Mary Dejevsky: It's patients who must come first

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As a group, junior hospital doctors have never been exactly backward in coming forward about the iniquities of their pay and conditions. But their present campaign – in which they are essentially saying, "Please, please, let us work more hours every week, because otherwise we won't gain enough experience to be competent doctors" – seems to me to be disingenuous in the extreme.

What they are objecting to is the application of the European Union Working Time Directive that limits their working week to 48 hours. And the latest flag they are waving to advance their cause concerns two deaths at Musgrove Park Hospital in Somerset, which the coroner said raised "clear warning signs" over the working of the EU regulations. A man with breathing difficulties died after waiting more than five hours in casualty, and an elderly patient died – so the media reports go – "because" only one junior doctor was on duty to look after 100 patients.

Now far be it from me to call into question the coroner's conclusion (or perhaps the way it was reported), but who is actually to blame here? Given that doctors, junior or senior, are responsible for people's lives, it is surely sensible for the law to set maximum working hours. That happens with airline pilots and professional drivers of buses and lorries – jobs where fatigue can be a mortal danger. Would you want your injury assessed by a doctor coming to an end of a 72 hour-plus shift (which is what they used to work)? I wouldn't.

But, of course, patients at Musgrove Park could not choose. Nor, for the most part, can you or I. The choice, such as it is, is between an overworked junior doctor or none at all – which is where the nub of this problem lies. Why was a junior doctor in sole charge of more than 100 patients on a night shift? Why did someone with breathing difficulties have to wait so long to be seen? Because, by any normal person's standards, the department was not properly staffed. And why was that? Because everyone, from managers to consultants to many junior doctors, has an interest in not making the new arrangements work.

The obvious solution is that more – or at least some – senior doctors and consultants should work so-called "out-of-hours" shifts alongside their juniors. A recent survey showed conclusively that hospitality mortality rates rose sharply at night and weekends. It does not take a huge leap of imagination to suggest that poor staffing and expertise might play a role.

Hospitals had 10 years – yes, 10 whole years – to phase in the EU directive. It was agreed in 1999, when – as The Independent reported at the time – junior hospital doctors "celebrated" the success of their campaign to reduce 72-hour shifts. The transition, intended to be four years, stretched to 10, with the 48-hour limit coming into force only last year. Junior doctors' quarrel should be not with the Government or the EU – popular scapegoats both – but with their managers and consultants, who apparently think it's acceptable to organise hospitals for their own convenience, rather than the wellbeing of their patients.

The junior doctors, of course, say they don't want to go back to the days of working 72 hours or more, just a bit more flexibility would do it. No it wouldn't; for those with life and death decisions to make, 48 hours a week is quite enough.







Rule, Europa!



A year ago, I confessed to a little queasiness at the rendition of "Rule, Britannia!" at the Last Night of the Proms which seemed fractionally too close to jingoism for comfort. No such problem on Saturday, when Jiri Belohlavek, conducting the BBC Symphony Orchestra and the soprano, Renée Fleming, took the song at such a clip that you would have been hard put to catch a single word. From patriotic paean to post-imperial romp in one year flat is not bad going. Clearly, Belohlavek savoured wielding the baton at such a uniquely British occasion. Clearly, too, the audience took a shine to his accented English and his Central European manners. Here were stereotypes juxtaposed, in the nicest possible way; but maybe there was a little more, too. Was it my imagination, or was there a wider selection of flags being waved this year? After all these years, the Last Night of the Proms is suddenly a more cosmopolitan party







Wandering wirelessly



This time last week I was briefly in the resort of Sochi on the Black Sea coast, for a meeting with Russia's Prime Minister. When I learnt that our group was to be flown down to Sochi for the evening, the prospect filled me with dread. It was not that this would be an unpleasant and unproductive way to fill the time, it was the logistics of reporting the meeting that deterred. After a similar meeting two years ago, the only way to get the news across to London was to shout into my mobile phone, as a packed minibus careered down a mountain, the signal repeatedly interrupted by bridges and tunnels. This time, oh bliss, the guesthouse where the meeting took place was equipped with a wireless signal. Anxiety melted away.

Wi-fi, which is cheap to install and highly reliable, has transformed life for anyone who uses a computer while travelling, almost as much as mobile phones have revolutionised communication generally. Revisiting Russia, I was reminded that, 20 years ago, I reported from Moscow using a manual Telex machine and had to book international phone calls hours in advance. I don't know who invented, or popularised, wi-fi, but here's a grateful beneficiary saying thank you.

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