Hospital Dr News

“Seniors must provide w/e elective services”

Greater consultant presence at the weekend would improve clinical outcomes and create a more patient focused service, the NHS medical director has claimed.

In a debate with the BMA’s head of the consultants committee, Sir Bruce Keogh said that it wasn’t enough for the NHS just to cover emergency care at weekends.

He pointed to the mounting evidence that patients are more likely to die if admitted to hospital on Saturday or Sunday, and supports calls for greater consultant presence at the weekend and the availability of routine services.

Extending the service would “offer the opportunity to improve clinical outcomes with the added benefit of a much more patient focused service,” he said.

He added that “the clinical, compassionate, and patient convenience arguments in favour of change are compelling”.

But Paul Flynn, consultant obstetrician and gynaecologist and chair of the BMA consultants committee, sees little justification for elective care at weekends and asks who’s going to pay?

Drawing on his own experience, he refutes arguments that elective care over seven days is necessary to bring down waiting times or that the public expects it, saying “it flies in the face of all logic to reward a system that is not using its existing resources to best effect over five days by giving it the opportunity to mismanage them over seven”.

Keogh, however, explained that the new NHS Commissioning Board “has committed to looking at this matter in detail” and is “offering an opportunity for our profession to step forward to consider the challenge of delivering seven day healthcare purposefully and constructively to secure benefits for our patients, our society, and our NHS”.

He acknowledges that “there will be difficult problems to solve, not least around the economics” but he believes it is right to try “because it would enable us to be truly patient centred for the whole of the week, rather than two thirds of it, and we could improve access, shorten diagnostic response times, shorten hospital stay, and improve training”.

Many doctors are worried that the NHS is being commercialised and that their professional values and commitment are being devalued, he adds, but “this should not detract from the recognition that healthcare is a seven day commitment, and this is something doctors feel, believe, and understand”.

Debating the issue on bmj.com, Flynn said: “It is time the NHS listened to the doctors who can tell it how to solve these problems and stopped just throwing a longer working week at it.”

Given the “dire financial positions” of many NHS providers, “it is inconceivable that they will be able to staff operating theatres and clinics seven days a week, let alone provide all the other resources that this activity will consume,” Flynn argues.

“I and my colleagues will always be willing to be there when patients need us, but we cannot be expected to have the same sense of commitment to addressing either management inadequacy or a small measure of public inconvenience,” he concludes.

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15 Responses to ““Seniors must provide w/e elective services””

  1. Malcolm Morrison says:

    Where is the ‘evidence’ for Bruce Keogh’s ‘statements’? Can he tell us which other profession does ‘elective’ work at weekends? And do not the courts (judges) and Parliament (MPs) have the equivalent of ‘school holidays’?

    How does he think this matches up with the EWTRs? (for these apply to ALL employees!) And where does he think the money is coming from? In effect the NHS budget is ‘frozen’.

    Of course, ‘senior staff’ should be present at weekends when they are needed. But, by all accounts, this is already happening in most hospitals – and if it is not, then look at those particular hospitals to find out why it is not.

  2. Dr Death says:

    Does Sir Bruce plan to run hospitals 7/7 and 365/365? If so, then (within a fixed budget) roughly 30% of hopital beds need to be closed and the staff servicing these beds transferred to the (presumably larger and/or more successful) units which will run continuously. This is a massive political risk (closing a hospital is about as popular as opening a nuclear waste disposal site) and a huge practical task – I’m not sure Sir Bruce has thought it all through.

  3. Dr Death says:

    Well said Sir Bruce – let’s do the same for Courts (including parliament – presumably we could have the same amount of legislation dealt with by halving the number of MPs, reducing the Lords by about 80% and making them work 7/7, 365/365). How many schools could we close and sell of to the builders if we had them running all day, every day? All sounds good to me – nothing can go wrong.

  4. Bob Bury says:

    The man really is a plank! Of course it would be ‘nice’ to run a full service at the weekends. but that means running (e.g.) OPD clinics, and cold operating lists. That would not only require more consultants – there would be an even greater shortage of porters, nurses, radiographers, secretaries etc etc. And all at a time when we are being asked to cut £20 billion from the budget.

    What’s so difficult about this concept that our ‘leaders’ (rapidly becoming a term of abuse) just can’t get it?

  5. Dan McKenzie says:

    I always try to look at both sides of an argument and I respect Sir Bruce Keogh’s opinion, but….. Is there any healthcare system that has gone from 5 to 7 day full service? If so, did it improve overall patient outcomes? Was there a detrimental effect on the care in the week? How much did it all cost?

    We have all provided emergency care when needed (I have never done less than a 1 in 5 on call rota) and we have excellent outcomes within the confines of the resources available to us. To provide effective 7 day care must mean extra Doctors, Nurses, Radiographers, Technicians, Pathology Staff, IT support, Administrators, Porters and even Managers.

    We are being asked to slash our costs, close beds, turnover patients faster, and all with 5 years frozen pay, reduced pensions and removal of CEAs. The beds are often filled with very elderly patients with multiple co-morbidities that are no better served with 5 or 7 day full service working. There is a huge shortage of community beds available and little resource to fund them.

    The majority of other equivalent healthcare systems provide 5 day care and there are many other services run as such (most banking, schools, government etc). The ones that run 7 day services tend to be profit making (media, supermarkets etc).

