The trouble with the NHS's working week
Peter Hoskin 9:02am
If you like your literature gloomy, then, at first, there may not be much to interest
you in the latest Dr Foster Hospital Guide. A double-page diagram, across pages 10 and 11, is
mostly about the positive trends of the past ten years: declining mortality rates and waiting times, that sort of thing. The only particularly sour note sounds out from the timeline at the bottom
of the spread, which notes the creation of that big, galumphing NHS computer system in 2002, and then its abolition this year for not ‘achieving objectives’.
But keep pressing on, because there is much to be concerned about in the pages that follow — particularly in the second chapter, entitled ‘Reducing mortality at nights and weekends’. In fact, that chapter is so concerning that the Telegraph have splashed on it this morning, and it was discussed in the 0810 slot on the Today Programme. Its main finding is stark in its simplicity: you are more likely to die if you're admitted to an NHS hospital at the weekend, rather than on a week day. Here's the chart that Dr Foster have produced to show the effect:
Which is to say, the death rate for emergency procedures hovers around 7.3 per cent during the week, but then jumps to over 8 per cent on both Saturday and Sunday. Coincidence? Certainly not. The report puts it down, largely, to the fluctuation in staffing levels between Friday and Saturday. Consultants and other senior staff who were on the ward during the week are merely on call at weekends. The number of specialists at hand is diminished. And this is the result:
This might seem like a lot of fuss over fractional changes in percentage points. But don't forget that, in this case, those fractional changes speak of the very real difference between life and death. And besides, as the Dr Foster report notes, they are somewhat bigger for some hospitals than for others. This is a serial problem for a health service that was advised, last year, that ‘consultants must be more directly responsible for the delivery of 24/7 care’.
That same advisory document also reckons it will take until 2025 to reach ‘the recommended number of 10 full time equivalent consultants, as a minimum available to provide a 24/7 service in every department that is currently working,’ although it notes that wider reconfiguration could help. In the meantime, news like today's highlights the importance of data in exposing the hidden scandals of the NHS. The coalition has done great work in making various systems more transparent — but it can still, always, go further.
Previous
Purpleline
November 28th, 2011 9:25am Report this commentThe problem goes back to the Labour massive pay rises and contracts for Doctors and the European working time directive.
It would appear Doctors & Nurses are no longer in the business from a sense of calling, but are financially motivated.
From experience at weekends the number of foreign Doctors & Nurses mean the natural empathy of helping fellow nationals is no longer a driver.
I dare say in some cases hostile religious considerations are put before patients.
The problem with the NHS is that it is mostly staffed by foreign workers working for Money they cannot earn in their home market and ergo people die because of it.
cg
November 28th, 2011 9:39am Report this commentOf course, Purpleline would never do anything so vulgar as work for money. If P went abroad, then he/she would definitely give their time for nothing, right?
I'd have thought one of the main reasons would be that there are more drink related admissions at weekends.
The Oncoming Storm
November 28th, 2011 9:49am Report this commentMost likely this is a hangover from the very beginning of the NHS when rather than confront the BMA Bevin "stuffed their mouths with gold!" giving them the power to do what they want and whenever they want to. No one in the following 60 years has had the cojones to take them on.
Yam Yam
November 28th, 2011 9:55am Report this commentIt does help that what staff are available on A&E on Friday and Saturday nights are often stressed and harassed by denizens from the nation's pubs and clubs turning up in a state of severe intoxication.
strapworld
November 28th, 2011 10:19am Report this commentYou would think that, by now, the NHS would have learnt the lessons from Dr. Foster's reports. The warnings are not new, especially on death rates and numbers of nursing staff available. There is a real need, to coin a phrase, to go back to basics and create a nursing role which would allow for them to be used in any ward that are under staffed. The problem with modern day nursing is that they are trained for particular roles and so one trained in, say, care for the elderly cannot be used in the baby units and so on. The need for a hands on caring nurses who can give that TLC to patients is plainly obvious.
On death rates. What Dr. Foster never did, and I am not sure if they do so now, is take into account the demographics of the local hospital population. It could be that in some area's there is a majority of elderly people which could show a mortality rate much higher than other area's.
TomTom
November 28th, 2011 10:29am Report this commentObviously weekends are bad in A&E...just go visit and see the drunks, football thugs, Friday-night bingers. Then ask why the mortality rate is high in August, it is because doctors change over on their 6-month contracts and move hospitals OVERNIGHT.
You journalists do live in a salon world completely divorced from where the rubber meets the road
Nicholas
November 28th, 2011 10:33am Report this commentAs with the Police and Border Agency these services have gone soft and need to revert to a disciplined framework with the bolshy unionism removed. As Purpleline notes the idea of a calling for all these services is long gone. This was made crystal clear to me when I had to go to A&E and found not nurses who nurse but bolshy bureaucrats and jobsworths instead. Far more aware of what they don't have to do than what they should be doing and treating patients like irritating distractions from their main occupation of filling in forms and gossiping about X-Factor. Florence Nightingale must be spinning.
michael
November 28th, 2011 10:44am Report this commentCant force Sunday working ...wanna stop Labour' laws killing in hospital?- Cow tow to the unions.
