Jill Rubery makes a passionate case for retaining unsocial hours compensation for trainee doctors.

A recent BBC Newsnight item on the current contract dispute for trainee doctors began by asking why trainee doctors should be compensated for weekend working when Saturday was ‘just another working day’.

This immediately took me back to a research project of mine in the late 1990s into employment change in six large organisations in the North West. What struck me most forcibly at the time was the finding that management in all six organisations seemed determined to reduce or remove distinctions between standard and non-standard or unsocial working hours. The changes were rationalised in a range of ways but the underlying agenda was clear – to allow management to treat every hour in the week as the same in order to increase their control and reduce costs.

The Newsnight question is perhaps an example of a common phenomenon in management speak. Namely, that if a notion is repeated often enough it may eventually become the accepted norm but that does not make it right either for the employees or for our society’s health.

We now have Jeremy Hunt, the Secretary of State for health, calling for UK workers to work as hard as the Chinese or the Americans. Does this signal the beginning of an attempt to normalise long hours working for all? Perhaps there will also be a campaign for us to be content with the miserly eight days average vacation enjoyed by American employees that a UK outside the EU – and free of even the weak constraints of the EU working time directive – would be able to impose on its workforce?

This is the background against which we should assess the constant chatter about work-life balance policies. As Professor Steve Fleetwood has perceptively argued, these measures are little more than a smokescreen for the relentless pressure towards more variable, extended and employer-driven working schedules that characterise employment relations in much of the UK labour market today.

Now it is the turn of trainee doctors’ working hours to be subjected to this treatment. Instead of 60 hours of the week designated as standard hours (7am to 7pm Monday to Friday) with hours outside this band accruing various premiums, the current proposal for the new contract is to extend the envelope of standard hours from 60 to 90, from 7am to 10pm six days of the week.
The comments by Hunt at least make clear what this new contract is all about: it is about reducing costs and expecting people to work more for less. This was also the case in the late 1990s.

Whatever the reason given for extending standard working hours into the unsocial hours bands – whether it be meeting changing consumer demands, diversifying the business, extending operating hours of equipment or premises, unblocking hospital beds or simplifying payroll transaction costs – the motivation was to reduce costs.

Each of the stated objectives, except simplifying accounting, could have been achieved with the retention of unsocial hours premiums. Rather lame reasons are often proffered for these trends, namely that it suits some to work these unsocial hours. No premium is therefore said to be needed to recruit these staff and, by implication, no extra payment is deserved. This is the argument behind the Newsnight question – the new norm is that every working hour is now the same and this greater flexibility in working arrangements matches the varied and changing lifestyle choices of the new generations.

To be clear, for trainee doctors working unsocial hours is not a lifestyle choice, it is an obligation. There are some variations by speciality, but among hospital-based trainees those not regularly working unsocial hours are the exception. As not only an employment researcher but also the mother of a paediatric registrar the issue for me is not just the unsocial hours but their combination with long hours and high stress work. Evening work comes on top of – not instead of – five day working. At weekends doctors often work from 8am to 10pm, taking travel times and handovers into account. It takes over the whole weekend and, for those with children, offers no chance of seeing them either in the morning or at night. British managers have decided that it is normal to work weekends and late into the evening, but they haven’t yet told the schools, the childcare providers or indeed the children.

The motivation is clearly to cut NHS costs. The government asserts that the plan is cost-neutral as cuts in premiums will be balanced by rises in basic pay. However, no detailed comparisons have yet been made available to check the figures. Given the scale of cuts proposed, including scrapping GP trainees’ supplements and cuts to progression for part-time staff and those undertaking academic training, the estimates that this amounts to a huge pay cut for many trainees – of the order of 15 to 30% – look much more plausible.

Even if the package were overall cost-neutral, many trainees would still face very sizeable cuts. And is it just a coincidence that proposed major cuts are being made just as the majority of new doctors are women, or is the NHS following the common pattern where once an occupation becomes associated with women’s employment it is suddenly no longer worth so much?

To be clear, the cuts in pay are supposed to enable managers to schedule doctors to work even more weekend shifts without additional compensation. And hospital trusts are to be freed from financial penalties if they fail to provide safe working time schedules for staff and patients. So pay goes down and unsocial hours are expected to rise. Doctors are an exemplar of a group whom, to use a human resource management cliché, we all trust to ‘go the extra mile’. One has to wonder if major pay cuts, more weekend working, and the removal of working time safeguards, is the right way to secure goodwill for the future.