NHS Trusts must avoid complacency

Health Secretary John Reid today warned NHS Trusts not to be complacent about the approaching August 1 deadline for the working time directive. At a conference in Birmingham he urged all NHS Trusts to firm up the proposals they have been working on for the last two years as to how they would deliver ahead of the deadline.

Mr Reid said that although there was no single magic solution for ensuring working hours for junior doctors comply with the European Working Time Directive, he urged health chiefs to look at the results of a joint project undertaken by the Department of Health's NHS Modernisation Agency and the British Medical Association, called 'Hospital At Night'.

The Hospital At Night project aims to encourage hospitals to decide which healthcare staff they really need to have resident out of hours and which non-medical staff could take on work traditionally done by doctors at night.

In a speech to NHS human resource specialists in Birmingham, John Reid said:

"The Working Time Directive is an issue that I take very seriously. That is why we have already invested heavily in finding solutions nationally, working with the profession.  The NHS must now strive to ensure that that these lessons feed through into local innovative solutions which are effectively implemented.

"The Hospital At Night project is a striking example of how the Working Time Directive can create better working lives for junior doctors and better services for patients.

"The project advocates that the best way to achieve care for patients at night is to have one or more multi-disciplinary teams working in the hospital, who between them have the full range of skills to meet patient needs.  It contrasts to the traditional model of junior doctors working in relative isolation and in speciality based silos – a situation which is stressful for doctors and undesirable for patients.

"Many staff have skills which are presently under-used.  Making best use of them will not only help to meet the requirements of the working time directive, but will also empower staff and offer a better service for patients.  All staff working over the out of hours period should work more effectively as a team, helping each other out when busy and understanding what each other is trying to do.  That means doctors should concentrate less on what they perceive as their roles and more on what the patient needs – providing strong clinical leadership of an effective professional team.

“We know from international experience that the team working which is a key part of Hospital at Night can provide effective, safe care for patients and ease the pressure on doctors.

“A lot of work has been done in the NHS to prepare for the Directive but there is still a lot of work for all of us to do.  I want to see all trusts taking the lessons from Hospital at Night and using them, where appropriate, to help deliver the Working Time Directive from 1 August.”

The Hospital At Night project gathered evidence from 20,000 clinical episodes across eleven Trusts.  The evidence provided strong support for a multi-disciplinary team working approach to staffing hospitals at night. 

It showed that:

  • the number of calls in all specialties falls markedly after midnight.  At 5am, the number of calls to doctors is a quarter of the number at 5pm
  • a very small proportion of out-of-hours work relates to patients in a life threatening situation;
  • a significant proportion of the night-time work is non-urgent and could be brought into the day;
  • better administration could reduce medical staff workload at night by up to a half.

Hospital At Night has been piloted in four NHS sites - Morecambe Bay NHS Trust, Wirral Hospital NHS Trust, Royal Liverpool and Broadgreen University Hospital NHS Trust and Homerton Hospital NHS Trust. 

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