In a letter to the prime minister, the college warned that it fears the Bill “will cause irreparable damage to patient care and jeopardise the NHS”.

After amendments to the Bill announced this week in the House of Lords, RCGP leaders went over the head of health secretary Andrew Lansley, voicing concerns directly to Downing Street.

Read more in GP.

The research analysed all 14.2 million admissions to NHS hospitals in England during the 12 months from April 2009 to March 2010, and for every 100 deaths among patients admitted to hospital on a Wednesday, 116 similar patients admitted on a Sunday would die.

However, the likelihood of patients dying in hospital is less at the weekend than during the week. For every 100 deaths among patients in hospital on a Wednesday, 92 deaths would occur among similar patients already in hospital on a Sunday. The findings are consistent for both emergency and elective admissions.

The results of the analysis in the Journal of the Royal Society of Medicine are also consistent with data from 254 not-for-profit hospitals in the US, despite differences in the organisation and delivery of care between English and US hospitals.

Lead researcher Professor Domenico Pagano of the Quality and Outcomes Research Unit, University Hospital Birmingham Foundation Trust, said: “These results offer conclusive evidence that confirms previous reports of increased 30-day mortality risk for patients admitted to hospital with emergency conditions at the weekend compared with the rest of the week. Previous reports, however, have not accounted for differences in patient characteristics associated with admissions on different days.”

He said several factors that might be associated with the increased risk of death for patients admitted with emergency conditions. Some may be more seriously ill and had they been less ill, would have had their admissions postponed until a week day. He also speculated that there may be aspects of care at the weekend that disadvantage patients, such as reduced or altered staffing and skill mix; reduced availability of diagnostics; and less availability of senior staff to review cases and to be readily available for escalation.

The study also demonstrated an increased mortality risk over the 30 days follow-up for patients admitted electively at weekends compared with similar patients admitted during the week.

Pagano said: “This could be because patients planned to have higher risk elective procedures at the beginning of the week are admitted over the previous weekend. Consequently the risk profile of elective patients admitted at weekends may be different and possibly higher from those admitted during the week.”

The study analysed all deaths within 30 days from admissions, whether in or out of hospital. For emergency cases the ratio of in-hospital to out of hospital deaths is approximately 2:1, similar for admissions at weekends and during weekdays. For elective patients the ratio is 2:1 for those admitted at weekends but is almost reversed to 1:2 for those admitted during the week.

Commenting on the study, Dr Andrew Goddard, Royal College of Physicians director of medical workforce, said: “This study is further evidence that patients admitted at weekends are more likely to die following admission than patients admitted to hospital during the week. There are many reasons for this, but the two most important are that the patients are more ill and there are fewer doctors available.

“The Royal College of Physicians has already called for any hospital admitting acutely ill patients to have a consultant physician on-site for at least 12 hours per day, seven days a week.”

Well, you’d be wrong - I’m not going to mention any of that. I’m not even going to lambast the surgeons for their self-serving toadying up to HMG - Jerry Nelson says all that needs to be said about their motivation. No, I thought I’d talk about death.

I’ve been thinking about it quite a lot recently. Not just because I’m getting older, and have recently acquired a proper illness for the first time in my life (yes, much better now - thanks for asking), but because during the past year I trained with the British humanist Association (BHA) to become a humanist celebrant, officiating at non-religious funerals. It may seem like an odd thing to take up in retirement, but it actually turns out to be very challenging and rewarding job.

And when you think about it, it’s a natural extension of a medical career. We deal with patients and their relatives at a very fraught time in their lives, and some of the patients die (although not all, hopefully, even in my hands). This means that we are used to talking to relatives and helping them to cope with worry and distress. When I did the training course, I realised that this gave me quite an advantage over some of the other trainees, who were coming from backgrounds that didn’t bring them into contact with people in the same way (one exception, I suppose, being the young metropolitan policeman on the course).

That’s not to say that the training was easy. I had naively assumed that the public speaking aspects of the job would be a bit of a doddle. After all, I had spoken at numerous medical meetings and conferences, and had also done quite a bit of after-dinner speaking. When, early on in the training, it became clear that the trainers were assuming that we would all prepare written scripts for our ceremonies, I was quietly contemptuous.

What did I need with a script? I had never read from a script in my life - I’d just wing it, like I always did. But of course, they were right. You can’t afford to make mistakes; you only have a short time to meet the family, get all the information about the deceased and produce a eulogy. I suddenly realised that this was much more important than any other speaking engagement I had undertaken. If I made a mess of a presentation at UKRC, it didn’t really matter - no one died, as they say. Well, here someone had died; this was the only funeral the family would have, and I had to get it right.

I actually almost gave up the training at that point. I’m glad I didn’t, but it’s a fact that I get much more nervous before a funeral than I ever did before the biggest conference presentation. It has been a privilege, though, to go into people’s homes and hopefully to be able to help them through a very difficult few days. I’ve been impressed by the dignity and courage of the bereaved relatives and friends, not least in a recent case of the sudden death of a 56-year-old man from a sub-arachnoid heamorrhage.

