Results of a survey, published today by the Royal College of Surgeons of England, show that since the restrictions of the European Working Time Regulations (EWTR) limiting doctors to working 48 hours a week, patients in NHS hospitals are in fact much less safe than they were a year ago, and the situation is getting worse.
The survey of 980 surgeons and surgical trainees covered all nine surgical specialties and all strategic health authorities in England as well as surgeons based in Scotland, Northern Ireland and Wales, and compared responses with a similar survey undertaken last year.
It reveals 80% of consultant surgeons and two thirds of surgical trainees admit patient care has deteriorated under the directive. This compares with 72% of consultants and 59% of trainees consulted in October 2009.
Two thirds of trainees (65%) say their training time has decreased – a quarter more than in October 2009 (41%). More than a quarter of senior surgeons are no longer able to be involved in all of the key stages of a patient’s care (up from 18% in October 2009).
Two thirds of trainees have reported a decline in training time in the operating theatre and 61% of consultants report that they are operating without trainee assistance more frequently since the directive was implemented.
The report finds 41% of consultants and 37% of trainees reported ‘inadequate handovers’. And almost three quarters of trainees (72%) of trainees and two thirds of consultants (61%) are consistently working more than the permitted hours. Over half of trainees say they cover rota gaps, which result in them working in excess of their contracted hours.
The survey paints a picture of an NHS that, one year on, is still totally overstretched due an arbitrary hours regulation. Patients are increasingly being assessed only by junior members of staff or routinely passed between many different doctors with varying levels of experience, often with unsafe, inadequate or no handover procedure. Senior surgeons, under pressure to get through operating lists, are now operating alone while their juniors manage wards without support and guidance because working rotas are so finely stretched. This lack of exposure to vital hands-on training alongside experienced colleagues is rapidly eroding NHS care and causing a critical shortage of capable, skilled surgeons in the future.
John Black, president of the Royal College of Surgeons, said: "To say the European Working Time Regulations has failed spectacularly would be a massive understatement. Despite previous denial by the Department of Health that there was a problem, surgeons at all levels are telling us that not only is patient safety worse than it was before the directive, but their work and home lives are poorer for it. The new Government has indicated it shares our concerns, but there is not a moment to lose in implementing a better system that would enable surgeons to work in teams, with fewer handovers and with the backup of senior colleagues."
