Letters: Doctors' Hours

The disaster of doctors' hours

Share
Related Topics

Your recent leading article highlighting the problems of poor-quality locum cover in UK hospitals ("An emergency in out-of-hours cover", 30 June) is a welcome intervention in the disaster that has followed the introduction of the European Working Time Directive.

However it is grossly unfair on many hard-working hospital consultants to suggest that the previous system relied on junior doctors working without supervision. It is a dangerous consequence of the EWTD that much of the time when consultants and trainees work together has been lost by the need to spread thinly all the available doctors across 24 hours.

In surgery, it has become common for the consultant to be in theatre operating alone on emergencies, while the single junior doctor tries to look after multiple sick patients from several specialties.

It is the EWTD and not the Modernising Medical Careers process that produces the need for so many "locum" doctors to fill rotas. If they were allowed to work a sensible combination of work and on-call of up to 65 hours a week, there are sufficient doctors in the UK for a consultant-led team rather than single overworked individuals to provide 24-hour care.

This would give not only better, safer continuity of care for patients, it would allow high-quality training for the next generation of doctors.

John Black

President, Royal College of Surgeons,

London WC2

I was centrally involved in the early attempts to balance the competing needs of safe patient care and safe medical cover, being involved in the negotiations with the Department of Health (DoH) on behalf of the profession centrally, and in my own NHS Region trying to translate this into practical working patterns.

When this saga started we were told by the DoH that agreed European law required us to implement progressively shorter hours for doctors in training until they were down to current expected levels. We warned that this was impossible as increasing the number of trainees to fill the gaps would lead to a surplus of applicants for consultant or specialist posts, and that to increase these posts as needed would take money and time. I remember being told that we would have to work longer hours. I already worked an 80-100 hour week and did no private practice – I enjoyed the work but my family largely did without me and I tended to fall asleep when not working. I remember a junior doctors' representative solemnly telling me that at my age I needed less sleep!

If blame has to be laid, it seems strange that we allow politicians using an idea scribbled on the back of an envelope to implement experiments on medical care without a proper trial or the approval of an ethics committee. I would also defend the many Health Service managers who worked constructively with us, suggesting many helpful schemes to try to make this work. We warned that the scheme would hit the buffers if it kept to the time scale envisaged but the politicians ignored us. Now we are expected to take the blame.

John Atkins

Hon Consultant, fetal maternal medicine,

James Cook University Hospital,

Middlesbrough

Your leading article gives the impression that hospital consultants can choose, like GPs, whether to work out of hours. This is incorrect. The vast majority of consultant contracts include on-call as part of the job plan. Without this we would be even more concerned about providing continuity of care, the provision of which now lies principally with consultants.

One should also raise the question of whether any doctor who may be faced with emergencies at any time can adequately remain competent to recognise and deal with them if they opt out of "on-call" work. It is my personal opinion that GPs should not have had such an option.

Dr Pam Tomlin

Honorary Consultant Paediatric neurologist,

Royal Preston Hospital & Manchester Children's Hospitals

Stop moaning about 'betrayal'

I do wish that Lib Dem supporters who keep protesting against the "betrayal" of their values by the party leadership would take a reality check.

Presumably they voted Lib Dem at least in part because they support proportional representation. And presumably they knew that with proportional representation there will more often than not be a coalition government. And in a coalition government there will have to be compromises.

In the short life of this government, we have had the rise in capital gains tax (a Lib Dem idea), the raising of the tax threshold (another Lib Dem idea), the safeguarding of the state pension (yet another), and the projected replacement of short prison terms with community service (still another). Do they think Tory activists are happy about these "betrayals" of Conservative values?

Yet all these moaners seem to be able to see is the rise in VAT and the projected cuts in benefits. Yes, these compromise Lib Dem principles, but that is the nature of coalition politics – ask any German, Dutchman or Swede.

Perhaps they would prefer to stay true to every single one of their principles – and stay permanently on the fringes of British politics.

Michael Bennie

Newton Abbot, Devon

Mary Dejevsky (Opinion, 2 July) wants to know what Nick Clegg has done wrong. Perhaps I can help her.

Liberals like Lloyd George and Beveridge established an honourable tradition of recognising that freedom to make money should be tempered by a duty to protect those who, through no fault of their own, are unable to achieve a reasonable standard of life. By supporting a programme which seeks to make the poorest pay a disproportionate share of the cost of a crisis created by the richest, Clegg has betrayed that tradition.

