Hospitals should operate seven days a week
The most senior doctor in the NHS is demanding that hospitals have a full complement of doctors at weekends to make the health service more convenient to access as “people get sick seven days a week”.Sir Bruce Keogh, Medical Director of the NHS, criticised the culture in hospitals of only treating emergency cases at the weekend with little or no routine surgery or diagnostic testing done outside normal office hours.
He said the current system ‘lacks compassion’ because patients are forced to wait for investigations or take time off work or arrange childcare in order to be seen.
Studies have shown that patients are around 16 per cent per cent more likely to die if they are admitted to hospital at the weekend due to a lack of senior staff.
His comments come as a survey revealed that four in ten doctors are opposed to hospitals operating a seven-day service saying they would need extra pay to work unsocial hours.
Sir Bruce is attempting to reform NHS hospital working hours by talking to hospital chief executives around the country to identify which services can be opened at the weekend first.
He said: “What other industry shuts down for two and half days a week? People get sick seven days a week, they need help seven days a week.
“I want to get to a position where the NHS is indistinguishable on a Saturday from a Wednesday but we won’t get there overnight.
“Twenty years ago there was a debate about Sunday trading and the situation has changed quite substantially. Now in a secular world, the prime occupation on a Sunday is shopping.
“There is a really powerful moral and professional argument for seven day routine services. It would contribute to people’s lives, to the economy and bring a bit of convenience into healthcare.”
In London alone it is estimated that 500 lives a year could be saved if mortality rates at the weekend matched those in the week.
A poll conducted by the website, Doctors.net, has found that four in ten doctors are opposed to such a move.
A seven day working week would mean senior doctors would have to be paid more for working at the weekend and that services would be reduced in the week when staff needed days off in lieu, they said.
Some claimed the NHS is unable to afford proper staffing for a five-day working week, let alone seven days. Childcare issues were also raised as a major stumbling block to doctors working all week.
Currently hospital wards are staffed mostly by nurses and junior doctors often covering hundreds of patients each with consultants and other senior staff on call from home.
Research commissioned by Sir Bruce found that NHS patients were ten per cent more likely to die if they were admitted on a Saturday compared with a Wednesday and 16 per cent more likely to die if they were admitted on a Sunday.
Not all of the deaths were emergency cases, showing that patients seen routinely were at greater risk too.
Chairman of the British Medical Association’s Consultants Committee, Dr Mark Porter, said: “This snapshot poll reflects consultants’ abiding concern for the quality of patient care. Some patients clearly need acute specialist care on a 24/7 basis with appropriate diagnostic and support teams.
“It may be appropriate for other departments to have an on-call consultant available out-of-hours, rather than having a senior doctor present at all times. Hospitals have to be flexible to patients’ needs.
“This is a complex issue and we need to look at the evidence and determine what works best for different areas of medicine.
“The ongoing cuts in NHS resources at present make a consultant-based service more difficult as the NHS is often at full tilt just covering emergencies at weekends.”
Sir Richard Thompson, president of the Royal College of Physicians, which has called for weekend working said: “It is good news that doctors are recognising and supporting the need for seven-day working.
“In December 2010, the Royal College of Physicians called for consultant physicians to be available to care for very sick patients at least 12 hours a day, seven days a week.
“I am worried that patients are still not getting the best care that they deserve at night and at weekends. Too many junior doctors are covering too many very ill patients, and this has to change.
“To support this change, consultants will need diagnostic and other support services, such as radiography and support from junior doctors. We will also need changes to workforce planning and working patterns.
President of the Royal College of Surgeons, Norman Williams, said: “The evidence continues to mount that we need to rethink how surgical care is delivered for patients’ seven-days-a-week. In particular, mortality and complication rates vary widely for patients admitted as emergencies at the weekend.
“In order to address this, clinicians and managers must work together to reconfigure hospital services in a way that strengthens the quality of care given to patients regardless of when they are admitted.”
Tags: BMA, Doctors, Health Professionals, National Health Service, NHS, NHS Deaths, preventable crisis, RCP, RCS