What is the EU doing to Britain’s doctors?
A rigid EU directive restricting the hours junior doctors can work has led to a crude rota system that bewilders patients and damages medical training, says Max Pemberton
A patient lies in bed, groaning. He is pale and clammy. A nurse frantically draws the curtains around the bed and takes his blood pressure. It’s dangerously low. Another nurse scrabbles to find the pager number for the on-call doctor covering the ward. The patient calls out and then vomits on to the floor.
“What was I supposed to do, pick up my bag and coat, walk out and let him die?” says my friend Ruby, who had been standing on the ward at the time. She takes a sip of tea as she sits in my flat and tells me the story. The doctor covering the ward was in the A&E department and wasn’t answering his pager. With each minute, the patient deteriorated. “One of the nurses came up to me and asked me to take a look at him because of his blood pressure,” Ruby continues. “How could I say no?”
Usually, any doctor present on a ward would be expected to help in such a situation, but not any more. According to the way that rules governing junior doctors’ hours are being implemented, Ruby had finished work and should not have helped. To do otherwise breaches the European Working Time Directive (EWTD), and this has serious implications for the hospital.
The EWTD was fully implemented in the NHS last year. It was intended to prevent long-distance lorry drivers from falling asleep at the wheel, but it has been applied to doctors with the intention of improving safety and patient care. It ensures that all junior doctors – classified as any doctor in training below the grade of consultant – do not work more than 48 hours a week over a 26-week period. It stipulates that they may not work continuously for more than 13 hours and that they have a break every six hours.
On the face of it, this seems highly sensible. No one wants to go back to the dark old days of medicine when juniors routinely worked 90 hours a week. It was bad for doctors and, most importantly, bad for patients. But the new system has had unintended consequences. The rigidity of these rules means doctors are expected to down tools the minute they have worked their allotted time and walk out, regardless of what is going on around them.
The New Deal – an agreement between the Department of Health and the British Medical Association – means that punitive measures will be taken against trusts unless they comply with the EWTD. It requires total, absolute compliance, and if one doctor works just half an hour over the stipulated time, the entire rota is deemed to have “breached”, with severe financial penalties attached.
This means that doctors like Ruby, who find themselves confronted with a sick patient as they are about to walk out of the door, are placed in an impossible situation. If they stay and help, they risk the wrath of the management and uncertainty about whether they are still covered by hospital indemnity; if they keep walking, they breach the duty of care they have to patients.
Thankfully, Ruby put down her bag, rolled up her sleeves and went to see the patient. He was having a heart attack and her prompt input probably saved his life.
I’ve known Ruby since medical school. We’ve worked together and I know that she would never walk away from a patient who needed her help, even if it might land her in trouble. She, like countless doctors up and down the country, joined the profession because she wanted to use her knowledge and skills to help people. It’s unbelievable that this dedication is now being jeopardised because of a piece of legislation that was supposed to improve care.
The reality is that no doctor is going to walk away from a patient in need, and the trusts know this. There is an implicit pressure placed on junior staff by senior doctors and management to lie on the forms monitoring the hours being worked. We all know that if we tell the truth, the trust will be fined, its debts will increase, redundancies will follow or services will be reduced, and this will only make the situation worse and further affect patient care. But this pressure also creates a growing resentment among hospital doctors that they are not being paid for the work they are actually doing.
Even more worrying is that the way in which medical care is delivered has changed. In order to comply with the rigid legislation, new rotas for the junior medical workforce have been drawn up by hospitals. The emphasis has been on ensuring that services are covered by a skeleton staff while still complying with the rules governing hours worked, with no room for ensuring continuity of care for the patient. This has resulted in a cataclysmic change whereby there has been a decoupling of the junior workforce from the seniors.
Prior to the EWTD, junior doctors were attached to a team, typically composed of a newly qualified doctor, a senior house officer, a registrar and a consultant. This “firm”, as they were called, was a tried and tested way of delivering patient care. The most junior members of the team learnt from the registrar, who in turn learnt from the consultant. It was a well-oiled machine with an inbuilt support structure for the junior members. The roles and responsibilities were clear and there was a strong sense of belonging, which ensured that juniors would follow their patient from the moment they were admitted, or seen in clinic, to the point of discharge.
