EU rules are making British doctors ‘lazy clock-watchers’
European rules are creating a generation of “lazy, clock-watching” junior surgeons who lack the skills to operate safely, their bosses have warned. A year after the EU directive limiting workers to a 48-hour week was brought in for the NHS, 80 per cent of consultants polled by the Royal College of Surgeons said quality of care had already been damaged by the changes, with risks to patients who are repeatedly “handed” from one shift to the next. The survey also found that two thirds of junior surgeons said their hours in training had been cut.
Consultants who took part in the study were most damning about the impact of the changes on their trainees. Among responses from more than 500 senior surgeons taking part were repeated warnings that the rules were creating a generation of “clock-watchers” with a “lazy work ethic” who no longer felt personal responsibility for their patients.
Trainees were now spending so little time in operating theatres that they would lack the “cutting skills” required to perform safely when they became consultants, many warned.
College president John Black urged the Government to take urgent action to address the concerns, having pledged in its Coalition agreement that it would work to limit the application of the EU rules in the UK. He described the situation facing the NHS as “acutely urgent”. Mr Black said: “Without action we are going to see a generation of specialists with less experience than any that have gone before.”
Many consultants responding to the survey said the changes – which began in 2007 when a 56 hour maximum working week was introduced, following EU legislation – were already changing the attitude of young doctors, who were becoming too detached from the patients in their care.
Marjan Jahangiri, Professor of Cardiac Surgery at St George’s Hospital in London said: “We have created a generation of surgeons who lack technical skills and operate within a “clocking off” culture where they do not feel personal responsibility for their patient.”
The surgeon said the change in attitude was “as fundamental and dangerous” as the lack of expertise among junior doctors, who now received far less training than their predecessors. She said: “We have now got a system where trainees begin keen and motivated, become restless from a lack of training opportunities, and they will end up lazy and unskilled”.
The heart surgeon, 48, said that by the time she became a consultant, nine years ago, she had undertaken 900 cardiac operations. The current generation were likely to become senior doctors after performing less than 300, she said. Consultants who used to do most of their surgery assisted by trainees said they were now often forced to operate alone.
While some juniors ignored the rules and came in on their days off, most had far less time in the operating theatre because of strictures limiting them to a maximum of 48 hours, including all time on call, as well as their night shifts, and time on wards and in Accident and Emergency departments.
One respondent to the survey described the directive as the “single most damaging factor affecting training and continuity of care”. The surgeon added: “The most insidious problem is that it fosters the concept that you are responsible for a patient only for a shift. “A consultant surgeon has a particular and continuing responsibility – we are training clock watchers whose work life balance is more important than anything else.”
More than half of the 982 consultants and trainees polled said they were not truly complying with the rules, with many saying they lied about the true hours they worked because of pressure from NHS managers.
Among consultants who did comply with the 48 hour limit, 56 per cent said they had only done so at the expense of patient safety.
Many of the risks came from the increased numbers of “handovers” from one shift to another, and the use of inexperienced locums to cover gaps in rotas.
While some respondents in the anonymous survey said only luck had avoided serious incidents, others described specific errors which they attributed to the new system – such as the removal of an eight year old’s ovary, instead of her appendix, by an inexperienced doctor.
Mr Black said the NHS was “skating on very thin ice” under the current system, given that most doctors said they were still working longer than the 48 hours,
Doctors described handover procedures between teams which were unsafe, inadequate and in some cases, non-existent.
Trainees also described despair about the system, with many saying their training had suffered, and others saying they were only managing to improve their skills by lying about their hours and working on their days off.
Estimates suggest the current generation of trainees will have spent about half as much time in training or on call as those who became consultants before the EU rules were introduced. A consultant summed up the training problems as a “complete disaster”, adding: “I just hope my colleagues can look after me when I get old. The only problem is they are going to be getting old too.”
