EU Working Time Directive (NHS)

Andrew Gwynne Excerpts

Thursday 26th April 2012 Westminster Hall

[Andrew Gwynne (Denton and Reddish) (Lab)]

Thank you, Mr Howarth, for calling me to speak. It is a pleasure to serve under you.

I congratulate the hon. Member for Bristol North West (Charlotte Leslie), who opened the debate, and the Backbench Business Committee on granting the debate. In fact, I want to pay a particular compliment to her for the comprehensive way in which she opened the debate and put forward her case.

Clearly, the working hours of all health workers, and not just junior doctors, are incredibly important to our NHS and to the quality of care that patients receive. I am glad that we have had a chance to examine those issues in some detail today in this Backbench Business Committee debate.

It is concerning that there have been reports in the press, and indeed from Members in Westminster Hall today and on other occasions, that there are cases where locum health workers have charged extortionate amounts for short-term cover in the NHS, with the potential knock-on effect on the quality of care that patients receive. As a number of hon. Members, including the hon. Member for North Antrim (Ian Paisley), have said, that is a matter that is of particular concern, especially for small rural hospitals; that was a point that he made eloquently. It is an issue that I will explore in some detail later.

As we all know, the European working time directive is European Union legislation and it was enshrined in UK law as the Working Time Regulations 1998. Except for doctors in training and workers in certain excluded sectors, the directive has applied in full to most workers, including all employed doctors, since 1 October 1998. The directive imposed a general limit of 48 hours on the working week. However, it allowed member states to let individuals opt out of that limit if both an employer and an employee agreed. At the time of its introduction, the UK was the only country to take advantage of that measure and allow an individual opt-out. There are now 16 member states using total or sectoral opt-outs, as the hon. Member for South Northamptonshire (Andrea Leadsom) correctly stated.

Particular concerns arose in relation to the health and social care sector, and importantly in relation to the position of doctors, as well as junior doctors, who, since August 2004, were gradually brought within the provisions of the directive. From August 2004 to August 2009, junior doctors’ working hours gradually moved towards compliance with the 48-hour working week. Although junior doctors in some specialties could work a 52-hour week until 31 July 2011, most junior doctors have been subject to the average 48-hour working week since 1 August 2009 and all junior doctors have been subject to that limit since 31 July 2011.

Of course, there have been particular concerns in relation to the health sector, and importantly regarding the position of doctors and junior doctors, which have led to this debate today. Although the directive applies to other sectors as well, it has always had a particular effect on the NHS, given how night-time and weekend cover has been organised in most hospitals, as we heard from the hon. Member for Central Suffolk and North Ipswich (Dr Poulter).

I note what several Members have said, particularly in relation to training. My hon. Friend the Member for Vauxhall (Kate Hoey) commented on Guy’s and St Thomas’ hospital, which is nationally and internationally renowned. The previous Labour Government commissioned the independent chair, Professor Sir John Temple, on behalf of NHS Medical Education England, to examine the impact of compliance with the directive on the quality of training. The hon. Member for Totnes (Dr Wollaston), who speaks on such matters with a great deal of experience, specifically referred to that. Although Sir John Temple’s 2010 report concluded that quality medical training can be delivered within a 48-hour working week, it also highlighted some challenges to be addressed, including round-the-clock team working. Those concerns have been echoed during today’s debate.

Other issues relating to the working times of doctors and junior doctors also need to be addressed. As Sir John Temple’s report found, there were concerns about post-graduate medical training, the objective of which is to produce fully qualified specialists who are able to provide high-quality, safe patient care. Experience of delivering services is an integral part of a junior doctor’s training. “Time for Training” highlighted some of the difficulties created for trainees and the service, especially in providing out-of-hours and weekend emergency patient care. Again, a number of Members have spoken about that today.

Some small, practical changes by employers, such as improving handovers and team-working at night, more involvement of doctors in designing their own working patterns, less reliance on junior doctors and more involvement of consultants during out-of-hours periods, have led to positive results without the need for excessive working hours. Clearly, issues remain, and I do not say that we have it right. Such matters should always be kept under review.

As I have said, the directive raises issues for health services across Europe, and Members have raised a number of concerns today about the directive’s impact on the NHS in the United Kingdom. We should consider ways to resolve those issues and be ready to work constructively with the European Commission and other member states to seek suitable solutions fit for our country’s needs.

As we know, the Commission is re-examining the directive. That is an acknowledgement that, although the legislation will remain, member states have had a number of issues with its implementation.

[George Eustice (Camborne and Redruth) (Con)]

The hon. Gentleman will be aware that in 2008 the previous Labour Government attempted to make some changes to the working time directive. The European Commission started that process, but the European Parliament voted at that point to abolish altogether the opt-out on the 48-hour maximum working week. The previous Government quickly slammed the lid and ran away from any idea of reforming the working time directive. Does he think that that was a mistake and that the previous Government should have persevered with their original intention?

[Andrew Gwynne]

The previous Government were right to attempt to have the matter re-examined. Whether the previous Government’s acceptance of the ruling needs to be reconsidered is something we are discussing today. We have a new Government, of course, and they have a responsibility to take up such matters with European Union institutions, as I would expect a future Labour Government to have the same responsibility to pursue concerns raised by this Parliament. Of course, it is incumbent on the Government of the day to try to resolve such matters with EU institutions. I accept that, were there a Labour Government instead of the current coalition, it would be right for our Government—irrespective of which party is in control—to take up such matters with EU institutions.