The Liberal Democrat voters of my acquaintance were powerfully influenced in their decision to vote Lib Dem by the intention to scrap the ruinous Trident programme. By dropping that commitment he has betrayed them.

It might be argued that all this is worth it if, in exchange, we get a voting system which is more proportionate, giving the centre party a better chance of a fair representation. However, AV is not a proportional system, and its adoption might well delay the arrival of a properly proportionate system.

Jim Cordell

Manchester

Use Lido or you could lose it

Your architecture correspondent queries the lack of usage of Lidos in general and the Saltdean one in particular (1 July). As a gentleman said at one of the public meetings, the best way to ensure ongoing maintenance would be to use the facility so that money was going through the till.

In the three weeks before last weekend's sun and heat, Saltdean Lido was open every day and yet enjoyed the company of fewer than a dozen swimmers in total. There is no way that any pool could survive on this level of usage, whoever runs it.

If rather than attempting to wrest the lease from the legitimate owner (and thereby plunge the building into an even more uncertain future), every one of the Facebook campaigners bought a season ticket that would raise a significant amount towards repair and maintenance. In the absence of that, there remains the need to subsidise the facility in some way, and that is what the owner is trying to achieve.

Mark Strawbridge

Nottingham

Cuts we could live with

Regarding the resistance to benefit cuts, as a 61-year-old, £600-a-day business consultant, I find that using my free bus pass when visiting clients is of great value, and the £250 winter fuel allowance arrives in nice time to fund some pre-Christmas customer entertaining.

More seriously, I attempted to help a young man who became known to our family. Orphaned at 16, he was living on benefits on his own in a flat provided by the local council.

I arranged an interview for him through contacts at a local distribution centre, where there was a vacancy with the prospect of development training. He declined to even go to the interview, because "It's warehouse work, and warehouse work wouldn't suit me." As far as I know, he remains on benefits and Jobseeker's Allowance (ha! - some jobseeking).

If his – and my own – state payouts were stopped or curtailed, would this be "vicious Tory cuts", or a more sensible use of public money?

Richard Charnley

Leamington Spa, Warwickshire

No wonder

Articles on super heroes are a rare treat in the "better" papers, but your correspondent Guy Adams in Los Angeles (1 July) needs to borrow Wonder Woman's Lasso of Truth when next he researches an article. He states that WW's arsenal includes the "Lasso of Truth, Bracelets of Victory and the ability to fly". If this were true, why does the "Amazon Princess" own an "invisible jet"?

Steve Mullane

Southampton

Diet revolution

Health Secretary Andrew Lansley and George Osborne appear to have devised a wicked wheeze to solve the pensions "timebomb". Disregard everything that Jamie Oliver has been banging on about (report, 30 June). Bring back the deep-fried reconstituted meat, the chips and the saturated fats. Let the poor eat them while they are at school and they will never live to see 65. Pension problem solved!

Simon G Gosden

Rayleigh, Essex

Perspectives on World Cup football

Green's gift to the English game

Robert Green has done English football a massive favour. But for his gaffe, the team would have won their group, would have squeezed past Ghana by the odd goal, beaten Uruguay in the penalty shoot-out, and in the semi-final lost heroically to Spain with a hard-working performance, a dodgy penalty and an offside goal against them.

As England are only eighth in the present Fifa rankings, a semi-final defeat to Spain would have been acceptable to the more pragmatic English public. This scenario would have prevented the vitriol which is now being spewed out daily in our newspapers, but the hysteria, hyperbole and hallucinations surrounding the team before every major tournament would still be in place.

At least now, perhaps, the nation will realise that its team will never possess the technical skills of the South Americans, the improvisation of the Dutch and the Spanish, or the organisation of the Germans.

J McGregor

Wigan

Players' wages: are they worth it?

Some quick back-of-an-envelope sums show that our toothless lions and their coach earned in their month of South African shame the equivalent of the annual salaries of 10,152 newly appointed NHS staff nurses.

Maybe, in this era of austerity, it is time to ask ourselves, our broadcasters, football clubs, breweries, sportswear manufacturers, one another and particularly the men themselves if they think we might spend their earnings more wisely?