In an odd way, it makes me more sanguine about the possibility (or I suppose that should be certainty) of my own demise - I think I can see my own kids behaving like that relatively young man’s sons - not being afraid to shed tears on the day, but still producing an affectionate yet witty eulogy, and then getting on with their lives.

As for why I became a humanist after forty plus years as a card-carrying member of the C of E, well I didn’t. Like most humanists, I just suddenly discovered that I already was one.  And yes - I am planning my own funeral. It’s going to be a cracker, but I hope to keep you all waiting for a while yet.

Health minister Earl Howe has tabled a number of amendments in a bid to placate concerns raised by the House of Lords.

Chief among them is a clearer directive to both clinical commissioning groups and the health secretary to promote a ‘comprehensive health service’, following fears that CCGs could ration some services.

Clauses have also been inserted requiring CCGs to give clearer evidence on how they are tackling health inequalities and promoting education and training, and to diminish the potential for conflicts of interest.

It comes in the week when the Royal College of Psychiatrists joined the Royal College of Radiologists in opposing the Bill in its current form. A survey of psychiatrists finds that 85% believe the Bill will have a negative impact on the health and social care system, and 80% consider it to be fundamentally flawed.

Other amendments include bestowing the health regulator Monitor with the power to require healthcare providers to promote integration of NHS services; a new duty on the health secretary, NHS Commissioning Board and CCGs to report annually on their progress in tackling health inequalities; and duties on CCGs and the NHS Commissioning Board to promote patient involvement in their own care.

Health secretary Andrew Lansley said: “The principles of our modernisation plans - ‘no decision about me, without me’ for patients, clinical leadership with doctors and nurses leading discussions on services, a focus on results for patients and reducing bureaucracy - have always been at the core of the Bill. These principles are widely accepted as reported by the independent NHS Future Forum. But we have been carefully listening to the ideas raised as the Bill has progressed through Parliament. And as a result we have today tabled a series of amendments to address these remaining issues.”

Report stage in the House of Lords is due to start on 8 February. The BMA and the royal colleges are yet to respond.

Professor Sue Bailey, president of the Royal College of Psychiatrists, said: “On behalf of our members and patients, we will scrutinise these amendments carefully in order to make an informed decision on whether or not they address the very real concerns of psychiatrists.”

The college wants the Bill to ensure parity of esteem between mental health and physical health; a reduction rather than an increase in health inequalities; that integrated care is safeguarded over competition; that competition is only used in the NHS where it can be shown to clearly benefit patients; and, continuation of a system of effective postgraduate medical education and training.

The online survey, by medical defence body the MDU, shows that 99% of the respondents use some form of modern communications technology in their day-to-day work.

The most popular use of technology was for emailing other members of staff with 92% of doctors stating that they do this, while 64% track test results electronically and 63% use the internet to research patient symptoms.

Sixty eight per cent of hospital doctors also revealed that they had recommended a telephone ‘app’ or website to a patient, an indication of the perceived benefit to patient care.

However, many of the doctors surveyed also expressed concerns about the impact that modern technology could have on patient confidentiality, with 41% stating that they were concerned about this aspect of patient care.

Dr Mike Devlin, head of advisory services at the MDU, welcomed hospital doctors’ embrace of communications technology and its benefits but warned that technology brings new risks and threats.

“It is important that any technology employed does not threaten a hospital doctor’s ethical and legal responsibilities,” he said. “A full assessment of confidentiality and security of data should be undertaken and appropriate policies and procedures put in place.  In addition, doctors should ensure that the use of technology complies fully with any policy that their NHS trust may have in place, many of which do not allow patient-identifiable information to be held on personal IT devices or equipment.”

Other findings from the survey include 44% of hospital doctors use a smart phone; 64% of consultants use a laptop; and, 8% of hospital doctors are using Twitter for work.

Read tips on managing the use of communication technologies.

1. Ensure you are familiar with up-to-date and relevant guidance, such as that provided by the GMC, the Information Commissioner and the NHS, as well as your legal requirements.

2. Do not store professional data on your personal computer (it could lead to breaches of confidentiality and could contravene local NHS policies and procedures) and do not store patient identifiable data on personal mobile devices and unencrypted memory sticks.

3. Nominate a person to be responsible for procedures for handling confidential data.

4. Prevent unauthorised access to confidential information, for example by using password protection, restricting access to clinical records on your intranet and providing members of staff, including locums, with unique passwords.

5. Make sure patients have “opted-in” to receiving information electronically.

6. Ensure you have a written contract, outlining confidentiality requirements, with the company that repairs and maintains your IT systems.

7. Take professional advice before connecting your computer to a network and keep a record of the advice.

8. Ensure that hard disks are properly erased, removed or destroyed before disposing of any of the hospital’s computers.

9. Before agreeing to exchange emails with patients, inform them that no email exchange can ever be 100% secure and ensure the patient is happy to proceed on that basis. Seek assurance from the patient that the email address supplied by them is secure and cannot be accessed by unauthorised third parties, such as work colleagues or family members.

