Examination of Witnesses (Questions 220
- 238)
WEDNESDAY 3 MARCH 2004
DR GILL
MORGAN, MR
ALASTAIR HENDERSON,
PROFESSOR HUGO
MASCIE-TAYLOR
AND MS
RACHEL ALLSOP
Q220 Earl of Dundee: But what particular
aspect of any of the on-going pilots would you put your money
on to catch on faster than others?
Professor Mascie-Taylor: What will appeal is
the argument that I have already outlined that between the hours
of one to eight there is relatively little activity in many, but
by no means all, hospitals, and, secondly, I think the increasingly
clear demonstration that a great deal of the work is generic—that
is, it can be done either by people who are not doctors or by
people who are relatively newly qualified doctors. The resistance
will come in specialised units dealing with esoteric areas of
medicine where the problems are not generic and where a more specialised
view is necessary for patient safety, and, as I think I have said,
there will be resistance to change because people in general initially
resist change, and one should not discount that but one simply
has to manage it and attempt to discriminate between what is resistance
through simply resistance to change and what is genuine resistance
to what might be a solution. Finally, Hospital at Night is but
one solution in a range of solutions; not the solution.
Dr Morgan: What is really important is that
there is not a single answer. If there were a single simple answer
we would have done it. This is a set of issues where you need
a whole series of menus that you can call off in individual organisations
when you have done proper analysis of what the problems are. The
issue of resistance is smaller now because one thing the NHS is
very good at is delivering targets to deadline and, without doubt,
this is seen as a key target for managers to be delivering at
a local level and, therefore, it has the full support of the most
senior managers in terms of implementation. There are two outstanding
issues that are concerning our members if you go into SiMAP
and Jaeger in particular, and they are really around a
number of specialisms where, even if a hospital can be compliant
for 95 per cent of the services in the hospital, there are a number
of specialties we know have real profound problems. There are
the very complex tertiary services—for example, neurosurgery
or something like that—but there are some more routine services,
in particular paediatrics, obstetrics, and anaesthetics, where,
although the overall hospital may be compliant in those three
specialties, they tend to have more out of hours work than others
and there tends to be more pressure. So there are a lot of hospitals
who are mostly compliant but have a problem in the specialties.
The second problem is there are a number of hospitals across the
country that are strategically important but are geographically
isolated, so they serve very rural populations, they are at the
bottom end of viability in terms of the numbers of patients that
come in, and they tend to have very low numbers of consultants
and junior doctors. Those hospitals have specific problems because
you cannot stick lots more doctors in because every doctor would
not have enough work to do, and we know that one of the aspects
about the quality of care is the more you do routine work the
better the quality of care that comes out, so there is a real
challenge here in those hospitals at how you sustain and manage
them, and they are strategically important because they are often
isolated. An example would be some of the hospitals in Cumbria
which may be 50 or 60 miles away across pretty poor roads to the
nearest hospital that could offer a substantial range of services.
So it is those two categories now that people are particularly
worried—individual specialisms and small geographically
isolated hospitals where the problems are very profound, and it
is increasingly an even higher problem in those very rare specialties
in those hospitals.
Q221 Chairman: Thank you very much. We have
had correspondence from others and there are two elements that
look difficult on specialism and these types of hospitals. I understand
what you mean; it is the type of hospital. Turning to the reference
period, I do not know whether you have found any difficulty about
the operation of the reference period. Some people have said to
us that they will try to manoeuvre the reference period to some
degree, but I would like a comment on the reference period and,
secondly, within that comment, would it be helpful if the reference
period was a year without any other conditions, for example? Some
people have suggested that in other parts of the economy. At the
moment it is related to collective agreements, of course, but
it would be possible to do it perhaps. What is your view, because
this is a point that will be covered by the Commission when they
come up again with the text.
