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Hospitals warned over need for better quality weekend care

Hospitals will face sanctions unless they deliver the same standard of care seven days a week in a shake-up aimed at cutting the increased death risk at weekends.

weekend care, nurse, hospital bed

£1 billion of changes is needed to improve weekend care

Sir Bruce Keogh, NHS England’s medical director, said he was setting out “pretty radical changes” which were backed up with some “pretty hard levers” to make sure hospitals complied.

He told the Sunday Times that hospital trusts will be contractually bound to run a full service seven days a week - with breaches costing them up to 2.5% of their annual income of up to £500 million.

Sir Bruce indicated the changes, which could cost around £1 billion to implement, would result in hospitals making more efficient use of equipment and expertise.

The increased risk of mortality at the weekend could be as high as 11% on a Saturday and 16% on a Sunday, according to an analysis of more than 14 million hospital admissions in 2009/10.

Under the plan, within three years all patients admitted to a hospital ward as an emergency will see a consultant within 14 hours, and those already in hospital will be reviewed by one every 24 hours.

Routine surgery will also be available for minor conditions, such as hernias, as well as blood tests, heart checks and biopsies, saving patients from having to take time off work.

Services such as X-rays, ultrasounds, CT and MRI scans will be carried out promptly at weekends, following the review.

On the BBC’s Andrew Marr Show Sir Bruce explained that “junior doctors are feeling particularly stressed at the weekends because of the complexity of patients, the complexity of diagnosis and treatment, and they feel unsupported.”

He said: “This has been brought to our attention and we worry about that, not only because it may relate to the higher mortality but also because it implies that we could be training the next generation of doctors better.”

Effectively shutting down many services at the weekend was also wasteful, he added.

“It seems strange in many ways that we should start to wind down on a Friday afternoon and warm up on a Sunday while operating theatres are empty, outpatient clinics echo, expensive diagnostic kit isn’t being used and in the meantime people are waiting for diagnosis and treatment.”

Sir Bruce indicated that the changes would add around 1.5% to 2% of the annual hospital running costs.

“The budget of the NHS is, broadly speaking £100 billion. Only half of the expenditure is spent in hospitals, the other half is spent outside hospitals.”

But he said: “What we do know is that if you have more consultant presence in a hospital at the weekend, several things happen: firstly you don’t have inappropriate admissions to the hospital.

“Secondly, when those patients are admitted they get a diagnosis quicker and the appropriate treatment is started more quickly.

“That means that patients spend less time in hospital and the hospital as a whole runs more efficiently.”

Sir Bruce said he believed a clause in contracts which says that organisations cannot force consultants to work at weekends could be removed,

Setting out his plan, which will be put to NHS England’s board on Tuesday, he said 10 benchmarks had been identified for hospitals to meet.

“We have identified 10 clinical standards which will deal with what our expectations are in terms of diagnostic capacity in organisations at the weekend - so how their labs work and consultant presence as well.

“Those seem to be the two things that are at the heart of this matter. We are going to put those into the NHS contract for organisations over the course of the next three years.

“We are going to make organisations be absolutely transparent about whether they are meeting these 10 clinical standards or not.”

Organisations which do not have suitable levels of consultant presence will be prevented from contracts to train junior doctors.

The Care Quality Commission will ensure that no hospitals receive the highest ratings unless they meet the conditions and “for acute services to be judged safe, they have to be safe 24/7”.

“These are some pretty radical changes with some pretty hard levers behind them,” Sir Bruce said.

He will also ask NHS England to set up pilot schemes in 2014/15 to improve GP access for at least 500,000 people to help move to a seven-day model across the health service.

Health secretary Jeremy Hunt said: “Patients should be at the heart of the NHS and be able to depend on it every day - not just Monday to Friday. I want the NHS to expand to provide seven-day services so that more patients get the right care, when they need it.”

Dean Royles, chief executive of the NHS Employers organisation, said: “Seven-day working is probably the most important issue facing the NHS at the current time, and movement in this direction is essential if we are to ensure its sustainable long-term future.

“The NHS can’t afford to sit back and rest on the laurels of its 65-year history, and Professor Keogh’s report adds to the momentum for change and progress.

“We are increasingly seeing hospitals and community-based health services develop innovative services that anticipate and respond to patient needs, but all too often NHS employers find the terms and conditions of doctors are getting in the way of progress.

