Patients suffering from cuts in doctors' hours

Doctors claim future safety will be further undermined because junior doctors are spending less time undergoing vital training because of the European Working Time Directive.

They are demanding national action to tackle the impact of the regulations introduced last August, which restrict junior doctors' hours to a maximum of 48 a week.

A survey by the Yorkshire Post has found some hospitals in the Yorkshire region are struggling to fill rotas owing to shortages of junior doctors, making them increasingly reliant on expensive locums. Doctors say rural hospitals are among those worst hit.

Figures show one in five junior doctor positions were unfilled at the Doncaster and Bassetlaw NHS trust in May, while 34 out of 40 rotas were reliant on locums. On one midweek night, 15 junior doctors covered 700 medical and surgical beds.

At the Mid Yorkshire trust, which runs services in Wakefield, Pontefract and Dewsbury, 48 out of 60 rotas relied on locums and one in 10 junior doctor positions was unfilled.

In Sheffield's hospitals, 14 junior doctors covered more than 900 beds overnight, while 30 per cent of 87 rotas relied on locum cover.

Shortages of junior doctors meant that half of 10 paediatric intensive beds at Sheffield Children's Hospital were shut between February and April, leading to the cancellation of 35 operations and the transfers of eight sick children being turned down.

Health chiefs have launched a review of paediatric staffing in the region amid warnings other key specialties are also coming under pressure.

The director of workforce for the Royal College of Physicians, Andrew Goddard, said: "If you talk to any doctor, be it a surgeon or a physician, they will say hospitals are approaching breaking point. All of the medical admissions units are stretched to the limit and there don't seem to be enough doctors to go round.

"There are fewer doctors working during the day, which is going to have a big impact on their training and the safety of patients in the future."

The college's findings showed doctor-patient ratios were better in Yorkshire than many other parts of the country – but this masked significant shortages in the region's rural hospitals.

Some hospitals facing financial pressures were leaving gaps on rotas which put pressure on existing staff to cover more patients and the college had "significant concerns" about the quality of some external locums employed to cover gaps who were typically non-UK-trained doctors.

Dr Goddard added: "The use of external locums and gaps on rotas has very major implications for patient safety."

Sheffield orthopaedic surgeon John Getty, a council member of the Royal College of Surgeons, said trainee surgeons were losing out on vital experience as they dealt with significantly lower volumes of cases. Continuity of care for patients was also being "seriously compromised" because of changes in shift patterns.

He added: "Care has been totally disrupted because half the time the team isn't there.

"I am a big supporter of the NHS but there is no question that we need a reorganisation to deliver service work and training. The concern is the generation coming through now are not getting that operative experience that they need. If we don't train the surgeons now for the future there won't be a surgical workforce in 20 or 30 years' time."

The chairman of the British Medical Association's junior doctors' committee in Yorkshire, Chris Smith, said it was "deeply concerned" about the impact of rota gaps on training.

"In the long term if doctors are not getting their training, it could have an impact on patient care because they will be less well trained than their predecessors," he said.

A Department of Health spokeswoman said a "robust approach" would be taken in future negotiations over the revision of the working time directive.

"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," she added.

A regional health authority spokesman said it was aware of a "small number" of gaps in training doctors in some parts of the region under new rotas which began this month.

He added: "However, recruitment is better than last year at this point and there is no indication that these gaps are having any negative impact on frontline services."

There are no "immediate concerns" for frontline paediatric services, he said, but the authority is reviewing staffing to ensure they were sustainable in future.

The director of postgraduate medical education at Sheffield's hospitals, Andrew Gibson, said every patient had a consultant caring for them at any time of the day or night, adding: "High quality, safe patient care is always our priority and all our junior doctors are supported by consultants at all times."

Sheffield Children's Hospital said seven paediatric intensive care beds were now open after problems with junior doctor staffing were resolved.

"As the number of paediatric intensive care beds varies depending on the time of year, we can confirm the current number of beds open is appropriate for the current demand," said a spokeswoman.

Hospital chiefs in Doncaster said 13 junior doctor positions were vacant out of 226 following the start of this month's new rotas. Thirteen out of 35 rotas needed locum cover.

314M BILL FOR CONSULTANTS

The NHS in England spent more than 300m on management consultants in the last year, figures showed today.

The cost is almost the same as the amount spent on skin and lung cancer services combined, the data for 2009-10 showed.

The Government released the figures to show how much was spent on management consultants – as well as advice from architects, lawyers and surveyors – in the last year of the Labour government.

Overall, primary care trusts and strategic health authorities spent 313.9m on consultancy services.

Health Secretary Andrew Lansley said: "I am staggered by the scale of the expenditure on management consultants in the NHS."