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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 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. | 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 - irrespective of whether admissions are emergency or elective. | 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 junior doctors felt particularly stressed at weekends because of the complexity of cases, 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, 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. | "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 on Tuesday, set out 10 new clinical standards for hospitals. | |
| These include: | These include: |
| Sir Bruce said organisations would need to be "absolutely transparent" about whether they were meeting the standards. | |
| He 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. |
| 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. | 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. |
| 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 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. |
| More consultants working weekends would stop inappropriate admissions and diagnoses would be speeded up, in turn helping hospitals run more efficiently financially, he said. | More consultants working weekends would stop inappropriate admissions and diagnoses would be speeded up, in turn helping hospitals run more efficiently financially, he said. |
| Sir Bruce said the changes had been widely backed by doctors' groups and political parties. | Sir Bruce said the changes had been widely backed by doctors' groups and political parties. |
| "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. |
| 'Seals the deal' | 'Seals the deal' |
| Dean Royles, of NHS Employers, which represents hospitals, told BBC Breakfast the review "seals the deal" on the case for seven-day working. | Dean Royles, of NHS Employers, which represents hospitals, told BBC Breakfast the review "seals the deal" on the case for seven-day working. |
| 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". | 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". |
| 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". | 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". |
| 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". | 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". |
| 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. | 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. |
| The Welsh government has not ruled out seven-day working, while the Scottish administration has committed to having consultants in wards seven days a week. | |
| A review in Northern Ireland earlier this year found disparities in out-of-hours hospital care, compared to weekdays. The Regulation and Quality Improvement Authority said specialist consultant ward rounds and formal weekend handovers were needed. | |
| 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." | 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." | 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." | 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." | 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." | 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." | 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." | 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." |