And a very large \”Well Done!\” to the EU

Some hospitals narrowly avoid “catastrophe” every weekend, research by the Royal College of Physicians has found, because doctors’ shifts are limited by the European Working Time Directive and they do not want to work anti-social hours.

What would we all do without that guidance from Brussels?

Live longer perhaps?

29 thoughts on “And a very large \”Well Done!\” to the EU”

  1. You skate over, “and they do not want to work anti-social hours” That is a different problem to the working time directive. Maybe the EU could produce a Patients Sickness and Injury Time Directive, legislating the times when people can fall ill or have accidents?

  2. That’s very badly written.

    Is it trying to say they come close to catastrophe because x and y, or that they manage to avoid catastrophe, thanks to x and y.

    Whatever doctors say, don’t believe them, is my motto, one of the few groups you can probably trust even less than the EU.

  3. As usual with this kind of Telegraph piece, you need to knock off the top three paragraphs and read the buried facts which the top three paragraphs misrepresent. Which tells you:

    1) 60% of doctors don’t think there’s a problem with staff shortages.

    2) 75% of doctors don’t think there’s a problem with the Working Time Directive.

    3) only 10% of senior consultant posts in emergency medicine are vacant.

    4) beds have been cut because better care has led to shorter stays.

  4. The article appears to ignore how they manage to have a more competent healthcare system in those nasty european countries, coping with the self same directive without all the problems we seem to have.
    Maybe its got more to do with the NHS structure or the doctors union.
    Perish the thought that games are being played

  5. I do not want Doctors who have been awake for ridiculous hours making decisions about my life and death.

    I want them working sensible hours that give them sufficient downtime to be capable of thinking very hard and finding out what’s wrong with me.

  6. I don’t know what the Telegraph is quoting there, because the word “catastrophe” does not appear in the RCP report.

    Today’s consultants got the rough end of the change in working hours, because they had to work very long hours as junior doctors, and now have to do more on-call than consultants used to, to compensate for the reduced hours juniors are doing. It’s not surprising that a fair few of them are willing to have a moan about it.

  7. Have to agree with John B here (#3), this (the original Telegraph source article)seems to me a classic ‘bash the NHS’ piece which takes the ‘take out of context’ and ‘misquote statistics’ approach we so rightly criticise from Eoin Clarke or @RichardJMurphy and seeks to apply it in a way that accords with our expected prejudices should we read the DT.

    In terms of whether the Working Time Directive is a good thing – having worked in the Transport Industry, weekend cover should not be an issue if appropriate shift premiums for working those ‘unsociable hours’ are included. The WTD covers the overall hours over a 13 week period I believe – no double counting for weekends or night shifts.

    Couple of questions –

    1/How are they rostering in cover – ~Are the Doctors themselves setting their shift patterns in the way that Brown allowed them to negotiate a 100% pay rise for a loss of all out of hours cover and fewer overall hours?

    2/ If we need more Doctors, surely this isn’t an issue given the huge demand for places from Students on Medicine courses. Of course it would mean a cull of the huge numbers (estimated at nearly a million) of Non-productive Labour supporters within the NHS Management Structure, but that can’t be a bad thing, surely?

  8. @PaulB It might not use the word ‘catastrophic’ but to point that out is rather to split hairs. The preface reads in part:

    ‘The unnecessary pain, indignity and distress
    suffered by older patients in NHS facilities have been hauntingly documented by the Parliamentary and Health Service Ombudsman and the inquiry into care at Mid Staffordshire NHS Foundation Trust. The independent public inquiry, chaired by Robert Francis QC, found that for many the most basic elements of healthcare were neglected and staff displayed ‘insufficient care for patients’ dignity with some left in degrading conditions and others inadequately dressed’. This inadequacy resulted in ‘horrific experiences that will haunt them and
    their loved ones for the rest of their lives’.

    I mean, perhaps you have a different definition of catastrophic?

  9. VP:
    1) on-call arrangements for hospital doctors are not of-course determined by provisions for GP out-of-hours cover.

    Consultants in each speciality have an on-call rota which shares on-call duties among them. They are paid at a rate of time and a third, but counting only the time typically worked during an on-call shift, not the time they have to spend sober and available but not actually in the hospital.

    2) last time i checked, there were about 40,000 managers in the NHS. I’m surprised to read that nearly a million of them are non-productive labour supporters. Perhaps your estimate is awry. It does take some time to turn a medical student into a consultant, so it might be better not to sack all the management staff responsible for estimating future needs, even if some of them do have the temerity to vote for the wrong political party.

  10. It was eventually recognised that it was awful that junior hospital doctors had to work 75 hours a week (some 50 years after Richard Gordon famously commented that most doctors married nurses or barmaids because they were the only females they met). So the Labour government talked to the BMA – result was not the sensible one of increasing the number of junior hospital doctors by one-third by getting them to work four years at 56 hours a week instead of 75 hours a week for three years. No, BMA said they should increase the number of consultants and the government told the NHS to do so.
    Go and check and see one of the multitude of reasons why the NHS was the second-worst (after British Fail) management that I have ever had the misfortune to encounter.