Ms Allsop: We have not had any difficulties
with reference periods at all. We have an agreement to use the
number of doctors in a rota as equivalent to the number of weeks
that we take as a reference period so, if you work a 1 in 8 rota
we will take 8 weeks as a reference period; if you work for 1
in 13, we will take 13 weeks, so we do the rota as a reference
period and we do that with agreement and we have not had any difficulties—nor
have I heard of difficulties with other employers local to Leeds.
Dr Morgan: In terms of whether a year would
be better, because the NHS is 365 days a year 24 hours a day,
it is easier for us to manage it in smaller aliquots, because
you would not want to run a service and then find you had not
averaged it out; that you are getting to the end of the year and
you cannot continue to deliver the service in the way that is
needed, so it is easier to manage in smaller aliquots.
Professor Mascie-Taylor: Many of these people
are not even in post for an entire year. Many of these posts are
six month posts.
Chairman: Moving
on to the SiMAP and Jaeger judgments, in my own
mind the effects are quite separate but most people seem to treat
them together for the moment. Lady Howarth?
Q222 Baroness Howarth of Breckland: Dr Morgan
and I keep meeting in a variety of places. It is good to see you
again! Before moving to SiMAP and Jaeger, could
I ask a question that comes out of all this debate and that keeps
on coming up? The Working Time Directive was introduced as a health
and safety measure and has become much more an organisational
and work change issue. Although these two are related, do you
see any problems or advantages? It seems to me that some work
practices have developed which might not have developed had the
Working Time Directive not been there. Would that be your view?
Dr Morgan: You have to take that in the two
stages that Hugo was identifying. Most of the changes for the
pure, if we can call it that, Working Time Directive had already
happened, or were happening because of this New Deal that was
negotiated, and it is fair to say many of them are unpopular because
it has meant junior doctors now working shift systems which has
implications for them in terms of how they feel engaged with the
firm they work with and the workplace. At that level, therefore,
I think the changes would have happened anyway because we had
already signed up. Now when you add in the complexity that is
coming from Jaeger and SiMAP and from having to
hit 48 hours in a few years, then you get into a very different
interplay of what you have to do, and the simple measures of just
changing rotas, which is really how the 56 hours were handled—and
I am being overly crude and simplistic but that is what happened—is
not good enough to deal with the next step that is needed. It
has been a piece of quite good work going on in the NHS because
we have really genuinely looked not only about how do we hit the
hours but how do we hit the hours and improve the services we
can offer to patients by being much more targeted in what we do,
and it is also having spin-offs about the career pathways available
to other professions. When we reach the end of this period, therefore,
this will have been seen as quite a useful set of changes even
though it is fairly painful to be going through it and trying
to deliver.
Mr Henderson: On that, it is important to be
publicly clear that the health and safety agenda—and not
just staff safety but patient safety as well—is really crucial
and the intentions are right. It is also important to remember,
because it is sometimes easy to assume that this is happening
as a result of some sort of wicked European Directive, that this
is happening across the world—Australia far more so, in
America as well—safe hours is an international issue. So
that is really important and, following Gill's point, it has been
a really exciting catalyst in lots of places for thinking about
the right way to provide services and how we most effectively
use the resources, and so we should not let go of the fact that
it has made us think about the best way of providing services—and
it is the right way to go. I do not want to be treated by a doctor
who has been up all night, in the same way as I do not want to
be flown by a pilot who has been up all night. It is the right
thing to be doing and we must not let go of that, with the difficulties
that we have.
Professor Mascie-Taylor: I am no expert, as
you can imagine, on health and safety but I suppose my question
would be, "Is this the health and safety of the employee,
or the health and safety of the patient?", because they may
not be the same, and I say no more than that. There seems to be
a lack of clarity about whose health and safety we are rightly
concerned with, and there is no doubt that the move to 58 hours
has had significant effects potentially on both the training of
doctors and on patient safety—and we could explore those.
