Would the NHS be safer without the European Working Time Directive?
Edmund Stubbs, 15 June 2016
As the EU referendum draws near and the possible repercussions for the NHS following a British exit become a polemical topic of discussion, it is pertinent to ask what issues might most affect the NHS?
One piece of legislation affects the NHS more than any other: the European Working Time Directive (EWTD). Introduced in 2009, this legislation effectively reduces the number of hours a doctor can work per week and per day, stipulating minimum rest periods for them which are enforceable by law.
Fatigue leading to human error is recognised as a considerable risk factor in healthcare worldwide. Before the introduction of EWTD many staff members, especially doctors, worked unrealistic and unsafe hours, sometimes amounting to as many as 100 per week.
The EWTD was introduced to prevent employers in any sector from compelling their workforce to work excessively long periods, thus it represented an enhancement of EU workers’ rights, and, in sectors such as healthcare, there can be little doubt that it (thereby) improved health and safety. Before it, many commentators agreed that NHS working hours needed to be limited by effective regulation.
However, as with many other blanket measures employed in an organisation as large and varied as the British health system, it has produced a number of unexpected and arguably harmful outcomes, the most serious of these being a reduction in the training hours that NHS staff, especially doctors, receive.
To become a competent consultant, especially in disciplines such as surgery, many hours of hands-on experience are required. It is estimated that the EWTD led to trainee surgeons losing around 3,000 hours of their learning time over their seven-year training programme. In the parallel case of a trainee pilot reducing qualifying flying time the negative consequences are perhaps more obvious but no more serious.
For this reason the EWTD may have resulted in better rested staff working for the NHS, but for some highly skilled specialisms, personnel may be less experienced in what they do. This possibility poses a dilemma for British healthcare, it seems when you reduce hours you may merely move unacceptable risk from that due to fatigue to that due to inexperience.
It may be advisable therefore to maintain EWTD working time limits for lower skilled employees and for those who are already qualified, but in the case of those who need to gain qualifying expertise in complex specialisms, where many hours of experience are essential to achieve a high level of competency it might be advantageous to remove EWTD type rules from their fields of expertise altogether. This would be a possibility were Brexit to occur.
Were the EWTD to be retained for all NHS staff, an option might be to increase the number of years required to become fully qualified in certain advanced specialisms. However, were the imposition of EWTD limits to working hours to be regarded as voluntary in such cases, there could be two options, a quicker route to qualification could be envisaged for those who wish to opt out of the directive, whilst a slower route, lasting more years, could be available for those who wish to remain within it.
Whatever the result on June 23rd, there is no support for returning to the unsafe 100 hour working week endured by previous generations of NHS staff. A legal limitation on the number of hours worked by healthcare staff must remain national policy inside or out of the European Union.
Edmund Stubbs is Healthcare Researcher at Civitas