Safety of patients is paramount

Dr Mark Hannon highlights a number of serious problems in the implementation of rosters that aim to comply with the European Working Time Directive

As the battle between the HSE and the IMO on the implementation of the European Working Time Directive (EWTD) winds its way tortuously through various court actions with no end in sight, numerous hospitals around the country have begun to implement new rosters. Some of these are EWTD-compliant, most are not, and all are unrealistic and unworkable.
One would assume that, in the course of any contract negotiations between employers and employees, any changes to work practices would only be introduced once negotiations were successfully completed. However, the HSE seems to think that the introduction of radically different working conditions for Ireland’s NCHDs can be done in a completely haphazard and piecemeal fashion, once a thick blanket of misinformation is used to conceal the whole sorry process. The unfortunate fact is that the HSE is already having much success with this policy.
The first issue to address is the introduction of new rosters. Many hospitals have introduced some form of altered work practice since July 1, as they were instructed by the HSE to become EWTD ‘compliant’. However, the majority of these new rosters simply involve the introduction of a shift system.
12-hour night shift
For example, in some hospitals, Senior House Officers are being asked to work 12-hour night shifts for seven nights in a row. In return, they are granted the following week off. However, the EWTD specifically outlines that the working week must not exceed 48 hours; the shift system is totally in breach of this, but it is a lot cheaper for the HSE to run than the previous on-call system. I would contend that the only purpose these new rotas serve is to save money for the HSE; they do not bring any hospital any closer to EWTD compliance.
The second issue to recognise in the debate is that of misinformation. There are many, mostly outside the NCHD body and working in other areas of the health service, who firmly believe that the introduction of unfeasible and unsafe work practices is being driven by NCHDs through the IMO. It is also widely believed that the HSE would be willing to continue with the previous rostering system regardless of cost, if only the IMO would stop harassing the HSE to speedily implement the EWTD.
In fact, nothing could be further from the truth. Obviously the NCHD body wants reform to rostering practices – any system that allows a doctor to work for over thirty hours in a row is manifestly unsafe and in need of change – but the IMO has consistently demanded that these changes be implemented in a consistent, logical fashion across all of Ireland’s hospitals, in a manner that guarantees both patient safety and NCHD training. Current HSE practice seems to be aimed at cutting costs and nothing else.
A golden opportunity
Of course, the EWTD presents a golden opportunity for the HSE. Most citizens, even those with no involvement with the health service, are aware that NCHDs work very long hours and that reform is needed. Everyone is aware that we are in a recession and non-essential spending must be reduced.
However, few outside the medical world realise the importance of training and patient safety, and so it is proving very easy for the HSE — with the aid of a campaign of misinformation — to convince outsiders that they are doing their best to implement shorter hours for NCHDs, but are hindered in their efforts by the IMO.
However, all NCHDs know that the manner in which the HSE is trying to implement the EWTD will essentially destroy training. For example, attendance at study days or academic meetings will be almost impossible under a shift system. Teaching opportunities such as the post-take ward round will be lost forever. Senior medical staff will become de-skilled, as they will have to cover the roles of their juniors when their juniors are not at work; conversely, junior staff will have to assume roles far beyond their remit if their senior colleagues are absent.
Although this issue has slipped from the headlines of the mainstream media, it is as important as ever. Indeed, these negotiations could be the moment that defines hospital medicine in Ireland for the next 20 years. It is essential that training is preserved, and no cost-cutting, no negotiating, no European law, must be allowed to interfere with this. Otherwise, it is our patients who will pay the price in the long term.