    Please focus on improving the service we currently provide without spreading us all even thinner.

  6. Dr Pijush Ray says:

    Some people are ignorant of their own stupidity! Send them to the planet that they belong – there is taxi waiting for Mars! Quick get them on it before they cause any more chaos!

  7. Mr Steve Havenga says:

    In O&G, we are already committing to doing far more resident on call consultant cover on Delivery Suite (will be 91 hours per week soon in our trust), incl weekends; similarly Paediatricians and Emergency Medicine and Generalist Physicians are also joing the ranks providing resident cons cover round the clock. This is for emergency work however. It will take a lot more resource and money to open up elective work over weekends in the same way and the other posters above have all alluded to this- it’s not just a consultant that provides a clinic or list – from the cleaner to the secretary to the Registrar/SHO to the ODP to the Nurse to the manager, a whole team of people has to then be employed to cover those weekend activities. There was difficulty enough trying to persuade GP’s to open up their surgeries over weekends so I’m not quite sure if Bruce Keogh actuallly grasps it.

  8. Dr Disillusioned says:

    Presumably this does NOT include GP surgeries – who work a 5 day week 8H00 to 17H00 with no after hour call obligation let alone after hour work obligation.

    It would therefore seem that the non-stated objective that will happen is a promotion for all after hour work and weekend medical care to be shifted to 7/7 working hospitals.

    If that is the case then the funds could come from closing all NHS GP surgeries – future medical care being provided by an even more impersonal centralised conveyor belt shift system

  9. Ron Langstaff says:

    I spent most of my twenties and thirties on a one in two. Now in my fifties as a Consultant Orthopaedic Surgeon I am perfectly happy to work at weekends doing elective work as long as Sir Bruce joins me.

  10. Wayne Sunman says:

    I am delighted that Sir Bruce has taken an interest in what happens when hospitals are less-well staffed. This isn’t necessarily an argument for 7 day elective working, as it is the outcomes of emergency admissions that are less goood if they come in at the weekend.

    I would encourage Sir Bruce to take a look at the recurring nightmare that is Christmas. I would submit that this problem might respond to certain staff groups spending more of their public holiday in hospital, but it won’t really get better until social services and the carers they contract adopt a 7 day working pattern. Currently when social workers go on holiday they are not covered and how many times do we find ourselves deferring the discharge of frail, older patients until after the weekend when social services, primary care and community services will be once again available.

    If Sir Bruce is serious about this he will take a whole system approach and the whole system includes social services. Otherwise, he will end up spending money, alienating staff and destabilising secondary care with little measurable benefit.

    It is no surprise that Richard III was buried under the social services car park, nor that the Battle of Bosworth was fought on a Saturday. He is till waiting for a social worker to be allocated!

  11. Dr Contentious says:

    Perhaps there is a compromise possible?
    Full services for 6 days a week.
    Some NHS staff taking Monday off instead of Saturday.
    Same hours.
    If no weekend supplements in pay-rates then same costs is current routine activity spread over 6 days not 5…
    Better for patients I suspect.

    Can’t we change our mindset that Saturday is always weekend day and therefore sacrosanct?

  12. Graeme Taylor says:

    I heard Sir Bruce making considerable sense on the radio the other day about a seven day service. However, most of the problems have been outlined above and it is not a system that seems to have been adopted around the world.
    My main objection is Sir Bruce playing politician and trying to confuse two separate issues. He alludes to poorer clinical outcomes for weekend admissions and this deserves a whole system analysis, before concluding how much may or may not be due to increased senior hours in hospitals. But senior emergency cover is completely separate to elective clinical outcomes, most of which occur in the five day week. Therefore, the poor outcomes and death rates, on which he bases his arguement applies mainly to emergency admissions and it is the height of political cynicism to try and blur the two and argue for seven day elective services. Patient convenience is a weak reason and it seems, to me, to be more about providing a cheaper ‘unit cost’ within the hospital service, with us bearing the brunt.

  13. Dr Pijush Ray says:

    Wayne Sunman I like your comment about Richard III. Leicester City Council have sent out a penalty notice to him for “not properly displaying a parking ticket” in a Pay & Display Car Park!

  14. The Wanderer says:

    Many points well made by other writers. However it seems to me that it is unaffordable to have weekends as routine. Our hospitals are already stuffed to the gunnels with occupancy exceeding 95% -98% much of the time, is it any wonder that MRSA and to her bugs are a problem. Please look at the Swedish experience. The elephant in the room remains cost, just to add Saturdays as routine adds 20% to the salary bill, and I suspect our surgeons will need Monday off as there will be no beds!
    There is a disconnect in thinking at work here, please will our leaders put 1+1 together (2+2) is too hard.

  15. Mr stephen Porter says:

    Oh dear,
    I suspect Bruce Keogh is as far away from the coal-face of working in the NHS as ‘the east is from the west’. Consultants are the spearhead of a very large team of individuals. If he wants a consultant seven daya week service, he will need a seven day a week hospital, with all the staff (and that includes managers) providing a 24/7 service. Is that what is being proposed? I think not!
    Singling out Consultants is typical of the type of sloppy thinking that has characterised NHS policy making for a long time.

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