Caring round the clock

In October 2013, NHS England’s national medical director Sir Bruce Keogh set out a plan to run NHS services seven days a week to improve the patient care at weekends and tackle the high death rates that occur on Saturdays and Sundays. This came following research from Imperial College London, which showed that patients were 16 per cent more likely to die if they were admitted to hospital on a Sunday and 11 per cent more likely to die if they were admitted on a Saturday. It also found that the risk of death within 30 days of a planned operation increased every day of the week after Monday.
    
Re-visiting this agenda, David Cameron has taken on the seven-day plan as part of the Conservative’s healthcare plans. In his first major speech following the Tory election victory, he said: “While our hospitals are working hard Monday to Friday to get patients better, sometimes it can feel as though Saturdays and Sundays are more about just somehow getting through to Monday. Diseases don’t work weekdays 9 to 5. And neither can we.
    
“When you have sat through a night in the hospital watching a loved one and praying for the morning; when you have spent a weekend longing for the week – you know just how important these changes are.”
    
Whilst details of funding a seven-day NHS were not included in his speech, during its general election campaign the Conservatives pledged an £8 billion increase in spending on the NHS per year above inflation by 2020.

How will it be achieved?
Cameron’s speech was low on details and specifics of how a seven-day NHS would be implemented, but gave an assurance that it didn’t mean staff being overworked. He said: “This isn’t about NHS staff working 7 days a week. It’s about different shift patterns, so that our doctors and nurses are able to give that incredible care whenever it is needed.
    
“It’s about key decision makers being around at the weekend; junior doctors being properly supported; and resources like scanners up and running wherever they are needed.”
    
One of the major factors towards the plan is improving access to primary care. Cameron pledged that 18 million patients will have access to a GP at mornings, evenings and weekends by the end of this financial year during his speech. While he didn’t say how this would be done, the Conservative’s general election campaign committed to recruiting 5,000 more GPs between now and 2020. What’s more, the government’s GP Access Fund is already underway, where GPs can bid for funds to facilitate extended opening hours.

Industry feedback
Whilst the seven-day NHS plan is admirable and welcomed by voters, NHS workers and others in the industry have voiced their concern, mainly about the sketchy details about how the plan will be implemented. Even more importantly, how it will be funded.
    
Nigel Edwards from independent researchers the Nuffield Trust has warned that the £8bn will keep current services running, but little else. Staffing is a critical challenge. He said: “We have known for some years that there is a higher risk of mortality in our hospitals at weekends – this needs to be dealt with. Moving to a seven‑day service will help improve the flow of patients though hospital and the problems that result from the surge of demand on Mondays. Whether the
Government will provide the funding available to achieve this aspiration is a key question though – the extra £8bn it has pledged by the end of 2020/21 will be enough to keep existing services running but little else.”
    
Highlighting the major and complex challenge such a plan involves, Nigel Edwards added: “The government should be under no illusions about the impact a seven-day NHS will have. It will mean significant changes to the way services are run across the country, and it will also require recruiting a critical mass of specialist staff. Making seven-day working a reality may also mean closures or mergers of local services, such as emergency surgery or maternity units. So, this will not only cost additional money beyond the £8bn but it will also require political bravery.”
     
Meanwhile, Paul Briddock, director of policy at the Healthcare Financial Management Association (HFMA), has urged for clear guidance on how the money is to be spent. He said: “The government’s pledges are a step in the right direction. However, these plans will cost additional money in an already stretched system, therefore any extra funds committed should be coupled with guidance on how best to implement these fundamental changes to the way the NHS works at the moment.
    
“Proposals such as seven-day services will need careful financial planning. However, despite having cost implications, the benefits of increased access to primary care provision should also lead to less unnecessary and expensive hospital admissions in the long run.
    
“One immediate practical challenge is a shortage in the number of GPs available to deliver these changes and the need to increase both the intake of doctors coming in the system and training through the GP ranks.”
    
Patient Safety
At the start of the year, the British Medical Association (BMA) warned that the plan for a seven-day NHS was an “unfunded, undefined” strategy that is “wholly unrealistic” because of existing staff and financial problems in the NHS. It said the plan could threaten patient safety due to the ambitious nature of the plans and lack of detail, which could lead to underfunding and unrealistic handling of demand. This could also lead to routine operations being cancelled on weekdays because of the pressure, it warned.
    
In June, the BMA made a legal request for the government to clarify its seven-day strategy, but this was refused. Commenting on the refusal, BMA council chair Mark Porter said: “Doctors want the care we provide for sick patients to be of the same high standard, seven days a week.
    
“Urgent action on this has been bedevilled by calls for the entire NHS to be delivered on a seven-day basis without any clear prioritisation.

“The government should clearly define what it means when it uses the term ‘seven‑day service’ so that we know how much the additional services would cost, and how many extra doctors, nurses and other NHS staff would be needed to deliver them.”

Manchester leads the way
Greater Manchester is on its way to become the first big city to provide seven-day services. GP appointments, community services and diagnostic tests will be accessible for the local population by the end of the year.
    
A trial of the scheme covering 500,000 patients across Greater Manchester has already seen a three per cent cut in hospital visits and saved £425,000 in Central Manchester’s NHS area.
    
The scheme will now be expanded so that everyone in need of medical help will get same-day access to a doctor, supported by diagnostic tests, seven days a week.
    
The city will be taking control of its entire £6bn health and social care budget next April as part of the NHS’s devolution plans.

Recruitment is the key
Delivering an NHS that offers high quality care seven days a week will be down to the staff delivering such care. Nigel Edwards concludes: “Getting the right workforce in place will be a critical challenge as the main driver will be the need to recruit highly paid medical staff, as well as support staff. General practice in particular is very stretched and it takes time to recruit in extra capacity. In addition, the NHS currently pays a premium for weekend working so negotiations over terms and conditions for staff will need to be handled carefully.”
    
Dr Nav Chana, chairman of the National Association of Primary Care, adds: “Any increase in the number of GPs must be accompanied by more sophisticated approaches to recruitment and retention, as well as a fundamental review of the model of care in which GPs operate.”

Further information
Read David Cameron’s full speech at tinyurl.com/ma47xu5

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