In theory, the hours that junior doctors work in Scotland are compliant with the European Working Time Directive, which states no-one should be forced to work more than 48 hours a week.
In practice, the directive is being broken every day in hospitals across the country.
The pressure on health boards and the Scottish Government to be more honest about this situation, and to act to improve it, has been growing for some time now, and today, in The Herald, the father of a junior doctor who died driving home from a shift has added his voice to the criticism.
Brian Connelly decided to speak out after looking through the records of the hours his daughter Lauren worked at Inverclyde Royal Hospital in Greenock. They show she worked the first 10 days without a day off and worked four days of 12 hours or more. She was killed on the M8 seven weeks into the job and Mr Connelly believes the accident happened because she was so tired from the hours she had been working.
Certainly, the effects of the rotas doctors such as Lauren Connelly are expected to work are well known. There is good evidence doctors make more mistakes if forced to work many night shifts and, as Dr David Reid, chairman of the BMA's Junior Doctors Committee, said recently, you would not necessarily want to be treated by someone coming to the end of a long run of back-to-back shifts.
For a long time, this was part of the accepted culture - indeed, it was a badge of honour worn by doctors who expected the next generation to pass the same test. It was also part of official NHS ideology, as a handbook for junior doctors found by Dr Connelly shows. "Be prepared for ...hunger," it says. "You will work, eat (little) and sleep. That is it."
Fortunately, that handbook has now been withdrawn but it is clear the culture of long hours and exhaustion endures and that some junior doctors are still working gruelling shifts with no time to eat or drink, and in some cases sleep. As figures published recently by The Herald as part of the NHS: Time for Action campaign showed, many junior doctors are routinely working 90 hours a week.
This is no longer acceptable in the modern workplace, but particularly so in a job that concerns the wellbeing of patients. In the words of Mr Connelly, how is this consistent with the employers' duty of care or the NHS's responsibility for patients?
The problem has been that, until now, health boards have been able to avoid a technical breach of the European directive by giving staff a few days off so that, over six months, average working hours do not exceed 48. This means health boards are staying within the letter of the law while breaching its spirit.
As Mr Connelly says, greater honesty is now required on the hours doctors are working. Some improvements have been made in recent years - and hospitals are complying with the letter of the law. But no doctor in the modern NHS should be working in the kind of conditions that Dr Connelly had to endure, for the sake of the patients, but for the sake of the doctors too.
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