EU Working Time Directive (NHS)

Jeremy Lefroy Excerpts

Thursday 26th April 2012 Westminster Hall

[Jeremy Lefroy (Stafford) (Con)]

I congratulate my hon. Friend the Member for Bristol North West (Charlotte Leslie) on pursuing this matter with vigour over many months—indeed, for more than a year.

I first became aware of the problem of doctors’ hours, particularly those of junior doctors, about 29 years ago when I started to go out with one, because I never saw her. I am happy to say that she is now my wife—and now complains that she never sees me, but that is another issue. In those days, many doctors worked what were called one-in-three or one-in-two shift patterns. There was even a celebrated one-in-one shift pattern right here in London, although I forget at which hospital, which meant that the junior concerned was in the hospital for six months, 24/7, without coming out unless the consultant allowed him or her—in those days, usually him; I am glad that, these days, it will probably more often be her—to leave the hospital. Those days, thankfully, are gone. I remember the doctor to whom I am now happily married working non-stop through a weekend. I wondered, in the end, however good a doctor was, whether patient care and safety was given sufficient consideration, and frankly it was not. That was so across the NHS. As all hon. Members have said, we are not going back to that stage: we will not and should not. This debate is not about that.

I also bring into play my experience as the Member of Parliament for Stafford, where, I am glad to say, things in the local hospital are improving steadily. We expect to hear about Stafford, and the whole NHS, in Robert Francis’s report later this year. Great efforts have been made to improve patient care and safety in my local hospital.

This debate is happening because all hon. Members are concerned about patient care and safety, not because we are all anti-Europe or want to find some fault with the European Union. It so happens that, in this case, the EU is causing the problem. Therefore, we have to bring that into the mix.

We introduced the European working time directive into the NHS with too little forethought. One reason in particular comes to mind. As we have heard, we needed some 4,000 extra doctors to take up the extra work that was required due to the imposition of the EWTD. Where were those doctors to come from? I pay credit to the previous Government for setting up several new medical schools, including one at Keele in Staffordshire, which are beginning to provide a stream of excellent new qualified doctors into the NHS. That is a positive step, but there was a disconnect between the timing of those doctors coming into the system and the European working time directive’s coming into force in the NHS in 2009. That has caused a major problem that I will mention briefly later.

I do not want to go into all the details, because hon. Members have covered them well. Suffice it to say that the categorisation of on-call time is one of the most important factors. As we have heard, Denmark, Greece, Ireland, Poland, Slovenia and Spain all have different ways of allowing on-call time to be counted: not as full hour for hour; perhaps as partial hour, or not at all; using a form of words such as “It’s training, not work”—I would hesitate to say that there is a difference between training and work—or using a contract-based rather than a person system.

There is a problem, however, although it is not one dreamt up by parliamentarians. Let me quote from a letter that I received from the Association of Surgeons in Training in the west midlands last year, which first brought the issue to my attention in detail, although I had been aware of it in general. Mr Henry Ferguson, who is the west midlands representative, wrote as follows:

“The EWTD is putting surgical patients at risk by producing thin layers of medical cover with frequent handovers. There are not enough surgeons to cover shift rotas and therefore there is inadequate staffing, particularly overnight and at weekends. Due to this shortfall, more locum doctors are needed to cover gaps in NHS shift rotas… Unless the restriction to a 48-hour working week is solved, the next generation of consultant surgeons will be short of experience.”

That is absolutely the case. I have spoken to friends who are consultant surgeons and they reckon that perhaps up to two years of training is lost. Surgeons, in effect, have to be trained for two years longer under the current scheme than under the old scheme. There is also a knock-on effect, if we are to have surgeons who are ready to fulfil the high expectations that we rightly have of them.

What are the consequences? I have already referred to training, and the figure of 65% of surgical trainees saying that training has suffered has already been quoted. My hon. Friend the Member for Central Suffolk and North Ipswich (Dr Poulter) talked about the problem of handover, which I link to the loss of continuity of patient care under the general heading of patient safety. Under the old system, one consultant and one firm would be responsible for a patient all the way through the journey through the hospital. Yes, there were problems and not everything went right, but we knew who was responsible for the patient. As we have heard, however, handovers can cause a tremendous loss of data in some cases, particularly when they are done between people who are extremely tired—certainly the ones handing over are tired, after many hours at work. The cost, too, has already been referred to; in my own hospital, a locum was apparently paid £5,667 for 24 hours’ work. That case is not exceptional, and we have heard other, equally astonishing ones.

Finally, returning to recruitment and the disconnect between the time of a new flow of doctors coming through from our medical schools and the implementation of EWTD in the NHS, I have already referred to the problems caused. In my own hospital in Stafford, for instance, as well as in many others throughout the country, we are seeing a real problem in getting doctors, particularly for emergency departments. As my hon. Friend the Member for Bristol North West said, we fear that certain specialties will become less and less attractive. Medical students now will rightly look at what offers not only a chance of a really fulfilling career but, at the other end, a good work-life balance. If they see that certain specialties do not, they will reject them and we will continue to see shortages.

We have heard some excellent suggestions from my hon. Friend on the way forward—recategorisation of on-call time, a section-wide opt-out, perhaps, or legislation allowing certain professions to work at higher minimum hours per week—and all such things should be looked at. I am grateful to see in his place the Minister who has done so much for the NHS in the two years since he took office. I very much urge him, however, to work even harder than he is already is to ensure that patient care and safety are put at the heart of the NHS in that most important respect.