On balance my view would be that it has been useful—on balance
but not entirely. As we move to 48 hours and SiMAP and
whatever, then I think we have to re-debate those issues. Secondly,
it is interesting to speculate that if these limits are about
the health and safety of the patient—and I am not sure they
are but if they are—then at some point that will have an
interesting effect, I suspect, in the area of litigation. Patients
or lawyers may conclude that breaching an apparently acceptable
norm may have an implication for patient safety, and I think that
is yet another either foreseen or unforeseen consequence of these
changes that we have yet to fully explore. The implication of
it I do not think has been worked through.
Q223 Baroness Howarth of Breckland: Having
then accepted the Working Time Directive in your terms takes us
on to SiMAP and the Jaeger judgments, and they do
get lumped together, although by now we are very aware of the
differences. Now, because there are a lot of questions we could
cover in a general way here, I simply want to ask the generic
question to start with which is are we going to be able adequately
to provide the proper level of community care for the patients
with these two elements in place, and what are the things we should
be looking at first in order to try and change to ensure that
we can?
Dr Morgan: I think our position is that as we
stand on 1 August, with the number of doctors in the system, whilst
some hospitals will be compliant with SiMAP and Jaeger,
and they may be entirely compliant or 95 per cent, there are a
number of specialties that SiMAP cannot be delivered for
in a number of these small hospitals and if you add in both
SiMAP and Jaeger the numbers will increase, so there
are going to be sizeable numbers of places on 1 August that cannot
be compliant in view of SiMAP and Jaeger.
Q224 Baroness Howarth of Breckland: So are
you saying there would not be a breathing space for Jaeger?
That you really feel that could not be met?
Dr Morgan: Yes. We think both of them are a
bridge too far in terms of how you organise services and what
we need to do, and we do not support the continuation and are
actively lobbying both Government in this country but also Europe
to overturn both of them. Not at the expense of the opt-out, however;
I think that is very important. We cannot achieve 48 hours as
we stand -
Q225 Chairman: I understand the point.
Dr Morgan:—But we will have a good chance
by 2009.
Chairman: We are looking at a document
which will go to the House but also to the Commission but we are
in a period where we think some things could be changed—for
example, the consequences of the Jaeger judgment. It is
not a completely static situation, and that is the why we come
to it here.
Q226 Baroness Howarth of Breckland: That
is why we are interested in your view and what it is that the
arguments might be in terms of changing that, and any arguments
would be welcome on that one. Picking up one other point, paragraph
19 of your written submission says that joint guidance on compensatory
rest which the Confederation, the Department of Health and the
BMA Junior Doctors Committee were about to publish has been shelved
as a result of the Jaeger judgment. Do you propose to do
anything instead of that? Could it be published without the
Jaeger judgment, or is that not possible?
Dr Morgan: If there is a change in the status
of the Jaeger judgment then the guidance we have issued
is on the shelf ready to go but, as Jaeger stands at the
moment it is so clear and unambiguous about the rules, that any
guidance does not help or clarify and we are very averse to sending
out a paper that does not add a whit of human knowledge.
Professor Mascie-Taylor: This is a real difficulty
with Jaeger. SiMAP has perhaps some desirable and
some less desirable aspects but it will undoubtedly further change
the pattern of work and, therefore, there are completely predictable
effects on both training and potential effects on safety. As far
as Jaeger is concerned, it is unpredictable but if one
takes it certainly as I read it, then I think it would make hospitals
extraordinarily difficult to manage because one would be faced
with the position where one really did not know on any day of
the week what staff would be working and what staff would not
be working.
Q227 Baroness Howarth of Breckland: We heard
from the BMA at some length about issues around this, and got
a sense that many people would be setting this aside. Do you think
there are ways that the NHS can protect themselves against litigation
in the meantime while all this is going on?