“We are now facing a once-in-a-generation opportunity to change how the NHS works. Patients, employers, medical Royal Colleges and the government all want to see seven-day care. I hope this report will help accelerate progress and we make the ambition a reality.”

Peter Carter, chief executive and general secretary of the Royal College of Nursing, added: “The evidence has been increasingly clear for some time that the way parts of the NHS operate at the weekend simply has to change.

“What is required is a whole system change. It is not simply a question of changing the way some consultants work, there is a level of complexity which needs to be addressed, taking in everyone from porters to radiographers to technicians, all of whom provide vital services which help keep patients safe,” he said.

“We welcome Sir Bruce’s work in building a consensus around this issue and hope that the practicalities can be agreed in order to make this a reality everywhere as soon as possible.”

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Readers' comments (8)

  • Agree with absolutely everything that Keogh says: these few simple (but radical) steps will make a huge difference to patients and clinical outcomes - well done!

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  • Unfortunately this report does not indicate what is meant by a " full service seven days a week "

    Routine OPD, Full Operating lists? Where are the staff never mind the money going to come from ?

    Reports like this are unrealistic and lead to patient expectation which will not be met.

    Irresponsible!

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  • If a hospital is fined 2.5% of its budget surely the people that really suffer as a result are the patients as there is less money within the trust for patient care. How does this fit with the philosophy of 'patients should be at the heart of the NHS' espoused by the Health Secretary?

    Surely there are more creative ways to ensure that patient safety is guaranteed at weekends and in the event of creative failure penalising the management responsible and not the patients would be a better option.

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  • If you run an unsafe unit that puts patients at risk, you have a duty to report it and do something, even if it's only to resign.

    It doesn't matter if you're a doctor, a nurse, a manager, a technician or a therapist. You're either part of the problem or part of the solution on this matter.

    We warned successive managers that care was becoming unsafe due to poor staffing and that lack of access to senior staff, investigations and some interventions made the weekends and bank holidays (like Xmas!) unsafe for patients.

    We stood up for our patients when we warned managers, why can't we stand up again and show them the results of their reckless cuts?

    Why do allow politicians and the wretched tabloids to blame nurses working in unsafe units?

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  • How is this going to be funded? They have already frozen our pay for years, they have scr*wed us over pensions and they are in the process of reneging on the existing Agenda for Change. We have done nothing to oppose any of this. Removal of enhanced pay for weekends, nights, holidays, etc. would probably be met with no more than a whimper.....and they know it. But it still won't lead to better care.

    After 30 years of working 24 hour rotational care, weekends, Christmas, New Year, highdays and holidays, my knackered body screamed enough, and I changed my job to a monday-friday, 'home at a decent hour' job. I still work full-time and my job is busy and challenging. However, I got my life back and my family got back a wife and mum. No one will ever make me work weekends again.

    Keogh needs to look first at the NHS's treatment of its most precious resource, its staff. It is this fundamental, incredibly important issue that everyone who publishes a report or comes up with a new initiative or scheme, completely disregards. Keogh, Cameron and the general public have no right to demand this 'better quality' care without paying for it. Unless and until, we are employed in decent numbers, properly resourced and remunerated, then simply calling for or demanding that it happens is pointless.

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  • We used to have really good care over the weekends, so what happened? I`ll tell you. Management dropped the ball, that's what.
    I watched it happen 10 years ago, little things like when the canteen had reduced hours, and then they started closing off the car-parks closest to the hospital, (reserved for management naturally), at weekends and nights. As if the whole place closes down when they are not there. This situation exists everywhere does it not? And is this insignificant, of course not, it tells us nurses exactly what they think of us as employees. I.E., a burden. We`ve been treated like sh#t at every opportunity by everyone, and what do we do about it, nothing. It will just keep getting worse, so the best thing you can all do is leave and find a better employer.

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  • I don't think closing down car parks has anything to do with poor care.

    Reduced medical cover, reduced nurse staffing levels and complete lack of availability of normal services has a much greaer impact. The gaps are filled mainly by nursing staff having to do everyone elses job from physios, to phlebotomists and ECG technicians and everyone in between.



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  • Cant wait to see how Trusts are going to afford all this. keogh seems to think they will find the money by reduced length of stay, hmm... optimistic at best!

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