Surgeons across the country say patients are much less safe in the NHS since the August introduction of European Working Time Regulation (EWTR) 48 hour working limits as continuity of care for patient collapses, this is the damning assessment of a survey of NHS surgeons. Services are only being held together by a ‘grey market’ of doctors willing to covertly breaking the legislation to maintain care for patients. At the same time the College learns more than 100 further hospital rotas have applied to break the legislation (so-called derogation) because they cannot meet the legislation. This comes despite an original deadline of 28 May and further hospitals are expected to report failure.

The College surveyed 900 surgeons - almost an eighth of the UK surgical workforce – with responses from more than 360 consultants and more than 500 trainees to see how surgical services were faring under the new working time restrictions. It found some alarming results:

• 64 per cent of all respondents thought quality of care had worsened due to the EWTR.
• More than half of consultants believe compliance with EWTR has been achieved at the expense of patient safety (overall 44 per cent of respondents agreed).
• A third say handover arrangements are inadequate in their hospital and 23 per cent say they cannot stay involved in all stages of individual patients clinical care that require their expertise.
• 62 per cent of surgeons said they were not working a truly compliant 48 hour week with 70 per cent estimating they worked more than 48 hours – with these surgeons estimating they averaged between 55-60 hours a week.
• A quarter of respondents say other professionals in the healthcare team are acting up to cover tasks previously done by surgeons and 43 per cent say they are covering rota gaps in other areas of their own hospital to keep services running.
  

Patients are being lost and at increased risk of dying as a direct result of so many shift changeovers and rotas which leave no time available to handover. Trainee surgeons across the country are staying on unpaid after the hours limit because they want to see through care for patients. They are also taking on additional paid locum work in the hope of gaining the training opportunities they cannot get in their formal working week. Meanwhile hospitals are relying on this goodwill because they know they couldn’t stay open without them. As a result there is an emerging grey market in hospital cover with doctors true working hours being kept off the books.

John Black, President of the Royal College of Surgeons said: “Throughout this affair the call from the Department of health has been that this legislation is about making patients safer. We now have a clear message from the frontline that patient care is being made significantly less safe through systems that lead to poor continuity of care, the loss of teams and ‘wildcat’ closure of services.

“We now have the ridiculous situation where the Department of Health in public moralises over fears that trainees are being coerced into working over 48 hours while privately relying on these doctors to stay longer or cover additional dead-end shifts as locums because there is no way the service could keep running otherwise.”

Service failures are already beginning to show in Northern Ireland and Wales*, areas that have always struggle with recruiting doctors, and this is a pattern likely to be repeated across the country as winter bites and burnt-out clinicians drop out of unworkable rotas.

The Department of Health no longer have a clear idea of the effect EWTR is having. Those hospitals which had a plan on paper to deal with EWTR were allowed to stop sending in performance data. Department of Health is now only tracking those who admitted they have problems. In July around 240 Trusts submitted a return, this has fallen to 122 Trusts in August.

Earlier this year, surgical trainee organisations worked out an ideal working system that would offer safe  and high quality patient care, ample training time and retain a good work/life balance for surgeons in training. They established that a core working week with flexibility to be on-call up to a combined total of 65 hours a week would be best and the Royal College of Surgeons calls for a sectoral opt-out of the European legislation to achieve this.

• View Survey results
  

Notes to Editors

1. * Various media reports on NI and Wales difficulties include:
   http://news.bbc.co.uk/1/hi/northern_ireland/foyle_and_west/8227143.stm
   http://www.walesonline.co.uk/news/cardiff-news/2009/09/22/startling-10m-overtime-bill-for-welsh-surgeons-revealed-91466-24747530/
2. The Royal College of Surgeons of England is committed to enabling surgeons to achieve and maintain the highest standards of surgical practice and patient care. Registered charity number: 212808. For more information please visit www.rcseng.ac.uk
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