Weekend hospital care: 'Seven-day week' for senior doctors

 

Sir Bruce Keogh says seven-day healthcare is "absolutely compelling, both clinically and morally"

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Hospitals in England will have to ensure senior doctors and key diagnostic tests are available seven days a week under new plans.

The measures form part of a vision unveiled by NHS England to tackle higher death rates at weekends.

The changes, proposed by medical director Prof Sir Bruce Keogh, will be applied to urgent and emergency services over the next three years.

Sir Bruce said the case for change was clinically and morally "compelling".

The British Medical Association, which represents doctors, said the case for seven-day services had been made and the focus needed to shift to delivering it.

'Expect more'

Research suggests death rates are 16% higher for patients with emergency conditions admitted on Sundays compared with those admitted on Wednesdays.

Why do more patients die at weekends?

  • Variable staffing levels
  • Fewer decision-makers of consultant level and experience
  • Lack of support services, like diagnostics
  • Lack of community and primary care services to prevent unnecessary admissions and support discharge

Source: NHS England

Sir Bruce told BBC One's Andrew Marr show "society has moved on and people expect more and more from services at the weekend".

"It seems strange in many ways that we should start to wind down on a Friday afternoon and warm up on a Sunday... and [in the] meantime people are waiting for diagnosis and treatment," he said.

He said that, historically, the NHS had been good at providing a five-day-a-week service but medicine had advanced.

Sir Bruce said junior doctors felt particularly stressed at weekends because of the complexity of cases, and often felt "unsupported".

"We worry about that, not only because it may relate to the higher mortality rates, but also because it implies that we could be training the next generation of doctors better," he said.

The proposals, which will be discussed by the board of NHS England on Tuesday, set out 10 new clinical standards for hospitals.

These include:

  • All emergency admissions to be seen by a consultant within 14 hours
  • Seven-day access to diagnostic tests, such as X-rays, ultrasound, MRI scans and pathology
  • Patients in intensive care and other high dependency units to be reviewed by a consultant twice a day
  • Weekend access to multi-disciplinary teams, which include expert nurses, physios and other support staff

Sir Bruce said organisations would need to be "absolutely transparent" about whether they were meeting these standards.

He said the changes would be contractually binding. It is possible a clause in consultants' contracts stating organisations could not compel them to work at the weekend could be removed, he said.

Analysis

Anyone who has been in hospital will be aware of the change of pace the weekend brings.

Theatres lie empty, equipment is turned off and there are noticeably fewer staff around.

It is, therefore, no surprise that many believe a truly seven-day service is long overdue.

This review has provided a vision for what services could look like. But the big question now is how it can be implemented.

The NHS is in the middle of its biggest savings drive in history and there remains much work to be done to get hospital consultants fully signed up.

This promises to be just the start of a long process.

"These are pretty radical changes with some pretty hard levers behind them," he said.

He had earlier said a system of incentives, rewards and sanctions would be built into contracts by 2016-17 to encourage hospitals to follow the new standards.

Breaches could cost hospitals up to 2.5% of their annual income of up to £500m, and they could face losing their right to use junior doctors.

Sir Bruce told the Marr show the changes would cost about 1.5-2% of the annual running costs of the hospital and said he was confident about finding money from other parts of the NHS to pay for the plans.

More consultants working weekends would stop inappropriate admissions and diagnoses would be speeded up, in turn helping hospitals run more efficiently financially, he said.

"We believe the arguments for this are absolutely compelling both clinically and morally," he said.

'Calendar lottery'

Dean Royles, of NHS Employers, which represents hospitals, told BBC Breakfast the review "seals the deal" on the case for seven-day working.

Start Quote

Our lives and health are totally dependent upon this vital service”

End Quote Patients Association

Dr Mark Porter, chairman of the British Medical Association Council, backed the changes, saying "there should be no calendar lottery when it comes to patient care".

He said the BMA was in negotiations with NHS Employers and the government to find an "affordable, practical model for delivering this care" while safeguarding doctors' work-life balance.

But Prof Chris Ham, of health think tank the Kings Fund, said there were concerns over funding because many hospitals were already struggling and financial pressures would only grow.

The Patients Association said: "Our lives and health are totally dependent upon this vital service and we look forward to its implementation with the least possible delay."

Dean Royles, chief executive of NHS Employers: "The clinical case for change is now overwhelming"

Health Secretary Jeremy Hunt has commended the move, while shadow health secretary Andy Burnham said the government needed to clearly set out how it will be paid for.

The Welsh government has not ruled out seven-day working, while the Scottish administration has committed to having consultants in wards seven days a week.

A review in Northern Ireland earlier this year found disparities in out-of-hours hospital care, compared to weekdays, and said specialist consultant ward rounds and formal weekend handovers were needed.

 

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  • rate this
    +29

    Comment number 85.

    @75.AlanJ

    Imagine a hospital has 3 consultants per shift on weekdays currently. and they have 2 shifts. That means 6 consultants, they have to go to a 4 shift week as yours is. But the minimum safe amount is 3 per shift. No way that is workable, they'd have to hire more consultants. All well and good, but the NHS is being starved for money. This is the problem, NHS is asked to cut.

  • rate this
    -14

    Comment number 81.

    @67, when you see your vet at the weekend, how much does he/ she charge?
    If GPs were able to charge that kind of money per appointment, either to the NHS as a whole, or to the patient individually, there would be no problems with seeing a GP on the weekend.

    As it is there is an OOH GP service in your area, so you do have access to a GP at the weekend, just not every GP at every practice.

  • rate this
    +28

    Comment number 78.

    There is nothing to stop Consultants working shifts - many do already. But if you recognise the true actual time spent working weekends instead of the current underestimate then they will be unavailable for part of Monday - Friday. Without any manpower expansion all you do is spread what is there more thinly

  • rate this
    +10

    Comment number 76.

    Before such knee jerk reaction, one should have looked into how efficiently we are using the current 5 days a week NHS service. Elective list cancellation, patient not turning up for day case or outpatient appointment, theatres going jobless should have been tackled first by root.

  • rate this
    +45

    Comment number 58.

    As an Anaesthetist / Intensive Care doctor I already work up to 7 days per week. However my contract says covering emergencies instead of routine work is not equivalent in hours to normal Monday-Friday working. At the same time, there are fewer nurses, labs, paramedical and support staff at weekends - this would also need addressed

 

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