EU Working Time Directive (NHS)

David Nuttall Excerpts

Thursday 26th April 2012 Westminster Hall

[Charlotte Leslie]

My hon. Friend makes an extremely good point. That issue was contested to some extent when the directive was first introduced, but the previous Government saw it as a health and safety issue, and therefore the NHS was included in it. There are many reasons why we need not be in this position. There are many aspects of the negotiation that are deeply regrettable, and I agree with my hon. Friend. Although this is going over old ground, it is vital to look at that to find out how to get out of our current situation and secure patient care.

[Mr David Nuttall (Bury North) (Con)]

My hon. Friend will be aware that maternity units have closed in many constituencies, including mine. I was told that one reason why the health authority wanted to reconfigure the unit, as it put it, was the impact of the working time directive. Does she find that impact of a European regulation on my constituents in Bury North as shocking as I do?

[Charlotte Leslie]

I find it shocking and outrageous that that is allowed to happen. Its importance cannot be overestimated. Lives are being put at risk because of Brussels bureaucracy that does not even begin to protect the workers whom it says that it is designed to protect. This is one of the most important issues in the NHS, and I urge the Minister to do everything possible to work with colleagues in the Department for Business, Innovation and Skills to sort it out.

To return to the point about the flu pandemic, many people say that things will be okay because the 48-hour week is an average that can be measured over six months; so if there is a pandemic everything will be fine, because the doctors can sort it out and go back to normal afterwards. Well, if the pandemic were to last more than six months, I do not know where that would leave us. If it were to last less than six months, we would not have any doctors able legally to perform routine functions. That demonstrates how rigid, bureaucratic, badly thought-through and frankly dangerous the directive is.

The cost, however, is not only human: it is financial, and it is massive. Colleagues are concerned about the closure of their constituency hospitals and the ability of those hospitals to find coverage. Hospitals are floundering and struggling to find staff for an ever-increasing demand on the NHS. Let us not forget that the restriction on staff is happening at a time of unprecedented demand on our health system. Stafford hospital closed its accident and emergency department in the evening because it could not find cover. Other hospitals are taking other measures and spending exorbitant amounts of money on temporary staff to fill the gaps. Many colleagues will have read about the £20,000-a-week temporary doctor who was brought in to fill the gaps. Hon. Members will be shocked to learn that a staggering £2 billion has been spent in the past two years on temporary staff in the NHS. If we think about the financial challenges that the country faces and where else that £2 billion could have been better spent, that figure demonstrates how crucial the issue is. One hospital trust spent £24 million on temporary staff because of the staffing problems caused by the directive.

As I have hinted, the grim irony is that, for all the contortions and scheduling arrangements that hospitals, doctors and trusts go through to accommodate the directive, it is not even doing what it was supposed to do and make the work-life balance for doctors better. I received an e-mail from a junior doctor who is soon to get married and wants to spend time with his fiancée and plan his wedding, and who is frantic, not only about the erosion of his training and his future professionalism, but also about the destructive influence of the directive on his home life and his work-life balance. He writes:

“The directive certainly hasn’t made any impact on quality of life. Having worked 60-70 hours a week, now doing 48 hours, I am no less tired...the stated aims of improving work life balance and improving training are farcical.”

Then he goes on to talk about the realities that junior doctors face. He says:

“There is simply not enough time in the 48 hour week to get trained, particularly in the craft specialities, so we all go in on our days off. If we don’t, we don’t get trained and it is us, our careers, and ultimately the patients who suffer. Training used to happen in our official working hours, now we work just as hard, but get trained in our time off, and don’t get paid.”

And he is not alone. The Association of Surgeons in Training reported similar exhaustion because of the directive, and the Royal College of Physicians, as I have already mentioned, reported soaring sick leave since it was introduced.

I have spoken to junior doctors who report worrying signs of things to come. Given the contortions of shift working under the directive and the changes to on-call working time, junior doctors increasingly report that they are reluctant to specialise in disciplines that have more arduous on-call demands and require presence at the hospital, such as acute medicine, general surgery, obstetrics, gynaecology and anaesthesia. An unofficial straw poll of senior house officers in one city showed that they nearly all did everything they could to avoid being on the acute register because that was such a nightmare. They just thought, “Why would we?”

Statistics showing the number of applications and the number of positions available in those disciplines suggest that junior doctors who report such trends are not wrong. We are beginning to see our most talented doctors moving away from the disciplines that put the most stress on their work-life balance because—let me stress this—of the directive. When making lifestyle choices, doctors are looking at those specialist disciplines and thinking, “Why would I go into that?” which is extremely worrying for the future of our NHS provision. We have to stop that trend before it becomes more cemented.

--- Later in debate ---

[Ian Paisley (North Antrim) (DUP)]

Thank you, Mr Brady, for giving me the opportunity to speak unexpectedly early in the debate; I really appreciate it. The European working time directive is a complete disaster. Those are the words not of some amateur politician, someone on the street, a journalist or a headline maker, but of the president of the Royal College of Physicians, Sir Richard Thompson. He has described the European working time directive as “a complete disaster” for both patient care and the quality of training. He said:

“We are not providing the service or the training that we require. I cannot overemphasise the damage to service provision and to training.”

