My posting below on the WTD has prompted some feisty comments.

Alas (or happily) my new Intense Debate Comments mode will not allow overlong comments. So here is my latest refinement in response to reader Norman Fraser:

Apology duly accepted. Plus it is all about a blog posting drawing on a short newspaper article, not a piece of detailed research on the way the NHS works, so be gentle.

I duck nothing. You give the impression that I am a champion of 80-hour shifts. There are obvious problems with those, even if doctors are fast asleep for good slices of the time.

All I am saying is this:

–  the more changes of shift you have, the more likely it is that one doctor’s trained ‘sense’ of what is happening for a large number of patients all under supervision will not be transferred to the next doctor. It can’t be

–  so, the usual trade-offs: the fewer the shift-changes, the less information-decay, but also the new risk of tiredness (and exploitation of junior doctors)

–  I tend to trust the people at the coal-face on this one rather than civil servants. Much less need or requirement to ‘spin’

–  Finally (central point) the effects necessarily are marginal and hard to translate into raw numbers: no death certificate is going to say "killed by mistakes caused by WTD-imposed shift-changes". So central data will struggle to capture the phenomenon

My core point (and why this Labour Government rightly strove long and hard against the extension of the WTD, the main aim of which which has little to do with hospitals but a lot to do with other EU countries wanting to curb the UK’s flexible labour practices) is that each sector and each organisation should work out what works best. It is the unnecessary attempt by Brussels to usurp local private choice across the EU space which is annoying and probably damaging.

As to how other countries do all this, pass. Our problem is (I think) that precisely because the NHS is so vast (pros and cons of that) we need so to speak systemic solutions for everything, reducing options of local choice/flexibility.

Plus we Brits adhere slavishly to and enforce detailed EU norms once they enter the UK legal bloodstream, usually to a degree which amazes our EU partners. That really is the result of the way our political/bureaucratic culture (as genetically modifed by aggressive diversity/human rights and other legal requirements) operates in practice.

Oops. Being long-winded again.