Meeting the European Working Time Directive has proved a major challenge for acute specialties in 2009. Those responsible for providing maternity, paediatrics, surgery and anaesthesia have faced particular difficulties not least because of the need to have specialty specific clinical services available 24 hours a day.
The European Working Time Directive has meant that since 1st August 2009 all staff in all NHS organisations, with the exception of a very small minority, should now be working no more than 48 hours a week. Implementation of the directive has been achieved across the NHS. In essence the directive is health and safety legislation aimed at ensuring both the safety of patients and the safety of the NHS staff who work for those patients.
As a positive by product it should also, if implemented properly, serve to safeguard the quality of training and the work/life balance of junior doctors who used to be the NHS staff group most likely to be working more than 48 hours.
Sustainability is key to realising the benefits of the directive for NHS staff who should not now be working more than 48 hours per week. As the directive has now largely been met its future success depends on strategic health authorities, trusts and commissioners working together to ensure that a 48 hour working week is maintained.
Senior workforce consultant at NHS East of England, Jacky Beaumont, says that across the region the SHA managed the implementation programme with its primary care trusts and acute trusts. “It was managed really well so we haven’t got any major concerns. There are plans in place for some derogations and trusts with derogated rotas have a two year period to achieve that.”
She explains that the SHA also provided a lot of support to Skills for Health - Workforce Projects Team (WPT) after being commissioned to carry out a number of pieces of work across England with trusts for whom implementation was proving more difficult. “Skills for Health were very good at supporting trusts and there is no doubt that there has been wide stakeholder engagement on this, they managed to generate energy and enthusiasm for EWTD implementation... They have played a really overarching role in moving EWTD forward.”
In the North West SHA EWTD lead Dr Debbie Kendall reports a similar experience: “NHS North West went a year early in terms of implementing EWTD and I think we had an enormous advantage over the rest of the country in doing so. We were in the fortunate position of being able to spend this year ironing out difficult problems.” Dr Kendall says that implementing EWTD has been a ‘huge challenge’ for the NHS but something that it has done ‘remarkably well.’
“It will take time to embed and now the focus will be on delivering training in 48 hours,” she explains. She also praises Skills for Health - Workforce Projects Team for providing ‘fantastic’ targeted support to trusts that have had difficulties.
“They have also provided a portal through their website with all the documentation and resources available. Their energy and enthusiasm has helped drive forward EWTD nationally... They have always been at the end of the phone and ready to get involved.”
At NHS South East Coast Eleanor Bell, EWTD lead, says the region has worked hard to achieve compliance. “Some trusts have needed to make use of a derogation but have continued to make changes: so far in 50 per cent of rotas with derogations doctors are now working 48 hours,” she explains.
Ms Bell continues saying that the ‘wealth of evidence and information’ on successful implementation of EWTD provided by Skills for Health - Workforce Projects Team has been very helpful. “Skills for Health have been very supportive and proactive in developing interventions to support trusts and SHAs in their work to achieve EWTD... They are also happy to speak to trust staff directly. I think it would have been much harder to achieve EWTD compliance without this team.”
Ms Bell explains that going forward the SHA has identified PCT EWTD leads to help work with the SHA to performance manage acute trust compliance. “The intention is for PCTs to fully take over the performance management of trusts once they fully understand the issues; we do not expect any trusts to have difficulties in achieving full compliance by the end of the derogation.”
Head of service improvement and workforce at NHS South West, Maggie Boardman, is somewhat sanguine about the implementation of EWTD. “I think that in the end implementation went better than we might have expected. We have got 23 derogated rotas across four hospitals in the South West and we have got about 20 further rotas reporting that they are experiencing problems. Our main focus now is on making sure we can sustain compliance and we are looking at all the options for that.”
Ms Boardman says that the SHA has ‘boosted’ its EWTD team until March 2010 in order to make sure trusts are still achieving a 48 hour working week for doctors. “We are working towards mainstream monitoring by service commissioners who should be assured that people working in trusts are compliant; PCTs should make sure they are assured of that,” she says.
Ms Boardman believes that it was ‘great’ to have a ‘really informed group of people’ in the Skills for Health - Workforce Projects Team who were ‘authoritative’ and enabled trusts to draw upon the right resources.
Neil Sellen a senior workforce consultant based at NHS East of England warns that although the EWTD has largely been met, long term change solutions have yet to be built in to a lot of trusts: “We are working with some organisations... the problem is that more than half of trusts have just recruited more doctors,” he explains. However, he says that the ‘suite of tools’ developed by pilot sites and Skills for Health was invaluable in terms of highlighting best practice to struggling trusts.
Working Time Directive 2009 
