How feasible is a 7 day NHS?

So, Jeremy Hunt, the Health Secretary for England and Wales, wants consultants to work a 7-day week, and is prepared to impose this. Simon Hamilton, the local Health Minister, agrees. This demand is based on there being 6,000 extra and unnecessary deaths (in England and Wales) when patients are admitted at the weekends. This assertion is questionable.
Elective patients are admitted during the week, and not so much at weekends.  Ancillary services in the community may be reduced at weekends; A&E departments traditionally are very busy on Friday and Saturday nights. Accordingly the ‘mix’ of patients admitted at weekends may differ from those admitted during the week.
What does this 7-day working mean beyond what already happens?
For example, some hospitals have a ‘surgeon of the week’ responsible for the daytime care of all emergency patients, so this surgeon will be in hospital at the weekends, often for much of the day. (During their week-shift, such surgeons don’t do any elective work.) And outside normal working hours, there is a shared on-call rota.
Will other surgeons be expected to do elective operations or out-patient work during the weekend?
Most ‘medical’ admissions are emergencies, but not all physicians can do all procedures. A patient admitted at a weekend might need, say, a cardiac angiogram, yet only some of the physicians can do this. What happens to such patients admitted at the weekends?
And consultants don’t work in isolation; teamwork needs nurses in theatres, in out-patients and in the wards; other consultants in pathology and intensive care, support staff such as secretaries, cleaners, porters etc. Under this base proposal they will all need to be there.
Some specialities don’t do much emergency work; but a patient might present with a strange rash, needing the expertise of a dermatologist.
Are these patients to wait until the next working day?
If there are, say, seven consultants in a speciality, then 7-day working must be spread amongst them, one fewer during parts of the working week.
 So if there is to be less work done during the week—will this be followed by complaints about facilities not being fully utilised? Is this another opportunity to present the case for further cuts?
What all this 7-day working disguises is the current lack of staff and facilities in the NHS compared to other westernised systems; it’s no surprise to me that so many medics are voting with their feet these days.

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  • eireanne

    was not sure whether the 24/7 medical service referred to GPs being available non-stop rather than to hospital services. I thought lack of/poor GP care at nights and weekends meant that patients GPs could treat ended up in hospital .

    In any case whether referring to hospital or GP services – 24/7 availability is perfectly feasible as long as extra medical, nursing, technical etc staff are employed.

    Unless they are the whole story is rubbish – the NHS can hardly cope with current staffing – everyone employed there from consultants to ward auxiliaries is doing a heroic job in today’s circumstances and deserves our full suport

  • Zeno

    “Some specialities don’t do much emergency work; but a patient might present with a strange rash,”

    I don’t think a rash is anything to be concerned about. Rub some ointment on it. The problem is not people turning up with a rash expecting to see a Consultant Dermatologist at 1am. I think we both know that.

  • chrisjones2

    Surely its not just about emergency treatment?

    We pay vast costs for buildings and equipment that are often used just 5 days a week. Why not make it 7 days – less maintenance downtime?

    Why should I wait say 2 weeks for an xray when it can be done in the evening or at a weekend? Why do basic lab tests (that physically don’t need 7 days) take 7 days?

  • Korhomme

    The dermatology example is an extreme one; I understand that there is only one, rare, true life-threatening dermatological emergency. I’ve never seen it, and wouldn’t know how to recognise it or how to treat it.

  • Korhomme

    There are arguments in favour of ‘resting’ operating theatres and other clinical areas.

    Court buildings (and Stormont) aren’t used at weekends.

    Lab tests are done quickly; getting the results to GPs is slow—I understand that systems aren’t fully computerised and results aren’t sent by internet.

  • Korhomme

    some further information:

    https://fullfact.org/live/2015/jul/7_day_nhs_6000_deaths-46562

    Quite why more patients who are admitted at weekends die remains unclear. It may not be related to 7-day consultant working.

  • Zig70

    Chris is right. Few private business with the asset costs of the NHS and productivity levels would operate anything other than 24/7. It makes practical and economic sense. The issues of maintenance are well practiced in industry. Also, Doctors have milked it to the level were public support is not what it was. They’ll get the same sympathy lawyers got over legal aid.

    I think I’m right in saying Gerry Robinson advocated 24hr theatres
    http://www.telegraph.co.uk/news/health/news/9876178/Yes-we-can-fix-the-NHS-says-Gerry-Robinson.html

  • Korhomme

    The economics of the NHS are very difficult; plenty of costs, but how are the returns measured? Certainly, a car factory or a chicken factory is most economical when working 24/7; but does this apply to the NHS?

    ‘Resting’ of operating theatres is an infection control measure; just how long facilities must be rested is debatable.