Tom Ladds

Bollington, Cheshire

An outlandish proposal

I have a novel solution to the problem of controversial decisions deciding football and other sporting matches: "honesty".

Imagine a world where goalkeepers admitted that the ball had indeed crossed the line. Imagine a situation where the last person to touch the ball before going over the line for a corner, goal-kick or throw-in owned up to the fact. Imagine a player stopping the game to say "Hold on, Ref, I played the ball with my hand!"

Oh for the days when cricketers "walked" when they knew they were out.

Maurice Waller

Seaford, East Sussex

React Now

Latest stories from i100
Have you tried new the Independent Digital Edition apps?
iJobs Job Widget
iJobs General

Lead Application Developer

£80000 - £90000 per annum + competitive: Progressive Recruitment: I am current...

Year 3 Welsh Teacher vacancy in Penarth

£110 - £120 per day + Travel Scheme and Free training: Randstad Education Card...

Senior Developer - HTML, CSS, PHP, JavaScript, VBA, SQL

£30000 - £35000 per annum + benefits: Ashdown Group: We are working with one o...

Male Behaviour Support Assistant vacancy in Penarth

£55 - £65 per day + Travel Scheme and Free Training: Randstad Education Cardif...

Day In a Page

Read Next
A destroyed UN vehicle is seen in Beit Lahia in the northern Gaza Strip on July 29, 2014 following Israeli military strikes.  

Now diplomacy has failed, boycotting Israel might be the only way we can protect the people of Gaza

Yara Hawari
Prime Minister David Cameron walks on stage to speak at The Confederation of British Industry (CBI) annual conference on November 4, 2013  

Does Cameron really believe in 'British Values'?

Temi Ogunye
Save the tiger: The animals bred for bones on China’s tiger farms

The animals bred for bones on China’s tiger farms

The big cats kept in captivity to perform for paying audiences and then, when dead, their bodies used to fortify wine
A former custard factory, a Midlands bog and a Leeds cemetery all included in top 50 hidden spots in the UK

A former custard factory, a Midlands bog and a Leeds cemetery

Introducing the top 50 hidden spots in Britain
Ebola epidemic: Plagued by fear

Ebola epidemic: Plagued by fear

How a disease that has claimed fewer than 2,000 victims in its history has earned a place in the darkest corner of the public's imagination
Chris Pratt: From 'Parks and Recreation' to 'Guardians of the Galaxy'

From 'Parks and Recreation' to 'Guardians of the Galaxy'

He was homeless in Hawaii when he got his big break. Now the comic actor Chris Pratt is Hollywood's new favourite action star
How live cinema screenings can boost arts audiences

How live cinema screenings can boost arts audiences

Broadcasting plays and exhibitions to cinemas is a sure-fire box office smash
Shipping container hotels: Pop-up hotels filling a niche

Pop-up hotels filling a niche

Spending the night in a shipping container doesn't sound appealing, but these mobile crash pads are popping up at the summer's biggest events
Native American headdresses are not fashion accessories

Feather dust-up

A Canadian festival has banned Native American headwear. Haven't we been here before?
Boris Johnson's war on diesel

Boris Johnson's war on diesel

11m cars here run on diesel. It's seen as a greener alternative to unleaded petrol. So why is London's mayor on a crusade against the black pump?
5 best waterproof cameras

Splash and flash: 5 best waterproof cameras

Don't let water stop you taking snaps with one of these machines that will take you from the sand to meters deep
Louis van Gaal interview: Manchester United manager discusses tactics and rebuilding after the David Moyes era

Louis van Gaal interview

Manchester United manager discusses tactics and rebuilding after the David Moyes era
Will Gore: The goodwill shown by fans towards Alastair Cook will evaporate rapidly if India win the series

Will Gore: Outside Edge

The goodwill shown by fans towards Alastair Cook will evaporate rapidly if India win the series
The children were playing in the street with toy guns. The air strikes were tragically real

The air strikes were tragically real

The children were playing in the street with toy guns
Boozy, ignorant, intolerant, but very polite – The British, as others see us

Britain as others see us

Boozy, ignorant, intolerant, but very polite
How did our legends really begin?

How did our legends really begin?

Applying the theory of evolution to the world's many mythologies
Watch out: Lambrusco is back on the menu

Lambrusco is back on the menu

Naff Seventies corner-shop staple is this year's Aperol Spritz