  11. Interested: stuff put in quotation marks is suppose to be a quote, not a paraphrase. And the section you quote doesn’t so much as mention the European Working Time Directive, which is what the Telegraph’s paragraph is about.

  12. Tim, since those of us in high-stress private-sector jobs to whom the WTD applies entirely ignore the WTD you can rest assured that it is routinely ignored by both management and clinical staff in hospitals.

    Indeed, if it applies at all to clinical hospital staff in the UK that is a direct result of a Bliar government’s overzealous gold-plating of the regulation. Most doctors are paid highly enough (and do an important enough job) to slip through one or more of the many exemptions in the WTD.

    None of which should be taken to imply support for either NHS management or the pointless and unenforceable WTD. Just if you are going to read ideologically biased sources you should bear their ideological bias in mind.

  13. Article 17:3 C(i). Doctors are exempt. Explicitly doctors in training are exempt.

    Any doctor suing his health authority for whatever damages for making them work 48 hours and 1 second a week will be (i) laughed out of their profession and (ii) laughed out of the European courts.

    Trust some British civil servant to pro-actively use it as an excuse for their own failings.

  14. Paul B

    Re: 1/ I bow to your superior knowledge in this regard – I thought that Roster patterns took account of the fact that there was likely to be more demand for the services at the weekends, or are you saying that they don’t roster in much cover over the weekends and the demand is taken care of by an ‘on- call’ rota? If they are not being given some form of recompense for being available to cover in case of emergency (The equivalent I assume of some kind of IT support roster) then that’s surely something the BMA should try and negotiate?

  15. If there’s any doubt then all hospitals should be designated as seagoing fishing vessels and be ordered to fly the flag of a member state. Doubt could probably be eliminated by designating all hospitals as seagoing fishing vessels and instructing them to fly the flag of Panama. Simply dig a moat around every hospital and fill it with salt water and a modest stock of cod.

  16. And article 22:1 A gives everyone an individual opt-out from the whole 48-hour caboodle. Rather depends on whether or not the Bliar government, y’know that great sovereign thing in Westminster that is supposedly so much better at making decisions than Brussels, transposed that into national law though, doesn’t it.

  17. Paul B re:2/ – the NHS is, I believe the third or fourth largest employer in the World, (US DOD, Red Army and Walmart) and not every non-productive position has a managerial title, and indeed in every encounter with the Public Sector in whatever guise, (be it NHS, Police, Education sector or other agency) the front-line professionals I have encountered (including Friends who are Doctors) have frequently bemoaned ‘inappropriate’ Amounts of resources being assigned to managerial or consultative positions, and the tenacity with which such bureaucracies tend to defend their existence.

    I will say that the Million figure referred to the entire Public Sector (the ‘Client State’ or NPPS ) rather than the NHS specifically, so on that I stand corrected.

  18. Obviously non-managers resent managers, in any organisation. This is for the obvious reason that people don’t like being told what to do. It doesn’t mean that the opinions of non-managers on the worthlessness of managers are valid or justified.

  19. @PaulB: ‘Interested: stuff put in quotation marks is suppose to be a quote, not a paraphrase.’

    I think you are confused. The fact that it is in quotes does not mean that it must come from the report.

    Intro: ‘Some hospitals narrowly avoid “catastrophe” every weekend, research by the Royal College of Physicians has found…’

    Sir Richard Thompson, president of the Royal College, further down in the article: ‘One doctor told me that his trust does not function well at night or at the weekend and he is ‘relieved’ that nothing catastrophic has happened when he arrives at work on Monday morning.’

    OK, he says ‘catastrophic’, and the intro says ‘catastrophe’, but it’s pretty clear to anyone, except the stupid or wilfully blind, that the intro refers to the quote, and that the quote is the president of the Royal College’s take on his own college’s research, with the word itself coming from contact he has had with a colleague (he’d hardly quote him if he didn’t think there was some sort of ongoing potential for catastrophe, would he?).

    So when you say, ‘I don’t know what the Telegraph is quoting there, because the word “catastrophe” does not appear in the RCP report.’, does that help you?

    @PaulB ‘And the section you quote doesn’t so much as mention the European Working Time Directive, which is what the Telegraph’s paragraph is about.’

    Sure, and if I’d said here’s the proof that the WTD has caused the (potential and elsewhere past) catastrophe, you might have a point.

    But I didn’t – I simply used it, while stating it was only the preface to the report, to show that there was, at least in some people’s eyes, a potential and past catastrophe.

    In that sense it was merely a rebuttal of your point, which was that there *was* no catastrophe, and that the whole thing was a load of Telegraph flim flam, rather than an acceptance that there was one and a disagreement over what caused it.

