The trouble with the NHS’s working week

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.