[George Eustice]

Does that mean it is the Labour party’s policy in opposition to seek to reform the working time directive?

[Andrew Gwynne]

The Labour party’s position is to support much of what the working time directive has brought about. Some real issues have been raised by Members of all parties in today’s debate. I recognise a lot of the issues and concerns, and it is incumbent on the Government of the day to resolve such matters to best suit the needs of the member state—in our case, the needs of the NHS throughout the United Kingdom. We support the working time directive, however, and its positive achievements, which have not been touched on to a great extent in today’s debate. There have been some positives.

We therefore have reservations about changes to the European working time directive. High-quality, safe patient care and the maintenance of further enhancement of the quality of training and education for junior doctors are important. I note the issues raised today, and specific areas must be looked at. We heard concerns about the maintenance of training standards, but patient safety must be paramount, and we should co-operate with all interested parties to develop sensible, workable and achievable solutions to the problems. If we allow a relaxation of the European working time directive for junior doctors, the danger is that we run the risk of a gradual return to their working dangerously long hours. I urge the Government to tread carefully because as the hon. Member for Bristol North West said, to be fair, some aspects of the working time directive had laudable aims. As was echoed in a number of contributions today, we do not want to see a return to the dangerous working hours worked by some doctors in the past.

[Charlotte Leslie]

Does the hon. Gentleman acknowledge that even if we relax the working time directive, with its detriments to the NHS, doctors would still be bound by the new deal and the 56-hour week? I see no return to the bad old days while the new deal is in place, although I think it, too, needs looking at again.

[Andrew Gwynne]

I shall come on to the new deal shortly, but no one would want to go back to the past with tired doctors working excessive hours. Many Members recall the very real horror stories that surfaced from time to time, in particular through the 1980s and early 1990s, when it was not uncommon for junior doctors to be working a 100-hour week, as we have heard in the debate. The hon. Member for Totnes called on her personal experience and the hon. Member for Stafford (Jeremy Lefroy) called on his domestic experiences from the past to make some reasonable points about the stress and strain that the old ways of working placed on doctors. I was reassured by their comments that they did not want to see a return to those days.

An article in the BMJ, the British medical journal magazine, looking at the effects of the working time directive, suggested that it was hard to draw firm conclusions. It also found that reducing working hours to fewer than 80 a week had not adversely affected outcomes for patients or in postgraduate training in the USA, where similar restrictions were introduced. As we heard from my hon. Friend the Member for Oldham East and Saddleworth (Debbie Abrahams), the systematic review found the same, and that cannot be discounted because it does not necessarily fit some arguments. I do, however, take full account of today’s anecdotal evidence from Members, although it might well be wise to look at the wider, long-term implications of relaxing some of the directive’s conditions.

If we go back a number of years, to the 1990s, the new deal tried to establish that full shift working should not exceed 56 hours. Through the 1990s, compliance with the new deal was poor, so a new contract was introduced in 2000. The implementation of the Working Time Regulations for employed doctors in the training grades has helped to protect doctors from working dangerously long hours, improving patient safety.

I accept, as we have heard from several hon. Members, that press reports of locum doctors costing hospitals and the NHS some quite extortionate amounts are concerning. Some reasonable points were made by the hon. Member for Central Suffolk and North Ipswich, who speaks with experience on these matters, about the clocking off and clocking on culture, which is certainly a concern. Clearly, questions must be raised about spending so much public money in these financially restricted times, and we need to know what will be the knock-on effect for the quality of patient care, especially if patients are continually seeing different doctors every time.

The Minister, in answer to the hon. Member for Kingswood (Chris Skidmore), mentioned the 11% drop in the use of locums since May 2010 and the increase in the number of doctors, which is welcome. I will just make the point that those extra doctors were trained and came through the system under the previous Labour Government. It would be churlish of the current Government not to recognise that as they take some political capital. May 2010 was not month zero; those doctors were coming through the system previous to that.

This debate has been a positive step. As we have heard, a number of issues surround health workers, especially junior doctors, and I agree that they should be further examined as we seek ways to resolve the problems. However, we should approach with some caution the idea of relaxing some of the directive’s conditions in relation to junior doctors as in the longer term it might cause more problems than it solves.

In closing, I refer to the opening comments of the hon. Member for Bristol North West in which she said that we all value the expertise and professionalism of NHS staff and that the aims of the working time directive were very reasonable. Long hours were dangerous for both doctor and patient and we do not want to return to those days. She is right. Although we recognise that there are issues to consider in relation to staffing implications and the cost to the NHS, we do not want to see the positives that have been secured disappear. I look forward to hearing from the Minister an indication of the current Government’s thinking on how to strike that important balance for those working in our medical and clinical professions in the NHS. I feel a bit like Daniel in the lion’s den. I urge the Minister to tread cautiously, and I mean that with all sincerity. Yes, there are some issues, but he really should resist the knee-jerk reaction of his party’s anti-EU wing, which is probably its mainstream. He needs to look holistically at the issues, the concerns and the benefits.