In theory, the working conditions of junior doctors have been transformed since the bad old days when they had to work super-long hours with no rest or proper meals, but there is still a gap between the theory and the facts. There have been improvements, and the Scottish Government is heading in the right direction with its reforms, but there is still legitimate concern about whether the improvements are happening quickly enough and how enduring they will be once they are in place.
The problem has been that, despite European legislation stating no one in the UK should work more than a 48-hour week, health boards have been able to avoid a technical breach of the law by giving their junior doctors a few days off so that, over six months, their average working weeks do not exceed the 48-hour limit.
The fact that health boards have been working in this way, to the letter, rather than the spirit of the law, means that doctors can still work onerous shifts – doctors such as Lauren Connelly, who was killed driving home from her job at Inverclyde Royal Hospital in Greenock. Dr Connelly was just seven weeks in to her job and had worked the first ten days without a day off and many long stretches, including a 12-day run of 107 hours.
Four years on from her death, it is sad to note that the lessons appear not to have been learned with an investigation revealing that some junior doctors are still working more than 100 hours over two weeks before they get a day off. Most health boards are also asking their junior doctors to work 12 days in a row.
The figures, obtained through the Freedom of Information legislation, are worrying for one simple reason: anyone, let alone a doctor making critical decisions about their patients' health, would struggle to perform to the best of the ability after 12 days in a row. There is also evidence that doctors make more mistakes if forced to work many night shifts.
Is there hope of change? Yes, because the Scottish Government has decreed that from February next year no junior doctor will be able to work for more than seven days in a row in any shift pattern, but we know from experience that changing the rules alone is not enough to change the persistent culture of long hours. What is to stop health boards working round the new rules in the way they have worked round the European Working Time Directive by working junior doctors seven days in a row, giving them a single day off, and then putting them straight on another seven days in a row?
Vigilance will be required to avoid such a situation happening and it may be that Healthcare Improvement Scotland will need a strengthened role to ensure the rules are being met. The signs are there for an improvement in the working lives of our trainee medics, but a change in the rules alone will not be enough to protect junior doctors or the patients they treat.
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