A spokesman for the Department of Health said: “The Health Secretary will support the Business Secretary in taking a robust approach to future negotiations on the revision of the European Working Time Directive, including maintenance of the opt-out. “We will not go back to the past with tired doctors working excessive hours, but the way the directive now applies is clearly unsatisfactory and is causing great problems for health services across Europe.”
Family victory over British Stasi
The “Stasi” was the former Communist East German Secret Service, notorious for spying on its own citizens
Town hall snoopers are dealt a blow today by a landmark ruling in favour of parents who were spied on 21 times using anti-terror laws to check they lived in a school catchment area. A tribunal will rule that Poole Borough Council was acting illegally when it put Jenny Paton, Tim Joyce and their three daughters under covert surveillance for three weeks.
Officials had claimed it was necessary to use the controversial Regulation of Investigatory Powers Act to find out if the family had lied about their address to win a school place for their youngest child. They wrongly suspected the family of cheating and tailed them round the clock, filling out detailed surveillance forms and describing their car as a ‘target vehicle’.
But the Investigatory Powers Tribunal, which heard a complaint from the family last year, has concluded the council’s operation was an improper, unnecessary and unlawful use of the powers.
Campaigners hailed the ruling as a landmark victory that would curb the worst abuses by so-called ‘town hall Stasi’ who train hidden cameras and even undercover agents on the law-abiding public.
And it comes after Home Secretary Theresa May said there would be a dramatic reduction in the use of the RIPA powers, with councils having to obtain a warrant from magistrates before starting any investigations.
The Daily Mail has made a string of revelations about abuses of the powers including spying on those suspected of putting their bins out on the wrong day, dropping litter and making unwanted donations to charity shops.
Labour introduced guidelines to try and stop councils and other public bodies abusing the RIPA powers to investigate trivial offences. But critics say officials are still able to use the laws to spy on families suspected of, for example, bin crimes and are demanding tougher safeguards.
Miss Paton, 41, an environmentalist, last night hailed the ruling as a ‘huge victory against the Big Brother state’. ‘Local authorities should not have any form of surveillance powers at all – it is inappropriate,’ she added.
Corinna Ferguson, legal officer for the civil rights group Liberty, said: ‘Intrusive surveillance is vital to fighting terrorism and serious crime but weak legal protections and petty abuses of power bring it into disrepute.
‘Former ministers claimed that the innocent had nothing to fear but the sinister treatment of Jenny and her kids proves that these powers need to be far more tightly restricted and supervised.’
Miss Paton and Mr Joyce found they had been under surveillance only when they were called to a meeting with council officials to discuss their school application. The family has declined to fight for compensation over their ordeal.
Defending Poole council last year, John Nash, the then director of children’s services, said: ‘We believe we act responsibly, in the best interests of people who live in Poole, using these powers.’
Children at risk in ‘failing’ British nurseries
Thousands of children are being left in the hands of “inadequate” childminders, nurseries and crèches, according to Ofsted. Figures show more than 800 childcare providers have been branded as failing in the last two years, while almost 12,000 were no better than satisfactory.
In all, almost a third of early years care is said to be not good enough since the introduction of Labour’s “nappy curriculum” in 2008, it was disclosed. According to Ofsted, many were also given the lowest possible rating for keeping under-fives safe, raising fears that adults may not have been given criminal record checks.
Nurseries and childminders can also be failing in their duty towards “safeguarding” for a lack of first aid, unhygienic premises and a poor health and safety record.
The disclosure follows the announcement of a major review of early years education by the Coalition Government amid fears that many children are not being given a “good start”. The review – led by Dame Clare Tickell, chief executive of the charity Action for Children – will cover child welfare, education and early development.
Ministers have refused to rule out abolishing the Early Years Foundation Stage – a series of 69 targets introduced by Labour that must be followed by all state and private childcare providers.
New figures published by Ofsted chart standards achieved by childcare providers in England since September 2008 – when the rules were made compuslory.
According to the watchdog, two per cent of the 40,081 nurseries, childminers and crèches inspected over the last two years were “inadequate”. A further 30 per cent were merely rated satisfactory. The watchdog has previously said that satisfactory – the second lowest rating – was not “good enough”.
