As the Minister is aware, doctors in training are one of the three groups of workers excluded from the provisions of EU Directive 93/104 on working hours, the others being fishermen and oil rig workers. The reason doctors in training, who are land based, have been included with two sea based groups is too complex to explain here. However, I ask the Minister to introduce national regulations to limit the amount of time in which doctors in training can work in our hospitals.
This EU directive applies to the area of health and safety. The time spent working is not only of concern to the doctors themselves, it is also fundamentally of concern to the patients. Doctors in training are generally considered to be those who have completed their basic or undergraduate medical training and are preparing for a recognised higher medical qualification. Most are working towards some specialist status but some are undertaking the specific training in hospitals for general practice and they need to gain the necessary experience to obtain specialisation in this field.
The duration of their training is not defined in this country but it usually continues here or abroad until they have got a consultant post. The imbalance between the number of doctors in training and the number of consultant posts and the resultant bottleneck was one of the reasons for the establishment of the Tierney group which produced its report on medical manpower.
Over 30 per cent of the doctors in this country could be described as doctors in training; they are doctors on whom the general running of the hospital service depends. Many of them come from abroad; in some of our hospitals we must rely on staff 80 per cent of whom come from abroad. Without their service commitment our hospitals could not function. It is also important to remember that these are training posts. The Minister mentioned this in the Doolin Lecture. He discussed the fact that lack of structured education in some hospitals has meant that many of our best young doctors go abroad, with many of them not returning.
The junior doctors' relationships with patients, even when they are well supervised by senior doctors, is paramount to the welfare of patients. At nights and weekends, the brunt of cover must often go to those who have been on duty without any break that day. Indeed, they often return to duty the next day without any sleep. Having worked myself as a junior doctor at a time when, through lack of staff, our hours on call were appalling, I have little sympathy with those who take the view that because they did it in their day, junior doctors should continue to do it today.
Working hours should not be so extended that patient care is adversely affected. The life and health of the young doctor is also important. We are lucky in that we could introduce national regulations because all our doctors are covered by much the same contracts. I do not suggest that specific hours are desirable at this stage because the Minister has many aspects to consider. However, they should be short enough to allow doctors not just to lead a normal life, but also to have time for study and to attend courses which are part of their training, as well as long enough on duty for them to get the necessary practical experience.
Above all, action should be taken immediately because there is also a risk to the life and health of patients. It should not be increased by having them cared for by over-tired doctors. In some of the most serious cases that have occurred in the UK, some of which have been fatal, the hours worked by junior doctors before the disaster occurred were horrific. Some were on duty for 36 hours without any sleep.
Monitoring of whatever regulations the Minister introduces is also essential because young doctors are in a semiapprenticeship role. They are in a weak position to refuse additional workloads imposed on them by seniors who may be important in their futures for progressing their careers in this country. In a small country such as this, bad feeling regarding lack of co-operation in one area can be known very easily, even though it may be in the best interests of everybody concerned.
It can be difficult to calculate hours of work because of the "on call" system but it is not impossible to devise a plan. We already have a 65 hour week in place. Various levels could be placed on the "on call", for example, by deciding if one was at home it was worth less than if one was in the hospital, etc. In this way the hours could be worked out.
It is not only the recent Tierney report on medical manpower which will influence the number of junior doctors, their career structures and the hours they work. The proposed radical changes being considered by the Medical Council and the medical schools as regards medical training, make action in the area of limitation of hours of work even more urgent. If the intern year is incorporated into the undergraduate programme a service gap will result. We may need more front line cover by consultants, much of which is secretarial and carried out by interns but which would be better carried out by those with experience in that field. The recent fracas in the accident and emergency department in University College Hospital, Galway, showed that unrealistic rostering routinely leaves services understaffed, so administration must be urgently looked at as well.
While there will be a cost to putting a legal limit on the hours a doctor in training may work, the cost of not changing them may be even more serious because doctors who work excessive hours are likely to be involved in medical accidents. The risk to patients from over-tiredness in doctors could become a factor in claims for compensation for professional negligence and action should be taken long before this is the primary reason for so doing. The health and welfare of doctors in training should be reason enough.