Dr Morgan: If you take Jaeger, many people
in the profession regard it as not being helpful and not where
they would want to go and they would not have argued for it, so
there would be many organisations where at a local level there
will be a collective agreement that Jaeger is not implemented
in full, put it that way, and I think that will happen. The problem
with that is twofold: firstly, it is not a stance that the Government
could condone because it is about breaching the Directive, even
though individual organisations will take perfectly rational choices
between sustaining patient care and breaching something that everybody
at a local level feels cannot be delivered. That can only hold
provided there are no individual cases so, if an individual junior
doctor decided to take a case, that would throw the whole thing
into disarray. Secondly, if there were a problem that happened
and this was then pulled in as part of the problem, the only thing
the NHS can do to protect itself against that is to do its best
to offer good practice and good care on every occasion which it
does anyway. So I do not think there is anything over and above
it. SiMAP is much more worrying on the ability to hold
the line because there is a split here between the medical profession—certainly
the medical profession as led by the BMA—and the management
community. As a management community we would say SiMAP
is a bridge too far; the BMA are clearly saying they believe it
is valuable and should be implemented now. We believe that the
NHS cannot implement it now; it may be something which is aspirational
to move to but cannot be implemented in full on 1 August, so it
really depends on the views of individual doctors about how they
wish to move forward on that and, where there is a split in the
profession, it is very hard to know how individual trusts could
protect themselves if an individual doctor said, "I am not
prepared to work" and went to a court. We are quite clear
under those circumstances the BMA would support them and I think
that would put local management in a very difficult situation
in terms of the sustainability of services as of 1 August.
Q228 Baroness Howarth of Breckland: Being
precise, is that because of the specialisms? Or is it broader
than that?
Dr Morgan: The biggest category is the individual
specialisms and the geographically isolated and small, because
you can be small in a city but it is not a problem to get cross
cover, so it is the small and isolated, but even in hospitals
which will be largely compliant which have a problem in those
specialties, every hospital is really an amalgam of historically
developed services so many hospitals will have another specialty
that they might have a problem in but it will be different from
organisation to organisation depending on the history. An example
of a problem that could arise is that where I worked before in
a health authority we had a small ENT team where a critical member
of the team had a road accident and sadly died, and the implication
of that was the whole hospital could not be compliant in any way
because there is no way you can get locum staff in of the quality
and the calibre, so I think it is going to be more than the specialist
areas and the general small hospitals because of these sorts of
unforeseen circumstances.
Lord Colwyn: We have covered patient safety
to a certain extent. Could we move on a little bit to the training
aspects of this? When I was a medical student many years ago in
the early `60s you looked forward to the junior doctor bit; you
had had your training and if you passed your finals that was great,
and you got your experience doing these two awful years where
you spent all night and day working and found out how to cope
and be a doctor. Our previous witnesses this afternoon told us
how junior surgeons apparently are going to get one sixth of the
training that they used to get. Is this going to be a problem
and lead to reduced standards in any way in patient care? I am
thinking of A&E where there is such a wide spectrum of medical
practice. I have to say I changed to dentistry and did not end
up doing it!
Professor Mascie-Taylor: I think it is impossible
to predict with certainty the effect of the changes. I suspect
that I served the same sort of apprenticeship that you served.
Inevitably there is a view amongst some of the more senior members
of the profession that that apprenticeship is absolutely vital
and is the very central point of training. I can understand that,
but I think we have to accept that there is a need to move away
from that and that training will be delivered in a more proactive
and systematic way. It also needs to be recognised that that will
take dedicated time, and I am not sure that is recognised at all.
It certainly is not recognised in the contracting process. More
senior doctors will have to spend dedicated time specifically
training more junior doctors, as opposed to more junior doctors
learning by some undefined and vague osmotic process over a period
of time. I think there are ways around these issues; the long-term
effect of them is unpredictable because it will be tied in with
other things—a move within medicine towards increasing subspecialisation
of both general practice and hospital practice, so that will have
an effect that I do not think is easy to read, and it is part
of societal change. There does seem to be perhaps quite a healthy
development of a different attitude to fill out work/life balance,
and it seems to me the challenge for the NHS is probably not to
resist that but simply to recognise it, engage with it, and find
ways of making sure that the training that doctors and all these
other staff receive is at least adequate and, hopefully, better
than adequate. That needs to be very broadly recognised, and not
only in particular bits of the Health Service. It has a real cost,
it does affect capacity, and that needs to be much more widely
understood.
