Lack of weekend NHS consultants risking patients’ lives

Seriously ill patients are being put at risk on NHS wards because not enough consultant doctors are working at nights or weekends.Lack of weekend NHS consultants risking patients' livesConsultants are sometimes “reluctant” to work weekends, say the authors of the report published today by the Royal College of Physicians (RCP) in New toolkit to deliver increased consultant care to acutely ill medical patients with the help of the Society for Acute Medicine.

Hospitals will need to switch more consultants from weekday to weekend rotas, say the organisations and where that is not enough they will have to employ more of the senior doctors.

Studies show the chance of dying in hospital is between 10 and 14 per cent higher if admitted as an emergency at the weekend than during the week.

The two organisations are consequently calling on hospitals nationwide to ensure that a consultant is present on every acute ward for at least 12 hours a day, seven days a week.

At most only four in 10 hospitals currently meet this “gold standard”. Frequently smaller district general hospitals which have problems filling weekend rotas, fail to do so.

Dr Chris Roseveare, president of the Society for Acute Medicine, said: “Clearly, when you go to hospital as an emergency you are vulnerable.  You need to be cared for by someone with the skills to deal with the acute problem. Consultants have those skills.  Going into a hospital where there isn’t a consultant available is something we want to avoid.”

But he said: “There’s a culture in which consultants are traditionally reluctant to provide weekend working.”

He explained: “Traditionally the consultant’s job plan has been geared around providing a weekday service, plus a weekend service shared with colleagues.”

What the Society and the RCP wanted to do was create weekend emergency care which mirrored that provided in the week, as closely as possible without damaging the weekday service.

Dr Mark Temple, an acute care fellow at the RCP, said consultant-led care was “key” to delivering the highest quality care.

Even when consultants were at hand, he said, they were often torn between their acute medical unit (AMU) duties and responsibilities elsewhere.

“They are pulled in two directions,” he said. The organisations want this “doubling up” to stop.

Consultants should also start by 8am so they can do their ward rounds and give patients admitted overnight a full and prompt assessment, the report recommends.

Last week the RCP warned that the “erosion” of the ward round meant that some doctors were not giving patients the time by the bedside they needed to properly gauge their needs, recognise them as people rather than ‘conditions’, and share vital information with nurses.

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