Patients' lives are at risk from 48-hour week, warn doctors

Surgeons report an increase in 'near misses' due to the working time limits imposed by EU legislation

Patients' lives are being put at risk by controversial new rules that limit the number of hours surgeons can work each week, according to research by the Royal College of Surgeons published today.

Nearly two-thirds of surgeons have witnessed a decline in the quality of patient care and safety since the European Working Hours Regulations (EWHR) were introduced in August, according to the survey.

Surgeons across the country report scores of "near misses", in which patients have almost died, as a direct result of changing work patterns, which doctors claim have caused widespread disruption to continuity of care.

The regulations introduced shift work to operating theatres to comply with a 48-hour working week. This means patients are looked after by three or four surgeons each day and, as a result, crucial investigations and procedures are missed or lost during handovers between teams.

The reduction in official hours also means that trainee surgeons have lost 20 to 30 per cent of their training time, according to the British Orthopaedic Trainees Association. Such an erosion of training opportunities is catastrophic for patient safety, doctors warn, as it will lead to less proficient surgeons in the future.

Opposition MPs and patient safety campaigners have attacked the Government's decision to push through the reforms despite warnings from doctors. The new evidence will increase pressure on ministers to admit it was a mistake to adopt the regulations.

Norman Lamb, the Lib Dem health spokesman, said: "This damning report is deeply worrying. Ministers ignored warnings about the impact of the EWHR and rushed through reforms without thinking about the impact on patients or front-line staff.

"With almost half of doctors worried about the safety of their patients, there must be an urgent assessment of the impact these rules are having on care and medical training."

The survey of 900 surgeons found that 70 per cent were working 55 to 60 hours a week in order to cover gaps in the rota and ensure patient safety is not compromised. Many of these surgeons feel pressured by their NHS employer to comply with the 48-hour rule on paper while working unpaid "hidden" hours to keep the service afloat.

Some trainees are also taking on additional paid locum work in the hope of gaining the training opportunities they cannot get in their formal working week.

John Black, president of the Royal College of Surgeons, said: "We have the ridiculous situation where the Department of Health is privately relying on these doctors to stay longer or cover additional dead-end locum shifts because there is no way the service could keep running otherwise."

Peter Walsh, chief executive of Action Against Medical Accidents, said: "The NHS has had years to prepare for the European directive, and we have continually been told that patient safety would not be affected. There can be no excuse for allowing patient safety to be compromised and patients to be harmed needlessly; this survey is extremely worrying and, frankly, scandalous."

A Department of Health spokesman said there was no evidence of harm being caused to patients and little evidence of a reduction in the quality of training. "Hospitals such as the Homerton in east London, which have been working a 48-hour week for more than two years, have produced evidence that shows the change has decreased hospital mortality."

A medic's fears: 'Safety has been compromised'

Dr Ben Caesar, a trainee orthopaedic surgeon in the West Midlands and president of the British Orthopaedic Trainees Association, believes it is "only a matter of time" before a patient dies needlessly

"We warned the Government that the changes would lead to more errors and compromise patient safety, and that's exactly what has happened. A patient may now be passed between different surgical teams three or four times a day. Every time this happens, you increase the risk of something being missed because no one person is taking responsibility.

"Just last week a man who underwent a major leg operation, and who was at risk of kidney complications, didn't have the right blood test or his urine monitored for 24 hours, just because it got sidelined during the handovers. Fortunately, he was fine, but this could have been very serious and I'm hearing about near misses from surgeons all over the country.

"Junior surgeons are increasingly disaffected: this is a vocational thing for us, but we have been forced into a punching-in and punching-out job. We are not getting the training opportunities we need and patient safety has suffered as a result. The only winners are the NHS trusts who have cut their wages bill."

Nina Lakhani

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