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

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

iJobs Job Widget
iJobs General

Trade Desk Specialist (FIX, Linux, Windows, Network Security)

£60000 per annum: Harrington Starr: Trade Desk Specialist (FIX, Linux, Windows...

Service Desk Analyst (Windows, Active Directory, ITIL, Reuter)

£35000 per annum: Harrington Starr: Service Desk Analyst (Windows, Active Dire...

PHP Web Developer (HTML5, CSS3, Jenkins, Vagrant, MySQL)

£40000 - £45000 per annum + Benefits + Bonus: Harrington Starr: PHP Web Develo...

Network Engineer (CCNA, CCNP, Linux, OSPF, BGP, Multicast, WAN)

£40000 per annum: Harrington Starr: Network Engineer (CCNA, CCNP, Linux, OSPF,...

Day In a Page

Read Next

Simon Usborne: The more you watch pro cycling, the more you understand its social complexity

Simon Usborne

i Editor's Letter: The final instalment of our WW1 series

Oliver Duff Oliver Duff
A History of the First World War in 100 Moments: Peace without magnanimity - the summit in a railway siding that ended the fighting

A History of the First World War in 100 Moments

Peace without magnanimity - the summit in a railway siding that ended the fighting
Scottish independence: How the Commonwealth Games could swing the vote

Scottish independence: How the Commonwealth Games could swing the vote

In the final part of our series, Chris Green arrives in Glasgow - a host city struggling to keep the politics out of its celebration of sport
Out in the cold: A writer spends a night on the streets and hears the stories of the homeless

A writer spends a night on the streets

Rough sleepers - the homeless, the destitute and the drunk - exist in every city. Will Nicoll meets those whose luck has run out
Striking new stations, high-speed links and (whisper it) better services - the UK's railways are entering a new golden age

UK's railways are entering a new golden age

New stations are opening across the country and our railways appear to be entering an era not seen in Britain since the early 1950s
Conchita Wurst becomes a 'bride' on the Paris catwalk - and proves there is life after Eurovision

Conchita becomes a 'bride' on Paris catwalk

Alexander Fury salutes the Eurovision Song Contest winner's latest triumph
Pétanque World Championship in Marseilles hit by

Pétanque 'world cup' hit by death threats

This year's most acrimonious sporting event took place in France, not Brazil. How did pétanque get so passionate?
Whelks are healthy, versatile and sustainable - so why did we stop eating them in the UK?

Why did we stop eating whelks?

Whelks were the Victorian equivalent of the donor kebab and our stocks are abundant. So why do we now export them all to the Far East?
10 best women's sunglasses

In the shade: 10 best women's sunglasses

From luxury bespoke eyewear to fun festival sunnies, we round up the shades to be seen in this summer
Germany vs Argentina World Cup 2014: Lionel Messi? Javier Mascherano is key for Argentina...

World Cup final: Messi? Mascherano is key for Argentina...

No 10 is always centre of attention but Barça team-mate is just as crucial to finalists’ hopes
Siobhan-Marie O’Connor: Swimmer knows she needs Glasgow joy on road to Rio

Siobhan-Marie O’Connor: Swimmer needs Glasgow joy on road to Rio

18-year-old says this month’s Commonwealth Games are a key staging post in her career before time slips away
The true Gaza back-story that the Israelis aren’t telling this week

The true Gaza back-story that the Israelis aren’t telling this week

A future Palestine state will have no borders and be an enclave within Israel, surrounded on all sides by Israeli-held territory, says Robert Fisk
A History of the First World War in 100 Moments: The German people demand an end to the fighting

A History of the First World War in 100 Moments

The German people demand an end to the fighting
New play by Oscar Wilde's grandson reveals what the Irish wit said at his trials

New play reveals what Oscar Wilde said at trials

For a century, what Wilde actually said at his trials was a mystery. But the recent discovery of shorthand notes changed that. Now his grandson Merlin Holland has turned them into a play
Can scientists save the world's sea life from

Can scientists save our sea life?

By the end of the century, the only living things left in our oceans could be plankton and jellyfish. Alex Renton meets the scientists who are trying to turn the tide
Richard III, Trafalgar Studios, review: Martin Freeman gives highly intelligent performance

Richard III review

Martin Freeman’s psychotic monarch is big on mockery but wanting in malice