-Or change the law.
M. Rowley
November 28th, 2011 11:21am Report this commentNo, no, no. This surely cannot be right. The BBC and our political elite are always reminding us that 'the NHS is the envy of the world' and that our system of healthcare is second to none. Remember how that nasty Daniel Hannan was cut down to size by David Cameron for suggesting that the USA would be mad to adopt an NHS of its own. Can't you poor deluded fools see that this report from Dr. Foster, whoever he is, is just a vicious right-wing slur on our beloved health service.
Magnolia
November 28th, 2011 11:23am Report this commentIt's pretty well known that all the money has been diverted into elective care under labour's target driven NHS.
The Royal College of Surgeons recently spoke out against lack of funds for emergency out of hours care.
We all know that emergency cases are made to wait for sometimes over a day while operating theatres get clear of elective cases.
I've lost count of the number of kids that have had burst appendices because they've been put into bed at night with antibiotics to wait for an experienced surgeon to operate in the morning.
The changes to medical training have resulted in less experienced junior doctors.
No great wiz doc would choose to work in East Yorkshire.
The problems with quality of care at Scarborough started when the private hospital closed down there.
I wonder how many experienced and senior staff with valuable skills suddenly went looking for new jobs?
In2minds
November 28th, 2011 11:45am Report this commentSeveral people above have mentioned the weekend drunks. I have a young relative who works in A&E and tells me all about it. Drunks are the problem.
Sir Everard Digby
November 28th, 2011 12:51pm Report this commentEver been on a general ward at the weekend? Lucky to find anyone in the evenings. Visited my mum very late one night - no staff around as all 3 of them had gone to another floor for their mandatory tea break!
Same old NHS. If you find someone who is bothered,the standard of care is quite good; if not,god help you.
Old people seem some way down the list.They cannot often help themselves and us relatives have to cover the slack.
A&E is well staffed by comparison. Just as well as the out of hours provision locally ends at 10.pm,so there is nowhere else to go. A pleasant experience in the evening it is not.
NHS Trusts do not like A&E self admissions as they have to fund the treatment. GP referrals they do not.
Thnaks New Labour for making everything a commodity.
ButcombeMan
November 28th, 2011 12:54pm Report this commentThe real scandal is much deeper than just death rates and staff working hours. It goes to the very heart of asset utilisation in government. A major hospital with all its functioning units from cleaning through diagnostic equipment to operating theatres represents a huge capital investment. It should not be a five day a week operation. iT should never be a five day a week operation.
Michael O'Leary made Ryanair profitable through high utilisation of the capital assets (planes). The big battle for Andrew Lansley is to ensure similar efficiency with health service resources. I see no real sign that this is being grasped or even really understood.
Gerry Robinson spotted much the same thing in his TV programmes. Operating theatres closed on Friday afternoons.
starfish
November 28th, 2011 1:19pm Report this commentI regard these reports with extreme suspicion
Is this 'jump' statistically significant?
As strapworld says, what is the local population demographic?
Are the people being admitted comparable - are those apparently dying at weekends actually in a worse state than those in the week?
My experience of the NHS is that their staff always seem to be on some sort of shift turnover - at all times of the week
Are the rosters for the various places compaarable?
Lazy journalism
TomTom
November 28th, 2011 1:54pm Report this commentProbably a London problem. We have one hospital for 550,000 so London really should manage with 16 instead of 75
Dennis Churchill
November 28th, 2011 3:29pm Report this commentM. Rowley
November 28th, 2011 11:21am
I agree this Sacred Cow status of the NHS is forcing us to put up with third world standards.
Just how much real support is there for a Free At The Point Of Use service as opposed to a mixed insurance based model?
It has become an international health service both in its staffing and patients but only UK taxpayers fund it. We now hear people are employing private nurses to care for their relatives who are in NHS wards to prevent them being left without food water or basic nursing care.
Like a lot of the worst aspects of modern life a vocal and politically dominant minority seem able to stifle any real debate.
Roger Taylor
November 28th, 2011 7:12pm Report this commentRe: TomTom and Starfish's comments, Dr Foster have always and continue to calculate adjusted mortality rates that take account of the local population. The statistical differences are significant. Full details on all of this is in the report and the methodology both of which can be downloaded from www.drfosterhealth.co.uk along with the data.
utternutter
January 29th, 2012 6:07pm Report this commentYes, more supposedly neutral reports from Dr Foster. After all it's just data and statistics never lie. Yes there are NHS assets lying unused during evenings and weekends. Regrettably the NHS does not have the staff to run as it does during weekdays for 24/7. This is nothing to do with consultants on the golf course or at their private clinics but mainly about how budgets are settled at national level. Of course there is room for better use of resources but do not kid yourself that we have a 3rd world health system; the OECD reports that we have just about the most efficient and effective health system in the world. Try living in the US where the biggest cause of personal bankruptcy is inability to pay medical bills (health insurance not withstanding)and where 45 million uninsured people get a barely adequate safety net service ie they can go to the Emergency Room for urgent care(A&E in the UK). That's where we are headed if this health & social care bill gets onto the statute books and believe you me deaths will go up not down.
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