But the introduction of the EWTD led to rotas becoming increasingly elaborate and abstruse. This has meant that juniors are now routinely not attached to a particular consultant or team – rather, they float between teams, providing cover. Both the patient and the doctor become casualties in this. Junior staff are expected simply to do jobs handed over to them, with no understanding of why or how their actions affect the wellbeing of the patient. There is no appreciation of cause and effect and no true ownership of the work done.
Doctors have become fleeting, transient figures in the overall care of a patient, who often sees no doctor more than once. This results in a diminished experience of health care, leaving patients confused, isolated and scared at the lack of continuity. They have to explain the same problem to each doctor they see, investigations are not followed up, things slip through the net. It’s not safe.
Doctors don’t want to work like this. We feel like automatons, clocking on and clocking off; any sense of vocation or meaning in our work is destroyed and the opportunity to learn from our seniors by following them and developing a relationship with them and their patients is removed.
The result of all this is that doctors are increasingly taking opportunities to work abroad, particularly in Australasia. As we lose doctors in this exodus, gaps in the rota only become worse and the junior staff are spread thinner. The Royal College of Surgeons reports that nearly two thirds of surgeons have witnessed a drop in the quality of patient care and safety since the directive was brought in last year, and that as many as three or four surgeons will now be responsible for a patient in a single day.
We became doctors because of the patients, and patients come into hospital because of the doctors. Yet this basic relationship has been shattered because of the implementation of one piece of legislation. Patients feel abandoned and alone on the wards, and doctors feel under-trained and disillusioned.
We don’t want to work ungodly hours and fall asleep while writing up a patient’s notes. But we want the opportunity to serve our patients to the best of our abilities, to learn from our seniors and to become the best doctors we can. Is that really too much to ask?
What have we come to when middle-class girls see whoring as a career choice?
Bel Mooney bemoans modern Britain where “There is no such thing as right and wrong”. While Left-dominated schools preach that, the sort of thing she deplores below will be encouraged. Unlike the USA, few people are churchgoers in Britain so they hear very little that counters the nihilistic gospel of Leftism. In fact they are much more likely to hear Christianity mocked by the BBC and other Left-dominated media
When it comes to human failings, I always try to be understanding. In fact, readers of my Saturday advice column in the Mail will know that it’s my stock-in-trade. But there are times, I’m afraid, when sympathy fails me and I am left nursing a deep anger which needs putting into words.
Sometimes, even those words fail me. How else to respond to this week’s story of well-educated girls — brought up in decent homes with every privilege — choosing to sell their bodies for a fast buck, not caring how many footballers use them in one week?
Frankly, I am dumbstruck at their stupidity, their vulgarity and their degradation of what it means to be a woman today, in a world where sexual equality was won through great courage and at great cost by the generations who came before them.
I think of all those who fought hard for women’s equality, and I can hear them turning in their graves at the sleazy stories of Jennifer Thompson and Helen Wood — the two young women who earned £1,200 each for threesomes with Wayne Rooney.
Of course, in one sense we read of Rooney’s tawdry transactions with these young women and feel little surprise. The man is a rough, over-paid, self-indulgent fool who doesn’t deserve a loyal wife and the gift of an innocent child.
The only shock is that he wanted to pay for sex, since so many foolish girls seem willing to offer it to footballers for free. (Even ones who are as ugly on the outside as they are inside.) but what of the girls themselves? To read the detail of their stories is to realise, with utter disbelief, that no amount of education can prevent a greedy and deluded young woman from choosing prostitution.
Having intelligent, well-heeled parents, a stable home, moral guidance, a private education, and all the opportunities that modern life can offer a girl with brains, is no guarantee against them wanting to sell their bodies, it seems. What sort of world do we live in when middle-class girls see whoring as a viable career choice?
The beaten and abused women (often children) who are trafficked for sex all over the world have no choice about what happens to them. The abject females who stand on street corners in the red-light areas of our major cities, peddling sex (and risking their lives) to feed savage drug habits, do, at least, have some sort of ‘excuse’.
In the UK alone, 75 per cent of prostitutes started when still under-age, nearly three-quarters of all British prostitutes were at some point in care, and nearly half have suffered sexual abuse — with far more than that having suffered physical abuse within their families.
