Hospitals face collapse over hours for doctors

Britain's hospitals face collapse within 16 months unless the Government is prepared to break European law on doctors' working hours, the Royal College of Physicians is warning.

It says there are too few doctors and cutting their hours will leave hospitals with "gaping holes" in their medical cover, posing a "direct and alarming threat to safe levels of patient care".

The only alternative for the Government is to delay implementation of the limit on hours, in breach of European law, leaving it liable to heavy fines and open to legal action from individual doctors.

The report, a copy of which has been obtained by The Independent, was sent to the Department of Health and other medical organisations in January but has not been publicised. The dilemma has been caused by the European working time directive, which sets a maximum working week of 58 hours on average for junior doctors from August 2004.

The college's intervention, highlighting a threat to public safety, has split the medical establishment and prompted a fierce denunciation of the college's action by the British Medical Association.

A BMA spokesman said yesterday: "It is almost beyond belief that a medical royal college is seeking to delay an important piece of health and safety legislation designed to protect its members."

Although the deadline for cutting junior doctors' hours has been in prospect for a decade, meeting it has been made much more difficult by an unexpected ruling of the European Court of Justice in 2000, known as the Simap (Systeme d'Information pour les Marches Publics) judgment, which said time spent by doctors sleeping overnight in a hospital must be counted as part of their 58 hours on duty.

The Royal College of Physicians says in its report that this "unexpected, counter- intuitive" judgment will have a "huge and potentially devastating impact on the entire fabric of acute hospital medicine in the UK, with medical workforce shortages threatening standards of medical care".

The shortage of doctors in Britain is among the worst in Europe and the college estimates there would need to be a "50 to 100 per cent increase" in the number of middle-grade doctors in district general hospitals to keep services running round the clock within the new 58-hour limit. But extra doctors are not available.

Full compliance with the European directive would therefore be "extremely worrying, threatening at worst a collapse of acute hospital services", it says. At best, junior staff and consultants would be "dangerously demoralised" with "profound implications for ... the maintenance of safe acute hospital services".

Defying the European Court and delaying implementation, perhaps until 2007 or 2009, would risk being penalised with heavy fines but is the only way of avoiding this outcome. The report concludes: "Ultimately, it may be necessary to make a difficult decision between dutiful compliance with unsatisfactory legislation from the European Court and the maintenance of public safety."

Professor Carol Black, the president of the Royal College of Physicians, said about half of the 300-plus trusts in England running acute services would be unable to implement the new rotas safely.

¿ An emergency meeting of the BMA has postponed a vote on a new contract for GPs. Many doctors believe the changes would leave them financially worse off, and the deal was expected to be rejected.