Patients get sick seven days a week so why do we still have a five day service in the NHS? The secretary of state for health, Jeremy Hunt, has been advocating for a proper 24/7 service for a while, pointing to worrying, although contested, statistics that some patients admitted and treated in hospitals at the weekends have a higher chance of dying than during the working week, because there are fewer staff on duty. Others argue that elsewhere in the service sector, from a consumer point of view, we have long been used to extended opening hours to meet our purchasing, banking, communications, and leisure requirements and to suit our availability, so why not in the NHS too, in order to meet our healthcare needs? Also, it seems such a waste of resource to have expensive diagnostic equipment lying fallow for two days every week when demand exceeds supply.
There are counter arguments. All the reports show that the NHS is financially stretched over 5 days, with the acute hospitals heading collectively for a £2 billion deficit this year, so how would spreading the resource more thinly over 7 days be a solution? Given the widespread and enduring GP workforce shortages, what would be the point of calling for routine surgeries on Saturday and Sunday when there aren’t the doctors to cover Monday to Friday surgeries? Many clinical and scientific staff, particularly in hospitals, say that they are already working across seven days. Some report higher rates of non attendance ( DNA rates) at clinics that are provided at weekends, suggesting that the public appetite may not be there. The highly regarded CEO of Salford Royal, David Dalton, argues that there is a muddle about the government’s stated objective at the heart of the junior doctors contract dispute – this group of staff are the ones already most likely to work across 7 days.
But there is another argument about why this policy may be missing the point. We haven’t yet got an NHS that works efficiently and effectively and in a patient-centred way during the working week..
In primary care, patients report that getting a GP appointment is a challenge – booking ahead is often not possible, and for appointments that are needed on the same day, you have to ring at a particular time or you have missed your chance.
Patients with long term conditions who need more specialist care lament that either they rarely see the same clinician twice, or their healthcare professional doesn’t have the appropriate medical record to hand. ( Why not hand a copy of the complete record to the patient for safekeeping?) Carers worry about the reliability of the district nurses to turn up as and when promised, to keep their loved ones safe out of hospital.
The organisation of outpatients and follow-ups remains too often an antiquated and non-value adding activity, involving the laborious, expensive and time consuming (for both parties) face-to-face consultation with very suboptimal use of alternatives such as phone consultations, Skype, email exchanges and text messaging.
In mental health, there are scandalously long waits in many places for access to psychological therapies, for example cognitive behavioural therapy ( CBT) for people suffering from depression and anxiety. Meanwhile, these adults may be on sick leave, at considerable personal cost to themselves and to the economy, and at greater risk of hospital admission for physical or mental health problems, and even of earlier death. The situation is even worse for children who have been referred to the child and adolescent mental health service (CAMHS) where there can be waits of up to six months for treatment. Evidence shows that for 50% of young adults their mental health issues first surfaced when they were 11-15, but prompt treatment provides significant opportunities for these problems not to extend into adulthood.
These are all examples of services during the working week not operating in a way that meets the needs and expectations of patients and the public. The likely causes are a combination of capacity and efficiency problems – not enough staff, or not working as productively as possible. In some areas, access to care in a patient-sensitive, timely and convenient manner is available, but it’s still a game of chance. The return on investment for the NHS – and more importantly for patients to whom the NHS belongs – of getting this right is probably greater than striving for a comprehensive out of hours service which the public has not yet been consulted on.