Yet the ‘happy hooker’ myth (think Pretty Woman and Belle de Jour) continues to persist, and it seems that an increasing number of middle-class teenage girls find it exciting, rather than shocking or dangerous. They fantasise about the glitzy world of overpaid sportsmen who will, as Rooney did, fork out £200 for a pack of cigarettes — and six times that for a fumble — and they want a piece of it.
Now, let’s face it; there have always been ‘groupies’ — dim girls willing to sleep with famous men for the thrill of it. But what of those from stable, respectable homes who actively rebel against their upbringing and enter the oldest profession? These girls will sleep with any stranger for cash, whether a famous footballer or a sleazy businessman on an overnight work trip. They are something different; something very, very troubling.
To be honest, I’ve grown tired of feminists who defend so-called ‘sex workers’ on the grounds that what they do is somehow ‘empowering’. It is not.
When intelligent women make a free choice to shame themselves, and boast about bedding half a football team, they betray everything that women of my generation hold dear. Their behaviour pollutes the lives of younger girls they will never meet — by setting a terrible example.
Twenty-one-year-old Jennifer Thompson (or ‘Juicy Jeni’ as she chooses to style herself) was once a churchgoing teenager who went to a private school. Her father was an oil executive, her mother a PA.
Jennifer’s fellow prostitute (and alleged enthusiastic participant in lesbian scenarios) is 23-year-old Helen Wood — also from a middle-class home. Her mother is a primary school teacher, for heaven’s sake, and her father a university lecturer. I have no doubt the parents of both girls are asking themselves: ‘What went wrong?’
Of course, no outsider can answer that. But we can look at the world those girls have grown up in, and perhaps find some clues.
As a children’s author, I have found myself in many schools over the past 25 years and noticed one significant change — nowadays, girls of ten and over seem to have grown up far too quickly.
So many aspects of popular culture — from fashion, to pop lyrics and videos, to advertising, through to TV programmes like Big Brother and The X Factor — peddle a combined message of sleaze and greed.
This corrupting influence is very hard to avoid. Once, a little girl might have wanted to be a teacher or a doctor (and of course, many still do), but now, sadly, she is likely to say she wants to be a model, a pop star or a WAG.
The most frequent answer I get, when I ask little girls what their ambitions are, is: ‘I want to be famous.’
The disturbing truth is that many teenage girls will read the lurid stories about £1,200-a-night sex and think it sounds a very easy way of making a living. Better than studying; more interesting than a nine-to-five job; even ‘glamorous’. They do not realise that the line between wannabe WAG and girl-on-the-game is very fine indeed.
Just as bad — many teenage boys will think that what they learn from internet porn is clearly right and all girls are cheap slappers, up for anything if the price is right. Little by little, the gutter has become the cultural main street — and morality be damned.
How can women have changed so much in the space of less than a century? On the one hand, you have the noble history of active suffragettes and other brave women who took on the establishment and were punished most severely for merely demanding the right to vote. You have the women who played a vital role at home and as nurses at the Front in the two World Wars. You have the women who challenged institutionalised sexism in the workplace — and bequeathed us a world where equality is no longer an aspiration but a reality. We owe them all so much.
By sickeningly depressing contrast, just a few decades later, we have Juicy Jeni and Helen Wood, who have taken that precious inheritance and wiped their hookers’ stilettos all over it.
They are not the only ones, of course. Less than a year ago I wrote about the famous call girl known as Belle de Jour who was revealed to be Dr Brooke Magnanti, a high-powered scientist casually unabashed about her secret life as a hooker. She boasted of being ‘unbelievably fortunate’ because she enjoyed her horizontal job and had never had a bad experience with a client.
Everything she said proved that you can be blessed with a brain and a privileged life — and still be very, very stupid.
I wonder if ‘Juicy Jeni’ and Helen Wood read Belle de Jour’s lurid, self-serving ramblings as once they might have read fairytales. Or watched the sanitised TV series starring Billie Piper?
They are deluded indeed to believe that there is anything glamorous about this life of vice, well-paid though it is — for a while. The day will come, all too quickly, when they are raddled, used up and unwanted — and wondering what happened to the happy-ever-after they dreamed of, back when they were little girls.
And — you know what? It will be nobody’s fault but their own. They think they are selling their bodies. They end up selling their souls.