Dr Morgan: There is another issue going on here
in that all the changes that are happening to doctors often get
all conflated because they are very complex but there is a broader
set of changes. The British way of training consultants has been
very unusual. We have been unique in the world. There are about
two or three other countries that have copied our model, but we
have worked with very long periods of junior doctor training so
by the time you become a consultant you are incredibly competent,
and you can sell yourself anywhere in the world. The majority
of the world works to a system whereby they train specialists.
They are much more junior; they are the equivalent of our registrars
coming towards the end of their period of time; and they are much
more generally competent but much more specialistically experienced.
There was a different European judgment some time ago when, because
of the European Community and the free passage of goods and services
and staff, we were taken to the European Court because we were
not allowing into job interviews individuals who were specialistically
trained in other countries, so we have been working for now ten
years with I think it was the Calman report, to change fundamentally
the way we think about the training, and that is meaning less
specialist training. Now, that is causing problems. Consultants
do not like it because the implications of having a specialist
group of doctors rather than a consultant group is that the work
you do as a consultant will be fundamentally different from what
you believe it will be when you qualified and you trained, so
there are those sorts of changes going on, and the question that
needs to be put back to the profession is whether the amount of
training you will get is now fit for what you will be when you
are trained, and that is not the same as most people believe it
is because they still have the model of a traditional consultant
after twelve years of training, and we are not training for consultants
any more.
Professor Mascie-Taylor: And we have to ask
whether the NHS has adapted its system of care to a different
type of consultant.
Mr Henderson: Specifically on training, thinking
about this has been in many cases a useful catalyst as well. The
Royal Colleges have done a lot of thinking about this and are
certainly very good people to talk to on this issue generally
and on the Working Time Directive because they have done a lot
of good work on it, so it has been a catalyst for the colleges
to think whether training by very long hours and copying things
really is the best way to be doing things, and whilst there are
some real concerns about how it is organised to ensure that people
do not miss out there is an opportunity possibly to provide it
in a more structured and ordered way, and I think some of the
colleges are doing some quite exciting work on that.
Q229 Chairman: I know that you rightly stressed
the disadvantages in the immediate future of the SiMAP
and Jaeger judgments, but do you agree that in a way we
can differentiate them because the SiMAP judgment deals
with the definition of Working Time and in a sense something has
to be done about that—there has to be a proper definition
of Working Time—whereas the Jaeger judgment of course
covers the period from the beginning of compensatory rest, about
which there is absolutely nothing in the original Directive?
Dr Morgan: Yes.
Q230 Chairman: Would you agree that in a
way, although they are both important, and I am glad to have your
comments, we can in a sense differentiate them?
Dr Morgan: I think you can. Jaeger makes
no sense at all in terms of how you run NHS organisations. On
SiMAP I think there needs to be a longer discussion and debate
and there may be a timing issue in that, but there is some sense
in SiMAP. We would not support it and could not at the
moment because the NHS is working to a completely different mandate
which is why it appears to be out of kilter, because until a year
ago it was working to achieve 58 hours which it would largely
have achieved and, therefore, it is that judgment which has really
thrown the NHS completely out of kilter in terms of achieving.
So we think at the moment that is a bridge too far not just for
the British NHS but for the European health system as well.
Q231 Chairman: Can we just have a word about
senior hospital doctors now? Do you think there are any specific
consequences for senior hospital doctors which we have not covered?
Most of the time with other witnesses we have been talking about
doctors in training and so on, but do you see any problems which
are likely to arise for senior doctors over and above those that
have been mentioned so far?
