'Lauren had achieved her dream of becoming a doctor - she didn’t mind that the hours were long'

Some of them are drawn directly from the short medical career of my daughter, Lauren, but, as I discovered, her experience of long working hours and the resultant fatigue are all too common among junior doctors.

I also discovered that these consequences are well-known to the NHS and the medical profession. As I’ll explain later, they have been ignored and even trivialised.

Lauren Connelly

Lauren graduated after six years hard work and study. She had achieved her dream of becoming a doctor. She was enthusiastic about her work and particularly enjoyed her interactions with her patients at Inverclyde Royal Hospital in Greenock.

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She didn’t mind that the hours were long, that she frequently stayed late to complete necessary tasks or to respond to a sick patient, nor that on many occasions she returned home with an unopened lunchbox as she hadn’t time for a proper break, such was the intensity of the workload.

Usually, she arrived home, had something to eat, and then retreated to bed before her next shift. She didn’t complain – this was part of the job and she had worked under great pressure for prolonged periods when a medical student.

She finished working a 12-hour nightshift and died when her car veered off the road. Police believe that she may have fallen asleep at the wheel.

Several of Lauren’s friends, who had graduated with her, came to visit us. They all told the same story of their lives as junior doctors – long working hours followed by sleep before the next shift, too few breaks when working, and no social life afterwards.

It was a constant cycle of work, sleep, with food somewhere in-between. Tiredness was a constant in their lives. Despite this, they loved their jobs and did not regret for one minute that they had chosen to be a junior doctor.

Their experiences and Lauren’s had been predicted in the 2009 Scottish Medical Careers Handbook, which offered this advice to graduate doctors: “Be prepared to be exhausted for your first month working.

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You will work, eat (little) and sleep. That’s it.” Young medics were also offered this helpful advice: “you will not always get away on time/get lunch/dinner – be prepared for dehydration and hunger. Keep a bottle of water/bar of food nearby so you can avoid your own hypo when dealing with a patient’s!” They were also advised not to be discouraged if they “often feel maltreated, unjustly accused, everybody’s dogsbody.”

No doubt this was meant to be helpful and realistic advice to doctors at the beginning of their careers. However, an employer acknowledging that the working conditions it imposes on its employees will cause them to be exhausted, then trivialising its effects and offering them ineffective advice to cope with their fatigue falls woefully short of their duty of care.

I checked yesterday and this Handbook was still available on-line, complete with the Top Tips I’ve referred to and much more in similar vein.

The Handbook was incorrect in suggesting that doctors’ exhaustion would last only a month. In annual surveys since 2012, 20 per cent have reported that their working patterns have left them feeling short of sleep when at work on a daily and weekly basis.

These surveys show that 50 per cent work beyond their rostered hours on a daily and weekly basis. 38 per cent also report that the intensity of their work is either heavy or very heavy. Far from being limited to new doctors, many experience chronic fatigue throughout their careers.

Read more: Junior doctors in Scotland to be guaranteed 46-hour rest breaks

The consequences of chronic fatigue are well known. They include reduction in cognitive function and decision making similar to alcohol impairment, increased accidents and near misses when driving home from night shifts, and increases in fatigue related errors when working.

The aviation industry has recognised the dangers of reduced mental or physical performance resulting from sleep loss and has implemented stringent controls limiting the working hours of pilots and aircrew. The rail and road haulage industries also have rules restricting the hours of their workers.

Surely there are similar rules for doctors? Yes, there are but they are not effective.

The 1998 Working Time Directive is meant to protect the health and safety of junior doctors by limiting their working hours to 48 in any 7-day period. However, the legislation allows the employer to average out the hours over 26 weeks. The NHS asserts that junior doctors’ working hours are safe and that all rotas comply fully with the requirements of the Directive.

However, its calculation is derived from scheduled rotas and periodic surveys of hours worked. We know that junior doctors routinely work more than their rostered hours, but these inconvenient facts are ignored.

Many rotas also contain peaks of prolonged activity during which sleep deprivation increases together with the consequent risks to the health and safety of tired junior doctors.

These risks are measurable. The Health and Safety Executive use a Fatigue and Risk Calculator tool to identify dangerous shifts which put workers at risk of accidents and injuries.

The Royal College of Physicians used the tool in 2006 to assess the safety and suitability of various shift patterns being worked by junior doctors. They identified that the rota consisting of 7 Nights in Succession of 12 hours each shift had Maximum Fatigue and Maximum Risk scores significantly higher than daytime shifts and higher than nightshifts worked in industry.

The Royal College concluded that this shift was “essentially the worst possible rota that can be devised in terms of sleep requirements.” They also stated, “we do not recommend its use in the NHS” and advised that a safer rota be imposed as quickly as possible.

Yet Lauren had commenced working this rota when she died in 2011, 5 years after the Royal College called for a safer rota to be introduced. She had worked 8 hour shifts on each of the preceding 4 days. Had she completed her run of shifts, she would have worked for more than 117 hours and on 12 days without so much as a weekend off. Junior doctors continued to work 7 Nights in Succession rotas until at least until 2016.

They continued to be put at risk from the fatigue the Working Time Directive was intended to protect them from. Yet the NHS stated their working hours were safe and complied with the Directive. They comply only through statistical manipulation.

They do not comply with the spirit of the legislation and have not done so for 20 years. If the Directive had been implemented as intended, junior doctors would not be suffering from chronic fatigue.

There is also ample evidence that the levels of fatigue they experience may result in poor performance and may contribute to errors. Research from 2009 shows that doctors working a 48-hour week made 32 per cent fewer medical errors than those working 56 hours per week. The BMA is correct when it says, “well rested doctors deliver safer care for patients.”

To achieve this, there must be a substantial reduction to junior doctors’ working hours, which is what I have proposed. Firstly, junior doctors should not work more than 48 hours in any 5-day period; secondly, working periods should be followed by 2 days off; thirdly, actual working hours should be recorded.

These are ambitious aims and I do not underestimate the challenges which will have to be overcome to ensure they are met. The Scottish Government has made some welcome changes to shift rotas already and has also set up an Expert Working Group to report by December 2019 on how to achieve a 48-hour maximum working week.

I call on all MSPs to add their support to my campaign and to hold the Government to account to make junior doctors’ working hours safer. The NHS and our governments have had 20 years to implement the Working Time Directive in spirit as well as the letter of the law.

This delay has caused too many junior doctors to suffer from the fatigue it was intended to prevent. I have long believed that change will come about only as a result of direct political pressure that the NHS cannot resist and by effective legislation which ensures that the national scandal of overworked and chronically fatigued junior doctors is finally eliminated. I call on you to make this happen.

No-one can imagine the impact Lauren’s death has had on our family. We must not allow her experience to be repeated or any junior doctor be too tired to function to the best of their ability and to drive home safely after their work. We must not reward the commitment and dedication of medical staff with exhaustion. We must take better care of the people who work so hard to take care of us.