Unanswered questions about the seven day NHS
BMJ (Clinical Research Edition)
It would be useful if our traumas and crises limited themselves to office hours. Life would be simpler and safer if we only suffered strokes or multiple traumas, if we only found lumps or pee'd bloody urine, or if we only had heart attacks, mental health crises and babies from Mon 9am-Friday 5pm. But our illnesses and conditions don't limit themselves to office hours. So why does the NHS? And the thing that keeps coming up is that if we were starting this thing from scratch -this jewel, this
... cious, marvelous NHS -we wouldn't design a part-time, system. Clearly, the five day system creates inconvenience we have become used to: taking time off work to see a GP or Consultant, or to accompany a relative or neighbour; hospitals spending half of Monday 'warming up' systems and machines, and dealing with the backlogs and crises that built over the weekend. But it creates distress too. What are we to do out of hours? With a lump, a failed insulin pump, a teenager self-harming? And everyone 'knows' that if you're in hospital over the weekend everything goes quiet: tests can't be authorised because there aren't any Consultants; they can't be carried out because the machines are turned off, or the labs aren't staffed; nothing is signed off, and you can't be discharged because no-one can contact GPs, District Nurses or social care agencies. And that's before we get into the 'poor experience' of feeling neglected or unsafe because of low staffing and the absence of experienced staff. But much worse, much more frightening, is the increasingly compelling, evidence that five-day working costs lives. That your chances of dying are increased significantly because of the simple fact that you arrived there on a Saturday (an 11% increased risk of dying) or, even worse, on a Sunday (a 16% increased risk). And measuring the dead is only one aspect. What of the many who've survived but who've had worse outcomes than if they had been admitted on a weekday: delayed diagnoses and treatment, more complications, longer stays and more re-admissions? So, what to do? We need to find a way of doing something sensible and obvious, but fantastically difficult. This begs two questions: Question 1: How can we take on the extraordinary challenge of integrating services into a seamless, consistent, high-quality seven-day service? Question 2: Actually, how can we not?