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NHS response to European Working Time Directive results in better patient care

  • Published date:
    17 August 2005

Evaluation published for 'Hospital at Night' project

Hospital at Night, a model of shift patterns and staffing mix for the NHS to use in response to the European Working Time Directive has delivered improvements to patient care, according to a new report published today.

The report details evaluations from four acute hospital sites across England that piloted the scheme in 2003. 

The report concludes that Hospital at Night:

  • Helped improve patient care during the night by prioritising acutely ill patients, and ensures that patients are treated more quickly and are seen by doctors who are more alert
  • Had no negative impact on doctors training
  • Has not affected the achievement of national performance targets in the areas of A&E waiting times, cancelled operations and inpatient waiting times.

The Hospital at Night project redefined how medical cover is provided in hospitals during the out-of-hours period. The project requires a move from cover requirements defined by professional demarcation and grade, to cover defined by competency.

Key elements of Hospital at Night include multi-disciplinary teams, multi-specialist handovers, bleep filtering, extended nursing roles, and moving non-urgent work from the nighttime.

The project is a partnership between the Department of Health, the NHS Modernisation Agency, the British Medical Association and the Royal Colleges.

Public Health Minister Caroline Flint said:

'Implementation of the Working Time Directive for doctors in training in August 2004 was not easy, but it is testament to the hard work and dedication of staff that we have managed to come this far.  

'Hospital at Night played a key part role in helping trusts formulate new ways of working, achieve Working Time Directive compliance, improve patient care and encouraged a better work/life balance between doctors.

'As the report shows, the successful implementation of Hospital at Night prioritises acutely ill patients, and ensures that patients are treated more quickly and are seen by doctors who are more alert.

'The involvement and advice from professional organisations and colleagues in the wider NHS has been critical to the successful implementation of Hospital at Night.

'The Working Time Directive was a great opportunity for us to modernise the way we work to provide faster treatment for patients, a better patient experience and a better working environment for staff.

'Hospital at Night was a key element of this strategy. We need to build on this success. We must keep up the momentum in reducing doctors' hours - the job is not fully done but the principles underpinning Hospital at Night will be a key solution to the 2009 48-hour European Working Time Directive.'

Patrick Chu, Clinical Director of Haematology at the Royal Liverpool NHS Trust, one of the pilot schemes, said:

"The Hospital at Night model is a very good working model to help pave the way for the full implementation of the European Working Time Directive in 2009. It also has much wider benefits including training more highly skilled nurses, ,improving communications, team building and time management.  The hospital at night model can be improved further by applying the concept across the 24 hours of the working day."

The report also highlights:

Team working - At all Trusts for the pilots the multidisciplinary team comprised highly trained nurses and doctors from a range of specialties.  Doctors felt that team working reduced the intensity of their workload and allowed them to concentrate on specific patients without interruption.

Handover - All staff felt that the more formal handover that is a key requirement of Hospital at Night guidance improved patient care.  Doctors felt that they were picking up the most acutely ill patients and it was easier to get cross speciality referrals.

Night Coordinator role - The importance of the Night Coordinator role - a senior nurse at each of the pilot sites - was a critical part of the implementation and working of Hospital at Night teams. Nurses in particular reported that they felt more willing to bring problems to the attention of the Night Coordinator, which led to improvements in patient care.

Bleep filtering - The inappropriate bleeping of doctors helped doctors to see patients more quickly, carry out patient consultations without constant interruption.  It also contributed to improving the work/life balance of doctors by helping them finish their shifts on time.

Notes to editor

1. A wide range of approaches to support the implementation of the working time directive, whilst maintaining or improving the quality of   patient care, have been developed. One approach - the 'Hospital at Night model - has been piloted in four acute NHS hospital trusts in  England. 

2.       24 more acute Trusts have implemented the H@N.

3. The four Trusts who took part in the Hospital at Night pilot were The Homerton University Hospital NHS Foundation Trust, The Royal Liverpool and Broadgreen NHS Trust, The Wirral NHS Hospital Trust and Morecambe Bay Hospitals NHS Trust.

4. The University of Manchester's Manchester Business School and York Health Economics Consortium conducted the independent evaluation of the Hospital at Night pilot projects.

5. Copies of the full report can be downloaded from the above link.

6. Media enquiries only to Sally Aldous, Department of Health Media Centre, 020 7210 5230.

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