'New deal' for junior doctors crumbles away

THE GOVERNMENT'S plans to cut the dangerously long hours worked by junior hospital doctors, launched in a blaze of publicity last June, will fall at the first hurdle, according to a confidential Department of Health report.

Virginia Bottomley, the current Secretary of State for Health, whose daughter is a junior doctor, has made the reforms a personal crusade, pointing out that tired doctors can endanger patients. But the report suggests that problems with funding and recruiting extra medical staff will make it impossible for health authorities to obey the Government's instruction that no junior doctor should be working more than 83 hours a week by next April. The EC average is 59 hours.

Apart from causing considerable embarrassment to ministers, the imminent failure of the first stage of the reform may prompt fresh calls for junior doctors to be balloted on industrial action.

The document contains the most recent estimates from English health regions that the number of doctors contracted to work more than 83 hours a week has fallen by 2,000 to 5,300 since the 'new deal' was launched last June. It warns that eliminating the rest hinges on 'the availability of appropriate resources'.

However, junior doctors' leaders insist the actual number of juniors working more than 83 hours is far greater than health regions' estimates, which are based largely on payroll and contract data, rather than doctor surveys.

The report points out that only 32 of 200 extra consultant posts promised more than a year ago have been filled; these are needed to help ease the burden on junior doctors. Plans to redistribute junior doctors' posts to help cut down hours have also proved difficult to implement.

Doctors' leaders and the Government have never agreed on the resources needed to cut back junior doctors' hours. William Waldegrave, then Secretary of State for Health, earmarked pounds 12.4m last summer for employing the 200 extra consultants. The British Medical Association estimated that double that number would be needed each year of the 'new deal' timetable to ensure a 72-hour ceiling on hours by 1997, the eventual target.

Edwin Borman, chairman of the BMA's junior doctors' committee, said the Government would have to invest at least pounds 50m a year in the hours programme up to 1995: 'The situation is much worse than the Government figures suggest. Juniors are commonly asked by their consultants to do ward rounds or routine administrative work, when they are meant to be off duty. If they refuse, they know they won't get very far in their careers.'