Hospitals cut back on doctors' night cover

Big cuts in night cover provided by doctors in NHS hospitals were announced by the Government yesterday in a move that raises doubts about patient safety.

Nurses are preparing to take charge of hospital wards outside normal working hours in a restoration of their power not seen since the days of Florence Nightingale.

The move has been forced on NHS trusts by tough new restrictions on junior doctors' working hours imposed by the European Union. Under the European working-time directive, junior doctors are limited to working a maximum of 58 hours a week from August 2004. Currently, one third of junior doctors work more than 72 hours a week in the UK and are in charge of wards at night.

The directive already applies to most employees in Britain but doctors have been exempted to allow health services in Europe to prepare for the change. The NHS has traditionally relied on the long hours of junior doctors, and the cuts imposed by the directive threaten Labour's pledges to reduce waiting lists and expand the service.

Ministers gave the go-ahead yesterday to 19 pilot schemes in hospitals in England to test ways in which trusts can comply with the new rules – most focused on reducing the number of doctors on duty at night.

At the Birmingham Heartlands and Solihull NHS Trust, senior nurses are to replace junior doctors from 5pm to 9am on weekdays and all day at the weekend on acute medical wards. In trauma and orthopaedics, junior doctors will continue to provide night cover at Heartlands hospital but will be replaced by nurses at Solihull hospital, seven miles away, where the demands are fewer.

Peta Hayward, assistant human resources director at the trust, said: "We are matching resources to the need. There will be doctors available if urgent help is needed."

At Burton Hospitals NHS Trust, newly qualified doctors will be removed from on-call duties at night. A medical assessment unit at Northern Devon Healthcare NHS Trust will switch to 24-hour working and will be led by a nurse practitioner. At Nottingham City Hospital, five intensive care nurses specialising in heart patients "will ensure 24-hour comprehensive cover".

The Royal College of Physicians welcomed the "thoughtful and detailed" guidance but warned: "There are many emergencies where only immediate help from a skilled doctor is appropriate." The British Medical Association supported giving extra responsibility to nurses provided they were properly trained and available. "In principle we are in favour but whether it is practicable is questionable," a spokeswoman said.

The Royal College of Nursing described the move as a radical shift. Helen Caulfield, a policy adviser, said: "We may see really ambitious nurses wanting to develop specialist skills so they can run the service out of hours. It is a tremendous vote of confidence in nursing."

John Hutton, a Health minister, said the working-time directive was "a huge challenge" that called for a range of responses. "There isn't a one-size-fits-all solution as each hospital will face different problems," he said.

A spokeswoman for the Department of Health denied that nurses would take over from doctors at night. "A lot of the pilots may be looking at that but others are looking at changing rotas and providing other ways of working. This is about giving staff extra responsibility, breaking down traditional barriers and encouraging people to take on new skills. Obviously patient safety is a primary concern."

Liam Fox, the Tory health spokesman, said: "As someone who has worked as a junior doctor I understand the need to reduce the hours ... but you can only do that when you have sufficient doctors. This will mean increasing pressure on senior staff to provide cover for patients or the level of care will potentially diminish."