Editorial: Tired young doctors pose risk to safety

COMMENT

Notice of a national strike by junior doctors presents the country's hospitals with a dire emergency. The prospect of all 2000 trainee doctors walking out of the wards for six days from November 2 is not easily contemplated. And with the emergency comes a dispiriting sense of deja vu. Every time the doctors' industrial document is up for renegotiation we hear of the impossible hours they are expected to work and the determination to bring some common sense to their negotiations. Yet no settlement seems to solve the problem and here we are again.

The Resident Doctors' Association complains that although they cannot be rostered to work more than 72 hours a week, they often exceed that limit with no penalty payments. They don't want the money, they want fewer hours, says the association secretary, Dr Deborah Powell. They want to work no more than 10 days on end rather than the 12 they can be asked to work at present, and they do not want to work night shifts of 10 hours for seven consecutive nights.

Their employers, the country's 21 district health boards, are seeking to preserve flexible working arrangements. "People don't get sick or hurt just during normal working hours," says a spokeswoman for the boards, Jean O'Callaghan. "We need the flexibility to put doctors where they are needed when they are needed. Other health professionals accept this and work accordingly - why should trainee doctors be any different?"

Flexibility is obviously necessary but if young doctors are working 72-hour weeks it is doubtful that flexibility is doing patients much good. There comes a point at which fatigue is downright dangerous and that point is surely reached well short of 72 hours, whether they are worked around the clock a few days a week or 10- to 12-hour shifts seven days a week. It is a ridiculous load to expect of any workers and it can only be wondered how these conditions survived so many industrial settlements over the years. There may be a high turnover of trainee doctors but their union representatives have not changed for many years.

It must be hoped that the strike notice is a mere negotiating ploy. The boards accuse the union of acting hastily and sound willing to find a solution. In the meantime, however, the boards are preparing to suspend all but emergency services in the event that trainee doctors walk out in a fortnight. Even before then hospitals will start a planned reduction of services in preparation for the loss of medical staff. If this strike goes ahead it will be on a national scale. There will be no public hospitals available to back up those where the worst problems are likely to occur.

The health union's push for national agreements has already contributed to difficulties in renegotiating agreements for nurses and senior hospital doctors this year. The district boards have agreed to merge their varied needs and arrangements but it is a complicated exercise and takes time, they say. Dr Powell insists her members are not looking for more money, although she mentions that a claim for penalty payments was rejected during the negotiations which began in May. Money is plainly not the solution to a problem of overwork that carries a risk to patients' safety. Indeed, higher pay could merely reinforce the hours already worked.

Junior hospital doctors are medical graduates on a two-year term of general training before they move into specialist study and training. They typically arrive in the hospitals carrying substantial debt from the cost of the undergraduate course and facing the expense of a five-year postgraduate course. They are energetic and dedicated and probably willing to remain on duty for as long as a case demands. But they are a risk to themselves and their patients when they work beyond the point of fatigue. Their rosters ought to be sensibly defined once and for all, and strictly enforced.