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| Weekend hospital care: 'Seven-day week' for senior doctors | Weekend hospital care: 'Seven-day week' for senior doctors |
| (35 minutes later) | |
| Hospitals in England will have to ensure senior doctors and key diagnostic tests are available seven days a week under new plans. | Hospitals in England will have to ensure senior doctors and key diagnostic tests are available seven days a week under new plans. |
| The measures form part of a vision unveiled by NHS England to tackle the higher death rates at weekends. | The measures form part of a vision unveiled by NHS England to tackle the higher death rates at weekends. |
| The changes, proposed by medical director Prof Sir Bruce Keogh, will be applied to urgent and emergency services over the next three years. | The changes, proposed by medical director Prof Sir Bruce Keogh, will be applied to urgent and emergency services over the next three years. |
| But the cost and staffing implications have yet to be finalised. | But the cost and staffing implications have yet to be finalised. |
| 'Five-day model' | 'Five-day model' |
| Research suggests death rates are 16% higher for patients admitted on Sundays compared with those for patients admitted on Wednesdays. | Research suggests death rates are 16% higher for patients admitted on Sundays compared with those for patients admitted on Wednesdays. |
| Sir Bruce said it was time to "undo more than 50 years of custom and practice that have failed to put the interests of patients first". | Sir Bruce said it was time to "undo more than 50 years of custom and practice that have failed to put the interests of patients first". |
| His review said that, while some hospitals had started improving care at weekends, most still operated on a "five-day model", staffed largely by junior doctors and with little access to specialist equipment and tests on the weekend. | His review said that, while some hospitals had started improving care at weekends, most still operated on a "five-day model", staffed largely by junior doctors and with little access to specialist equipment and tests on the weekend. |
| "Two things are key to this. One is the availability of diagnostic tests at the weekend...Then you need someone experienced to interpret those tests and to institute the right treatment," he told the Sunday Times. | "Two things are key to this. One is the availability of diagnostic tests at the weekend...Then you need someone experienced to interpret those tests and to institute the right treatment," he told the Sunday Times. |
| "We have a system that is not built around the convenience of patients and is not compassionate to patients for part of the week." | "We have a system that is not built around the convenience of patients and is not compassionate to patients for part of the week." |
| The proposals, which will be discussed by the board of NHS England this week, set out a series of new standards for hospitals. | The proposals, which will be discussed by the board of NHS England this week, set out a series of new standards for hospitals. |
| These include: | These include: |
| To encourage hospitals to follow the new standards a system of incentives, rewards and sanctions will be built into contracts by 2016-17. | To encourage hospitals to follow the new standards a system of incentives, rewards and sanctions will be built into contracts by 2016-17. |
| Sir Bruce warned hospitals could face multimillion-pound penalties if they failed to keep up their standards at weekends. | Sir Bruce warned hospitals could face multimillion-pound penalties if they failed to keep up their standards at weekends. |
| He told the Sunday Times hospital trusts would be contractually-bound to run a full service seven days a week - with breaches costing them up to 2.5% of their annual income of up to £500m. | He told the Sunday Times hospital trusts would be contractually-bound to run a full service seven days a week - with breaches costing them up to 2.5% of their annual income of up to £500m. |
| Hospitals that refuse or fail to provide safe weekend care could also face losing their right to use junior doctors, he said. | Hospitals that refuse or fail to provide safe weekend care could also face losing their right to use junior doctors, he said. |
| Sir Bruce said the changes would cost about 2% of the NHS's operating budget of £97bn. | Sir Bruce said the changes would cost about 2% of the NHS's operating budget of £97bn. |
| More efficient | More efficient |
| The review also acknowledged that hospitals would need better support from community services, such as social care, if the seven-day ambition was to be achieved - so patients could safely be discharged when ready. | The review also acknowledged that hospitals would need better support from community services, such as social care, if the seven-day ambition was to be achieved - so patients could safely be discharged when ready. |
| A report on how care outside hospital needs to change will be produced in autumn 2014. | A report on how care outside hospital needs to change will be produced in autumn 2014. |
| That report may also include details of how the non-emergency work which hospitals do, such as hip and knee replacements, could be provided on a seven-day basis. | That report may also include details of how the non-emergency work which hospitals do, such as hip and knee replacements, could be provided on a seven-day basis. |
| In the meantime, the review team will concentrate on the cost and workforce implications. | In the meantime, the review team will concentrate on the cost and workforce implications. |
| This is to be twinned with the work of the urgent and emergency care review, which last month recommended the creation of a two-tier A&E system. | This is to be twinned with the work of the urgent and emergency care review, which last month recommended the creation of a two-tier A&E system. |
| The review team believes those changes would help the NHS become more efficient, freeing up money to pay for these changes. | The review team believes those changes would help the NHS become more efficient, freeing up money to pay for these changes. |
| 'Whole NHS system' | 'Whole NHS system' |
