Published: 15/01/2004, Volume II4, No. 5888 Page 22
Ann Mahon's staggering complacency about the EU working-time directive (HSJ People, pages 36-37, 11 December 2003) deserves a response. On 1 August, the 'new NHS' will begin to unravel, as small to medium-sized acute hospital trusts find it increasingly impossible to maintain a 24hour medical service.
The initial reduction of junior doctors' hours from 72 to 58 hours, and then further to 48, will involve a massive drop in clinical productivity. Some of this work can be taken by specially trained nurses and paramedics, but it is clear a good share will fall to consultants, with a further adverse affect on their productivity.
A more serious long-term problem is that the workingtime directive spells the end of UK-style training, under which doctors become consultants.
This has been under threat from several initiatives in the last decade but the workingtime directive is by far the most serious. In some specialties, the effect is more serious than in others. In surgery, for example, specialist registrars must not be denied access to the practical experience they need.
Ms Mahon makes no reference to growing evidence that many senior consultant physicians are putting in a retirement date of 31 July 2004. For older, and therefore more focused and specialised, physicians to be told suddenly they have total medical responsibility for their hospital at night, without junior cover, is proving too much.Also, some of them remain unconvinced by the offer of a specially trained nursing support worker.All these developments reinforce the fact that 31 March 2007 (full pension day under the new contract) will be a date of a mass desertion from the 'New NHS'.
Ms Mahon gives away the unreality of the pilot by reporting that several pilot sites feel they should have consulted medical trainees and consultants! She condemns negative attitudes and asks for clinical leaders to be identified, around whom positive attitudes can be formed. It shows how much the 'thought police' have taken over the NHS when genuine warnings of clinical disaster can be dismissed as a negative attitude.
The final irony is that, at a recent conference with senior European surgeons, English surgeons asked their continental colleagues how they managed to operate the working-time directive. The answer was that they did not even try. The legislation was almost universally ignored, even in Germany. In Spain, there was no attempt at implementation whatsoever.
Doctors in training obtained posts on the basis of mutually beneficial 'understandings'.
Professor Roger Dyson Councillor Essex county council