Professor Mascie-Taylor: I think there are a
number of potential difficulties because clearly, if you change
the working patterns of junior doctors and, in some ways, quite
fundamentally change the way doctors are trained and the way in
which the service operates in order to meet these particular pressures,
what has happened here is that a particular set of drivers for
change has been introduced with the force of legislation. There
are other drivers for change, work force issues being one, which
do not have quite a same force because there is not legislation
around them in the same way. The first major change, therefore,
is that there has been a very radical and there will continue
to be a very radical change in the way the whole profession has
to operate. As we have already said, the nature of being a consultant
and the nature of that consultant is fundamentally changing. There
are enormous changes afoot and I am not entirely convinced that
we have yet thought our way through all of them. There is then
a third set of issues around as well concerning what of all of
this will apply to consultants directly at some point and how
we manage that, and I think that is an area where less work has
been done by far than on junior doctors, for reasons we all understand.
I can speculate as to the likely effects of various aspects of
it if you wish, but the consultant body to some extent does feel
it has been the recipient of change and has not yet fully come
to terms with that, and I do not think either the consultant body
or the NHS has recognised the sort of changes that might come
to consultant practice.
Q232 Lord Harrison: When we come to write
our report and make recommendations, what would you say we should
say to the Government that they could do to help resolve the issue
of the ECJ judgments and the Directive as a whole?
Dr Morgan: The first thing to say on the European
Working Time Directive and the Department of Health is that Andrew
Foster, who is the director of HR, was the person who got the
Department of Health to take this seriously about four years ago
when he worked for the NHS Confederation, so we have had a very
high interest in this for some four years. I think Government
is working really quite hard. It is important to recognise this
is an interdepartmental issue and the DTI have the lead, and there
is a whole raft of other people affected by this and not just
the Health Service, so it is very easy to focus on the problems
of the Health Service which are what worry us on a day-to-day
basis, but the problems are much broader than that. For instance,
in Sweden they were worried about what they were going to do with
their pilots and the Armed Forces in terms of the Working Time
Directive. They are working hard in Europe through Ministers and
through officer links in partnership with a number of other countries
to protect both the opt-out—which is critical at the moment
and we cannot work without it—and to amend both SiMAP
and Jaeger, and they are genuinely doing as much as they
possibly can in the health field to produce the necessary changes.
You ask what more could they do in this country; I do not think
there is any more. We have a whole set of models that we need
to work and implement, but in the best of worlds whatever we do
in some hospitals SiMAP and Jaeger just cannot be
delivered unless there is a windfall of another 5,000 doctors
suddenly appearing—and I am not holding my breath!
Q233 Lord Harrison: So joined-up Government,
and then working with others, especially on the opt-out?
Dr Morgan: Yes.
Q234 Lord Harrison: Moving on, then, to
the question of consultation with the EU counterparts, what other
organisations are there like yours, and what are you doing with
them?
Dr Morgan: There are a number of organisations
like ours. There is an umbrella organisation, HOPE, Hospitals
of the European Union, which is chaired by a Frenchman, Gerard
Vincent, who is Chairman of our exact equivalent in France, and
I am part of the British delegation on HOPE, and we believe that
all the delegates—all the old countries plus the majority
of the accession countries—will put in a joint submission
arguing exactly what I have argued today, which is that we need
to keep the opt-out and we cannot achieve SiMAP and Jaeger.
Q235 Lord Harrison: Just out of interest,
in a sense is the fact that you have now started talking to your
colleagues on the Continent been brought about by an issue like
this, because it has been my feeling for ten, twenty years that
the NHS has been hopeless at talking to colleagues on the Continent—and
the other way round.
Dr Morgan: Yes. It is fair to say that when
the British NHS has looked overseas we have tended to look to
countries that speak English and, therefore, we have tended not
to talk very much to our closer neighbours. Having said that,
there are lots and lots of examples of good collaborative work
across Europe and HOPE is quite an old organisation—it has
been in being for twenty years, Britain has been an active member
of it, we have had an active Chairman of it and the next Chair
will be a British person, so we have been active in those sorts
of fields—but there is a difference between the activity
of national bodies who think outside, and what goes on if you
are in an individual organisation running it having to deliver
the targets today, and I think there most of the Health Service
connections are either with America or with the developing world.
