Reluctant weekend consultants 'risk lives'

11 October 2012

The reluctance of hospital consultants to work nights or weekends is putting patients' lives at risk, according to a report by the Society for Acute Medicine (SAM) and the Royal College of Physicians (RCP).

The report said that a consultant should be available at least 12 hours a day, seven days a week for every hospital ward in the country – and to achieve this either hours will have to increase or more doctors will have to be appointed.

Last year, a survey of hospital trusts found that almost every hospital in the country had a higher death rate at weekends and some had a significant increase – on average, 8.1 per cent of people admitted at weekends died compared with 7.4 per cent during the week. The research concluded that some of the deaths could have been avoided if there were more staff and patients had access to all the services that would normally be available during the week.

Nearly four years ago, an experienced GP in Leeds told Publicservice.co.uk editor Rory Baxter that falling ill on a Friday and needing a hospital admission was a bad idea because the NHS was still "a five days a week service", with some hospital wards becoming "virtual ghost towns" for two days.

Thursday was not a good day either because of its proximity to Friday and hospital staff started to wind down for the weekend, he said. And being admitted to hospital on a Monday was not much better because hospital staff would still be getting through the weekend's backlog and some of the equipment would not be in operation or even in situ. So the best options, he said, were to be ill on a Tuesday or Wednesday if at all possible.

SAM president Dr Chris Roseveare said: "There's a culture in which consultants are traditionally reluctant to provide weekend working – the consultant's job plan has been geared around providing a weekday service, plus a weekend service shared with colleagues. [But] going into a hospital where there isn't a consultant available is something we want to avoid."

In 2010, the then Health Secretary Andrew Lansley said: "Patients deserve better care at night and weekends and senior doctors should be available to provide acute medical care as needed. I have already asked Medical Education England to consider with the profession, the service and medical Royal Colleges how best to secure better patient outcomes and the right level of supervision for trainees through greater consultant involvement in direct clinical care at night and at weekends."

COMMENTS

In our hospital we have consultant rounds twice a day 7 days a week of acute medicine and have consultant presence in the ED 7 days a week However there are only so many of us. If we work 12 hours a day we will be working beyond EWTD (I already am) and so will be illegal as well as unpaid since no one is paid more than 12 sessions. Also, strangely, we would like to have lives outside work like all our patients
A P Volans - Acute Hospital

nonsense,

we have been promoting 24/7 care but are held up by managers who will not resource obvious change for the better, year on year!

the vision is there, the tools exist, but the 'corporate will' is sadly lacking.

less rhetoric more facts please
john - cornwall

I was recently admitted to North Devon District Hospital on a Thursday night/Friday morning and was dealt with very promptly. The orthopaedic surgeons were on duty, or seemed to be for at least 12 hours 7 days a week on a 7 day rotation. The care was exemplary.
Name not provided - Bideford

Apparently you don't want to need A&E after 2am - as told to me about a year ago by an A&E nurse who said that there aren't any doctors on duty at that time - perhaps this is true at just a few locations however I doubt it! Scary when it's an accepted thing within the health services. Needless to say, I'm praying I never need A&E at that time!
Caroline - NHS

Have you heard of the the Patient Record Network? http://www.gpcare.org.uk/site/nhspatients/patient_record_network/
Although it doesn't solve the staff shortages, at least the staff who are there can still give up to date patient care, even out of hours and weekends.
Gabby Prowse - Harbourside Family Practice, Portishead.

I am a hospital consultant who worked on site last weekend. Very hard. As did my medical, surgical and orthopaedic consultant colleagues. I worked all the weekdays prior to the weekend, and all those after it.

I was on-call again yesterday (Thursday), was in hospital working until close to midnight, and was back in again at 0830 this morning. At one point late in the evening, my bleep went off for ICU, and I was so tired that I actually forgot to answer it (don't worry - they got me on my mobile [which I'm not supposed to use in the hospital, but fortunately did]).

There were 75 medical admissions alone at the weekend, and this for a small DGH. The medical consultant and myself were still discussing some of the complex admissions at 10 pm Sunday night.

It couldn't possibly be that the increased death rate at the weekends is due to most GP's off-loading their on-call work, and the hospital wards being overwhelmed as a result? Oh no, far too easy for the GP quoted above to claim (unsubstantiated) that it is because of lack of consultant presence.

It is so cheap and easy to accuse the consultants of laziness yet again! We have picked up the slack from lack of junior staff, despite many of us being completely burnt out from unregulated 100+ hour weeks as juniors ourselves, and the ivory towered colleges and managers aren't in at night to witness any of our hard work, so it's all so easy to believe that it doesn't exist.

The public are all too eager to lap up the stereotypes of fat-cat golf-playing consultants who are only interested in private practice, and politicians are all too eager to find someone to deflect the blame for the NHS mess. Get real, folks, and stop slandering us! See what happens to your own cognitive state and motivation after even just 16 hours continuous hard work.

If Andrew Lansley or Jeremy Hunt want to increase senior doctor presence out of hours, then they have to accept that we can't be everywhere all at once, brains fresh as daisies after 24/7 working, and work out the logistics of how to provide simultaneous increased elective work as well as increased emergency presence (particularly in the present climate of stifling, obstructive bureaucracy).
Consultant Anaesthetist - Central Belt Scotland

The Trust i work for want to have 7 day working for Therapy staff but do not want to have more staff. As the only OT on my ward i will still only be there for 37.5 hours/5 days per week whenever i work but working at weekends will cost the trust more. If the NHS wants true 7 day working they need to put their money where their mouth is and fund it properly not just expect existing staff to spread themselves more thinly.
Joan - Chester