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The effective and safe management of patients in hospitals during the out-of-hours period has emerged as a key challenge for NHS organisations in recent years. At night, NHS hospitals have traditionally relied on multiple tiers of specialty-specific, resident 'on-call' doctors. This traditional model of 'on call' medical cover has been the subject of increasing debate in the medical press, with particular concerns about the impact of working excessive hours on the mental and physical health of doctors in training and the quality of care provided to patients.

More recently, the European Working Time Directive (EWTD) has acted as a major catalyst for changing the working pattern of doctors in training.

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