EU Working Time Directive (NHS)

Debate between Dan Byles and Baroness Hoey

Thursday 26th April 2012 Westminster Hall

[Kate Hoey (Vauxhall) (Lab)]

I, too, pay tribute to the hon. Member for Bristol North West (Charlotte Leslie) for her tireless work on this issue. I was pleased to be able to add my support to help secure the debate. It is a pity it is not taking place in the main Chamber, but it is great that we are having it and it shows to the Government the level of concern. Many hon. Members wish to speak, so I will be brief.

I come here not as a medical practitioner or as someone with any real medical knowledge, but as someone who cares deeply about the NHS and patient care. The hon. Lady outlined the difficulties very clearly, and in detail. We will hear many examples of what is wrong with the EU working time directive and its application to the NHS. We have to remember right at the beginning that the NHS is not a tick-box system of bureaucracy; it is about the care of patients, and the care of patients is in the hands of the people who work in it. If we allow the standards and the professionalism of our NHS work force to deteriorate because of the directive, we will leave a legacy that, in many years to come, we will look back on saying, “How could we have let that happen?”

I am privileged to have a great teaching hospital—Guy’s and St Thomas’, which is very near this place—in my constituency. A tremendous amount of effort has gone in to ensure that patient care is at the centre of everything that happens there. A terrific amount of work was done by the previous chairman, Patricia Moberly, to ensure that, fundamentally, everything that happens in the hospital is about patient care. It does not just serve its local community of Lambeth, but the whole of London, the whole of the country and patients from all over the world.

Understandably, the trust has implemented fully the EU directive. It is not, as was made clear to me, in the business of breaking the law. However, I have had many discussions about the directive, and the medical director of Guy’s and St Thomas’ told me that, despite doing everything possible to utilise more consultant presence out of normal working hours, and making every hour and minute count while a doctor in postgraduate training is at work,

“We are still left with a rigid template which is now seemingly outdated and needs revision for professional training.”

Many points have been touched on, but he raised the specific issue of the 13-hour shift limit leading to multiple handovers in a 24-hour period. He suggested that even an extension to 15 hours on weekdays, with appropriate compensatory time off later, would deliver a service with better continuity of care.

The medical director also raised the following important points:

“Many doctors in postgraduate training live in other towns and cities due to the rotational programmes of hospitals involved in their training. At weekends with 12 hour shifts, and with limited public transport services, especially on Sundays, there is more exhaustion from difficult commutes and two or three 12 hour shifts across a weekend rather than doing 1 X 24 hour shift with a better work life balance. We find that doctors try to re-organise their rotas to do this but we advise them that the EWTD does not allow this.

Doctors in craft specialties have fewer cases in their log books and less experience before gaining the certificate of specialty training than before. Perhaps they should be allowed to be with their consultant in an apprenticeship observer role to enable further exposure without being the provider of care to a patient beyond their…allowance.

Doctors in post graduate training should not feel that they are not allowed in the hospital beyond 48 hours. They should feel enabled to be in a learning environment—

and be able to—

“develop as a professional. Patient care is a 24 hour activity and EWTD has led to fewer doctors being in the hospital out of normal, working hours. This is inconsistent with activity in hospitals going up all the time, at all times.”

That is the formal response from my wonderful hospital. There are many other things that they would not want to put down on paper or read out in the Chamber, and I can understand why. From talking to many doctors, both training doctors and doctors with more experience, we know that what is actually being said is more serious than what is being said officially. It is much more stressful for many doctors to work in those patterns.

One close friend of mine who is a young doctor says that in the old days—I am sure we all remember the old days—a firm of doctors would be responsible for their patients pretty much all week, and on call on top of that. That meant good continuity of care that benefited patients and contributed to training. Doctors could see whether or not their treatment had worked. Now they have lots of zero days that interrupt the working week and mean that the teams are smaller day to day. It is rare for more than two to work together. That means that patients are seen by different people every day who do not know their case. They have repeatedly to answer the same questions, and getting things done takes longer because they do not know who has actually asked for something, perhaps earlier that day.

[Dan Byles (North Warwickshire) (Con)]

Quite rightly, hon. Members are very concerned about the impact on patient care, but is the hon. Lady aware of any work that has considered the financial cost of this regulation to the NHS?

[Kate Hoey]

We do not have to be GCSE standard—I have more than GCSEs, incidentally—to work out that it clearly costs more, because more and more locums have to come in, and extra people have to come in from abroad. Like agency nursing, that costs much, much more. I can never understand why, instead of bringing in agency nurses and paying more, we cannot have more nurses. The cost is a huge factor and it is going to get worse. With reductions, people will have to be more careful, and this will be a big issue. It is not good for doctor training—they cannot do their job properly and it is more stressful.

Nobody will admit that there is a huge amount of fiddling of figures going on. The only way that people in charge know that they are perhaps going to save people’s lives is to fiddle the figures and allow people to work outside the law. That is absolutely not trying to encourage that kind of behaviour in the NHS. I do not blame people for doing that, but it is a direct result of how we have got ourselves into this situation.

The Government are apparently saying that they are working urgently with Europe. I do not want to turn this into a debate on Europe. I think most hon. Members know my views on that. No matter how hard or urgently the Minister is working in Europe—I know what a good Minister he is—Europe’s idea of urgency and ours are a long way apart, so we have to find another way. Ultimately, as the hon. Member for North Antrim (Ian Paisley) said, this is about getting to the root of the issue. We live in an independent country and what we do in our hospitals and our NHS service should not be decided by bureaucrats in Brussels, with Governments misguidedly signing up to all sorts of things that the people of this country have never had any say in.

I will go back to what I say in every debate on Europe: it is time for the people of this country to have a say on what they feel their relationship with Europe is all about. An important part of doing that is to get the European working time directive changed, so that we can honestly say that we parliamentarians have done our bit to ensure that patient safety is improved and made better than it will be if this continues.