Setting the agenda

By Lord Warner of Brockley, Minister of State for Reform

Working Time Directive is high on the Government agenda and is seen as an integral link to a range of other staff and service development policies. In an article written exclusively for Calling Time, health minister Lord Warner gives the wider context to WTD 2009.

I want to start this article with a simple question – what is the current Working Time Directive agenda about? Well, at face value, it is about protecting the health and safety of doctors in training by reducing their working hours, and ensuring they have appropriate rest breaks. However, inreality it is about much more than that. It is about patients, planning, productivity and people management. It is about improving services, improving the effectiveness of medical education and training, andmeeting the needs of those who require NHS services in an ever-changing world.Achieving the full implementation of the Working Time Directive for doctors in training is a new challenge but we needto face it now, and this time increasingthe number of staff will not be an option. The Working Time Directive is a great opportunity for us to modernise the way we work as multi-disciplinary teams toprovide faster treatment and improvedexperiences for patients, as well as abetter working environment for staff. Looking at the 2004 pilots you can see that they used innovative ways ofdelivering services and covered a range of areas such as skill-mix, redesign of rotas, new roles and reconfiguration ofservices, whilst achieving compliance.

We must find sustainable solutions thatmeet the needs of those using healthservices and NHS National WorkforceProjects and their partners are now takingforward this work. A wide number of2009 pilots are now underway that look at new ways of working in many differenthealth settings and tackle key issues thatare particular in ensuring effective planning of both services and workforce across localhealth communities. Some of these pilots focus on maternityand paediatric services, whilst others arelooking at cross-specialty solutions, effective team working and handover.We must ensure early dissemination oflearning from the new pilots andcontinue to demonstrate the benefits ofexisting programmes.Another key focus of future work will belooking at the Hospital at Night model ofmulti-disciplinary care and team working.Many trusts have implemented Hospital at Night and all hospital trusts should have atvery least considered implementation. The next step is expanding the concept acrossthe 24 hours of the day.Sharing existing best practice and earlyplanning around these new ways ofworking is absolutely vital if we are to beproperly prepared for full implementationof the Working Time Directive for doctorsin training and not produce financialproblems or service reductions.

The wider context
It is important that people also understand how these changes fit in with the widerapproach that we are adopting to systemreform. Our aim is to create a health servicewhere care increasingly comes to people,rather than the other way round. Doing thiswill mean following international bestpractice in transferring more services out of hospitals and into the community. We cannot expect hospitals to continueworking exactly as they are. The White Paper Our Health, Our Care, Our Sayoffersan exciting opportunity for service reshapingand this is the context in which NHS organisations need to plan for achieving thefull implementation of the Working TimeDirective for doctors in training.

At the same time we are introducing the Modernising Medical Careers (MMC)reforms to postgraduate training. I wouldsay MMC and the Working Time Directive go hand in hand. It would not be possible to implement the Working Time Directivewithout a reform of medical training so I believe it is best to be addressing boththese two changes at the same time.

The scope, abilities and competencies ofnon-medical staff are changing and thishas implications for doctors. Nurses andother professional staff are taking onclinical tasks once only done by a doctor.We are now seeing the development of new roles that cut across various clinicalprofessions including doctors, such as thenew medical care practitioners.

There is a greater demand amongstdoctors for greater flexibility and more opportunities to work part-time. Femaledoctors in training are increasing, withparticipation rates over 65% and we haveto recognise these kind of changes are inevitable. Multi-disciplinary team working is on the increase, and there is clearevidence of a direct correlation betweeneffective team working, staff satisfaction,and improved quality of patient care.

There is change going on in society in termsof the way we work and the way we want care. NHS staff are part of that society. They have families, their own expectations and goals and all of the work around the Working Time Directive will impact on their roles and the care they provide. It will be achallenge to achieve compliance but it can be done and there is still time to prepare and put changes in place that can benefit the entire organisation.

However, this must not just be left to the HR Department; it is down to boards, clinicians and senior management teams. They need to be engaged in this work now and over the coming three years. They also need to ensure that their work towards the Working Time Directive fits in with wider work around productivity andefficiency in the NHS. We need to workto ensure that we get the maximum value from the extra investment in our serviceover recent years and the Working Time Directive gives us opportunities to do this. Overall, the NHS must look to what alreadyis in place so that they can achieve fullimplementation of the Working Time Directive for doctors in training and supportthe delivery of our other NHS priorities and key areas of work that are so important to the patients and public we serve.