Junior Doctors under Labour

Has the care provided by junior doctors got better under Labour? Certainly the hours worked have come down, with a limit of 48 hours a week imposed by European law last August, but there’s mounting evidence that this has not been done in a way that has improved medical training or made hospitals safer for patients, especially at night. A snapshot review by the Royal College of Physicians of the care provided by 887 clinical teams found that only 6% of teams included a consultant on duty at night, and that a single junior doctor could be responsible for as many as 400 patients (average 61).

When MD started this column eighteen years ago, one of the first stories was of a junior doctor covering 360 geriatric in-outpatients at night, some of whom were very ill and sprawled over eighteen wards (14/2/1992). By this measure, the hospital at night is no safer than it was then and many would argue it is much less safe. Eighteen years ago doctors worked ludicrous hours but were part of teams, had far more help at hand, got more on the job training, followed patients through and had rooms to sleep in when they were desperate.

The switch to shift systems to reduce hours need not have decimated medical training if it had allowed a truly consultant led service with protected time for training. But the NHS always does things on the cheap, so the vast majority of junior staff are left unsupported, with no consultant leadership. Typically, a junior doctor is only attached to a particular consultant for four weeks or less, so no chance to form any sort of working relationship. And with fewer doctors at night covering more patients, there simply isn’t time for supervised training.

There’s mounting evidence that shift systems are bad for your health and the Danish government has paid out to intensive care nurses who developed cancer after years of shift work. In the NHS, shifts are inevitable but only safe if staff have somewhere to nap when they are exhausted. Airline pilots and air traffic controllers have naps (although they don’t advertise the fact) and there’s good evidence that they improve concentration and reduce error afterwards. But the removal of on-call rooms from across the NHS has meant that a junior doctor looking after, say, 400 patients at night may well not have anywhere to put her feet up when it all gets too much. Just as galling is to be kicked out of the hospital at 16.59 even if you’re half way through treating a patient or desperate to stay on and learn a new skill. Why? Because managers are petrified of any breach of the 48 hour Europe-wide legal limit.

The morale of junior doctors relies on a sense of connection both to a clinical team and to patients you know and care about. Labour may have reduced hours but it’s also reduced clinical medicine to the level of unsafe and ineffective factory farming, which is another reason why NHS productivity has failed to improve despite massive injections of cash.

Secret Scandal

The Sunday Telegraph picked up the Eye’s coverage of alleged errors in the pathology department at Bristol Royal Infirmary (BRI) and interviewed the family of Jane Hopes, Director of Critical Care at North Bristol NHS trust, until she died from breast cancer at 55. It is alleged that pathologists at the BRI missed the cancer at a stage when it could have been treated but what is equally shocking is that her family had not been told about the allegation, nor that it has formed part of a large independent inquiry that they knew nothing about and so couldn’t volunteer to give evidence. When the family of a senior NHS manager are shown such disrespect, it shows how far we still have to go for openness and accountability in the NHS.

Meanwhile the inquiry team has assured MD that, although evidence in confidential and hearings are held in secret, any current risk to patient safety that emerges will be fed back to the BRI. Strange then that evidence of a further serious error and allegations that both the histopathology service and one of the pathologists is unsafe have not, according to the hospital, been passed on to them by the inquiry. MD gives evidence on May 6.