Working in the NHS these days can carry risks, whether for single-handed GPs or as any member of the medical profession in the shiniest of Foundation Trusts. MEWS - the medical early warning system operating in many hospitals to reduce risks in acute emergency situations - relies on criteria, including assessment and management systems, regular monitoring and improved methods of communication between medical staff.
All too often, there is no early warning system for the staff themselves, who are subject to constant onslaughts on their own health, with none of the MEWS criteria applying to them. Long hours, poor support, excessive bureaucracy, and violent patients - these cover a tiny fraction of the adverse matters to be borne by the average NHS practitioner.
Professional people whose health is undermined are at risk not only of becoming ill but also, in the run-up to diagnosis, their performance and conduct may also be adversely affected. Employers owe their staff - at all levels - a duty of care to ensure their health, safety and welfare at work are not damaged.
The long day's night
Apart from all the stresses of a job, including the doctor's need to keep up to date with current health and safety legislation, working time is one of the important factors affecting the state of a doctor's health, their capability for doing their work, and the effect on their working relationships with other members of the team - tired doctors do not work to their full potential.
Consider the limits on working hours in the transport and aviation industries, and any situation outside medicine that requires alertness, skill and efficiency as a matter of life or death. It stands to reason that an employer requiring staff to work without not only runs the risk of damaging their health, but also places patients at risk by reason of poor performance.
In 1991, the Court of Appeal confirmed to Bloomsbury Health Authority that requiring a doctor to work such excessive hours as to put his health at risk amounted to a breach of contract even though the doctor had contracted to work those excessive hours.
Although there is a great deal of interest in the 58-hour Working Time Regulations' (WTR) restricted working week for trainee doctors, long hours or otherwise poorly organised working practices that increase OH problems could, with care, be headed off at the pass by suitable and sufficient risk assessments.