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Saturday 3 July 2010
Letters: Doctors' Hours
The disaster of doctors' hours
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.
President, Royal College of Surgeons,
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.
Hon Consultant, fetal maternal medicine,
James Cook University Hospital,
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.
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.
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.
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?
Leamington Spa, Warwickshire
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"?
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
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.
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?
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.
Seaford, East Sussex
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