| Sir Bruce said it was clear that patients "want us to act now to make seven-day services a reality in all parts of the NHS". | Sir Bruce said it was clear that patients "want us to act now to make seven-day services a reality in all parts of the NHS". |
| He added: "This is not just about hospitals but the whole NHS system. One part cannot function efficiently at the weekend if other parts don't." | He added: "This is not just about hospitals but the whole NHS system. One part cannot function efficiently at the weekend if other parts don't." |
| Ahead of the publication of the review, Health Secretary Jeremy Hunt said: "Patients should be able to depend on the NHS every day - not just Monday to Friday." | Ahead of the publication of the review, Health Secretary Jeremy Hunt said: "Patients should be able to depend on the NHS every day - not just Monday to Friday." |
| Dean Royles, of NHS Employers, which represents hospitals, said: "Seven-day working is probably the most important issue facing the NHS at the current time. | Dean Royles, of NHS Employers, which represents hospitals, said: "Seven-day working is probably the most important issue facing the NHS at the current time. |
| "We are now facing a once-in-a-generation opportunity to change how the NHS works." | "We are now facing a once-in-a-generation opportunity to change how the NHS works." |
| A British Medical Association (BMA) spokeswoman said it supported high quality care seven day a week and "doctors firmly believe that patient outcome should not be affected by what day of the week they fall ill". | A British Medical Association (BMA) spokeswoman said it supported high quality care seven day a week and "doctors firmly believe that patient outcome should not be affected by what day of the week they fall ill". |
| But she said it is a "complicated problem which will not be easily resolved by one single 'quick fix"'. | But she said it is a "complicated problem which will not be easily resolved by one single 'quick fix"'. |
| Dr Paul Flynn, chairman of the BMA's consultants' committee, said more money would be needed if the proposals were to be a success. | Dr Paul Flynn, chairman of the BMA's consultants' committee, said more money would be needed if the proposals were to be a success. |
| "There are concerns that, without careful planning and careful management, this is not going to be possible for a lot of units without a big investment," he said. | "There are concerns that, without careful planning and careful management, this is not going to be possible for a lot of units without a big investment," he said. |
| Shadow health secretary Andy Burnham said: "This idea is right in principle but, with the NHS in increasing financial distress, the government must set out clearly how it will be paid for." | Shadow health secretary Andy Burnham said: "This idea is right in principle but, with the NHS in increasing financial distress, the government must set out clearly how it will be paid for." |
| Derrick in Swindon writes: "l had to be taken into hospital at 0300 GMT on a Sunday morning. I received first class treatment which included several tests (X-ray, blood tests, CT scan and various others). These tests took almost the entire day. No effort was spared. The ambulance service was also first class as far as l am concerned the service was wonderful." | |
| Scott in Birmingham emails: "I'm so glad to see a positive, common sense change in the NHS. I broke my leg on a Friday at 1530 GMT in 2010 and I was left to wait until Sunday to get a 45 minute surgery. While waiting, on Saturday night, a fatty embolism developed in my lungs which put me in the ICU and almost killed me. My leg did not heal properly after six months so I returned to the US to get it fixed. I'm lucky to be alive and grateful I was a healthy 30-year-old able to overcome the deficiencies of the system." | |
| Bernard in St Albans says: "I've been admitted to hospital twice at weekends in the past five years. Neither time did I see a senior doctor, I was always seen by juniors. I was admitted on both occasions, and felt I was admitted so that an experienced doctor or consultant could assess me on the Monday. This left me with a felling of vulnerability and that it was a game of chance." | |
| Joseph in Leyland writes: "In February this year I had a liver transplant over the weekend. The surgery lasted 11 hours and was a complete success. I cannot commend the surgeons and after care staff highly enough." | |
| Mrs Baron from Salford emails: "The care over the weekend is indeed of poor quality. Weekends tend to be staffed by a lot of agency nurses who are not familiar with the patients or the treatment. Staff levels are lower and contradictory decisions are made which end up being recanted on the Monday by the Surgeon saying 'who ordered that?' Bring back surgeons who can open people up if there are complications and make sure patients are not discharged on a Saturday when the surgeon actually want them to stay a few more days." | |
| Stephen emails: "As a registered nurse working in a cardiac catheter suite that offers 24/7 PPCI to patients having heart attacks, I appreciate the need for consultant input out of hours and at the weekend. However it is important not to lay the blame completely at the feet of NHS consultants. There are also important changes needed in the way social services deal with discharges at weekends. Because of local council budget cut backs, patients who are fit for discharge are holding up beds that could be used by patients in A&E who would gain better treatment once warded. I wholly applaud 24/7 consultant or at least specialist registrar input but this is not simply a case of the NHS getting it wrong." | |
| Yvonne in Bristol writes: "My Husband had a heart attack in March on a Saturday night at 2215 GMT. Just two hours later my husband was back in intensive care. It took 45 minutes from the time I called an ambulance to my husband being admitted to hospital - and all the way in the ambulance, my husband was being stabilised by the paramedics. It was 2300 when we reached hospital. He then had a stent fitted by a consultant. I do not know if the consultant was already at the hospital or if he was called in especially but we cannot argue with the care he received by the paramedics and the hospital staff. Thanks to them he is still alive for which I am extremely grateful." |