Focus Group: Hospitals and
Residential Care
DG EMPL – 12 July 2010
Study to support Impact Assessment
regarding Directive 2003/88/EC and the
evolution of working time organisation
About the Study
Aim: to provide evidence to enable the Commission to evaluate different options for action at
Community level regarding Working Time, to inform decisions on what action should be
taken, should any need for EU initiative be determined. CSES/ Deloitte’s work is being
undertaken in parallel with DG EMPL’s public consultation exercise with the social partners.
In order to measure the social and economic impacts of the WTD, the impact
assessment will include four in-depth studies focusing on:
 Health and safety aspects of working time
 Economic impact on businesses
 Financial and organisational impact on public services
 Use of the 'opt-out'.
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Study Objectives
The specific aims of the study to support the Impact Assessment are to:
 Identify key social and economic changes in working patterns in the EU
which affect the organisation of working time
 Analyse the main needs of workers, businesses, public services, consumers
and other stakeholders in the EU regarding the organisation of working time
 Review the health and safety effects of various working time organisation
patterns
 Analyse the economic costs and benefits to businesses in the EU arising
from the Directive
 Data collection and analysis on the financial and organisational costs and
benefits of the Directive for key public services in Member States
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Impact of WTD on Hospitals
A starting point for discussions - preliminary reading and discussions suggest that:
 Av. working hours in the NHS have fallen significantly in the past decade. From August
2004, junior doctors have been subject to EWTD with a 5 year phased transition period.
A 48 hours max. av. weekly working limited has applied since August 2009.
 44% of junior doctors were in Band 3 in March 2001, the earliest banding data available.
0.3% of junior doctors were in Band 3 in September 2009, the latest banding data
available. Substantial investment by NHS in complying with WTD
 Temple report a "Time for Training" investigated how the quality and adequacy of training
has been effected by a 48 hour week. While differences of opinion between
stakeholders, report found that training could be accomplished within 48 hours
 Some concerns regarding amount of time available for training in particular medical
disciplines (surgeons, anaesthetists, obstetricians?)
 Individual hospitals keep data on the working hours of junior doctors since this is linked
to compensation and compliance with New Deal requirements. NHS Employers regularly
collects compliance data on behalf of the Department of Health.
 However, there is no regional or national data on the extent of use of the opt-out by
doctors (this is sometimes monitored by individual hospitals/ NHS trusts but no
systematic data collection across all hospitals)
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Impact of WTD on Hospitals (2)
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EWTD has had a considerable impact on resource planning. In some cases, complying
with WTR has led to the reconfiguration and adaptation of service provision in hospitals
To comply with WTR, there have been changes to working patterns and shifts. Given that
doctors are working fewer hours than was previously the case, to what extent are they
under increased pressure and work intensity?
Finding adequate manpower to comply with EWTD while at the same time ensuring 24/7
service provision, covering staff shortages in particular specialties and covering sick
leave etc. has been challenging for some hospitals
While complying with WTR is not seen as that significant a problem by some NHS
Trusts, it can pose challenges for others. Resourcing issues vary between regions, with
particular problems identified in parts of Wales and Northern Ireland . There are also
resourcing differences between urban and rural areas.
Resourcing issues are also influenced by the changing composition of UK medical staff.
While not linked to WTR, it is worth noting the wider context: changing gender
composition of junior doctors, changes in immigration laws have made it more difficult for
UK hospitals to recruit doctors from countries that have been important recruitment
sources, including Australia, New Zealand, South Africa, the Indian sub-continent
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Impact of WTD on Residential and Social Care
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Biggest issue – fact that many care workers may be on-call for considerable periods per
week and also sleep-in at the social and residential care premises
Sleep-ins have previously been seen as cost-effective by employers that run residential
establishments such as care homes in covering 24-hour service operations using shift
systems. Workers are commonly paid a nominal shift allowance rather than a higher,
hourly rate.
In light of the SIMAP-JAEGER ruling, however, time spent on an employer’s premises
for a standard sleep-in shift counts as working time.
Organisations providing essential 24-hour care are exempt from daily rest requirements,
although they still have to provide workers with “compensatory rest”, which should be
taken as soon as possible after a shift’s end.
There are issues around whether sleep-ins result in residential and social care workers
exceeding the 48 hr av. working. There are also pay and conditions issues - whether
sleep-ins should be paid at the national minimum wage
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Impact of WTD on Public Services – Key Questions
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What are the financial and resourcing implications of WTR? How has this changed since i)
the original WTR were introduced ii) the adoption of the New Deal for Junior Doctors iii)
Working Time Amendment Regulations?
What are the main implications of WTR in respect of: medical training, patient satety and
service delivery?
What are the main regional variations in resourcing availability and how does this affect
compliance with WTD? Likewise, what are differences between rural and urban areas?
How far has WTD led to more flexible working practices?
How do rest periods work in practice and how is compensatory rest managed?
How does WTR affect different types of doctors within the NHS e.g. Junior doctors,
doctors, consultants, senior consultants?
What are the impacts of WTR and the opt-out respectively for safe patient care? How
does this differ between hospitals and residential care?
In the context of the financial constraints facing the UK health sector, what, if any changes
are likely in terms of i) resource implications for hospitals in ensuring compliance with
WTR requirements ii) the extent of usage of the opt-out?
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Impact of WTD on Public Services – Key Questions
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How is on-call time managed? What are the implications of SIMAP-JAEGER
in this regard?
What are the potential problems faced by hospitals and residential care
specifically with regard to the SIMAP-Jaeger rulings in terms of:
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Costs
Practical organisation of work to provide 24 hour services
Job quality
Negative impacts on the health of employees
What are the potential benefits arising from the SIMAP-Jaeger rulings
• Avoiding negative implications for workers of long-hours (health and safety
impact, risk of burn-out, negative implications for training, problems in
reconciling work and family).
• Avoiding negative affects of long-hours work for the employers and
government (added difficulties in recruiting and retaining staff, higher risks
of mistakes or accidents)
• Advantages for the obligations of public authorities to ensure quality and
continuity in provision of core services to citizens
• Benefits for service users in terms of service quality, reducing risks of
errors.
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Impact of WTD on Public Services – Key Questions
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Potential benefits of strategies that have been implemented to cope with
any issues arising from the Directive
 Experiences of reducing reliance on long-hours working by
alternative work organisations
 Legal constraints to implement such strategies
 Time needed and acceptance/negotiation process with employees
(organisation)
 Costs, effectiveness and efficiency of the strategies
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Impact of the Opt–Out - Key Questions
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What are the benefits of the opt-out from WTD in respect of ensuring
continuous resourcing of hospitals and residential care?
How prevalent is the use of the individual opt-out in hospitals and
residential/ social care? How effectively is monitoring carried out in respect
of working hours by doctors/ care workers?
What are the disadvantages of the opt-out?
We would like help with factual information about the opt-out, specifically:
 Approximate proportion of workers that have signed an agreement to opt-out?
 Any limits to the weekly working time of a worker who agrees to opt-out
 Specifically for workers who agree to opt-out – proportion of on-call time in their
total working time; level of activity required during on-call time
 Measures (and their effects) to ensure and protect health and safety of
employees who agree to work more than 48 hours a week on average
 Extent of recording of working time patterns of individual employees (who have
chosen to opt-out)? How practical would you find it to measure on call-time
according to the level of activity required?
 Pay rates for workers who agree to opt-out and perform over-time?
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