It is now just over five months since NHS trusts had to ensure that none of their staff were working more than 48 hours per week and become compliant with the European Working Time Directive. Despite the many doomsayers who, before the 1st August 2009 deadline, said it could not happen, over 95 per cent of trusts have managed to achieve a 48 hour working week.
Professor Wendy Reid, the Department of Health’s national clinical advisor on EWTD thinks that the scaled back working week has acted as ‘catalyst’ for change.
“The majority of rotas are reported as being compliant without compromising patient safety... Where we are seeing really successful change and long term solutions is where there has been a whole system change led by senior clinical leadership,” she explains.
Professor Reid, who has recently been visiting a number of trusts around the country to hear firsthand how EWTD is working and about any problems and difficulties that are occurring, says that only 3 to 4 per cent of rotas found it necessary to apply for derogation and that of those not all have used their derogation.
“Where rotas are derogated we are going back and asking strategic health authorities to quality assure those rotas, looking at plans for ending derogation in two years time as well as addressing risk,” she explains.
Next year Sir John Temple will publish his review ‘Medical Training England’ which will examine the impact EWTD has had on junior doctors’ training.
“My passionate hope is that it will show on the ground how innovative people can be with training, there are some big questions about training that need to happen and EWTD can act as a catalyst for these as well,” Professor Reid explains.
She warns that ‘every scrap’ of training time must be maximised and that rotas cannot be allowed to compromise training.
“It is important that EWTD helps to make trusts understand that they need to value training and this comes from having very senior clinical leaders explaining its importance to the trust board.”
Trusts were also given the flexibility to apply for derogation twice (in July and October) in order to help them prepare for a sustainable 48 hour working week target rather than simply to meet the August deadline and then regress.
In order to make sure they keep up with EWTD medical trainers have also been encouraged to make recruitment as efficient as possible and ensure that trusts are made well aware of future recruitment gaps. “We have to make sure we in the medical profession understand the ebbs and flows of recruitment and don’t let trusts know too late - this is important for patients and for training,” Professor Reid explains. “We must not allow rotations to be destabilised because of known gaps,” she adds.
Ultimately Professor Reid says that she is keen to recognise the hard work that has gone into achieving EWTD in NHS trusts across England: “We have to be serious and honest about continuing to find solutions and challenging senior doctors to be innovative.”
Working Time Directive 2009 