    To run a 24/7 service, you are talking of shift working. I worked shifts many years ago; 07.00 to 16.00, 16.00 to midnight and midnight to 10.00, a week at a time and then a week off. I found it very difficult even then.

    Shift working, particularly night time shift working isn’t without problems of concentration etc. And families? Besides, professional development is a daytime activity; after a night working, how many can do this? Or just attending a managerial meeting; I’ve never seen a high-up manager in at night.

    As for management and professionals; these two groups have a mutual hate and distrust of each other. The docs say the management doesn’t understand their work (and are jealous of their abilities); management says that the docs should do as they are told. Docs who go into management aren’t trusted by other docs, because they’ve ‘sold out’; they aren’t trusted by management because they are subversive doctor supporters. (It’s not just docs; all professionals have similar problems with management.)

  • Dan

    Sure, didn’t we have the whole range of politicians lining up in north Belfast before the election promising that the A&E at the Mater would remain…no matter what cost.
    Didn’t matter about best use of resources or staff in the trust or anything like that, just that they could keep ‘their’ A&E.

  • Turgon

    Another issue which may be relevant is that if one wants a 7 day a week NHS then in the hospital sector one realistically needs fewer larger hospitals.

    If one is to have 7 day a week accessibility to certain operations, procedures etc. one needs enough staff to run that 7 days a week service. That, in turn, means more staff in each hospital and in order for each of those staff to do enough operations to remain competent that means they need a larger population from which their patients will come. Hence, a smaller number of larger hospitals serving larger populations.

    That of course brings us back to the Donaldson report which has thus far been largely ignored.

  • gsblue

    I think Hunt’s statement during the week was a pre-emotive strike. His assertions of 6000 deaths don’t have a basis in evidence, but make easy headlines for papers. The situation is much more complicated.

    Looking at it cynically, and really I do think that the government line on this is pretty cynical, this is another attempt to demoralise NHS staff and decrease costs to help with the long to medium term aims of privatisation.

  • chrisjones2

    I agree ….but why aren’t they when there are huge backlogs in the courts?

  • Korhomme

    Positional power, self-interest. Go along to the High Court on a week day; litigants and witnesses are all expected at 10.30, yet when their case will be heard—if at all—is very much a lottery.

    And the legal process grinds very slowly, as they say; there are so many hairs to be split it’s unsurprising that it can take years for litigation to proceed. And it’s based on a fee for time system, rather than a lump sum. (Yeah, call me cynical.)

  • murdockp

    My personal view is this is more to do with medicine being a closed profession than anything else. Doctors want big salaries, consultants more so. That seven series BMW and a golf pad in the Algarve doesn’t pay for itself. So the last think the medical profession needs is system that trains doctors in large numbers. They have made sure that the machine only drip feeds the doctors that are required to keep earnings high. This is evidenced by Cuba who train a far higher number of doctors per capita than the UK & Ireland.
    If the government wants to solve this problem it needs to train double the amount of doctors and ensure that in the training contract there is a clause that says you leave the NHS any time within the first ten years of your career, you may back the £250k training fees your training would have cost.
    This is a fair way of dealing with the problem with the BMA does not want to see any increase in numbers that will affect the earnings of its members.

  • kalista63

    A great response by NHS workers https://twitter.com/search?q=%23ImInWorkJeremy&src=tyah&vertical=default&f=tweets

    For a politician to come off with this is a right brass neck given they have holidays most of us would die for. But we’re in our constituencies working, they say. Odd that, given the trvel claims that were put in when Parliament was recalled vote the Syria vote.

    Gideon and Dave berate us for banker bashing in case we send them abroad (aye, right) but guess what guys, our doctors could also sod off, go to Amerca and make much more money than they do here and also have a higher social status.

  • kalista63

    BTW, most medical admissions are not emergencies. Imagine walking through the RVH and past the specialist wards and departments. Most are elective or mixed.

  • Zig70

    I’ve always subscribed to the practice that management of experts doesn’t require managers at the same or higher level but managers as enablers. Have to say it hasn’t been easy to implement due to either defensive poor management, HR that don’t buy into/understand the concept or experts that feel the need to be managed by betters. Not easy.

  • 23×7

    I agree we need to train more doctors and consultants but do you have any evidence that the BMA doesn’t want this or is it really down to university and NHS funding?

  • 23×7

    I’m no Tory supporter but there is clear evidence of increased mortality at the weekends that must be addressed. This could be due to a variety of reasons including the availability of experienced staff.

  • 23×7

    Or shorter waiting lists.

  • hugh mccloy

    Clear evidence has been presented in deaths due to A&E closures, maternity closures, ambulance response times, capacity … what changed post those revelations ?

  • hugh mccloy

    Donaldson has not been ignored, it was out to consultation and post consultation papers have not been produced by DHSSPS.

