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A seven-day NHS could threaten patient safety, warn doctors
2 January 2015
Doctors from the British Medical Association (BMA) have warned that making the NHS offer seven-day services could threaten the safety of patients due to the over ambitious nature of the plans, which could lead to drastic underfunding and unrealistic handling of demand, leading to routine operations being cancelled on weekdays because of the pressure.
In a worded statement the doctors warn that current resources would be severely compromised, leading to poorer case during the week and directly placing patients at risk. They have said that the plan to push ahead with the seven-day plan is dangerous because of am “unfunded, undefined” strategy that is “wholly unrealistic” because of continual staffing and financial problems within the NHS.
The BMA feels the seven-day NHS is “neither desirable nor feasible” and is unlikely to attract enough patients to justify such a change. They contend that putting on outpatient clinics and performing routine operations on Saturdays and Sundays will increase the risk of such services being cancelled during the week.
“There is a real risk that patient safety could be compromised”
The BMA submission was made to the Doctors and Dentists Review Body (DDRB), which advises ministers on doctors’ salaries, for its inquiry into what medics should be paid in a seven-day NHS.
“Ill thought through implementation could threaten both the standard of service patients receive and the viability of the service … We believe that pursuing an ill-informed seven-day service model would be at best wasteful for the NHS and at worst threaten patient safety,” the BMA says in the executive summary of its evidence, which it published on Friday .
NHS England wants to start offering a wider range of services seven days of the week. Its reasons range from letting the NHS fit better around the working lives of patients, improve patient care over the weekends and battle the high mortality rates that occur on Saturdays and Sundays.
Prof Sir Bruce Keogh, NHS England’s national medical director, made the public announcement about the ambitious plan in October 2013. He said the plans would involve more than just an improvement to just emergency care – A&E care and urgent surgery – which is already close to a 24/7 service in many places.
“It is also about access to doctors, diagnostics and elective operations so that people do not have to miss work to get healthcare. If someone needs a day-case operation, why can’t they have that on Saturday, recover on Sunday and be back to work on Monday?” he said at the time.
Keogh wants hospitals to have access to x-rays, ultrasound scans and emergency general surgeries at weekends and believes that mental health and community care services should be available 24/7 if a seven-day NHS is to work at its best.
Patients were 16% more likely to die if they were admitted to hospital on a Sunday
One of the most pressing reasons NHS England decided to amplify their collective demand for a seven-day NHS was after research showed that patients were 16% more likely to die if they were admitted to hospital on a Sunday and 11% more likely to die if they were admitted on a Saturday. The fact diagnostic and treatment services at weekends were lacking was also another concern.
The key to the plan is funding and the BMA questions whether there is enough available saying: “The BMA believes that without significant resource investment, a seven-day service will not be possible without compromising and/or re-evaluating existing service provision in the NHS. There is a real risk that patient safety could be compromised in the week if the government attempts to implement seven-day services without additional resource investment.”
The BMA fully accepts that what day a patient is admitted in hospital should not be related to when they actually start their treatment. Their criticism is due to the fact that NHS England will not specify which services will be provided at weekends, how much this will cost and how they hope to staff it.
“The BMA believes a properly costed model for seven-day services is a prerequisite for implementation, otherwise the model risks being unsustainable for the NHS”, it says.
Dr Mark Porter, the BMA’s leader, spoke to The Guardian newspaper and warned that even if NHS England offered certain services at the weekends, patients would then be at risk of not being able to access those same services on weekdays as a result of inability in managing resources.
“If we’re going to transfer resources to the weekend, we should know what services we are stopping doing during the week in order to do that. If the decision is taken [by a hospital] to put half a dozen outpatient clinics on a Sunday afternoon then they have to be taken from somewhere else – that is, they won’t be on on a particular day during the week. That’s the inescapable reality of doing this within existing resources, but politicians’ vision doesn’t go into that sort of detail,” Porter said. Fundamentally then, Porter argued, services would not be extended but instead diverted.
Ministers believe a 7-day NHS does not necessarily need extra money
Even though the 1.3 m-strong workforce of the NHS is currently bursting at the seams under patient demand, Porter contends that Ministers firmly believe that no extra money is required for the 7-day NHS plan.
“It’s not realistic to carry on doing what we are doing at the moment and then add a new service on top of it within existing resources. More money is vital.”
He also said that no evidence has been supplied by the NHS that large numbers of patients want to come into hospital at the weekend for a diagnostic test or planned operation. One moot point that the BMA may side with is that many consultants already work at antisocial times, with some – such as those in emergency departments – doing so regularly.
NHS England maintain 2015 would see “significant progress” towards the goal of a seven-day service. “NHS England is the only healthcare system in the world that is trying to sort out the issue of seven-day-a-week services. Individual hospitals internationally have done some work on it, but never a national health service.
“Over the last year, local NHS trusts have been making good progress in developing their understanding as to how the service will work at a local level. During 2015, we expect to see significant progress towards making seven-day-a-week services a reality as we owe it to our patients to ensure it happens.”
The Department of Health said: “Patients expect to receive the same standard of care regardless of the day of the week. A seven-day NHS service will speed up diagnosis and discharge times as well as reducing the amount of time patients need to spend in hospitals at weekends . This is why we’ve asked independent pay experts [the DDRB] to advise on how employment contracts could be changed to make seven day services a reality.”
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