Higher weekend mortality is not down to Saturday night drunks
Sebastian Payne 5:40pm
You're more likely to die if admitted to hospital during the weekend. It's a shocking
truth, and one that's explored further in the Journal of the Royal Society of Medicine today. Last year,
as Pete blogged at the time, the 2011 Dr Foster Hospital Guide discovered that emergency
patients are 10 per cent more likely to die if admitted at the weekend. Today's report goes further than that, and finds that patients are 16 per cent more likely to die if admitted on a Sunday as
opposed to a weekday — for all admissions, not just emergency.
It's a finding that undermines the idea that the increased mortality rate can be put down to more drunks staggering into A&E at the weekend. In fact, if you compare those 10 and 16 per cent figures, it suggests that emergency wards actually perform less badly than other wards at weekends.
So what's to blame? Today’s report reaches a similar conclusion to Dr Foster: that fluctuating staff levels are the major cause, particularly with consultants and senior staff being only ‘on call’ at weekends. The JRSM also suggests that limited access to diagnostics and a reluctance among patients to admit themselves during the week are contributing to the trend. In any case, this is a scandal that needs addressing — and fast.
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charles hercock 1
February 3rd, 2012 6:10pm Report this commentYes. Senior staff could be available but at the expense of delaying further elective weekday surgery and lengthening waiting lists
A J Wells
February 3rd, 2012 6:21pm Report this commentNo one who has had to go into hospital or take someone else there on a weekend will be in the least surprised to read this. Avoid weekends like the plague!
startledcod
February 3rd, 2012 6:24pm Report this commentWhat, reform the system so it is no longer in the producer interest? Outrageous suggestion.
Mark M
February 3rd, 2012 6:45pm Report this commentIsn't it amazing? I can go in Tesco at 11pm on a Saturday night and am able to buy pretty much exactly the same stuff as I could on a Wednesday at noon.
The NHS is a national disgrace. Yes, people will always have stories of 'the NHS saved my grandad' but guess what, that's what a health service is meant to do. There are just as many stories of 'the NHS ignored my grandad while he slept in his own excrement', which I'm pretty sure a health service is not meant to do.
El Sid
February 3rd, 2012 7:14pm Report this comment"a reluctance among patients to admit themselves during the week"
Actually I suspect the effect works the other way. Doctors will tend not to send patients to hospital on a Sunday unless it's really serious, the more routine stuff can wait until Monday. So the average Sunday patient is in worse condition than the average Monday patient. This kind of statistic is meaningless without controlling for the severity of the incidents. While you can imagine that the absence of senior staff and lab support would make a difference to outcomes, I'm not convinced we have evidence of that based on these stats. I'd also suggest that you'll probably see more of a "wait until Monday" effect on Sunday than Saturday, so the average for the weekend will be less severe than Sunday alone. Oh look, that's what we see (10% vs 16%).
El Sid
February 3rd, 2012 7:14pm Report this commentOn the other hand, anything is possible if you pay the right people appropriately. But we're broke, so true 24/7 just ain't going to happen. Deal with it.
Magnolia
February 3rd, 2012 7:45pm Report this commentLess experienced Senior Registrars nowadays due to run-through-training and the EU working time directive.
The new hospital consultant contract was brought in to stop doctors from sloping off to play golf and a job plan was introduced. The only problem was that the doctors gave up all their free overtime and worked to their plan. Job plans are less likely to include week end days because they will cost more.
All changes brought in under labour.
Medical studentas are now 70% women so that tells us something about the high regard in which a career in the NHS is viewed.
Of course Andrew Landsley can change all of this. I wonder if he's got enough goodwill and reciprocated admiration with the medical profession left over from his NHS reforms to crack on with these entrenched problems?
roman lee
February 3rd, 2012 9:23pm Report this commentEl Sid
How nice of you to come up with plenty of reasons as to why it is the fault the sick and lame, absolutely nothing to do with the lazy who work there.
William Blakes Ghost
February 3rd, 2012 9:55pm Report this commentSo its a 'scandal' for people to have the weekend off is it? Well before we get all hysterical about forcing all levels of medical staff to work at weekends on a full 24x7 rota could someone please give us some sort of cursory estimate as to what it will cost to resolve this issue effectively?
I heard some probably left field rumours that the government has deficit debt and revenue stream problems so lets not make these worse without being sure of outcomes.
Clearly we need to address this issue but lets do it in a measured and sobre manner huh?
stephen bennetts
February 4th, 2012 9:29am Report this commentIf anyone was in any doubt over the need for reform of the NHS,this issue should make them think again. The problem with reform is that there are to may vested interests in the service to allow it to happen, for example consultants would have to give up their private work carried out at weekends.There is no good reason why care in the NHS should not be 24/7 !!!
Tom Pride
February 4th, 2012 9:35am Report this commentWhat amazes me about the NHS is the dichotomy between this story and others (infection deaths, neglect of the elderly, patient malnutrition, East Staffordshire Hospital, Maidstone and Tunbridge Wells NHS Trust) and the “envy of the world” claim by the opponents of any meaningful reform proposals.
Tom Pride
February 4th, 2012 9:35am Report this commentCont. It might be the “envy of the third world” and it certainly seems to attract enough customers from those climes but there does not seem to be a rush to copy this nationalised health format by other advanced and developing nations with functioning health systems. Are the elderly in other countries terrified of going to hospital? I don’t know whether the Coalition’s reforms will be good or bad but it does not surprise me that the producers and usual Statists are so loud in opposition. It makes me inclined to take a punt and support the reforms.
Charlie the Chump
February 4th, 2012 12:15pm Report this commentSo this marvellous free at the point of use system kills old people and people at weekends. And they want to feature it in the Olympic opening ceremony??
David B
February 4th, 2012 12:31pm Report this commentWhat would the response be of the left if this statistic had been found in a privately run institution. The issue is the left are blinded by the NHS to the extent they can see or accept no wrong in it
That is why all change is resisted
Paddy
February 4th, 2012 5:06pm Report this commentThe NHS is there to serve the people who work in it....not the patients.
ButcombeMan
February 4th, 2012 9:03pm Report this commentThe under utilisation of the huge capital resources that our major hospitals represent, is one of the most serious problems that needs tackling in the NHS.
Andrew Lansley has shown little sign that he understands.
Health, like many other public services, policing, emergency services etc, is obviously a 24 by 7 by 365 one might think. Not according to the asset management in most hospital trusts. This occurs because those in most trusts do not run hospitals as businesses. They are intellectually incapable of grasping the concept of return on capital investment through years, even generations of cultural ignorance of efficiency.
In mid week I visited a hospital in one of our major cities, astonishngly busy. Today it was like a morgue. It is always like that at week ends.
Hospitals as capital investments are like aircaft, they need to be kept working (or flying).
Existing methiods of hospital administration have failed to deal with this. Give clinicians more control and it will undoubtedly get worse.
Michale O'Leary makes no money when his planes are on the ground. So is it with any capital intensive equipment or resources.
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