One of the talking points in this year’s General Election were previously released figures which showed that death rates were higher in hospitals at the weekend than during the week. This difference could be explained by clinical factors. Hospital populations are smaller at the weekend, as routine and minor operations are not scheduled then and patients who came in on a planned basis earlier in the week are sent home. This means that very ill patients and patients admitted to A&E and pass away at the weekend represent a high percentage of the hospital population on Saturdays and Sundays than on other days.
Another thing which happens at weekends is that fewer NHS staff are at work. It is still the case that most of us expect to work Monday to Friday and to have the weekend off. There are some jobs which require weekend working, such as those in the care, retail and hospitality sectors – but these are still different from the norm, specifically requiring “weekend working” rather than treating all seven days of the week as the same.
At the General Election, David Cameron chose to attack the former without considering the latter. He promised a seven day a week NHS, so that you could get the same level of treatment any day. He was asked how the NHS would afford this – and he said that, obviously, extra money would have to be made available to fund extra doctors.
However, it’s not just extra doctors who would be needed. If appointments were scheduled across seven days a week, hospitals would need their whole workforce to be present seven days a week: consultants, doctors, anaesthetists, radiographers, nurses, domestics, receptionists, clerks, cooks, porters, managers, etc. Either current staff would have to increase their hours (unrealistic), or new staff would have to be recruited (unrealistic – not least because so many would have to be trained before they could take up work).
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Since the General Election, Health Secretary Jeremy Hunt has waded in, saying that hospital consultants have contracts which do not require them to work at the weekend, but they are going to have to work at the weekend to “save lives”. This totally misses the point. There is no proof that it is an absence of senior doctors which causes deaths at the weekend (as explained above). Therefore there is no guarantee that a presence of doctors will save lives at all. Hunt’s statement has met with derision from several health professionals, many tweeting pictures of themselves working long past their contracted hours are over.
Now the British Medical Association (BMA), the professional organisation for doctors in the UK, has also expressed concern and asked what is happening. They had helped organise a petition calling on Parliament to debate a possible vote of no confidence in the health secretary – but even this drew no clarification.
The BMA has pointed out that this is a legitimate matter of public concern. A recent survey of more than 2,000 people in England found that: •two thirds (68%) do not believe the NHS can currently afford to deliver seven-day services in hospitals; •almost nine in ten (87%) believe that doctors alone cannot deliver seven-day services and that a full range of support staff and other services must also be in place; •the vast majority (84%) say delivering seven-day services should not mean fewer services are available during the week.
Dr Mark Porter, BMA council chair, explained the BMA’s reasoning, sayinng: “Doctors care for their patients every day and understand their needs, and have been explicit in their support for more seven-day hospital services. We have repeatedly called on the government to outline how they will fund and staff them, and yet neither we nor the public are any closer to finding out the detail of the government’s plans.
“It is positive that the government, in their response to the public petition, have listened to the BMA and recognised that improving weekend care requires more than just ensuring greater consultant presence. Just adding a doctor to a ward will make no real difference if the support is not there. But recognising this is not enough, we need the detail.
“The government won’t even define what they mean by seven day services, despite confirming that such a definition does exist and that it would be in the public interest to say so. It is in everybody’s interests that the government is honest with the public and sets outs its plans.”
The position on seven day services is particularly serious as Monitor, the health service regulator in England, has been warning that NHS finances are in a critical condition here and suggested that no more staff should be taken on until budgets are more stable.
Dr Porter added, “Monitor’s warning of the huge financial challenge facing the NHS and their call for another recruitment freeze highlights once more the urgent need for answers. It is simply wrong to expect doctors, nurses and other NHS staff already delivering weekend care to deliver more without the extra resource urgently needed.”
For some two decades, successive governments have been looking for ways to get the public money spent on health services into the private sector. David Cameron has promised the impossible. We can only hope for a quick U-turn, of the kind that came from the Coalition when ministers accidentally promised the impossible. If not, goodness only knows what whacky formulae the Government will come up with. Either way, the NHS relies on the public who use it also to support it and defend it from misguided politicians.
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