That doctor may have worked 100 hours already this week…

As I said a week or two ago, I started my working life 25 years ago as a junior doctor, looking after sick people through the weekend without any sleep. Apart from the massive toll on my personal life, my patients certainly didn’t get the best out of their exhausted doctor. My career soon moved in other directions, and I thought junior doctors’ hours had been sorted. But it seems not. The story of junior doctors’ hours is an incredible extreme of how society fails to balance different human needs.

Granted, things are better than during the 1980s when an 80 hour week was seen as an unattainable aspiration. In the late 1980s Dr Chris Johnstone took to his bed in the street in protest at his work hours, eventually winning a high court ruling that working an employee so much overtime that their health was foreseeably damaged, was unlawful. By 1994 the maximum week was ‘only’ 72 hours (although this was weakly implemented with many doctors working longer).

Further progress came with the UK implementation of the European Working Time Directive, which meant that hours had to be down to an average of 48 per week by 2009. Still way too many – but allowing something approaching a normal life, even though the work was even more intense.

However, the devil is in the detail, and in this case in the averaging. Some doctors are still working weeks of over 100 hours, with fewer hours in other weeks. This summer, as if we were still in the early 1990s, it was debated at the BMA whether there should be a 72 hour maximum in any one week.  But as Dr Andrew Collier, co-chair of the BMA Junior Doctors’ Committee said, you can’t average your sleep across 26 weeks.

Even worse, in July 2014 the government announced that it would encourage junior doctors to opt out of the Working Time Directive, using the tired old argument that doctors need to work long hours to get enough experience (when did anybody, including a human being who happens to be a doctor,  learn anything useful while sleeping on their feet?) Medicine is a notoriously patronage-ridden profession, and ‘encouragement’ to opt out is unlikely to be limited to a friendly take-it-or-leave-it request.

Remembering my own horrendous experience of bad personal decisions and tears over tiny problems while I was working as a junior doctor – definitely the worst year of my life – I find it incredible that the situation has moved on so ambiguously in a quarter of a century. It seems to me that someone should fire up a campaign over this.

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Companies and doctors and unions

When you start to focus on an issue, it suddenly seems as if everyone is talking about it. But the last couple of weeks reallyhave been extraordinary for the shorter working week, with top people from Google, the medical profession and unions all saying how desirable it would be.

It has long been known that Google allow employees a regular day to be creative around their jobs, but Google’s co-founder Larry Page has now gone a step further and supported a shorter working week – “the idea that everyone needs to work frantically hard to meet everyone’s needs is just not true.”

Top public health doctor John Ashton, president of the UK Faculty of Public Health, said outright that the UK should switch to a four day working week, to combat stress, give people more time with their families or exercising, and reduce unemployment. This, he said, would help to correct “a maldistribution of work.”

TUC General Secretary Frances O’Grady has also been supportive, saying “Too few people in the UK are able to work the hours they want and need…But there’s also a growing problem with excessive working hours, with millions of employees under real pressure as they attempt to balance work with their everyday lives”. Senior Unison Scotland figure Dave Watson has also blogged supporting the case for a shorter working week.

Support is building, discussion is spreading…

Anyone can now ask to work flexibly…

It’s a day to celebrate! From today, all UK employees have the right to request flexible working  – in any form – it can be reduced hours, job sharing, working from home, or whatever variation is appropriate for the particular circumstances. Up to today, this right has existed but only for parents and carers. Now, anyone who has already worked for their employer for six months can make a flexible working request, whether their reason is caring responsibility, a thirst to increase their skills through training or education, a to great idea to start their own business, a desire to contribute more to the local community, a wish to slow down later in life but continue working, or simply a change the balance of their life.

This new policy seems like a real step in the right direction in the UK. The recognition that everyone, not just parents and carers, may want or need to work flexibly is very welcome. This kind of policy seems to have been one of the main factors that enabled the Dutch to achieve the lowest working hours in Europe.

However, the change comes with a sting in the tail. Everyone can now make requests to work flexibly, but previously when parents and carers made these requests, employers had to respond according to a strict process and employees had a right of appeal if their request was turned down. Now, that process and right of appeal are gone, replaced simply by an employer obligation to respond ‘in a reasonable manner’ to requests. Details are here.

Nevertheless, the broadening of the right to make requests is a very welcome and important change. It will be interesting to see how requests for flexible working increase, what proportion succeed, and the resulting changes in UK work culture and norms, over the coming few years. Perhaps this will be the day we look back to as the day everything changed.

Big change is possible

I had my first child a decade ago. At the time, I had the statutory right to a paltry four months’ maternity leave, because I had become pregnant quickly after starting my job. (I managed to take eight – thanks to my enlightened boss). My partner had the right to a mere fortnight of paternity leave, starting at the birth.

Now, nice as it was for us both to be around in those first couple of weeks, my baby was typical in that she spent most of her first fortnight asleep. During the ensuing months of wonderment, bonding, colic and projectile vomiting, I was on my own all day. I liked looking after my smiley bundle of baby, but sometimes, the days were very, very long indeed. Most days, adult company centred on groups where we sang that the wheels on the bus go round and round. And round, and round.  I got very envious of my partner for getting to go out into the wider world. I shouted at him for stopping for a coffee on the way to work.

Being wrenched from full-time brain- and people- work, dealing with global issues, to full time parenthood, didn’t work very well for me. I wanted to spend lots of time looking after my baby, sure – but I wanted my life to have other aspects, too. And meanwhile my partner wasn’t getting time to get to know our baby, because he was at work so much. And the baby was surely getting the impression that she had one main parent and one distant one, rather than two equal ones, which was how said parents felt about it.

Yet, once I had recovered from the birth, and once breastfeeding was part- rather than full-time, there was absolutely no reason why I, as the female half of the partnership, needed to be at home full time, and no reason why my partner could not do just as good a job of parenting.

But I didn’t think I would see change on this in my lifetime.

So this is a lesson in what is possible. Fast forward ten years. Maternity leave in the UK is now a full year; it has increased three-fold in ten years. And recently I have realised that something else, something bigger, has changed. I came across three couples, in one week, where dad is taking daddy leave. Not that nice-but-token fortnight at the beginning, but sharing the year of ‘maternity’ leave, so that mum and dad take six months each, or mum takes nine and dad three. More dads appear to be taking seriously the idea of equal parenting and equal work-in-the-world, from the very start. And next year the law will formally offer this option.

Yay!

It is living evidence that, with political support for regulatory tweaks, social norms and practices that seem very deeply entrenched can change quite quickly. The unthinkable can become reality.