We have rationed OOH and Weekend care for years. Now the comeuppance…

There is nothing wrong with aspiring to a 24/7 service but the rhetoric that suggests consultants and GPs are at fault is nonsense. The problem is of short termism and undercapacity issues, and standards are falling so far and fast that many altruistic doctors and nurses, especially juniors don’t wish to practice in the UK Regional Health Service systems. It is wrong to print that the doctors union is “resistant” – they are just telling us the feasibility in the short term..(Seven-day NHS service plan must prioritise emergency care, BMA says Priority must be given to urgent and emergency care in plans to boost seven-day hospital services, doctors’ leaders have said. ) More analytical, and less emotional, is Sir Bruce Keogh and his contribution is below. The biggest NHS shake-up for 50 years.

Anecdotal evidence from Jon Ungoed-Thomas and Marie Woolf  in the Sunday Times 26th July 2015 is illustrative:

Ending weekend ‘ghost town’ care comes too late for Millie – After tragedies involving children, the NHS is working to introduce a seven-day service in hospitals despite resistance from the doctors’ union

HSJ: Keogh: New research confirms ‘weekend effect’ on mortality

Sir Bruce Keogh’s thoughts:

The transparent provision of data and information to the public is one of our strongest drivers for promoting quality in healthcare. But the use of data to promote quality also exposes some inconvenient truths. Weekend care is an example.

We have evidence that mortality rates for patients admitted to hospitals are higher at weekends; that those patients tend to be sicker; that our junior doctors and trainee specialists feel clinically exposed and unsupported at weekends because of the complexity and demands of modern medicine; and that hospital chief executives are worried about weekend clinical cover.

It also seems inefficient that in many hospitals at weekends expensive diagnostic machines, laboratory equipment and pathology and imaging facilities are under-used, operating theatres lie fallow and clinics remain empty. Yet access to specialist care is dogged by waiting lists, and GPs and patients must wait for diagnostic results.

It is clear the lack of continuity of many services over seven days undermines our ability to tackle the mortality issue, provide continuous support for people with chronic conditions, achieve our safety ambitions and, frankly, provide a modern patient-centred service.

These concerns have led to calls for different service models in hospitals at the weekend from Health Education England, the Academy of Medical Royal Colleges, the Royal College of Physicians, the Royal College of Surgeons and organisations representing NHS managers and patients, with the aim of not only improving outcomes but also enhancing the training of the next generation of NHS doctors.

We have an ethical obligation to address these issues; but we also have a duty of care to NHS staff to ensure they have a reasonable work/life balance.

Every weekend, many consultants are going in to see their patients in hospitals, but it is not universal, which means our weekend services are fuelled by professionalism and goodwill rather than good NHS design. This is not sustainable. We need to design and organise our NHS to make it easier for clinicians to provide the care their patients deserve. The will is there. This is confirmed by junior doctors who tell me there has been a notable increase in consultant-led care at weekends over the last couple of years. The NHS is moving in the right direction.

The problem of diluted services and poorer outcomes at the weekend is not unique to the NHS.

The issue is complex with no single causative factor or solution. To tackle the problem we have developed 10 clinical standards, based on evidence and consensus.They seek to improve the availability of diagnostic tests at weekends, the availability of senior doctors to interpret and act on those tests and the provision of support services to enable the right treatment in a timely fashion. So this is not just about doctors, it is about teams and facilities.

This is potentially the biggest change in NHS philosophy and design since the advent of district general hospitals over 50 years ago. Some of the ambition can be achieved by offering services in a more networked and collaborative fashion between historically competitive NHS organisations. Some changes will require significant investment. So to get going we propose to focus on those patients requiring urgent or emergency care.

We already have 22 trauma networks in England that ensure we have the flexibility to provide first-class care to people who have had a major accident, whatever time of day or night. This has resulted in a 50% increase in survival over the past three years. Now we have announced how we will build on these networks, starting in the northeast and in West Yorkshire, to extend provision of seven-day services to the full spectrum of urgent and emergency care needs.

Professor Sir Bruce Keogh is medical director of NHS England

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This entry was posted in A Personal View, Rationing, Stories in the Media on by .

About Roger Burns - retired GP

I am a retired GP and medical educator. I have supported patient participation throughout my career, and my practice, St Thomas; Surgery, has had a longstanding and active Patient Participation Group (PPG). I support the idea of Community Health Councils, although I feel they should be funded at arms length from government. I have taught GP trainees for 30 years, and been a Programme Director for GP training in Pembrokeshire 20 years. I served on the Pembrokeshire LHG and LHB for a total of 10 years. I completed an MBA in 1996, and I along with most others, never had an exit interview from any job in the NHS! I completed an MBA in 1996, and was a runner up for the Adam Smith prize for economy and efficiency in government in that year. This was owing to a suggestion (St Thomas' Mutual) that practices had incentives for saving by being allowed to buy rationed out services in the following year.

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