Opinion Piece

No Time for Old Mistakes
by Tim Lund

There are less than five months to go to August. Many parts of the NHS have introduced EWTD 2009 ready rotas or are in the process of doing so. However, some services may rely on last minute solutions that carry increased risks.

We know that the quality of EWTD solutions in 2004 (58 hour week) were variable, including the wide use of 13 hour shift working for up to seven consecutive nights. The research base for helping to design rotas was limited and the inflexible ruling by the European Court of Justice in the Jaeger case didn't help.

However in 2009, the NHS can benefit from six years of clinically led EWTD pilot programmes and Hospital at Night services. They demonstrate that creative solutions can support the quality of patient care, clinical training and work / life balance of staff. Many services have also benefitted from the national programme of targeted support, led by the NHS East of England Workforce Team in partnership with Workforce Projects Team.

In addition, the royal colleges have published research on safer working patterns and services have had several years to adapt to the challenging SiMAP and Jaeger rulings.

EWTD 2009 remains a big challenge for parts of the NHS but there are no excuses for repeating the same mistakes from 2004. West Midlands Deanery are about to publish the EWTD pilots programme evaluation and have identified several key themes:

• Be clear about the nature of the service you want to provide and build EWTD into it, not the other way around
• The involvement of clinicians in developing and implementing solutions is essential. Clinical champions have played key roles in the pilots programme and junior doctor engagement is central to sustaining workable rotas
• Board level commitment is very important
• Effective project management involves a partnership between the project manager and clinicians in taking forward solutions
• Interorganisation and multisite solutions are sensitive and complex. They require a commitment to radical change and innovative thinking
• EWTD 2009 compliance is achievable.

August may be less than five months away but any organisation that needs to implement interim plans can use this as a stepping stone towards sustainable solutions. A lot can be achieved in a fairly short time if organisations have a clear view of the service they wish to run and are committed to staff engagement. It is vital that any temporary solutions continue to support doctors' education and training.

The evaluation report will be published on the healthcare workforce portal at, along with the range of learning resources and completion reports from the pilots.