The directive is a complete disaster in terms of providing a service to the people who need it the most—the vulnerable and the sick. It is a complete disaster to the physicians who are the lifeblood of the NHS; and a complete disaster to the future of our hospital structure.

In September 2010, the European working time directive impacted on hospital rotas. The Royal College of Physicians criticised “the reliance on locums” in rural hospitals in particular. It said that

“a service opt-out or modification should continue to be pressed for.”

The Causeway hospital in my constituency faces losing its accident and emergency department, which is the only such facility in one of the most rural parts of Northern Ireland. The area has one of the largest inflows of tourists at certain times of the year. Why is the department going to close? It is going to close not because it is useless or there is no demand, but because of its over-reliance on locums, which is a direct result of the European working time directive. It is a complete disaster for our rural hospitals. It is a complete disaster in terms of sickness leave among doctors. The report of the Royal College of Physicians, which was published in April 2010, shows that sickness leave has soared since the European working time directive was introduced. It says:

“The apparent rise in sickness rates of junior doctors since the introduction of the European Working Time Directive highlights the additional stresses that are being put upon trainees by new rotas.”

Let us not mince our words: this is a complete disaster. Let us be honest and say it as it is. As far as the NHS is concerned, the European working time directive has failed and we need to get a better plan or structure in place that coincides with the needs of patients and with the ability of our physicians to deliver the best care service in the world. The sooner that we call this as it is the better.

[Mr Nuttall]

The hon. Gentleman is making a powerful case. Does he agree that the effects of the working time directive on our respective constituents is one reason why an increasing number of people are reaching the conclusion that we would be better off out of the European Union?

[Ian Paisley]

The hon. Gentleman pre-empts me. He is a mind reader. He seems to be able to find something that perhaps we are all agreed on. If the directive is a complete disaster; if it is starving our patients of good care and our junior doctors and senior physicians of being able to deliver what they are brilliant at delivering, we should address the problem at its root. The root cause is that we have a poison in the body politic of this kingdom. We are being regulated by people who do not live in this kingdom, do not care about this kingdom, are not part of this kingdom or do not have the needs of this kingdom at their heart, and we should stand up and recognise that. The over-regulatory practice that is being put upon us by Brussels is destroying this country. The sooner that we realise that, the better, and the sooner that the Government realise that and recognise that they should address the root cause of the problem, the better for us all.

--- Later in debate ---

[Andrea Leadsom (South Northamptonshire) (Con)]

I am delighted to follow my hon. Friend the Member for Totnes (Dr Wollaston). What a fascinating speech, and what a fantastic insight. I congratulate my hon. Friend the Member for Bristol North West (Charlotte Leslie) because, so often, discussions about EU legislation revolve around the EU itself, but she brought to life the practical implications of EU legislation that is having a real impact on our society and patient care in the UK.

Article 168 of the EU treaty states:

“Union action shall respect the responsibilities of the Member States for the definition of their health policy and for the organisation and delivery of health services and medical care. The responsibilities of the Member States shall include the management of health services and medical care and the allocation of the resources assigned to them.”

It is fundamental in the treaty that health is simply not an EU area of competence. All that we are hearing about today is the unintended consequences of something that was introduced for an entirely different purpose. I want to go into the background of that.

Hon. Members will know that I have been involved with an all-party group on EU reform, and with the Conservative end of that—the Fresh Start project. It is trying to look at precisely how Britain could renegotiate a better relationship with the EU that would work in Britain’s better interest. The very first area we looked at was the working time directive. We looked at the headline figure that the cost to the UK economy is about £2.6 billion per annum, which is a real issue for us at this time. In its research, Open Europe suggested that halving regulation could deliver a £4.5 billion boost to GDP in the UK. What was slightly less expected from the research was the fundamental effect on the NHS, precisely because health is not an EU competence.

Why should that be the case? The all-party group recently visited the EU to talk to our MEP group and to commissioners about the working time directive and the impact on the health service. Our MEPs told us that the directive is the least popular piece of legislation ever introduced by the EU, and that 16 of the 27 member states have negotiated opt-out arrangements. Interestingly, under the Lisbon treaty, if a majority of member states get together and propose a reform, the European Commission and the European Council have to look closely at it and consider repeal of the legislation. I find it astonishing that we have not taken the lead so far in doing just that. It would certainly be worth considering.

[Mr Nuttall]

Is this country one of the 16?

[Andrea Leadsom]

Yes, Britain does have an opt-out.

[Mr Nuttall]

But not obviously for the NHS.

[Mr George Howarth (in the Chair)]

Order. If the hon. Gentleman wishes to make an intervention, he should stand up and do so in the approved manner and not mumble from a sedentary position.