Consultants could block plans to end situation in which weekend admissions have higher risk of dying than weekday patients.
Patients taken into hospital at the weekend as an emergency will in future be routinely seen by senior doctors, to end “ethically unjustifiable” higher death rates on Saturdays and Sundays under a radical £2bn plan that will see the NHS providing high quality care every day.
NHS bosses intend to end the situation whereby seriously ill patients admitted at weekends are at a 12% higher risk of dying than weekday arrivals because they often are treated by more junior medical staff and have to wait for crucial diagnostic tests.
Professor Sir Bruce Keogh, NHS England’s national medical director, will unveil plans on Sunday to give all urgent and emergency patients the same quality of care, regardless of which day they arrive – proposals that follow a year-long inquiry, involving some of the service’s most senior figures, into how it can achieve an historic expansion of NHS care.
Sceptics about the NHS’s ability to start delivering such services every day of the week have claimed that doing so will cost £31bn or two-sevenths more. But Keogh will argue that offering a seven-day service would only require a 2% increase in the NHS’s budget – about £2.2bn.
It is unclear if ministers will pledge to provide that money or insist that it must come from a reallocation of the service’s £110bn annual budget. “The costs are reassuringly low; this 2% isn’t huge at all,” said a member of Keogh’s review group.
The seven-day scheme will revolutionise the NHS, and force many of its 1.3m employees to work more antisocial hours and kickstart a debate over how seven-day services will be paid for, as delivering them will require the NHS to have more senior doctors.
Behind the scenes, though, NHS leaders are concerned that opposition from hospital consultants could yet jeopardise the move, which has strong backing from medical bodies. Consultants are currently the only group of staff in the NHS whose contracts give them the right to refuse to work at weekends, although some already do so voluntarily.
That veto is the key issue in ongoing negotiations between the British Medical Association (BMA), the doctors’ union, the Department of Health and NHS Employers organisation. The BMA recently dropped what was its steadfast opposition to the NHS offering more services at weekends and accepted that senior doctors needed to help the NHS tackle the increased mortality seen among patients admitted as an emergency on a Saturday or Sunday.
But sources close to the negotiations stressed that with the NHS’s finances under such pressure there was no money available to offer consultants in exchange for dropping the veto. It is uncertain if consultants will agree to Keogh’s planned major changes to their working patterns.
Keogh has previously said the “compelling arguments” make seven-day care for the sickest patients a moral imperative and medical necessity. “Imagine a young woman who finds a breast lump at 4pm on a Friday. How easy is it for her to get a diagnosis and good advice before the beginning of the next week? What kind of weekend will she experience?”, he wrote in the British Medical Journal in February.
He will announce his plans through an interview in the Sunday Times and appearance on The Andrew Marr Show on BBC One. However, he is expected to make clear the NHS does not plan to become what critics have called a “Tesco-style, open-all-hours health service”, routinely offering all normal services, including elective surgery and outpatient clinics, at weekends.
“Under Bruce’s plans for a seven-day NHS, people who end up in hospital on a Sunday afternoon after a fall, heart attack or road traffic accident will get better care because there’ll be more scans done and better access to consultants and emergency surgery, for example, in theory in every hospital, though we do need to reconfigure which hospitals provide exactly which services”, said a source close to the review.
“The NHS already has a seven-day service in that hospitals are open 24/7, but the service on a Saturday and Sunday is not comparable to Monday to Friday, at least not for urgent cases. But doing that will not mean that people can get their ingrowing toenail treated on a Sunday. That wouldn’t be a good use of resources.”
A detailed report on the issue, which will be considered by NHS England’s board on Tuesday, admits: “Progression towards improved seven-day services will be challenging.” It is explicit that the move will inevitably cost more money, especially because it will require more consultants and, in some hospitals, extra specialist nurses.
Work done by Keogh’s seven-day service review group with the Healthcare Financial Management Association (HFMA), which represents NHS finance officers, found that eight NHS foundation trusts which examined the practicalities of introducing seven-day working for emergency and urgent inpatient care and diagnostic services found that doing so would need them to hire 100 extra consultants. That would be a significant extra cost, as consultants are typically paid around £100,000 a year.
However, at a conference on seven-day working last month attended by many NHS leaders the HFMA’s Steve Warburton, director of finance and business services at Aintree University Hospitals NHS Foundation Trust in Liverpool, said: “Investment in seven-day service at the ‘front end’ of the hospital may pay for itself by reducing unnecessary admissions and length of stay”, because the presence of senior doctors at weekends and availability of back-up services would help get patients discharged sooner. The Academy of Medical Royal Colleges, which represents the professional bodies to which all different types of doctors belong, argued in a detailed report last month that seven-day care would reduce the heavy pressure on hospitals by freeing up beds sooner, so making it easier for staff to admit new patients more quickly.