According to unpublished research commissioned by the Department of Health, many hospitals are unlikely to meet April's deadline for an 83-hour ceiling on the working week. Regional task forces set up by the Government two years ago to implement the 'new deal' are being hampered by resistance from senior staff, it says.
Virginia Bottomley, the Secretary of State for Health, whose daughter is a junior doctor, treated the reforms as a personal crusade when she was a junior health minister.
An independent preliminary evaluation of the new deal, prepared for the NHS Management Executive by Dr Irene Higginson, a senior lecturer at the London School of Hygiene and Tropical Medicine, identifies widespread failures in the phased programme. Her research shows that recommended changes in working patterns have barely started in many areas.
Although the Government has created 350 extra consultants' posts to spread the workload more evenly, several regions have recruitment problems, made worse by what is seen as the low prestige of the posts.
Dr Higginson also highlights fears that some of the pounds 25m allocated for the new posts over the past two years has been siphoned off for other projects. She interviewed several groups of doctors across four English health regions, and examined the records of all 14 regions.
One particularly embarrassing finding is Dr Higginson's confirmation of long- standing complaints by junior doctors that the Government is using unreliable criteria to assess the success of its scheme. Health ministers are using the hours contracted by juniors to judge its progress, rather than the actual hours worked. The report says the regional health authorities have made good progress on collecting information about contracted hours. 'The actual hours worked by juniors were more difficult to determine and were not recorded in routine returns.'
Dr Higginson also found consultant members of local new deal implementation teams presiding over some of the most exploitative juniors' regimes. 'Some task force members seemed uncomfortable with this situation and had to deal with the offending consultants by either offering resources, or threatening to suggest a review.'
Another problem is slow progress in shifting the many 'inappropriate tasks' that junior doctors routinely carry out, on to other workers, such as administrative assistants.
While some regional task forces were working hard to reduce hours, others 'felt there was only a limited amount they could do to assist . . . and were sometimes overwhelmed by the resistance they met' at senior hospital staff level. The task forces should be given powers to enforce implementation, the report states.
Although some hospitals are well on target to meet the deadline, progress is patchy, says Dr Higginson. The target of restricting the doctors' working week to 83 hours 'may not be possible'.
Juniors have become increasingly sceptical about the Government's commitment to bringing about a genuine reduction in hours. Edwin Borman, chairman of the Junior Doctors' Committee, that represents around 24,000 medical staff, said: 'We are concerned that health authorities see the New Deal as predominantly a paper exercise. They are changing the contracts, but not reducing the actual hours juniors are on their feet, on the wards, looking after patients.' The average working week for junior doctors in other EC countries is 59 hours.