The European Working Time Directive, or EWTD as I shall refer to it for the rest of this blog, has had the greatest effect of any EU legislation on the NHS. Implemented in the NHS aiming to protect the Health and Safety of NHS workers and their patients by restricting working time and imposing mandatory rest periods, it has fallen victim to some unintended consequences.
For specialisations with complex procedures requiring experiential learning there is no substitute for the time spent on the most cases possible.
Over the last couple of years I have had many conversations about the EWTD and its effect on Surgical training. The result of the EU Referendum and the recent Junior Doctors dispute have not helped. While the EWTD remains in force as long as we are in the EU, likely to be several years, it is hard to imagine that the real protections given will be dumped wholesale.
The head of the Royal College of Surgeons was asked by the Government to form a Taskforce drawing on expertise within and without the NHS to examine the issues and make recommendations. It reported in April 2014 and left no doubt that the EWTD had been particularly damaging to the training of surgeons and doctors working in acute medicine.
Of the five recommendations the Taskforce made the one that felt closest to home was:
On July 22nd 2014 the Government officially accepted all the recommendations of the Taskforce. Jeremy Hunt, then Secretary of State for Health stated, “ We share the longstanding concerns about the impact of the Working Time Directive on patient care and doctor’s training. Doctors should have the flexibility they need to access the training they want. This would lead to better care. We will never go back to the past with tired doctors working long hours, but it is clear that the Directive does have a negative impact on the training of doctors in some specialties. We will now look at how training and working time could be separately identified so we can give doctors the flexibility they need.
For me the key aspect of surgical training is the actual intensity and volume of experience for trainees as they develop skills as confident, competent and safe surgeons. I hope that the Governments support for these recommendations will have a swift and beneficial effect but experience would suggest that it will be a long drawn out and partial solution to the problem. The current stresses in the NHS and Brexit will not make it any quicker.
I hope to be proved wrong.