Junior Doctors (Working Hours) (Hansard, 18 May 1982)

§ Mr. Doug Hoyle (Warrington)

I beg to move, That leave be given to bring in a Bill to regulate the number of hours worked by junior doctors in both the public and private sector; and for connected purposes. I base this Bill on much evidence. The Fourth Report of the House of Commons Social Services Committee brought forward the fact that, whether on duty or on call, junior hospital doctors work an average of 90 hours a week, and in many cases longer than that. The report said that this represents an exploitation of junior hospital doctors, and it made the important point that if they work those hours they cannot provide the best service for the patients.

In addition, the Secretary of State for Social Services, in a written answer to a Parliamentary question in February 1981, said that in most specialties over one-quarter of junior hospital doctors are working over 104 hours per week, and in certain specialties, such as surgical, there are instances where 50 per cent. of them are working over 104 hours per week. Long hours must have a detrimental effect because decisions are impaired by lack of sleep, overwork and stress. That must affect patient care. The effects are difficult to quantify, but during the past 20 years there has been an increase in sophistication in medicine, which must add to the stress on junior doctors and doctors generally.

Many doctors can relate incidents where, through overtiredness, they have given wrong advice or wrong treatment which they have often been able to correct. However, in some instances they have not been able to do so.

The Health Service Commissioner's Report covering April to September 1980 records that a senior registrar was called, but unfortunately was asleep, and failed to respond. As a result a baby was still-born. The report goes on to say that: The failure of the senior registrar to go promptly to the patient.… had a tragic result. It has not been denied that the still-birth was avoidable. The report goes on to say that: Overpowering fatigue is a familiar torment to many who work in the caring services. Junior doctors should not have to put up with such conditions. In other instances of working long hours, they have been involved in car accidents. In 1976 a doctor fell asleep at the wheel of his car and was killed. In 1979, a doctor similarly fell asleep while driving in a busy shpping precinct where many shoppers were present. It was most fortunate that there was no loss of life, but there could well have been. In 1980—for obvious reasons I do not wish to name the doctor—a senior house officer in Manchester committed suicide. His parents said that the fear of making mistakes while he was overtired contributed to this sad event.

It is impossible to say how many more doctors have died or been injured or how many patients have suffered or lost their lives because of the problem of working long hours. It has been kept to a minimum by the dedication of the medical profession, but we should not expect doctors to labour under such conditions for such long hours, and it is ludicrous that we should expect them to do so because of an outmoded code of ethics. Hon. Members should contrast the hours that doctors work with the hours worked by a heavy goods vehicle driver or, as my hon. Friend the 197 Member for Ealing, Southall (Mr. Bidwell) knows, with the hours worked by a train driver, an airline pilot or a helicopter pilot, where we put the safety of the passengers first. It is much more important, given the relationship between a doctor and his patient, to put the needs of the patient first and do everything possible to safeguard the doctor's health.

There will be a cost. I want to reduce from 90 to 60 the hours that a doctor may be on call and work. That would mean increasing the number of junior hospital doctors by one-third. We must put that increase in context. To do what I suggest would cost £70 million, but we must set that against the health bill for community and hospital services generally of over £5,000 million. It is an increase of 1.3 per cent. However, I do not believe that it needs to be as much as that. Junior hospital doctors' time could be reorganised. There is an overlap in the specialties. In many instances two teams do the work of one. General medicine and geriatrics is one example. We could consider the reorganisation of surgery. Instead of bringing the patient into hospital the day before to determine whether he is fit to have the operation, he could be brought to the outpatient department some days before he is to enter hospital to see whether he or she is fit to undergo the operation.

A quarter to a third of junior hospital doctors' time is spent waiting for consultants, doing the rounds or being on call. Their time could be far better organised. Better administration would bring about greater efficiency. However, the sum of £70 million would be a small price to pay for the health of junior doctors and for the safety of their patients. Therefore, I hope that the Bill will command the unanimous support of the House.