7 Day Working

It's not a secret that the DoH and Sir Bruce Keogh are keen to introduce 7 day working. This clearly needs to be divided into emergency work and routine work. The usual methodology in press statements is to mention 7 day working, talk of Tesco's and then drop in the figures from Dr Foster which suggested a higher rate of deaths for weekend emergency admissions.

In reality the 7 day working which is being pushed for has nothing to do with emergencies and everything to do with PFI barons. Reducing the need to have as many theatres, wards and clinic rooms rented. The NHS is not looking to get more work done but simply spread it though the week and without paying consultants on Saturdays and more than Mondays.

In the current Trent survey the majority of doctor's expressed that they already work often onerous on call rotas, are often married to other doctors working onerous on call rotas and find it hard to imagine how they will cope if both partners work 1 in 6 on call in addition to 1 in 6 weekend service. They were willing to work at weekends when they felt it was appropriate and they were able but only if it remained voluntary rather than compulsory. About half have had already spent weekends working on elective cases.

A minority of respondents did back the move to seven day working for elective work, with the commonest descriptive phrase being that it was 'the direction of travel'.

As for the facts surrounding emergency work, there is a large study looking at the impact of biochemical markers of illness severity on mortality rather than listed long term co-mordities as HES data studies do. This study showed no increase in mortality for weekend admission once patients were stratified with markers of illness severity. This study of over 1.5 million patients however demonstrates that as hospitals are set up for emergency not elective work at the weekend, a patients chance of mortality from elective surgery at the weekend was 30% higher than on a weekday for case matched patients. How much would it cost to provide the same level of staff at weekends to make remove that difference? Probably too much to spend to make the politicians look good.

Maybe it would be better to nationalise the hospital PFI contracts?

Let us know what you think.