What we want is flexibility—F for flexibility, as the hon. Member for North Antrim (Ian Paisley) so helpfully put it—so that we can try to get a better outcome for everybody.

So much has already been said and covered, particularly by my hon. Friend the Member for Bristol North West (Charlotte Leslie), who did so well to secure the debate. As she made her remarks, I was concerned that she was going to cover absolutely everything. She pretty much did, so I will just concentrate on one area—surgery—where the effect of the working time directive has been particularly damaging.

Although, as some hon. Members have pointed out, the British Medical Association has said that all training can fit into 48 hours, surgeons I have spoken to are concerned. The body that represents trainee surgeons, the Association of Surgeons in Training, has stressed that surgery is very different from all other aspects of the medical profession. It has clearly taken on the BMA in trying to make that point. As the hon. Member for Vauxhall (Kate Hoey) said, surgery is a craft specialty like chefs, for example—a lot can be learnt from books, but in the end there is nothing like hands on practical experience. Operative and procedural skills define the surgical craft and they are finite in number, with the majority to be gained during working hours. By limiting those hours, we are working against their training and therefore their competency as future consultant surgeons. As the ASIT survey confirmed, the majority of surgical trainees would welcome the opportunity to work in excess of the hours permitted—we are not doing them any favours by restricting their hours.

The Royal College of Surgeons estimates that 400,000 hours of surgical time are lost every month. ASIT believes that the restrictions imposed by the directive will be detrimental to the quality of training for junior surgeons and, therefore, to the quality of surgical service and provision in the future. Ultimately, as said by many of my colleagues today, the restrictions will be harmful to patient care. We also risk deterring junior doctors from specialising in surgery, as they are only too aware of the consequences of the restrictions. The royal college and ASIT both call for flexibility to enable UK surgeons to work up to a maximum of 65 hours per week, including time spent on call.

In addition to the effect of the working time directive on doctors’ training, the legislation is impacting on the continuity and quality of patient care in our hospitals. According to a survey by the Royal College of Surgeons, 80% of consultant surgeons and 66% of surgical trainees said that patient care had deteriorated as a result of the directive. Those consequences are worrying, and we need to focus on them.

[Debbie Abrahams]

In an earlier intervention, I referred to the systematic review. I appreciate that surveys give a certain amount of one-off evidence, but systematic reviews are the strongest form of evidence, and there were no conclusive results regarding an impact on patient outcomes. Whatever action we take, it surely should be based on the strongest evidence and not on evidence of lesser quality.

[Amber Rudd]

I am talking about evidence, and every Member present has been talking about their own evidence—

[Debbie Abrahams]

But not the strongest form of evidence.

[Amber Rudd]

Anecdotal evidence is absolutely relevant. We get such evidence from talking in our hospitals to consultants, patients and surgeons. That is much more relevant sometimes than the box-ticking consequences from a more desk-driven survey.

Our 24-hour health service has had to make dramatic changes to how hospitals are staffed. The effects of the reduction in hours have been further compounded by the Jaeger and SiMAP rulings of the European Court of Justice, referred to by my hon. Friend the Member for Bristol North West. Those decree that all time spent in the workplace should be regarded as work, whether at rest or not, which is a dramatic change from previous arrangements. As a result, hospitals have had to scrap all on-call arrangements in favour of full shift rotas, which is creating a multitude of problems. Consultants at the Conquest hospital in Hastings told me that, in order to staff a full shift rota in one department, they now need eight people instead of the six they used to have on the old on-call system. Sometimes there is not even enough work. Indeed, the exposure of each doctor to training opportunities in the day is diluted, and the extra doctors are employed purely to service a working time-compliant rota.

The rota and the system are driving health arrangements, which is surely wrong. It is an inefficient and costly way to manage doctors, and it is damaging to the quality of their training. It is particularly harmful for district general hospitals such as my own, the Conquest, which find that they are no longer able to support certain specialties, such as the neurology department in my example, which has now largely moved to the nearby Eastbourne general hospital. Unfortunately, as we have heard from other Members, the same impact on certain specialties is being experienced in their district hospitals. The doctors at the Conquest do a fantastic job, and I am extremely grateful for the hard work and commitment that they put in; but, from my conversations with the consultants, I know that those doctors are being stretched too thin.

[Sarah Newton (Truro and Falmouth) (Con)]

I have the privilege of representing a constituency in which the Royal Cornwall Hospitals Trust has another of the district general hospitals described by my hon. Friend. Does she agree that in remote rural areas with sparse populations, the impact on patient care of having to travel many miles to access specialist care will have a detrimental effect on treatment?

[Amber Rudd]

I wholly agree with my hon. Friend, who makes an important point about that particular problem for rural hospitals.

The shift system means that, instead of continuity of care, patients see—as we heard earlier, and I shall repeat the unpleasant phrase—a conveyor belt of doctors. Doctors do not get what they want either, which is to see patients through to treatment. Each time one shift ends and another begins, we have the handover process. As a consultant surgeon from the Conquest hospital said to me, someone unfortunate enough to be admitted to hospital at 7 pm on a Sunday evening would see four different sets of surgeons in just 24 hours. I know that there have always been handovers, but there are now more than ever, and each handover creates a risk of vital information being missed. We heard earlier about Chinese whispers, when expertise and important details may be lost. What is more, doctors are now under time pressure to clock off, so the chances of further mistakes are increased.

The Health and Social Care Act 2012 rightly puts doctors at the heart of the NHS, because they are best placed to manage the service and to deliver better results for patients. It is the doctors who are calling out for regulation to be relaxed, and it is essential that we listen to their cries for help. I am calling for a compromise and some flexibility that allows individual doctors and departments to make sensible decisions. Surgeons are asking for a maximum of 65 hours a week, including time spent on call, and that seems sensible.

We also need flexibility in how on-call time and compensatory rest for trainees are calculated. If a trainee wants to stay after their shift to watch an operation, to learn, and to benefit their training, they should be able to do so. We all want tomorrow’s doctors to be as good and as experienced as today’s doctors, so we must allow them to be the doctors that we expect them to be. We trust doctors with our lives, so we should trust them when they tell us they need more time to train.