  • hugh mccloy

    check out family courts and see the back logs

  • gsblue

    Even for some types of relative emergencies, there can’t be 24 operating as it has been shown that those taken to theatre overnight for surgery do less well – this applies for even relatively simple procedures such as appendicectomy for acute appendicitis.

    Complex procedures are even more difficult and overnight is often not the time to have staff on top form to do the best for patients. Same would go for doing extra much less urgent work at the weekends – if the exact same support team isn’t there as during the week, patient care could suffer. Doing routine procedures overnight would obviously be ridiculous for safety reasons.

    The issue is much more complex than Mr Hunt makes out, and I have no doubt he and his advisers know this. His primary concern isn’t patient care.

    It’s interesting when you look at consultant salaries in Ireland – they’re significantly higher than in the UK but were reduced a few years ago (still above UK levels), but were increased again when there was a loss of staff to elsewhere (particularly the states).

  • hugh mccloy

    This is more of a move to force GP’s and other areas to go private, just like dentistry.

  • gsblue

    The evidence is entirely unclear as to what the cause is.

  • hugh mccloy

    You should bring the likes of Dr Jarman into this, many factors in hospital deaths

  • hugh mccloy

    The more smaller hospitals the gov close the less training spaces there are, most of the issues we see today have been created since 2005 by gov planning based on £ not medical panning based on otucomes

  • Sergiogiorgio

    I disagree with your last sentence Eireanne. I’ve seen some truly awful consultants, doctors, nurses and auxiliaries within various NHS hospitals over the years. I’ve also seen some excellent staff as well but these seem to be declining. Until we can accept that the NHS is no longer fit for purpose and can no longer be adequately funded in its current state, the situation will continue to deteriorate. This “sainted” NHS narrative is a socialist fairy story and stops us facing the reality that the NHS needs to change. Throwing money at it just doesn’t work, the last Labour government showed that. Stafford?

  • Korhomme

    Communication and understanding; easy to say, so hard to put into practice.

  • Korhomme

    It’s a complex problem, not made easier by politicos spouting off about things they really don’t understand. Sorry, I don’t know who Dr Jarman is.

  • Korhomme

    Perhaps because the courts aren’t seen in the same way that the NHS is. Clients and litigants benefit from faster court access; lawyers might not. Vested interests?

  • 23×7

    rubbish. The last labour government slashed waiting lists and basically saved the nhs, as they always have to do. Labour Failure to properly defend their record on the NHS at the last election was a joke. The rest of your post is just nonsense.

    http://www.theguardian.com/society/2014/jun/17/nhs-health

  • chrisjones2

    ie the Catholic A&E at the Mater?

  • chrisjones2

    Which shows an NHS riven by petty rivalries and competition for money and jobs / promotion , unfocused on patient care

  • Korhomme

    That’s a bit unfair, I think. Any organisation has problems, often the petty rivalries and jealousies you speak of. The NHS is no different; both ‘sides’ will always claim to be working for their ‘customers’ or ‘clients’—those people that in the good old days were called ‘patients’. I don’t really think that people are unfocussed on patient care, rather that professionals and managers see things differently and have different priorities.

  • Korhomme

    Would you accept that all law graduates should work for 10 years for the government? Or those with an accountancy degree? And so on. Why should medics be a special case?

    While being trained, after graduation, medics are also working. It may be a (notional) cost to train them, but they give back in hours what this training costs.

  • Korhomme

    A problem with ever larger hospitals is that N Ireland is much closer to the Highlands and Islands of Scotland in terms of demographics that it is to England and Wales—from where most of the ideas seem to come from.

    I don’t know if the number have changed since my day, but as an example; for 24/7/365 nursing in an ICU on a one-to-one basis, then five WTEs had to be employed.

  • Korhomme

    Appendicitis is a good example. Most patients do not need a middle of the night operation, they will come to no harm if, rather than 3AM their operation is performed later at, say, 10AM.

    Further, gallstones are s significant cause of illness here, more so it seems than on the mainland. The best way, in terms of patient satisfaction, cost etc, is for patients with a suspected attack to have an early scan to confirm the diagnosis, followed by an early operation in the same hospital episode. Delays in the systems can make this ideal very difficult to achieve.

  • Korhomme

    If you are on Twitter, you probably have seen #IminworkJeremy. Here, the author of this hashtag explains:

    http://www.theguardian.com/commentisfree/2015/jul/20/jeremy-hunt-hospital-doctors-iminworkjeremy-consultants-weekend#comment-56069515

  • Ciaran Wasson

    A private business operating 24hrs does so to increase profits as each transaction increases income; OTOH in the NHS each transaction increases costs and brings no new income at all