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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 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".Sir Bruce said the case for change was clinically and morally "compelling".
The British Medical Association, which represents doctors, said the case for seven-day services had been made and the focus needed to shift to delivering it.
'Expect more''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 - irrespective of whether admissions are emergency or elective.
Sir Bruce told BBC One's Andrew Marr show "society has moved on and people expect more and more from services at the weekend".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."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.""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.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". Sir Bruce said junior doctors felt particularly stressed at weekends because of the complexity of cases, and often felt "unsupported".
"We worry about that because it may relate to [the higher] mortality rates," he said. "We worry about that, not only because it may relate to the higher mortality rates, but also because it implies that we could be training the next generation of doctors better," 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 on Tuesday, 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. Sir Bruce said the changes would be contractually binding. For example, he said it was possible a clause in consultants' contracts stating organisations could not compel them to work at the weekend could be removed.
"These are pretty radical changes with some pretty hard levers behind them," he said."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 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. Breaches could cost hospitals up to 2.5% of their annual income of up to £500m and they could face losing their right to use junior doctors.
Hospitals that refuse or fail to provide safe weekend care could also face losing their right to use junior doctors, he said. Sir Bruce told the Marr show the changes would cost about 1.5-2% of the annual running costs of the hospital and said he was confident about finding money from other parts of the NHS to pay for the plans.
Sir Bruce said that media reports saying the changes would cost about 2% of the NHS's operating budget of £97bn were incorrect. More consultants working weekends would stop inappropriate admissions and diagnoses would be speeded up, in turn helping hospitals run more efficiently financially, he said.
"We're not convinced it will be more expensive," he told the Marr show. Sir Bruce said the changes had been widely backed by doctors' groups and political parties.
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."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.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.Organisations would then need to be "absolutely transparent" about whether they were meeting those standards.
'Seals the deal''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. Dean Royles, of NHS Employers, which represents hospitals, told BBC Breakfast the review "seals the deal" on the case for seven-day working.
A report on how care outside hospital needs to change will be produced in autumn 2014. Professor Terence Stephenson, chairman of the Academy of Medical Royal Colleges, said it would not be easy to achieve but the organisation had "led the argument for this principle".
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. Dr Mark Porter, chairman of the British Medical Association Council, backed the changes, saying "there should be no calendar lottery when it comes to patient care".
In the meantime, the review team will concentrate on the cost and workforce implications. He said the BMA was in negotiations with NHS Employers and the government to find an "affordable, practical model for delivering this care, while safeguarding the need for a healthy and productive work-life balance for doctors".
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. Health Secretary Jeremy Hunt has commended the move, while shadow health secretary Andy Burnham said the government needed to clearly set out how it will be paid for.
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." 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."
Dean Royles, of NHS Employers, which represents hospitals, said the review "seals the deal" on the case for seven-day working. 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."
"The clinical case for change is now overwhelming," he told BBC Breakfast. 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."
"This is something the NHS wants, the government wants, the medical royal colleges want and, most importantly, a change that patients want and need." 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."
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". 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."
But she said it was a "complicated problem which will not be easily resolved by a single quick fix". 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."
Dr Paul Flynn, chairman of the BMA's consultants' committee, said more money would be needed if the proposals were to be a success. 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."
"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."