Junior doctors still work 36-hour shifts
HSE report reveals a 'major concern'
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Thursday January 15 2009
Some junior hospital doctors are still working shifts of 36 hours or more despite a four-year-old EU directive aimed at reducing unsafe hospital practices.
A new report has reviewed progress on the European directive, which was aimed at ending the traditionally dangerously long shifts of junior doctors who suffered sleep deprivation, fatigue and put patient care at risk.
The directive, which was transposed into law in Ireland in 2004, covered various types of workers, including junior doctors and lorry drivers, and ordered that their working week be reduced on a phased basis with another cut due later this year. There are around 4,500 junior doctors in hospitals around the country and they are seen as essential to maintaining services because of a lack of senior consultants.
The report published by the Department of Health found the stipulation, since August 2007, that a junior doctor's working week should not exceed 56 hours has proven difficult for hospitals to put into practice and no hospital is yet entirely compliant.
Although it was achieved in a number of hospitals which piloted new work rosters, many hospitals just ended up reverting to their old ways once the test phase was over.
Dr Cillian Twomey, a Cork geriatrician and chairman of the National Implementation Group which oversaw the pilot scheme, warned that some of the shifts worked by junior doctors are "up to 36 hours in duration . . . and sometimes longer".
"Clearly periods on duty will have to be of much shorter duration in the future," Dr Twomey said.
From August this year the new phase of the directive will come into force, reducing the working week to 48 hours.
The report said that while the challenge in meeting the new work limits this year would be difficult, it would be even more daunting to ensure junior doctors got all the rest breaks they should be receiving under the legislation. It said no hospital in Ireland was fully compliant with the law on work hours and rest breaks.
If hospitals are to continue to provide the level of surgery, medicine and anaesthetic cover they need, the report said it would be impossible to comply with the law on work rotas in the medium to long term.
Hospitals, in drawing up the new work rotas, will have to assess priorities such as safe patient care, the time required for the junior doctor to train and the chance to work alongside experienced consultants as much as possible.
Rosters
The report highlighted a "major and repeated concern" that many hospitals have not been able to continue with the new rosters after they were tested on a pilot basis.
It pointed to the need for a culture change in hospitals to move away from the way they have traditionally organised junior doctors' working hours.
Larger hospitals have had a better chance of complying with the directive because they have a greater number of junior doctors on staff.
It called for more senior consultants to be appointed -- a move promised by the Government but yet to be delivered. The objective is to reduce the reliance on junior doctors and use the funds instead to employ experienced doctors.
- Eilish O'Regan Health Correspondent