Figures show that two per cent of all providers were also inadequate at keeping children safe – one of a series of criteria that nurseries and childminders are judged against. Some 27 per cent were merely satisfactory.
Sarah Teather, the Children’s Minister, said: “Early years professionals should be congratulated on their hard work to drive up standards. “However, we want to see more children from poorer backgrounds getting the right support so that they have the same opportunities to achieve as their peers.” She added that Dame Clare’s review would aim to “ensure all young children are getting the best early learning, as well as keeping them safe and supporting their healthy development”.
The bureaucracy involved with the Early Years Foundation Stage has been blamed for a sharp drop in the number of registered childminders. The latest figures show the equivalent of 520 childminders left the profession in the three months to the end of June. Numbers have now dropped by 6,396 – 10 per cent – following the introduction of the compulsory rules two years ago.
The number of “non-domestic” early years providers – such as nurseries – fell by 134 in the last three months.
Calcium supplements linked to heart attacks
Another unwarranted “correlation is causation” assumption. There may be something in the theory offered but the effect is very small and could simply indicate, for instance, that people who feel in poor health are more likely to take supplements and it is the pre-existing poor health that leads to heart attacks rather than the supplements
PEOPLE taking calcium supplements have about a 30 per cent higher risk of heart attack, research suggests. A review of existing studies on about 12,000 people found an increased risk for those on supplements, which are often prescribed to older women for the prevention or treatment of osteoporosis.
People taking supplements equal to 500mg or more per day were analysed through 11 studies, which compared them with people not on supplements.
According to the Food Standards Agency, adults need 700mg of calcium a day, which should come from dietary sources, including milk, cheese and green, leafy vegetables.
A study from experts at the University of Auckland and the University of Aberdeen said diets high in calcium do not increase the risk of heart attacks. It is the effect of supplements, which increase the levels of calcium circulating in the blood, which causes the increased risk.
Experts believe higher blood serum levels lead to hardening of the arteries, which can cause heart attacks. The authors said: “Serum calcium levels have been positively associated with an increased incidence of (heart attack) in large observational studies. “Ingestion of equivalent doses of calcium from dairy products has a much smaller effect than calcium supplements on serum calcium levels”.
Today’s study excluded patients who were taking both calcium and vitamin D supplements. Vitamin D is needed for the body to absorb calcium. The authors said it was unclear whether the findings would apply to these patients.
Nevertheless, they called for a rethink on giving people calcium supplements for bone health. “Given the modest benefits of calcium supplements on bone density and fracture prevention, a reassessment of the role of calcium supplements in the management of osteoporosis is warranted,” they said, writing online in the British Medical Journal (BMJ).
Calcium has a number of important functions, including helping build strong bones and teeth. It regulates muscle contraction, including the heartbeat, and makes sure the blood clots normally.
Carrie Ruxton, an expert with the Health Supplements Information Service, which is funded by an association representing supplement manufacturers, said: “It is important to note that calcium is an essential mineral for the health of the bones and the nervous system.
“Ensuring adequate intake is vital. However, the latest data from the UK National Diet and Nutrition Survey showed that one in 10 young women have calcium intakes below the lower reference nutrient intake (LRNI), a level at which deficiency is likely. “Calcium supplementation can help to ensure adequate intakes in people with poor intakes or higher requirements, for example during growth.”
Judy O’Sullivan, senior cardiac nurse at the British Heart Foundation, said: “We need to be cautious about the results of this analysis because none of the studies involved were designed to look specifically at the relationship between calcium supplements and the risk of heart attack. “However, the research should not be completely ignored. Any new guidelines on the prevention of fractures in those most vulnerable to them should take this type of analysis into account.
“Anyone who has been advised by their doctor to take calcium supplements shouldn’t stop because of this research alone.”
There is a new lot of postings by Chris Brand just up — on his usual vastly “incorrect” themes of race, genes, IQ etc.