There is a lot of contact with Africa in particular, and now some
in China.
Mr Henderson: There has also been some other
connection in the European CEEP Committee which is public sector
employers in Europe. Your general point about engagement with
Europe is something that from our point of view we hope will change
as our role develops. As you know, we are taking on this new role
with devolution of employment responsibilities from the Department
of Health, and I think that gives us a real opportunity as an
employers' association for NHS bodies to start having that talk
with Europe that in a way we have not in the past. NHS organisations
have always been represented by Government but now with these
changes we have the opportunity to start talking as an NHS organisation,
and I think that is a real change that we are really keen to take
advantage of, so that we are talking as organisations as a whole
and not as Government.
Q236 Lord Harrison: I am a passionate believer
in talking to people who do the same job elsewhere because you
always learn something and they always learn something from you.
Dr Morgan: Absolutely.
Professor Mascie-Taylor: And there are huge
professional links for us across the profession. Certainly within
the medical profession there are extensive links in many areas
of medicine into Europe. Equally, it has to be said, those are
largely bioclinical or scientific linkages as opposed to service
clinical linkages, but there may be something that could be built
on that, focusing on very specialist society norms and the way
services can be delivered as opposed to purely clinical and scientific
matters, that could be quite helpful.
Dr Morgan: On HOPE, in the high level reflection
process that has been going on around health, Health Ministers
have involved a number of NGOs in that work and HOPE has been
at the table for that high level reflection process, and HOPE
itself was influential, I have no doubt, in persuading the French
to change their position because they had been willing to compromise
on SiMAP and Jaeger provided that the opt-out went,
and the Government has now formally changed its position after
some fairly hard lobbying from the French Hospital Federation.
Q237 Lord Harrison: Professor Mascie-Taylor
has already mentioned the compatibility of work and home life
and also you talked about societal change, and we need to think
about the newer generation of doctors and how they respond to
that and how they make demands, indeed, to get a better balance
between work and home life. Would you like to say a bit more about
that in respect of the Working Time Directive?
Dr Morgan: It is important to recognise that
lots of people in the NHS work long hours and while society is
changing, the majority of people still work in the NHS because
they feel they are contributing, they have a public responsibility
and a public duty. The NHS has to cover 365 days a year 24 hours
a day, so working in the NHS is always going to feel different
from working at Tesco's or HSBC or wherever—and so it should!
Now, the task for the NHS is how do you recognise that vocation,
that duty, those responsibilities but how do we do that in a sensible
and sensitive enough way so that the individuals can match their
professional aspirations as well as their family aspirations.
Some of the most vociferous people against reducing doctors' hours
have been doctors because they feel passionately that they offer
a better service if they offer continuity of care. So this is
a balancing task that there will never be simple answer to; even
if we double the number of doctors it is still going to be there.
You do not leave a sick patient at five o'clock in the evening
because you are going off duty; you stay with that patient until
care is needed—and thank Heavens.
Professor Mascie-Taylor: And if you extend that
point in terms of SiMAP and, particularly, Jaeger,
you see where it takes you.
Q238 Chairman: Thank you very much. We have
covered the ground very well and we are extremely grateful to
you for your contributions. It is quite a tricky dossier which
all of us are engaged in. We hope that our report will reflect
some of what you have said to us, if not all, and that we do have
at least some influence on not only the consultation but the result
of the consultation. There is not much point in consulting unless
something comes out of the current situation, and we will certainly
be aiming to make our contribution to those results. So thank
you very much. As I said, we will send you the transcript and
if you want to correct it please do, but please get it back to
us quickly because we are anxious to report within a relatively
short time.
Dr Morgan: Thank you very much, my Lord Chairman.
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