EU red tape rules are making our doctors lazy clock-watchers
European rules are creating a generation of “lazy, clock-watching” junior surgeons who lack the skills to operate safely, their bosses have warned.
A year after the EU directive limiting workers to a 48-hour week was brought in for the NHS, 80 per cent of consultants polled by the Royal College of Surgeons said quality of care had already been damaged by the changes, with risks to patients who are repeatedly “handed” from one shift to the next.
The survey also found that two thirds of junior surgeons said their hours in training had been cut.
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Consultants who took part in the study were most damning about the impact of the changes on their trainees.
Among responses from more than 500 senior surgeons taking part were repeated warnings that the rules were creating a generation of “clock-watchers” with a “lazy work ethic” who no longer felt personal responsibility for their patients.
Trainees were now spending so little time in operating theatres that they would lack the “cutting skills” required to perform safely when they became consultants, many warned.
College president John Black urged the Government to take urgent action to address the concerns, having pledged in its Coalition agreement that it would work to limit the application of the EU rules in the UK.
He described the situation facing the NHS as “acutely urgent”.
Mr Black said: “Without action we are going to see a generation of specialists with less experience than any that have gone before.”
Many consultants responding to the survey said the changes – which began in 2007 when a 56 hour maximum working week was introduced, following EU legislation – were already changing the attitude of young doctors, who were becoming too detached from the patients in their care.
Marjan Jahangiri, Professor of Cardiac Surgery at St George’s Hospital in London said: “We have created a generation of surgeons who lack technical skills and operate within a “clocking off” culture where they do not feel personal responsibility for their patient.”
The surgeon said the change in attitude was “as fundamental and dangerous” as the lack of expertise among junior doctors, who now received far less training than their predecessors.
She said: “We have now got a system where trainees begin keen and motivated, become restless from a lack of training opportunities, and they will end up lazy and unskilled”.
The heart surgeon, 48, said that by the time she became a consultant, nine years ago, she had undertaken 900 cardiac operations. The current generation were likely to become senior doctors after performing less than 300, she said.
Consultants who used to do most of their surgery assisted by trainees said they were now often forced to operate alone.
While some juniors ignored the rules and came in on their days off, most had far less time in the operating theatre because of strictures limiting them to a maximum of 48 hours, including all time on call, as well as their night shifts, and time on wards and in Accident and Emergency departments.
One respondent to the survey described the directive as the “single most damaging factor affecting training and continuity of care”.
The surgeon added: “The most insidious problem is that it fosters the concept that you are responsible for a patient only for a shift.
“A consultant surgeon has a particular and continuing responsibility – we are training clock watchers whose work life balance is more important than anything else.”
More than half of the 982 consultants and trainees polled said they were not truly complying with the rules, with many saying they lied about the true hours they worked because of pressure from NHS managers.
Among consultants who did comply with the 48 hour limit, 56 per cent said they had only done so at the expense of patient safety.
Many of the risks came from the increased numbers of “handovers” from one shift to another, and the use of inexperienced locums to cover gaps in rotas.
While some respondents in the anonymous survey said only luck had avoided serious incidents, others described specific errors which they attributed to the new system – such as the removal of an eight year old’s ovary, instead of her appendix, by an inexperienced doctor.
Mr Black said the NHS was “skating on very thin ice” under the current system, given that most doctors said they were still working longer than the 48 hours,
Doctors described handover procedures between teams which were unsafe, inadequate and in some cases, non-existent.
Trainees also described despair about the system, with many saying their training had suffered, and others saying they were only managing to improve their skills by lying about their hours and working on their days off.
Estimates suggest the current generation of trainees will have spent about half as much time in training or on call as those who became consultants before the EU rules were introduced.
A consultant summed up the training problems as a “complete disaster”, adding: “I just hope my colleagues can look after me when I get old. The only problem is they are going to be getting old too.”
Tags: Doctors, Health Direct, Health Professionals, Labour shambles, nanny state, RCS, red tape