Tuesday, March 17, 2009

Hospital waiting lists will soar due to European laws, British surgeons warn

Patients face a significant increase in waiting times for operations as 'insane' European rules mean doctors' hours are cut so much medics will not be able to cope, surgeons have warned.

The key pledge of Labour's NHS reform has been to reduce waiting lists and now the majority of patients are treated within the target of 18 weeks from seeing their GP. However this will be reversed as junior doctors will be limited to working a 48-hour week, from their current 56 hours, it is claimed. The extension of the European Working Time Directive will effectively result in the loss of thousands of doctor shifts, John Black, President of the Royal College of Surgeons said. And the Government fears there will be a lack of locum doctors available to step in and help fill the gaps, following changes in doctors' recruitment.

It means patients will have to wait months for routine operations as surgeons prioritise emergencies rather than scheduled cases. The Royal College of Surgeons wants trainee surgeons on a 65-hour working week in order to produce safe, properly trained doctors and cover the workload required by hospitals.

Mr Black said: "If the 48 hour limit is enforced, surgeons will have to make a hard choice between caring for emergency cases and dealing with elective cases as there will not be the time available to do both. Surgeons will put patient safety first and focus on looking after emergency patients. "All the progress on reducing waiting lists will go out of the window. Forty eight hours for surgeons is currently insane if we want maintain surgery in the NHS."

Doctors have calculated an average hospital trust outside London will lose the equivalent of three trainee surgeons and other specialities such as paediatrics, trauma, and intensive care are likely to be similarly affected. Smaller surgical units may have to shut or be merged in order to comply with the Directive, Shadow Health Secretary Andrew Lansley warned.

It is understood the Department of Health is considering increasing the length of time it takes to qualify as a consultant surgeon from seven years to eight or nine so doctors can gain enough experience and also comply with the limited working week.

Vanessa Bourne of the Patients Association said: "How can this be happening in a supposedly patient-centred service? Access to high quality safe care is the paramount requisite for patient and clinician alike and this muddle needs sorting out before patients are put at risk."

The new regulations come into force on August 1 at the same time hospital trusts are trying to cope with organising the new intake of junior doctors. The shake-up of doctors' training, which caused a fiasco in 2007, means more trainees are in longer-term posts so there are now fewer candidates looking for locum posts and temporary jobs.

Remedy UK, the junior doctors pressure group, has calculated that switching all juniors from a 56 hour to a 48 hour working week is the equivalent of losing one working day per doctor per week, or up to 70,000 doctor days per week across the UK. Dr Matt Jameson Evans, co-founder of Remedy UK, said: "In many key specialties the system is already massively overstretched. "Just imagine the impact of a blanket reduction in doctors' hours by one full day a week. A creaking system will collapse. And yet most doctors want the freedom to choose to opt-out of 48 hours. "We're begging for some common sense - an official endorsement by Government of the individual opt-out for trainee doctors would go a long way."

Mr Lansley said: "NHS staff have been absolutely clear that if the 48 hour working week is imposed on them it will leave many junior doctors with insufficient experience from their training. It will also threaten the care that patients receive because there will not be the same continuity of care and because smaller surgical teams will have to be shut down."

Dr Andy Thornley, chairman of the British Medical Association's Junior Doctor Committee warned that the doctors' training will lose out because there will be an 'all hands on deck' culture to delivering patient care. He said: "Doctors will work hard to ensure that patient services are maintained, but the potential for disruption exists. The NHS will not be sustainable if we do not equip our junior doctors with the necessary training to be the consultants of tomorrow."

The Department of Health wants to delay the introduction of a 48-hour week for some specialities and is expecting an answer from the European Commission by the end of May. However this would only mean some doctors could remain on 56 hours until 2012 and will not solve the problem in the long-run, experts have said.

A spokesman for the Department of Health said: "Most UK doctors in training already comply with the Working Time Directive, and the overwhelming majority will do so by 1st August this year. However, we have notified the European Commission that we intend to operate a derogation for a small number of services involved in delivering urgent and emergency patient care."

The Working Time Directive is already in force in most areas of business, limiting the working week to 48 hours and setting minimum rest periods. Individual workers can choose to opt-out although some professions such as the Armed Forces are not covered.


Australia: Claims that public hospital waiting lists are "doctored"

THE Opposition wants the state government to launch an inquiry into allegations hospitals are fudging figures to avoid fines. The Victoria Police fraud squad is investigating claims many hospitals manipulate waiting list data to cash in on government bonuses and avoid paying fines.

Opposition health spokeswoman Helen Shardey said the practice showed the health system was "at crisis point". "The fact that these revelations have been sent to the police, the fact that the upper house is starting an inquiry to look into all of these matters of hidden waiting lists, I believe, is proof that the Brumby government is covering up, is not prepared to investigate and is concealing the truth." Ms Shardey said hospitals were forced to fudge figures to maximise every opportunity for funding because the health system had been mismanaged. "The Brumby government needs to investigate what is going on in our hospitals, where waiting lists are being fudged and where they are being altered to hide the true state of the time that people are waiting for procedures in our hospitals."

A computer expert who wrote a file carrying the alleged information - but who wants to remain anonymous - was employed to analyse patient data systems at several major Victorian hospitals. "Many of the hospitals and health services I have consulted with over the last year have admitted to me that they fudge the figures to avoid the fines and cash in on the bonus funding for meeting the reporting requirements," the file stated. The effect of the practice would mean a patient could be waiting up to a year for surgery but the file would show a much shorter wait, Fairfax reported today.

The file also alleges hospitals use two sets of waiting lists, where one is kept "in the drawer", used when beds become available or when a patient is clinically ready for surgery. Senior hospital staff privately admitted administrators want to avoid fines for not treating patients within required times and want to claim bonuses from the Victorian government for meeting targets, the file said.

The "ghost ward" claims follow allegations that a doctor at Angliss Hospital in Ferntree Gully was sacked after he submitted concerns about hospital data manipulation to an opposition-led upper house inquiry in January.


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