Maximising Training
Dr Ian Curran, associate dean from the London Deanery, gave a convincing presentation on maximising training; looking at the challenges facing EWTD compliance and how we might consider training differently by moving to more structured methods. He strongly emphasised the point that training differently will not lead to a reduction in quality or reduction in output of healthcare specialist training.
There was discussion about how do you develop the appropriate professional values that ensure high quality patient safety in the face of shorter available training time. One of the solutions to this will be to have the right person doing the right thing at the right time, cutting down on the number of tasks that are not educational and are more service oriented.
We should also be wiser with regards to how we approach training and understand what it is we are trying to teach. We can then not only be more targeted in the training we deliver, but we can also be smarter in the use of e-learning and the use of technology to create learning opportunities. Dr Curran also highlighted lessons from the aviation industry that might be adapted to health care.
It was noted that over the last five to 10 years we have increasingly become aware of the notion of higher order professional capabilities. The high order professional capabilities include: how to train people to lead; how we train people to be active members of the team; how people manage risk; how people manage crisis; and how people negotiate. Dr Curran closed the session by asking delegates how we can deliver training in a safer, smarter, wiser manner, sooner and better than before.
Signposting EWTD Solutions
A signposting workshop was held, led by members of Workforce Projects Team, NHS North West and NHS East of England. The workshop provided an opportunity for delegates to ask questions to a panel of EWTD experts, on topics such as the challenges faced by their organisations in implementing the 48 hour EWTD requirement for junior doctors.
A key topic discussed was the derogation criteria, as delegates appeared to have received mixed messages regarding changes to the derogation criteria. The panel were able to confirm that the derogation criteria set out by the Department of Health had not changed.
The panel members, who have supported a number of organisations in meeting the EWTD requirements, identified the main barriers that organisations had faced and the solutions that these organisations had used to successfully implement EWTD.
Delegates took away a copy of the signposting document that was jointly produced by Workforce Projects Team, NHS North West and NHS East of England, which identifies the 10 commonly cited barriers and various solutions to EWTD 2009 implementation.
EWTD Legal Issues
Jodie Sinclair and John Moore from the law firm Bevan Brittan gave an informative presentation on the legal issues associated with EWTD, outlining the legal implications of noncompliance. Jodie said the people on the ground in trusts were key to this important piece of health and safety legislation. Outlining how, with the patient choice agenda developing in the NHS complying with the EWTD is likely to be important for the reputation of hospitals and for the competitiveness of trusts.
It was noted that there hadn't been a great deal of litigation in this area to date and trusts were doing things right in the majority of cases in implementing the EWTD. However, trusts should not be complacent as there are serious penalties for non compliance. The Health and Safety Executive inspectors have quite a lot of power which can include fines for organisations and prison sentences for directors.
There is also potential for breach of contract claims and for employees to claim they have suffered a detriment because they have asserted their EWTD rights. If someone is dismissed for asserting their EWTD rights this is automatically unfair and the money that can be awarded at an employment tribunal in compensation is unlimited. Also doctors do go to court for unlawful deduction of wages if they think they are being paid the wrong banding supplement.Additionally, there is the risk of a case being taken to court under the new Corporate Manslaughter law which could mean a trust is prosecuted if there is death that involves a tired doctor.
Jodie brought to the group's attention the case of Stringer v HM Revenue and Customs [2009] which has established that employees should still get their full EWTD annual leave entitlement when on long term sick leave.
Working Time Directive 2009 
