Letter: Opportunity to rethink the NHS

Sir: The consequences of the reduction in the working hours of junior doctors (letters 17, 19 March) deserve further comment.

Long hours provided no benefit to training, and the end of this exploitation should be celebrated. However, we are now faced with the problem of service provision. Although a number of measures to reduce workload have been introduced (for example, increased clerical assistance), the vast majority of the reduction in junior doctor hours has been achieved by an alteration in working practice - "on-call" less frequently but with a much greater patient responsibility. We need more radical solutions if health care is to improve.

(1) An expanded role for nursing staff. This is already happening to a small degree. The reason it is not more widespread is related to monetary considerations and entrenched views. Most of us know that such staff would provide an excellent service to the public, as long as they receive support from medical staff and management.

(2) Re-evaluating the role of the hospital consultant. At present, early assessment of the acutely unwell patient is rarely by the hospital consultant. Are hospital consultants lazy? Certainly not; they are among the hardest- working professionals in our society. Do they dislike patients? Again, certainly not; although some enjoy their detachment from the "coal face", the majority relish patient contact. So what keeps them from the bedside? An increasing amount of their time is dedicated towards improving or even maintaining the service they provide. The reason for this is the system of health service management with which we are now shackled, a management against which consultants are continually battling to hold their corner. Changes in training have provided the opportunity for consultants to be involved in the primary care of patients in hospital. Given support from management and the right environment, this could be achieved.

Rather than a time of gloom, we are presented with the opportunity to rethink our health service. Maybe in five years' time a sick child presenting to the accident and emergency department will be assessed promptly by a senior doctor and, if admission is necessary, moved quickly to the ward for treatment by a well-trained nurse. Maybe this would even save money!

Dr KEVIN SOUTHERN

Paediatric Research Fellow

St James's University Hospital, Leeds