British school outsources teaching to India
A school has become the first in the country to contract out its teaching to India. Ashmount Primary in north London is using call centre-style staff more than 4,000 miles away to lead mathematics lessons for 11-year-olds. The service – which costs £12 an hour for each pupil – is being used as a cheaper alternative to employing one-to-one tutors for children falling behind in the subject. A private tutor in the capital normally costs around £40 an hour, it was claimed.
Academics said the move could be expanded to other schools nationally but warned that it risked undermining teaching standards.
The service – run by the firm BrightSpark Education – involves each pupil logging on to a special website and talking to a tutor via a headset. Children complete work on their computer that can be checked remotely by the Indian teacher.
The Islington primary school is currently using the technology with half of its final year pupils, with plans to offer it to nine and 10-year-olds. The school had been approached by the company to pilot the system.
Rebecca Stacey, assistant head teacher, told the Times Educational Supplement that the service had made a significant difference to her pupils’ grasp of maths. “We intend to roll it out so the whole of Year 6 is using it and perhaps down to Years 4 and 5,” she said. “We try to keep every pupil with the same tutor. The kids really enjoy it. It is a different way of approaching the subject with children who might find it harder to engage with maths.”
The school told the TES that it was far cheaper than paying £40 an hour to hire private tutors to teach maths to pupils falling behind in the subject.
Dylan Wiliam, director of London University’s Institute of Education, said such a system could work for more schools, but warned of potential dangers. “It will depend on how good their English is,” he said. “They will also need to understand the cultural conventions of this country. For example, long division is laid out differently in different countries. “Having said that, I am sure that this will become commonplace in time. If brain surgery can now be done remotely, why not maths teaching?”
He added: “As with many things in education, it¹s not a silly idea, but as we have discovered in recent years, a lot of things that appeared to be good ideas at the time turn out to be useless, or worse.”
The system was devised by a British-based entrepreneur, Tom Hooper, who employs 100 Indian-based tutors full time. All are maths graduates with teaching experience who are required to undergo security checks.
“I was a tutor myself to make a bit of extra money when I was at university and after I graduated,” he said. “But paying for additional tuition can be very expensive, in London you can be spending up to £40 an hour.” He added: “So it just seemed to make sense when I thought of providing live learning online, which could be flexible and engaging.”
All of the tutors are trained in the English mathematics curriculum.
Fewer British students ‘will take residential degrees’
Traditional university courses could become the preserve of an elite as growing numbers of students take on-line degrees, according to a report. Three-year residential degrees are likely to be limited to undergraduates at top research universities because of public spending restrictions, it was claimed.
The study by Universities UK, which represents vice-chancellors, suggests the emergence of a two-tier higher education system in the future as universities struggle to accommodate large numbers of new students.
The conclusions – published to coincide with the group’s annual conference on Wednesday – come weeks after record numbers of students were rejected from university. As many as 180,000 applicants failed to get on to degree courses this summer following a huge rise in applications combined with an effective freeze on new places.
This week, the Organisation for Economic Co-operation and Development warned that the UK had slipped from third to 15th in a global league table for the number of graduates being produced in each country.
Prof Geoffrey Crossick, vice-chancellor of the University of London, said the current system of delivering higher education was “no longer financially sustainable”. In a UUK report, he said the number of flexible courses – including part-time study, on-the-job training and internet-based qualifications – would “explode” in the future.
This would lead to a drop in the proportion of students taking full-time degrees and living in traditional student accommodation, he said, an experience that was likely to be limited to those at top universities.
“Fundamental rethinking will be needed in a world where the proportion of those who experience higher education in the traditional fashion will decline, where the range of alternatives will explode, and where the variety of providers will grow with it,” said his report. “There will remain a core of comprehensive, primarily residential and (most of them) research-based universities, but for the rest new markets and new business models will make them seem increasingly different.” It added: “Higher education as a life-course stage will narrow to just one part of the population who experience it.”
David Willetts, the Universities Minister, has already called for more students to consider apprenticeships as an alternative to university.
And the Open University, which runs courses on-line, has seen applications for degrees soar by around a third this year.
Prof Crossick said ministers would have to allow more private universities to receive state-funded students to accommodate the growing numbers of young people seeking to complete alternative degree courses.