    We’ve seen you on the NHS before: I really hope you don’t die in pain, starving, and dehydrated, and in a pool of your own very deep yellow piss in an NHS bed, while the nurses check their facebook status on their phones by the desk.

  20. According to the Telegraph, a “catastrophe” was what “research by the Royal College of Physicians has found”. Not a word that nearly but not quite appears in a hearsay quotation.

    I suggest you stop digging.

  21. PaulB, you’re like a stupid dogmatist with a bone.

    Here’s a direct quote from the report (not a ‘hearsay quotation’ in the Telegraph article, or a ‘hearsay quotation’ at all, unless you are accusing the Royal College of making stuff up now?):

    ‘My trust does not function well at night and I am relieved on Monday that nothing catastrophic has happened over the weekend’ Hospital doctor

    If you don’t think the use of the word ‘catastrophic’ entitles a journalist to use the word ‘catastrophe’, I question your understanding of language.

    I suggest *you* stop digging.

  22. I don’t understand why you want to defend the Telegraph’s blatantly misleading article. There’s some stuff in the actual report that should interest you as a critic of the NHS.

    But it remains false that “research by the Royal College of Physicians has found” that “some hospitals narrowly avoid ‘catastrophe’ every weekend”, as the Telegraph claimed. A true summary would be that research by the Royal College of Physicians has found that one doctor in one hospital is relieved that nothing catastrophic happens over the weekend. The meaning is very different.

    I don’t want to obscure that important point with the argument about the quotation, but your ‘direct quote’ is taking from a quotation in the report. Would it be accurate for me to quote you as saying “stuff put in quotation marks is suppose to be a quote, not a paraphrase”? Because you wrote those words in #20.

    Of course, you should say that. Because that’s what quotation marks are for.

  23. @PaulB: ‘It remains false that “research by the Royal College of Physicians has found” that “some hospitals narrowly avoid ‘catastrophe’ every weekend”, as the Telegraph claimed.’

    Have you actually read the original report?

    From the report (not the Telegraph):

    ‘Are services the same at the weekend?

    Emergency admissions activity at the weekends is around 25% lower than during the rest of the week.

    The largest volume of hospital-based clinical activity at the weekend is that associated with emergency medical admissions.

    Each year, there are 0.5 million outpatient appointments at the weekend, compared to around 14 million during the week.

    International studies suggest an increase in mortality of around 10% among patients admitted at weekends.

    It is not clear whether this is due to changes in casemix severity, clinical staffing or other organisational factors…

    …We must ensure the availability of primary care services whenever they are needed, including at the weekend and at night.’

    Actually, I agree with you re the Telegraph’s distortion – they’re not ‘narrowly avoiding’ any catastrophe, at all!

    Assuming the Royal College et al are right about a 10% greater mortality rate, plus having to wait all weekend to be admitted in an emergency, the catastrophe is happening!

    @PaulB: ‘A true summary would be that research by the Royal College of Physicians has found that one doctor in one hospital is relieved that nothing catastrophic happens over the weekend. The meaning is very different.’

    Logic fail par excellence.

    Unless, that is, you ignore all of the above

    and

    you think think that a 10% greater mortality rate at weekends is ‘nothing catastrophic’ (in which case I bow out of the argument, you’re a psychopath*)

    and

    you assume that the one doctor *is* in ‘one hospital’ (he speaks of a Trust)

    and

    you assume s/he’s the only doctor they spoke to, as opposed to the only one whose quote they ragged out for emphasis during the report…

    In which case, sure, I guess you could make that leap.

    *Actually, are you autistic? Serious question.

  24. Yes of course there are some interesting points to discuss in the report. But the Telegraph’s description of it is still wrong.

    And you’ve misunderstood what you quoted.

    International studies suggest an increase in mortality of around 10% among patients admitted at weekends.

    It is not clear whether this is due to changes in casemix severity, clinical staffing or other organisational factors…

    They’re saying that they don’t know what the cause is, but the first possibility they mention is that people who come to hospital at weekends are sicker and hence, regrettably, more likely to die. One needn’t be psychopathic not to blame the WTD for that.

    *I note your serious question. I refer you to reply given in the case of Arkell v Pressdram.

  25. I’ve misunderstood nothing, old bean.

    Mortality is higher, you wait longer to be admitted for emergencies, and they take longer to carry out tests on you. Various doctors, patients, and professors say weekends are a bit shit. It all amounts to a catastrophic state of affairs, if you happen to be an unlucky patient.

    You’re a shill for various lefty causes, and the NHS is one of them.

    You are autistic, then? I thought so. So it’s not your fault.

  26. Yes, mortality is higher at the weekend. Similar results are found in the USA. If I say (and I do) that some of the effect will be due to a difference in casemix severity, does that make me a shill for US healthcare?

    In view of your serious interest in autism, I suggest that you abandon attempts at internet diagnosis, and spend the time studying clinical psychology instead.

Leave a Reply

Your email address will not be published. Required fields are marked *