SENIOR doctors say NHS patients are dying as a result of new European Union rules that impose a 48-hour week on hospital staff.
The Royal College of Surgeons said, in a hard-hitting report, that lives were being lost because patients had to be switched between up to four doctors every 24 hours, instead of being cared for by the same team round the clock.
Junior doctors used to work 80-hour weeks, staying on call at all times and sleeping in the hospital. Surgeons said this guaranteed continuity of treatment.
In August, EU rules were introduced limiting their working week to 48 hours. John Black, president of the college, said that, as a result, no doctor was monitoring patients for long enough to detect changes in their condition and vital medical details were being mislaid in a chain of “Chinese whispers”.
The surgeons claim that the rapid changes in shifts mean that nobody is taking personal responsibility for patients. One surgeon who responded to the survey said: “No rapport is built with the patient and no responsibility is assumed by the junior \ for the patient care. An unmitigated disaster.”
The college has compiled a dossier from ward reports by surgeons, laying out the scale of the problem. This weekend the college released details to The Sunday Times of a series of “avoidable deaths” that it claims were caused by the way in which the new limits on the working week have been implemented since August.
— In one case a patient died of a rupture in her bowel because information about an obstruction had not been passed on from one junior doctor to the next when they changed shifts;
— A patient died of a brain haemorrhage following surgery that should not have been carried out. Information about the patient’s medical condition had become confused in handovers between three specialist registrars — doctors at the grade below consultant level
— A patient died of cancer after requests for tests were not passed on. An x-ray had detected an abnormality in the patient’s liver but no doctor took responsibility for chasing up the tests, and the patient was discharged from hospital. The college concedes the patient might have died even if the tests had been done.
The college also cited a series of other, non-fatal, errors that it had discovered by surveying 900 surgeons. They reported that a patient wrongly underwent surgery for a broken bone because instructions from a consultant were not passed to surgeons on the next shifts.
Another patient missed an emergency operation for a hernia because her case was not handed to the next shift. The patient then became “lost” in the hospital and was not seen by doctors on ward rounds for three days.
More than half of consultant surgeons and 44% of surgeons of all grades believe the 48-hour week has been achieved at the expense of patient safety, the survey showed. Black insists the deaths are an inevitable part of patients being looked after by a string of doctors working shifts, rather than because of poor communication by medics. “We now have a clear message from the front line that patient care is being made significantly less safe.
“Multiple handovers are inherently unsafe. Every handover is an accident waiting to happen,” he said.
The college is lobbying the government to introduce an opt-out to the rules for surgeons to allow them to work up to 65 hours a week. The surgeons’ leaders say the government could introduce legislation that would allow this if it had the political will.
The Department of Health defended the EU rules. A spokesman said: “Hospitals which have been working a 48-hour week for over two years have produced evidence that shows the change has decreased hospital mortality. There is no evidence of harm being caused to patients.”
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Posted on October 11, 2009