Letter: Hours cut for doctors spells hospital ruin

Sir: Articles by Jack O'Sullivan ("Prognosis is grim for the NHS", 7 March) and Polly Toynbee ("No promises to keep the NHS fully funded", 13 March) dealt with the problems of the National Health Service, the pressures on it which are increasing expenditure, and the fact that both the main political parties are outdoing each other in insisting that they will not increase its funding. However, there is one major influence which all articles in the press seem to miss, namely the effects of the New Deal on Junior Doctors' Hours.

In the part of a district general hospital which I manage, the item of expenditure which has increased far more than any other is nothing to do with technology or an aging population; it is simply the fact that junior doctors are working shorter hours. For years they worked 100-hour weeks with "additional duty hours" - those above 40 hours a week - paid at half time (the very opposite of the concept of overtime). Now they can only be contracted to work for 72 hours, which means we need more doctors and more money to pay them.

From an individual hospital's point of view, most of this is externally financed, but it still comes out of the total NHS coffers. However, even within the hospital it still has a marked adverse effect on our budgets, because we have to be careful that hours are not exceeded when doctors are taken sick or go on leave. Thus the cost of locums, and business for the locum agencies, has rocketed in the last three years.

This is not a one-off increase which will now stabilise. The process is continuing. Soon doctors will be allowed to work no more that 56 hours, and the Maastricht Treaty will reduce them even further to 48 hours. This will be coupled with the effects of the Calman report on training doctors which is just beginning to bite. Under this, junior doctors are there to be trained, not to provide the backbone of the service, particularly out of hours, which is what thay have been doing until now.

For very good reasons, the Government, under the influence of Europe, has set off a train of events but does not seem to have the faintest idea where it all lead. Not only will it result in a drastic increase in costs, it will result in the closure of many smaller hospitals because they will not have sufficient doctors in the same speciality to sustain on-call rotas and provide teaching.

If the issue of training and deployment of doctors is not addressed in a context which takes into account the impact on the rest of the NHS, it will be overwhelmed by forces that will very quickly get out of control,

W ALEXANDER

Redhill, Surrey