10. Where possible, use NHS mail services that include encryption where clinical matters are discussed.

11. Be aware of the GMC’s advice that you must take reasonable steps to ensure information is transmitted securely. In particular, ensure that you follow Department of Health guidance on the use of encryption when transmitting information about patients electronically or using memory sticks or discs.

12. Doctors should ensure patients are “aware that personal information about them will be shared within the healthcare team, unless they object, and the reason for this.” (GMC, Confidentiality: Protecting and Providing Information (2009), paragraph 10).

13. A patient’s “express consent is usually needed before disclosure of identifiable information for purposes such as research, epidemiology, financial audit or administration”. (GMC, Confidentiality: Protecting and Providing Information, paragraph 16).

14. If using the internet to research symptoms, make sure you are using trusted sites and that the information is not inaccurate or misleading.

The regulator will review the Professional and Linguistic Assessments Board (PLAB) test, which doctors qualified outside of the UK and EU currently have to undergo before they join the UK medical register.

Read more at GP.

Hard on the heels of a letter from GPs saying they’re in favour of the Health and Social Care Bill, comes another saying they’re not.

The first one had 50-odd signatories; the second 360-ish. Nah Nany Nah Nah. Most GPs are opposed to the Bill it would appear. (Interesting how everyone now seems to write to The Telegraph instead of The Times - probably the old pay wall issue).

Here’s the second letter:

Dear Sir,

The Clinical Commissioning Group (CCG) leaders who support the Health and Social Care Bill (Letters, January 28) do not represent the majority of GPs, who believe that the Bill will seriously damage patient care. More than 90 per cent of GPs polled by the Royal College of General Practitioners said that the Bill should be withdrawn.

The NHS is not in peril if these reforms don’t go ahead. On the contrary, it is the Bill which threatens to derail and fragment the NHS into a collection of competing private providers. The Bill will result in hundreds of different organisations pulling against each other, leading to fragmentation, chaos and damage to the quality and availability of patient care.

As GPs, we agree that clinicians need more involvement in planning the NHS, and that the health service needs to improve. We don’t need a Bill to achieve that. Drop the Bill and let’s work on the real issues: improving safety, efficiency, and quality of care.

Dr David Jenner

Lead, Eastern Devon CCG

…and 364 other GPs.

Our orthopods might have stronger grips than anaesthetists (see previous post), but the ‘internists’ come out on top in this amusing American ‘commercial’.

I watched last night’s episode with them, but then wished I hadn’t because of the memories it evoked. It featured Jennie, working as a district nurse, visiting an elderly man who was housebound with leg ulcers and living alone in a tenement flat. He was dirty, smelly and the flat was foul and infested with vermin and insects. The heroine was appropriately disgusted, but her innate goodness allowed her to overcome her middle-class feelings of revulsion and she became his friend.

Television always sanitises things, but the episode brought back the memory of events when I was a medical student at The London Hospital in the late 60’s, admittedly nearly a couple of decades later than the story, so things had started to change.

The first event was a request from a social worker to see if a group of us would volunteer to clean up the flat that belonged to a couple in their fifties. The man had summoned an ambulance to his partner and they found her cold dead in the bed, probably for several days, with a fungating untreated breast cancer. He was lousy with infected ulcers and was taken into hospital for treatment.

The one room they inhabited stank, and even after 40 years the memory of it makes my gorge rise! It was a scene far worse than any horror movie. Their four cats had been removed by the RSPCA, but the floor was covered with cat excreta. Electricity had long since been cut off and we used candles and torches for light. There was utter filth everywhere with greasy unwashed dishes strewn around the room and old rotten food on the table. None of us dared go near the bed which was a festering pile of verminous rags.

It was really a job for environmental health, not a bunch of naïve medical students. We did our best but made little realistic difference to the place. I came away mystified as to how a couple could descend to such utter degradation in the second half of the twentieth century. What had happened in their lives to render them so incapable of either caring for themselves or seeking help from others? What was their story; there would be one? Surely something could have been done to prevent that lady dying in such total darkness and despair?

The second event occurred the same year as some of us were wandering round the derelict areas of Stepney in the East End one warm summer’s evening. We came across an old building with boarded up windows but which had obviously been an institution of some sort. Above the door was engraved the words, “Dr Barnardo’s Home for Children. No Destitute Child Ever Refused Admission”.

Converted to Christianity at the age of 16, Thomas Barnardo believed he had a calling to be a missionary doctor in China. However when he began his studies at my alma mater in 1866 he discovered that his mission was on his own doorstep. The rest is history.

I learned a number of important things that warm summer so long ago. That compassion is more than just sentimentality, it frequently requires rolling up your sleeves and getting very dirty. That to be an empathic doctor requires at least some attempt to understand the complexities and perversities which govern people’s lives. And that one person with vision and commitment can make a difference to lives that seem blighted beyond hope.

These days the press is full of stories about indifferent doctors, uncaring nurses and neglected patients. Sadly many of these stories are true. We, in the modern NHS, would do well to reflect on the life of such people as Dr Barnardo, and many other similar pioneers whose love, faith and commitment helped so many.

Perhaps we will regain our soul!