17 September 2006

Another own goal

The closure of up to 60 hospital departments, planned by the government to enable it to meet the requirements of the EU's Working Time Directive, has been supported by the medical establishment, "as the only way to guarantee the highest standards of care for patients".

So says Jo Revill, health editor for The Observer today in a carefully spun article that effectively means the EU is causing the closure of key departments in hospitals throughout the country.

The squeeze started with the application of the Working Times Directive to doctors in training on 1 August 2004, when their average working week was restricted to 58 hours. That, itself – as we remarked at the time – was a popular move as there had been much concern about over-worked junior doctors making mistakes, and health care suffering as a result. But, from 1st August next year, the noose gets tighter when the permitted time drops to 56 hours and, two years later, it becomes 48 hours.

However, it is not only the restriction on hours which is causing the problem but a case in September 2003 (Landeshaupstadt Keil v Jaeger) when the ECJ held that all time spent by a doctor on-call in a hospital constitutes working time for the purposes of the directive.

Subsequently, the commission sought to redefine working time for doctors but its proposals have not progressed the case stands. Thus, as the Department of Health puts it, where work is of "low intensity", resident on-call arrangements would "not be a sensible use of doctors' time". Thus it "advises" employers to go back to first principles and look at "whether the service for patients could be delivered completely differently".

Combined with the growing NHS deficit, which means that health trusts are unable to fill the gaps with more doctors, delivering services "completely differently" means a "massive reconfiguration of hospital services", resulting in the closure of departments.

Mostly, it will affect the closure of casualty departments, small midwife-led maternity units and children's centres in smaller hospitals. It could also involve the closure of some hospitals in towns where they serve populations of less than 250,000.

However, the leaders of both the Royal College of Physicians and the British Medical Association are supporting proposals, agreeing that the Working Time Directive had made it increasingly difficult to maintain full emergency services running 24 hours a day in many hospitals.

The ultimate irony is that the directive need not have applied at all. It is part of the Social Chapter, from which Major excluded the UK during the Maastricht negotiations, and which Blair adopted when he came to power in 1997. That the health service is now having problems now is entirely due to Blair’s initial euro-enthusiasm when he came into office, making it a classic own goal.

It is fitting that, as he is on his way out, the fruits of that enthusiasm are now becoming apparent but, as always, it will not be Blair (or his family) that pays the price.