How many hours is too many?

There was a row over the weekend after plans were announced to cut junior doctors hours from 56 to 48 hours under the EU Working Time directive.  The British Medical Association suggested that inadequate cover had been prepared to allow for the cut in hours as a result of the directive.  The Tories agreed suggesting that the directive will have a serious impact upon staffing provision.

"The Conservative Party has warned the government repeatedly that forcing junior doctors to comply to the directive could compromise services and potentially undermine patient care."

How many hours is too many?

Whilst all of this concern for staffing levels in the NHS is welcome it raises the interesting point of just how many hours should people be working, especially in a profession such as medicine where staff are required to be mentally alert at all times to provide the very best care.  

The Working Time Directive was introduced in 1993 to limit the working week throughout the EU to things such as:

· A maximum working week of 48 hours
· A rest period of 11 consecutive hours a day
· A rest break when the day is longer than six hours
· A minimum of one rest day per week
· The statutory right to four weeks' holiday 

Why is this important?

Last year the CMI conducted a Quality of Working Life report.  The survey reveals managers in the UK have an alarmingly high level of concern about their health being negatively affected by the long ours they work.  Around half of the managers involved in the survey linked ersonal health problems to the long hours they worked. Of further mportance was that 45 per cent of respondents believed their productivity at work was disadvantaged by the long hours spent on the job.

The UK's long-hours culture is clearly having a negative effect on performance and productivity.  With 16.1 million days lost to absence at work, this raises huge issues about working practices and the way staff are trusted to deliver.  Work shouldn't be about how many hours you put in but the quality of work that you get out.  In 2005 the BBC surveyed the medical profession and found that 1 in 15 doctors will, at some point in their lifetime, have some kind of problem with alcohol or drugs ranging from misuse up to dependence that may affect their care of patients.  The stress inflicted by excessive working hours was suggested to play a major part in these statistics.

Getting the work/life balance right

Organisations in both private and government sectors need to be alert to the consequences of not getting the work-life balance right.  With nearly 30% of UK managers saying they have suffered from stress due to over-work it is an issue that cannot afford to be ignored, especially in an environment as important as our hospitals. 

This is a crucial issue that has seriously effected recruitment of talented individuals to the profession.  As far back as 1998 the BMA surveyed junior doctors and found that there was a serious morale problem, before suggesting the following improvements:

# Improved working conditions including shorter hours and better accommodation for doctors on call;
# Flexible working patterns family-friendly shifts, in-hospital creche facilities;
# Better pay;
# More hospital doctors to relieve pressure on existing staff;

The NHS has had 11 years to get this right and staff accordingly but even as late as this spring there were rumours that they were not ready for the new directive on August 1st.  Dr Andy Thornley, chairman of the BMA's Junior Doctors Committee had this to say back then. 

"The
NHS has had 11 years to prepare for the introduction of the 48-hour week for
junior doctors. The latest figures are alarming; suggesting that one in
three junior doctors is working hours that will be illegal in just four
months' time."

This whole situation shows a worrying lack of planning by the NHS.  Back in 2007 health secretary Patricia Hewitt reported that the NHS employed too many doctors and the number should fall by nearly 10,000 doctors from the 2004 high.  This was at the same time as the BMA reported 28,000 doctors were competing for 22,000 vacancies.  This follows similar news in 2005 that around 2,000 newly trained doctors would be unable to find work due to a lack of vacancies.  

Hopefully with the Swine Flu situation likely to put a strain on the health service this winter this example of bad management won't end up costing lives.