1. Tim Lund WTD National Programme Lead Skills for Health Workforce Projects Team

2. Introduction: Why the EWTD Matters Would you want you child to be treated by someone who had worked a 24-hour day? “Tired doctors are risky drivers”, New Eng. Journal of Medicine in 2005. Doctors 6 times more likely to have a car crash or near miss after working 24 hours International research shows working for 24 hours is the equivalent of drink driving

3. The Good Old Days: Go back 10 Years “Patients at risk from tired doctors” (BBC 1999) –Procedural errors 40%: Including one doctor who thought an emergency call to see a heart transplant patient was a dream and went back to sleep –Misdiagnosis 29% –Wrong prescribing 27% –Surgical errors 4% “Junior doctors prepare to ballot on Industrial action over unreasonable workloads”

4. The Vision for EWTD Implementation Joined up planning underpins high quality care & training Multi-disciplinary teams delivering high quality care, with more consultants / specialists. Clinical networks. Consistent with Darzi vision – clinical leadership vital “High quality care should be as safe and effective as possible, with patients treated with compassion, dignity and respect. As well as clinical quality and safety, quality means care that is personal to each individual.” Lord Darzi, June 2008

5. EWTD 2009 Reality: 4 Months to go Most doctors in training work a maximum 48-hour week but there are challenged services and many juniors fear for their training. Vast majority of Trusts expect to be compliant but time is short. Must support quality of patient care, training and work / life balance. National recognition of recruitment problems. More balanced view on international recruitment and training e.g. MTI £310m of national funding to support implementation Performance management / quality assurance regime. 65 hour weeks a red herring – see Greece. Derogation of limited help Excellent leadership and expertise in East Mids inc. David Sowden and Simon Markillie-Mallinson

6. Help Available: EWTD National Pilots Programme DH Commissioned Workforce Projects Team to lead EWTD programme WPT have sponsored 30 – clinically led- EWTD pilots and H@N – show creative solutions that support patient care, clinical training & EWTD 2009 Sponsored NHS targeted support programme and published signposting EWTD solutions. Top 10 barriers, solutions & good practice with NW/EofE Joint reports produced with the Royal Colleges on solutions in O&G, Paeds, Surgery and Anaesthetics. Key findings: –Don’t rely on recruiting extra middle grades – limited supply –Service redesign. Effective rota design is only part of a solution –Increased consultant cover can support quality of care and EWTD Solution for virtually every type of EWTD challenge. Lots of help available. www.healthcareworkforce.nhs.uk www.healthcareworkforce.nhs.uk

7. EWTD Programme Highlights “The Case for Hospital @ Night: The Search for Evidence”, found patient outcomes improved after introducing H@N team working: –reduced deaths within two days of admission and surgery –reduced no. of cardiac arrests –77% of Trusts responding to census were using H@N The Homerton, Guy’s & St Thomas’ and South Devon extended H@N to the 24/7. LoS reduced and quality of care improved More learning is retained when doctors are rested. Sheffield Uni research had shown 70% of doctors were happy with their training Patient safety. Warwick & Coventry Study showed clinical errors reduced by a third following 48-hour week and shorter shifts

8. Improving Patient Care: Case Study Urban District General Hospital Transient population Predominately elderly medical care needs Poor transport infrastructure Source: Wendy Reid, Clinical Lead for EWTD and H@N

9. Surgical Wards – Cardiac Arrest Data Total 04 = 33 Total 05 = 12 Reduction of 56%

10. EWTD 2009 Pilots Programme: Alder Hey

11. Sharing the Lessons Learnt Independent evaluation by West Mids Deanery and Birmingham University found… –Know the Service to be delivered and build the solution around the patients – not Directives –Clinical engagement, leadership and board level commitment vital –Project management is a partnership between the project manager & clinicians in taking forward solutions –Inter-org/multi-site solutions are sensitive and complex –EWTD 2009 compliance is achievable Key learning already shared through Securing Change, Identifying Options and case study booklets

12. Take Home Messages The EWTD is challenging but there are real opportunities for improving patient services Clinically led solutions have been developed for virtually every EWTD challenge The focus is on quality of care and training. Any interim solutions should be a stepping stone Essential that we continue to work together to support the NHS. Lots of support - but little time