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

Share
Related Topics

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.

React Now

Latest stories from i100
SPONSORED FEATURES
iJobs Job Widget
iJobs General

Recruitment Genius: Senior Environmental Adviser - Maternity Cover

£37040 - £43600 per annum: Recruitment Genius: The UK's export credit agency a...

Recruitment Genius: CBM & Lubrication Technician

£25000 - £27500 per annum: Recruitment Genius: This company provides a compreh...

Recruitment Genius: Care Worker - Residential Emergency Service

£16800 - £19500 per annum: Recruitment Genius: Would you like to join an organ...

Recruitment Genius: Senior Landscaper

£25000 - £28000 per annum: Recruitment Genius: In the last five years this com...

Day In a Page

Read Next
Serena Williams  

As Stella Creasy and Serena Williams know, a woman's achievements are still judged on appearance

Holly Baxter
Corbyn's style has the authenticity of being true to oneself  

Do modern leaders need ‘charisma’?

Boyd Tonkin
Refugee crisis: David Cameron lowered the flag for the dead king of Saudi Arabia - will he do the same honour for little Aylan Kurdi?

Cameron lowered the flag for the dead king of Saudi Arabia...

But will he do the same honour for little Aylan Kurdi, asks Robert Fisk
Our leaders lack courage in this refugee crisis. We are shamed by our European neighbours

Our leaders lack courage in this refugee crisis. We are shamed by our European neighbours

Humanity must be at the heart of politics, says Jeremy Corbyn
Joe Biden's 'tease tour': Could the US Vice-President be testing the water for a presidential run?

Joe Biden's 'tease tour'

Could the US Vice-President be testing the water for a presidential run?
Britain's 24-hour culture: With the 'leisured society' a distant dream we're working longer and less regular hours than ever

Britain's 24-hour culture

With the 'leisured society' a distant dream we're working longer and less regular hours than ever
Diplomacy board game: Treachery is the way to win - which makes it just like the real thing

The addictive nature of Diplomacy

Bullying, betrayal, aggression – it may be just a board game, but the family that plays Diplomacy may never look at each other in the same way again
Lady Chatterley's Lover: Racy underwear for fans of DH Lawrence's equally racy tome

Fashion: Ooh, Lady Chatterley!

Take inspiration from DH Lawrence's racy tome with equally racy underwear
8 best children's clocks

Tick-tock: 8 best children's clocks

Whether you’re teaching them to tell the time or putting the finishing touches to a nursery, there’s a ticker for that
Charlie Austin: Queens Park Rangers striker says ‘If the move is not right, I’m not going’

Charlie Austin: ‘If the move is not right, I’m not going’

After hitting 18 goals in the Premier League last season, the QPR striker was the great non-deal of transfer deadline day. But he says he'd preferred another shot at promotion
Isis profits from destruction of antiquities by selling relics to dealers - and then blowing up the buildings they come from to conceal the evidence of looting

How Isis profits from destruction of antiquities

Robert Fisk on the terrorist group's manipulation of the market to increase the price of artefacts
Labour leadership: Andy Burnham urges Jeremy Corbyn voters to think again in last-minute plea

'If we lose touch we’ll end up with two decades of the Tories'

In an exclusive interview, Andy Burnham urges Jeremy Corbyn voters to think again in last-minute plea
Tunisia fears its Arab Spring could be reversed as the new regime becomes as intolerant of dissent as its predecessor

The Arab Spring reversed

Tunisian protesters fear that a new law will whitewash corrupt businessmen and officials, but they are finding that the new regime is becoming as intolerant of dissent as its predecessor
King Arthur: Legendary figure was real and lived most of his life in Strathclyde, academic claims

Academic claims King Arthur was real - and reveals where he lived

Dr Andrew Breeze says the legendary figure did exist – but was a general, not a king
Who is Oliver Bonas and how has he captured middle-class hearts?

Who is Oliver Bonas?

It's the first high-street store to pay its staff the living wage, and it saw out the recession in style
Earth has 'lost more than half its trees' since humans first started cutting them down

Axe-wielding Man fells half the world’s trees – leaving us just 422 each

However, the number of trees may be eight times higher than previously thought
60 years of Scalextric: Model cars are now stuffed with as much tech as real ones

60 years of Scalextric

Model cars are now stuffed with as much tech as real ones