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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. |
Sir Bruce said the case for change was clinically and morally "compelling". | |
'Expect more' | |
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 told BBC One's Andrew Marr show "society has moved on and people expect more and more from services at the weekend". | |
"There is the issue about are we running our industry efficiently," he said. | |
"It seems strange in many ways that we should start to wind down on a Friday afternoon and warm up on a Sunday... and [in the] meantime people are waiting for diagnosis and treatment." | |
He said that, historically, the NHS had been very good at providing a five-day-a-week service but medicine had advanced and care had become more complex. | |
Sir Bruce said research had shown junior docs felt feel particularly stressed at weekends because of the complexity of cases they were dealing with, and often felt "unsupported". | |
"We worry about that because it may relate to [the higher] mortality rates," he said. | |
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: |
Sir Bruce said the changes would be contractually binding. For example, he said it was possible a clause stating that organisations cannot make consultants work at the weekend could be removed. | |
"These are pretty radical changes with some pretty hard levers behind them," he said. | |
He had earlier said a system of incentives, rewards and sanctions would be built into contracts by 2016-17 to encourage hospitals to follow the new standards. | |
He also warned hospitals could face multimillion-pound penalties if they failed to keep up their standards at weekends. Breaches could cost 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 that media reports saying the changes would cost about 2% of the NHS's operating budget of £97bn were incorrect. | |
"We're not convinced it will be more expensive," he told the Marr show. | |
He said more consultants working weekends would stop inappropriate admissions and speed up diagnoses - and this would help hospitals run more efficiently, freeing up money to pay for the changes. | |
He said the changes, which he said had been widely backed by doctors' groups and the political parties, would cost about 1.5-2% of the annual running costs of the individual hospital. | |
"We believe the arguments for this are absolutely compelling both clinically and morally," he said. | |
He said 10 clinical standards would be added to the NHS contract, including expectations on diagnostic capacity and consultant presence at the weekend. | |
Organisations would then need to be "absolutely transparent" about whether they were meeting those standards. | |
'Seals the deal' | |
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. |
Ahead of the publication of the review on Sunday, 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 the review "seals the deal" on the case for seven-day working. | |
"The clinical case for change is now overwhelming," he told BBC Breakfast. | |
"This is something the NHS wants, the government wants, the medical royal colleges want and, most importantly, a change that patients want and need." | |
A British Medical Association (BMA) spokeswoman said doctors "firmly believe that patient outcome should not be affected by what day of the week they fall ill". | |
But she said it was a "complicated problem which will not be easily resolved by a 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." |