Posted on Feb 05, 2014 by Ruth Loftus
The evidence over many years is pretty conclusive - people fall ill or have accidents on almost a 24/7 schedule. The logical outcome of this would be that the hospitals that have to respond to these crises would also operate on the same basis. However, the fact is that in the United Kingdom, there has been a tendency for hospital services to be managed much more in a Monday through Friday basis with weekend cover by clinical and other staff at a much lighter (and often less experienced) level.
Actually, as anyone with even a passing awareness of human nature swiftly realises, the situation is made more serious because alcohol induced mishaps – and malevolence – are sadly much more common at weekends and late at night. So the need for specialist accident and emergency services occurs well outside the neat daily weekday framework.
There is also mounting evidence that people in hospital over the weekend are at risk of being exposed to poorer care which can be particularly grave for those undergoing surgery just before, or through the course of a weekend. Again the issue is one of the quality of care. Wards are more likely to be staffed by agency nurses, by junior doctors or locums, specialist technical support may not be available and consultants may not be present. All of which can lead to higher patient mortality or poorer recovery experience. In fact, mortality rates for similar conditions are 16% higher in respect of weekend as compared to midweek admissions.
Fortunately, as part of the ongoing shake up of hospital services that has followed the recent crisis of confidence in the National Health Service, there is now a new commitment to ensuring that hospital care, technical support and management in England will move swiftly to being provided at a consistent high level through the whole duration of a seven day week.
The medical director of the UK Health Service, Sir Bruce Keogh has said that the need for a change in approach and attitude was compelling on both clinical and ethical grounds and that the move to a this new approach would be completed within three years. The British Medical Association speaking for the medical profession have given its full support to the proposals – though there are suspicions that some senior consultants may still have to be won over to the new regime.
The contractual arrangements between the Health Service and hospitals will encompass the seven day week philosophy and will set down performance standards that are contractually binding. The new standards will include requirements such as:
A 14 hour maximum time band within which emergency admissions must have consultant input
All diagnostic tests, for example MRI, X-rays and ultrasound should be fully available on every day of the week
A twice daily consultant review of all patients in intensive care or other high dependency facilities
Multi-disciplinary teams such as expert nurses, physios and other support staff to be available over weekend
Other developments could include removal from consultants contracts of clauses which at present means that they cannot be compelled to work at weekends
However, these changes do have inevitable cost implications and predictions state that they could add some 1.5-2.0% to the running costs of a hospital. This all comes at a time when the health service is in the middle of a massive programme aimed at bringing costs down. Senior management is confident that savings to fund this expansion of the service can be found and it is clear that there will be a series of incentives and penalties to achieve this goal with failures to meet the new measures resulting in further reductions in budgets and other penalties such as the use of junior doctors.
The opposing Labour Party, whilst agreeing with the principle of seven day services, asked for more specific detail on how the funds to bring this care pattern might be released. They expressed concern to any suggestion that smaller and more local facilities might be axed to find the funds that would be required.
The health service employers have welcomed the approach as an example of the innovative style which hospitals will increasingly have to adopt if they are to meet the expectations of patients and their families.
Other parts of the United Kingdom (Wales, Scotland and Northern Ireland) which each control their own health service, are also understood to be considering moves to direct consultants oversight of care in a seven day week.
The National Health Service which has been hit in recent years by a loss of faith from the public and by a drop in morale among staff across all areas of activity, is facing necessary dramatic changes to recover its status. Therefore, a high quality service throughout the entire seven day week could be seen as an essential component in achieving this.