Concern over readiness for EWTD in the Welsh NHS deepens

My concern about the effects from the implementation of the EWTD (European Working Time Directive) weren’t just confirmed at BMA Cymru Wales’ recent Policy day on the matter – they grew a whole lot deeper.

The Directive puts a limit on the working week of 48 hours for all employed doctors, including junior doctors, and it must be implemented by Trusts in full, no later than 1st August this year. Junior doctors were excluded from the original legislation because of the nature of their training, and the limit of 48 hours was to be phased in.

The deadline is fast approaching and despite the fact Trusts have had (literally) years to prepare for it, to say that we are still some way from being ready to move to a reduced working week, and thus ready to ensure essential protection for doctors and patients, is a massive understatement. This was highlighted by the Wales Audit Office just a few weeks ago.

A number of key messages came out of the Policy day, including drastic junior shortages, compounded by insufficient numbers of consultants to fulfill requirements of services to patients whilst at the same time trying to provide the dedicated and comprehensive training and support juniors need.

Also, members, with frontline-delivery experience, suggested a number of solutions in order for Wales to prepare and to cope with the implementation of EWTD. BMA Cymru, as the voice of doctors in Wales, will be taking these up with the Health Minister and with Welsh NHS Trusts in the next few weeks and as we approach the August deadline.

But with the situation already dire and morale amongst junior doctors at an all time low, without central support and adequate preparation from Trusts there is a significant threat to the current standard of medical training, to the delivery of healthcare provision, and to the quality of patient care as a result.

Getting tough on violence in the NHS

Myself and a GP member of BMA Cymru Wales gave evidence to the Assembly Audit Committee yesterday, on the back of the Auditor General’s latest report into violence and aggression against NHS staff. The committee’s holding an inquiry into the report findings, because the Auditor General has found that violence is still a big issue for NHS workers.

That’s despite the fact that the Auditor General first looked into this four years ago and uncovered serious concerns back then.

It would be unfair of me to say that the WAG hasn’t made any progress on this in that time, as some improvements have been made (for instance, the launch of the training passport scheme in 2005) but I’m afraid there is still along way to go. And what is worrying for doctors, is that the emphasis on tackling violence seems to be focussed on hospitals, when in actual fact, a big area of concern identified in the report is NHS employees working alone, such as GPs and their support staff. More investment needs to be made here with the introduction of safety measures such as panic buttons and CCTV being installed.

This inquiry is very timely, as it’s now, during the on-going NHS reorganisation that systems like the Primary Care Support Service could be given more scope for development, to help in areas like violence and aggression against doctors.

I generally got the impression yesterday that AMs sitting on the Audit Committee are extremely concerned about the issue and there is a strong will to change things. I just hope that happens sooner rather than later and that ways of tackling this growing problem feature heavily in the Health Minister’s NHS reorganisation plans.

Violence and aggression against Welsh NHS workers is still proving to be a big problem

The BMA welcomes this update on progress with regard to the work of the Ministerial task force on violence and aggression and while much has been achieved, there is still a great deal to be done.

It remains unacceptable that doctors and other healthcare workers are exposed to violence and aggression in the workplace on a daily basis.

The taskforce is beginning to put in place processes to protect and support staff but much more needs to be done to encourage reporting of violence and aggression in the workplace and this will only happen when people feel properly supported and incidents taken seriously.

Improvements in the Training Passport and Information Passport Scheme are to be welcomed but more action is needed and it is concerning that significantly more improvement hasn’t been made in tackling the safety of lone workers, which is especially important for primary and community care staff.

Doctors get sick too

Wales’ Auditor General report out today on staff sickness levels in the NHS makes for interesting reading for BMA members. It says it’s still a “significant problem”, even though some improvements have been made.

Since April 2004, time off work because of ill health has averaged out at 14 working days per year for an NHS trust worker. This is down on the previous two years, when the average rate was just over 15-and-a-half working days per year.

I don’t think it should come as any surprise that sickness levels by NHS staff are higher than in other professions. After all, they are coming into contact with various different kinds of illnesses constantly. Those with the strongest immune systems are going to succumb at some point!

Of course, we’re not just talking about physical ill health here either. “Sickness” can cover all kinds of ailments, including stress. And again, it’s hardly surprising if staff working in NHS trusts experience more incidents of stress than other sectors, considering the very stressful situations medics are faced with on a daily basis. Then you have to add to that the fact that occupational health services are found wanting in many parts of the NHS.

That’s exactly why the BMA is calling for a national roll-out of the Primary Care Support Service, as part of our consultation response to the proposed reforms of the Welsh NHS. The PCSS is currently the only occupational health service available to clinicians and disappointingly, isn’t on offer in all parts of Wales. Even the Auditor General, in his new report, highlights the need to improve occupational health services for NHS staff. If that happens, then maybe we really will start to see a dramatic fall in the number of sick days taken by employees looking after the health of everyone else.