The long, gruelling working week of a typical junior doctor was supposed to have been banished by the European Working Time Directive, but there is still concern about the hours trainee doctors are routinely having to work in Scotland's hospitals.
In October, for instance, figures published by The Herald showed some junior doctors are regularly working 90-hour weeks (the directive says no one should be forced to work more than 48). Then, in December, Brian Connelly, the father of a junior doctor who died driving home from a shift at Inverclyde Royal Hospital in Greenock, revealed that his daughter Lauren had worked 10 days without a day off and four days of 12 hours or more.
Now a powerful new voice has been added to the case for further reform. Speaking in The Herald today, Ian Ritchie, the new chairman of the Academy of Medical Royal Colleges and Faculties in Scotland, says the death of Dr Connelly demonstrates there is still a problem with the way junior doctors are trained in Scotland and that a rethink is needed.
As Mr Ritchie points out, there are two distinct areas of concern - concern for patients and concern for the doctors themselves. Mr Connelly believes that in the case of his daughter, her accident happened because she was tired from the hours she had been working. There is also good evidence doctors make more mistakes if they have to work long shifts, in some cases without even the chance to eat, drink or rest.
The Working Time Directive was supposed to have put a stop to this unacceptable situation and limited weekly working hours to a reasonable level. But some hospitals have simply worked round the legislation by organising their shifts in such a way that they obey the directive in practice but not in spirit. Hospitals can give junior doctors a few days off in a row, for instance, so that over six months, their average week does not exceed 48.
This avoidance strategy cannot continue, partly because, as Mr Ritchie points out, it is causing many junior doctors to leave medicine. Some hospitals have also found it hard to fill all their trainee posts, which adds extra strain to a system that is already struggling in some areas - a report this weekend showed staff numbers at weekends drop to 40% of the weekday level in some hospitals.
Mr Ritchie suggests part of the solution is for consultants to look at their working practices to ensure the welfare of their trainees - and that would certainly help as consultants have sometimes worn the hours they worked as juniors as a badge of honour. If consultants can adjust their hours to cover more weekends and nights, they should do so. Health boards which are not controlling the maximum hours of their junior doctors should also look to the example of those that are.
The Scottish Government has admittedly made some progress and gone some way to improving the hours of junior doctors but the job is far from complete. No doctor in the modern NHS should be working a 90-hour week. The sad truth is that many still are and that needs to change for the sake of the doctors and the patients.
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