A report released by the Healthcare Commission has raised serious concerns that children could be put at risk by inexperienced surgeons and a lack of basic child protection training in hospitals. Surgeons and anaesthetists in seven out of ten trusts reviewed by the Healthcare Commission do not have sufficient experience of treating children to maintain the proper level of skill, according to their findings. The concerns have emerged after the Royal College of Surgeons warned that waiting times for routine operations may soar as a result of European rulings on the number of hours junior doctors can work. The Working Time Directive will reduce the number of hours doctors can work from 52 hours a week to 48.

The Healthcare Commission report details failings in child protection training, pain management and life support two years after first bringing attention to the problems. Although there has been some improvement, many trusts are still failing to train staff to the correct level, with three out of ten trusts not meeting the basic minimum level of child protection training for key staff. Four out of ten trusts did not have the equivalent of one nurse per shift trained to assess and treat pain in children and three quarters of trusts did not meet guidelines in life support training. The Commission concluded that trusts need to address these concerns urgently to ensure that they are providing care that is both safe and effective.

The evidence presented by the Commission's report is concerning legal experts, who see a weakness in the NHS that could lead to more cases of medical negligence being brought by the parents and families of children who do not receive the correct health care. With staffing levels already at worryingly low levels, any reduction in the hours that doctors work could potentially put patients, both young and old, at risk.

One of the key elements in proving medical negligence is that the clinician must work to acceptable levels of competence that one would normally expect someone of similar experience and training to achieve. An area of concern amongst both the Healthcare Commission and legal experts is that some surgeons and anaesthetists are performing procedures on children without meeting the recommended levels of work to maintain their skills. This could leave them open to accusations of negligence if things go wrong.

Medical negligence claims are incredibly complex. There are time limits regarding the last date on which medical negligence claims can be started in a court of law and if the case has not been settled and damages paid by agreement prior to that time or proceedings have not been issued in the court then the opportunity to claim damages may have been lost.

However, for children the time limits are different, with the three year 'limit' not coming into force until the child's 18th birthday. The worry is that the change in doctors' hours could lead to more, protracted medical negligence cases being pursued, again complicated by the definition of 'levels of competence expected by someone with similar experience and training' becoming a very grey area.

Legal experts dealing in medical negligence claims are watching developments very closely, as well as liasing with medical experts to try to clarify the situation. But unless safety measures are put in place that will guarantee that doctors receive the same, high level of training and experience despite having to work reduced hours, the already complicated field of medical negligence could get much more difficult to untangle.