Can the NHS realise David Cameron's ambitions for seven-day services?

http://www.theguardian.com/healthcare-network/2015/jul/08/nhs-david-cameron-seven-day-services

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It is an inconvenient truth that people get sick at the weekend. Yet the NHS has for too long tried to manage its workload like any other industry: by consigning the majority of its work to weekdays, allowing GPs to shut up shop and hospitals to switch to standby mode over the weekend. As a result, you are 16% more likely to die if admitted to a hospital in England over the weekend than on a weekday. That was the finding of a 2012 study of over 14 million hospital admissions; other, more restricted, studies have reinforced the point.

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Shockingly, this disparity also exists in emergency care, with research pointing strongly towards a link between a lack of senior staff availability and increased death rates in this sector. At present, A&Es only manage to achieve a 12-hour consultant presence for 30% of the time at weekends, compared with 77% on weekdays. This situation is made worse by the fact that people are unable to access their GPs at weekends, and so present themselves at A&E in greater numbers, contributing to the A&E crisis observed over the winter months.

The NHS is not the only health system to experience heightened weekend mortality. German and French hospitals experience the same phenomenon, as a recent Civitas report illustrates. One major German study reports a 22% higher chance of death in patients undergoing surgery at the weekend. The French healthcare system is less transparent. This is possibly due to the French emphasis on patient choice of provider, making organisations anxious for their reputations and consequently less willing to share data or admit faults as compared with the NHS.

Studies also show this weekend effect to occur in the United States, where healthcare is predominantly consumer-driven.

So this is a problem which is being felt internationally and David Cameron’s commitment to a “truly seven-day NHS” is to be welcomed as a trailblazer that others might follow. But whether the NHS has the means to realise his ambition is far less certain.

NHS England points to a potential £30bn gap in its funding five years from now if no evasive action is taken. Even a doubling of the health service’s current annual efficiency drive would still result in a deficit of £16bn. In fact, the NHS would have to triple its efficiency savings to balance its books by 2020. The report states that the potential funding gap can only be addressed by sufficient additional investment from the government to enable major changes in infrastructure. However, the government has only agreed to £8bn a year of additional funding by 2020. Given the difficulty our health service has experienced in achieving its present 0.8% annual efficiency gain, managed in part by freezing the salaries of its staff, it seems wildly optimistic to expect it to triple its efforts.

Related: What will a seven-day NHS mean for healthcare professionals?

The government is not only struggling to keep the existing level of NHS provision financially viable, it is also failing to attract enough staff into the right areas. Fewer newly qualified doctors now wish to train in challenging specialities such as A&E or become GPs. GP training applications fell by a staggering 15% last year alone. It is therefore virtually impossible for the government to recruit the staff needed for a seven-day NHS, even if it had the money to pay for them.

NHS England may make the case that a seven-day service would help the NHS save costs in the long run by helping clinicians more efficiently treat disease. But its implementation requires more than a simple reorganisation of existing resources.

We cannot spread even more bread with the same amount of butter. Considerably more staff, being paid enhanced rates for working unsociable hours, are needed. The government must seriously address the problem of NHS funding before it can hope to curb weekend mortality.

So, where does all this leave the prime minister’s dream of a seven-day NHS? Probably in the pages of its election manifesto.