NHS Chief Asks Doctors' To Support 7 Day Working
The government is calling for seven-day working rules for consultants as well as nurses and other medical staff. Keogh has spoken out in favour of the shift, citing the need for improved standards. He has gone as far to say there is ‘hard evidence’ that patients are more likely to die of they are admitted over a weekend.
In a head-to-head debate in the British Medical Journal, the Chairman of the British Medical Association's Consultants Committee, Paul Flynn, rejects the idea – his main argument being that paying for senior doctors to be on the ward seven days a week is costly. He also questions where this funding will come from.
It is understood that Keogh has asked the NHS commissioning board to take a detailed look at the issue, which he says is already causing anxiety among junior doctors and hospital chief executives. According to Keogh, the medical royal colleges favour more consultant cover at weekends.
He says that the lack of many seven-day services damages five measurable outcomes for patients; preventable deaths, treatment of long-term conditions, outcomes from emergencies, patient experience and safety.
“We must ask why, in many hospitals, expensive diagnostic machines and pathology laboratories are underused, operating theatres lie fallow and clinics remain empty. Yet, access to specialist care is dogged by waiting lists, and general practitioners and patients must wait for diagnostic results,” Keogh writes.
“Imagine finding yourself in need of a blood test result, a diagnostic test, or specialist advice but having to wait an additional two days – for what reason? Intuitively many of us find this frustrating and unacceptable. Imagine, also, a young woman who finds a breast lump at 4pm on a Friday. How easy is it for her to get a diagnosis and good advice before the beginning of the next week? What kind of weekend will she experience?”
The other school of thought, led by Flynn argue that there is little justification for demanding consultants – other than those that serve accident and emergency units – work at weekends.
One argument often advanced is that seven-day working is necessary to meet the demands on the NHS and reduce waiting times. But, Flynn says, consultants are frustrated by their inability to make the service they offer more efficient. Financial and organisational systems get in the way. “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,” he writes.
“Any clinician can tell you off the top of his head three things that will make their clinic more efficient. Any surgeon can tell you three things that will make his or her operating lists more efficient. 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.”
Furthermore he rejects the argument that the public expects a seven-day service. “Schools and many businesses do not open at the weekends and much of the other infrastructure of society such as public transport does not operate a full service at weekends either,” he writes.
But the most important question was who was going to pay, he says. “Many NHS providers are already in dire financial positions to the extent that some of them are consulting on making staff redundant. 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. The public, I think, would rather such resources were focused on the sickest people who come to hospital.”
Keogh acknowledges that the proposals come at a time when doctors are worried about the impact of the economic crisis, structural change to the NHS and pension reforms. “Many are worried that the NHS is being commercialised and that their professional values and commitment are being devalued,” he says.
“This should not detract from the recognition that healthcare is a seven-day commitment, and this is something doctors feel, believe and understand.”