Junior Hospital Doctors (Regulation of Hours) (Hansard, 15 February 1989)

§ Mr. Terry Davis (Birmingham, Hodge Hill)

I beg to move,

That leave be given to bring in a Bill to regulate the hours worked by junior hospital doctors.

In recent weeks there has been great public concern about the excessive hours worked by many junior hospital doctors. In my opinion, the public are right to be concerned, and my Bill would put a limit on the hours that a junior hospital doctor can be required to work in the course of a month.

Like many other people, a junior hospital doctor is contracted to work a basic 40-hour week, from 9 am to 5 pm from Monday to Friday. As it is essential to provide cover during nights and weekends, however, he is also required to be on call at such times on a rota with other junior hospital doctors. The rota can be one in two, one in three or one in four, meaning that the doctor must be available for work on every second, third or fourth night and every second, third or fourth weekend in addition to the basic 40-hour week, without any time off in lieu of those extra hours.

If we take the Government's own target of a one-in-three rota, that means that, after working a 40-hour week, the doctor is required to be on call for one third of the remaining 128 hours in the week—that is, for 43 hours on top of the basic 40 hours—making a total of 83 hours a week. A junior hospital doctor must also cover for any other junior hospital doctor who is ill or on holiday, so the actual total can be even higher.

The position varies between specialties and hospitals, but it is not surprising that the Government's own figures show that junior hospital doctors are required to be available for work for an average of 86 hours a week. As that is only an average, the Government's figures also show that for some doctors the position is much worse than I have described. In England and Wales in September 1987 12,689 junior hospital doctors—half the total—were contracted to be available for work for 89 hours or more each week, and 2,528 of them were contracted to work or to be on call for more than 100 hours a week. That is more than 14 hours a day for seven days a week.

It is not simply a question of long hours, however. It is a matter of being on call for long periods at night and at weekends without a break. If a doctor is on call throughout the night, the night shift is added to the normal 9-to-5 working day, so that the doctor is there all day from 9 am all through the night and then through the next day until 5 pm—for 32 hours at a stretch. At weekends he will work from 9 am on Friday until 5 pm on Monday, without any guaranteed breaks for sleep or even rest at any time.

As I have said, this is not happening in all specialties and all hospitals—some doctors who are on call will still get a good night's sleep—but it does happen in some specialties and some hospitals, and it is most likely to happen in acute services, where patients need the most intensive care—and it is a scandal that it happens at all. It is against the interests not only of doctors but of patients. When a member of my family goes to hospital, I want the best possible care from the best doctor available, and I 330 want that doctor to be on top form. I do not want a doctor who is overtired, and I do not want a doctor who has gone without sleep for a couple of nights.

The fact is that tired doctors can kill patients, through no fault of their own. There are plenty of stories from doctors themselves about potentially lethal mistakes that they have made as a result of fatigue. The true scale of the scandal, however, was established by a confidential inquiry in three regions of the country in 1986. The inquiry was into the deaths of people who had had operations during the 30 days before they died.

The inquiry found 28 cases of deaths that could have been avoided, and in which fatigue was one of the factors. If those figures for three regions are extended to the whole country, the number of people who died and need not have died becomes 140—and that is only the number who have died unnecessarily after operations. We shall never know how many people have died as a result of a wrong diagnosis, or the wrong treatment from an exhausted doctor, without ever having reached the operating theatre.

The scandal was first brought to the attention of the House by the Select Committee on Social Services in 1981. At that time, junior hospital doctors were contracted to work for an average of 89 hours a week. The Government's response was to issue a circular and set up some working parties. During the next few years they issued two more circulars. When they came to take stock—after four years and three circulars—they found that the average had fallen by the pathetic figure of three hours a week, from 89 hours to 86. At this rate we shall be into the next century before we reach the Government's target of 72 hours a week.

What has been the Government's response to the latest figures? They announced what Ministers described as a "programme of action": they issued another circular, set up some more working parties and asked for more reports before the end of the year. With respect, I do not call that a programme of action; I call it a programme of procrastination. The House has been waiting for eight years for the Department of Health, the consultants, the hospital administrators and the health authorities to get their act together. We have waited long enough. It is time for Parliament to do something about the problem, and that is the aim of the Bill.

Clause 1 would put a limit of 72 hours a week on the hours for which a junior hospital doctor can be required to be available for work, averaged over a month. It would allow considerable flexibility in the arrangements to be made. It would also give plenty of notice to hospital administrators, as it would not come into effect until 1992. But our junior hospital doctors would still be required to be available to work more hours each week than their colleagues in the other member countries of the European Community, where the average is less than 60 hours a week. Clause 2 would therefore enable the Secretary of State to make further reductions to 60 hours a week at his discretion. Clause 3 would allow variations in cases of major emergencies, disasters and accidents, and clause 4 would enable the Secretary of State to approve variations and exceptions for particular specialties in particular hospitals if he were convinced that they were necessary.

The Bill is very reasonable and modest. It has been drafted by my trade union, Manufacturing Science Finance, which includes the Medical Practitioners Union, 331 which should be congratulated on its campaign to bring the scandal to the attention of the public. It has also been endorsed by the British Medical Association.

The Bill is in the interests of patients and doctors. It is identical to the Bill which has been introduced by my noble Friend Lord Rea in another place, where it received an unopposed Second Reading. I hope that the House will give me permission to introduce it here today.

Question put and agreed to.

Bill ordered to be brought in by Mr. Terry Davis, Ms. Hilary Armstrong, Mr. Frank Cook, Mr. Jim Cousins, Mr. Derek Fatchett, Mr. Martin Flannery, Mr. Doug Hoyle, Dr. John Marek, Dr. Lewis Moonie, Ms. Jo Richardson, Mr. Chris Smith and Mr. Robert N. Wareing.