PATIENT safety fears were raised today amid warnings that some surgeons and nurses in the Lothians have been working seven days a week solidly for three months.
Staff are said to be clocking up 72 hours every week as NHS Lothian battles to drive down patient waiting times. And there were demands today for an investigation, amid concerns patients may be put in danger by overworked and tired staff.
NHS Lothian said it acknowledged staff were “going the extra mile” but insisted hours were being monitored.
The claims of excessive working hours emerged from NHS Lothian employee director and former vice-chairman Eddie Egan, who raised the issue with the board. He said: “We need to get the waiting list numbers down, but I’m speaking to people working seven days a week and they’ve been doing that for three months in high-pressure environments.
“I am concerned that staff are being put under pressure. People are feeling morally obliged to turn up, even if they’re exhausted, because they know patients will be cancelled if they don’t. It’s potentially putting patients in danger.
“If you’re working seven days a week, in evenings and are possibly on call, it reaches a point where you have to query –are people safe?”
Some NHS Lothian staff members – such as surgeons, anaesthetists and theatre nurses – are being offered extra shifts at evenings and at weekends, as part of the effort to reduce the number of patients waiting longer than the target of 12 weeks for treatment.
The health board said there is “no evidence” that any staff members had worked for three months without a day off, but Independent MSP Margo MacDoanld said a probe should be launched in light of Mr Egan’s comments. She said: “This is an allegation that there has been potential danger with people working in life-threatening situations and very complex medical scenarios because they are too tired. We don’t want to alarm people if that’s not the case, but we’d better find out what the case is. Think of people with driving jobs who are not allowed to drive for too many hours because they need sleep and rest. If that’s true for drivers it’s certainly true for surgeons and nurses.”
It is understood that consultants can earn up to three times their normal rate of pay, while other employees such as theatre technicians and nurses can earn up to double their normal rates if they choose to work extra hours.
Offering extra shifts to NHS Lothian staff is among a series of measures brought in to address the issue of spiralling waiting times, alongside sending patients to private sector hospitals and the introduction of an outside company, Medinet, which provides private staff to run clinics inside NHS Lothian hospitals.
Mr Egan has raised additional concerns that Medinet staff, who are mainly based in England and travel to Lothian to work at weekends, could also be working too many hours, putting them at risk of burn-out. He added: “These staff are working the weekend here then flying down to England or wherever it is and are back to work on the Monday
“I keep asking who is ensuring they are observing the working time directive. I’ve been told they’re sure they are but I haven’t seen any evidence.”
Under the directive, staff members should not work longer than 48 hours a week on average over a period of 17 weeks. Staff members can opt out, although it is believed that no NHS Lothian employee has done so.
NHS Lothian expects Medinet to monitor the hours its staff work, but Tom Waterson, Lothian branch chairman for Unison, said it was the health board’s responsibility to monitor how long the doctors and nurses who were caring for its patients had worked. “No-one should be working more than 48 hours in one week,” he said. “The working time directive was not brought in to save money, it was brought in to protect health.”
Dr Jean Turner, executive director of the Scotland Patients Association and a former anaesthetist and MSP, said steps should be taken to hire more staff.
She said: “We have no objections to hospitals working for seven days a week but we need the staff, I don’t think patients want to think they’re being operated on by tired individuals.”
Dr David Farquharson, NHS Lothian’s medical director, said that while “activity” had increased at the health board to reduce the number of people waiting to be treated, patient safety remained the number one priority.
He added: “I would like to acknowledge the efforts of many staff who have been going the extra mile. However, we are very much aware of the risks of long working hours for both clinical and administration staff and, alongside our partnership colleagues, we are providing support for staff. Additional resources are being put in place in a number of clerical areas to assist waiting list booking staff. We are also recruiting more doctors and nurses and are using external suppliers, such as Medinet, to ensure our own staff are not overburdened.
“We routinely monitor the hours staff work in relation to the working time directive and, as professionals, doctors and nurses have an individual obligation to ensure that we don’t take on work that may impact on patient safety.”
• The Working Time Regulations were introduced in 1998 to regulate working hours in the UK. They make specific reference to “the need to protect the health and safety of workers”.
The regulations oblige an employer to take all reasonable steps to ensure that the worker does not exceed the limit of an average of more than 48 hours per week averaged out over 17 weeks.
However, this averaging out period may be extended to 26 weeks if the worker is treated as a “special case”.
For example, junior doctors are able to average out their hours over the longer 26-week period.
“Special case” workers also includes workers where their “activities involve the need for continuity of service or production”, which includes treatment or care provided by hospitals.
An employer that fails to take reasonable steps to comply with the limits on working time is liable to prosecution and a fine.
Local authority or Health & Safety Executive inspectors may also issue “prohibition” or “improvement” notices.