Healthcare crisis: Extra-long shifts have long been the norm

There had been hope that this might change when the European Commission drew up the European Working Time Directive (EWTD) in the 1990s. This aimed to restrict shifts to a maximum of 24 hours and reduce the working week to no more than 48 hours.

Although the directive's working time limits were introduced for Irish hospital doctors in 2004, for the next decade, the health service simply failed to comply with them. Shifts of 36 hours or more remained common.

The Irish Medical Organisation (IMO), the profession's representative body, has been fighting for years to ensure the EWTD is implemented in Irish hospitals. In 2013, it organised the '24NoMore' campaign, highlighting the danger of illegal working hours. This led to a 24-hour strike by trainee doctors.

At the same time, the European Commission referred Ireland to the European Court of Justice, saying the failure to ensure doctors worked less than 24 hours in a single shift was a "serious infringement" of the directive. In 2015, the court ruled that the Government had been in breach of the EWTD.

The HSE promised to achieve full compliance in 2014. Yet while it continued to report steadily climbing rates of compliance in hospitals, this data contrasts sharply with anecdotal reports from exhausted medical trainees who say that, after some initial improvement, chronic understaffing means extra-long shifts are again becoming the norm.

The Medical Council's latest Your Training Counts report, which surveyed medics in 2017, found that more than one-third of trainee doctors were working 60 hours or more in a typical week. A 2018 survey by the IMO indicated that 40pc of doctors were working shifts of more than 24 hours, while more than 80pc had worked more than 48 hours in a single week.

This is despite the HSE reporting last year that 98pc of hospitals were fully compliant with the directive. More than a third of respondents to the IMO survey said the way in which working hours were counted at their hospital was "inaccurate".

Like most industrial relations disputes, it isn't black and white. Significant gaps in staffing at smaller, regional hospitals means the situation there can be much worse than in the larger city teaching hospitals.

What's seldom mentioned is that some doctors will gladly work the overtime offered, happy to bolster their modest starting salaries as they strive to repay huge university loans.

Some trainee surgeons, for example, argue that being limited to 48 hours precludes them from assisting with lengthy, complex operations and prevents them from gaining the hands-on experience they need. Indeed, this has been borne out in the evidence: British studies have shown the introduction of time-limited surgical experience in the UK in 1994 was directly linked to a negative impact on training.

For most young doctors, however, this is just another reason why hospitals abroad look like much more attractive places to practise medicine - the Your Training Counts report also found that for almost two-thirds of doctors who planned to emigrate, the main reason was that working hours in Ireland were too long. As we continue to grapple with a medical manpower shortage, the work-life balance that continues to elude them in Ireland may be found in Canada, Australia or New Zealand.