Leading article: An emergency in out-of-hours cover

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The Independent Online

We publish today an account of the travails of a district hospital in Scotland that faces an acute shortage of doctors. According to the writer, a doctor who took it upon himself to find qualified locums, the problem is far from unique. After reciting a litany of unacceptable experiences, he blames, in ascending order, the European Working Time Directive; the changes introduced to medical training in the UK five years ago, known as Modernising Medical Careers (MMC); but above all the locum agencies, "whose abject failure to regulate themselves should surely have led to intervention by the General Medical Council by now". This "scandalous state of affairs", he says, places patients at risk.

With a few caveats, we agree. On the European Working Time Directive, we would point out that the Government had ample warning of when it would come into force and what effect it could have, particularly on hospitals out of "normal" working hours. There was shockingly little preparation by either the NHS or hospital managers, who seemed to think that, if they shut their eyes and objected loudly enough, it would simply go away. When it finally came into force, they were disgracefully unprepared. This was the height of irresponsibility. Equally irresponsible, though, was the acquiescence by consultants in a system that required junior doctors to work absurdly long shifts, with scant supervision, almost as a rite of passage. This should have ended long before any European directive came along.

Something similar could be said of the reforms known as MMC. There were plenty of arguments for bringing medical training into the 21st century. But the botched way this was done alienated almost everyone involved. MMC is at least partly responsible for the present shortage of junior doctors. Somehow this consequence of the new training regime seems not to have been anticipated. It is another failure of management.

But both of these aspects pale into insignificance beside the lamentable working of the locum arrangements, as described so graphically by the author of today's article. Hospitals, especially those outside the south-east, find themselves in a bidding war for often poorly qualified and inexperienced foreign staff with dubious expertise and unchecked references. After the case of Dr Daniel Ubani, the German locum who killed his first British patient with a huge overdose of diamorphine, the EU was blamed again for allowing doctors registered in one country to work in another.

The argument that no further checks may be made, however, is wrong. There are checks that agencies and NHS trusts may apply; but responsibility has tended to fall between the cracks of a system whose safeguards are clearly not working. The case of Dr Ubani illustrated the failings of the locum system as it applied to GPs. Today's article shows how it relates to hospitals. But many of the same points apply.

Despite a steady increase in the number of doctors in training, Britain still faces a shortage. But it is a shortage that has been exacerbated by avoidable factors. In 2005, the generous pay award for GPs placed them in a position similar to that of hospital consultants, able to choose whether or not to work "out of hours". The consequence was a mass defection from night, weekend and holiday duty that has left patients at the mercy of poorly regulated agencies. Despite court judgments that have condemned the system as woefully inadequate, no one seems in any hurry to remedy it.

Yet it should be beyond argument that doctors, whether in GP practices or hospitals, constitute a branch of the emergency services and should be obliged to provide adequate cover at all times. The medical profession may regard a requirement to work shifts as a retrograde step, but it is standard practice in most of Europe and something this country must require, too.