21.11.16
Implementing seven-day NHS should be a local decision, argues NHS Confed
Local areas should be free to choose whether to implement the seven-day health service, NHS Confederation has said in a new briefing paper.
The paper, ‘Commissioning and delivering enhanced seven-day NHS services’, explained: “In some instances, local factors such as demography, local health profiles and geography may mean that it is not appropriate or effective to commission and deliver particular services across seven days, however it is important that this decision is taken by local decision-makers.”
The seven-day NHS is a flagship government policy, but implementing it has proved controversial. The government’s efforts to introduce it, matched with new contracts, led to an unprecedented series of junior doctors’ strikes earlier this year.
The NHS Confed paper also noted that introducing a seven-day NHS must be “seen as a whole-system issue”, including primary care, acute care, social care, pharmacies, mental health and community services.
It recommended using the “potentially unique opportunity” of the STPs to deliver integrated care and consider what is needed in terms of care provision at different times of the week, and prioritising giving people care close to home whenever possible.
NHS organisations should also stress that they will use seven-day services to improve “outcomes for patients”, not patient convenience, the report added.
For example, it said that for mental health services, this might mean being able to deliver round-the-clock crisis care, but not talking therapies out of business hours.
There is mixed evidence to support the government’s claims that the seven-day NHS is needed to reduce high patient mortality rates at the weekend.
The first NHS Digital report into seven-day services found that over 50% of trusts have significantly higher weekend mortality rates, but a separate study from the University of Manchester’s Health Economics Centre found that this could be because more serious cases are admitted at weekends.
Today’s briefing paper called for greater clarity about the cost of health and care services, and the availability of transformation funding, in order to deliver the seven-day NHS.
In particular, it asked for the review of NHS payments to be completed urgently, and for a solution to the social care funding shortage.
NHS Confederation’s other requirements for delivering the seven-day NHS included clarity from NHS England on national standards for urgent and emergency care, which would allow local areas the freedom to decide how they are met; and an approach to inspection and regulation from NHS Improvement and the CQC that is focused on the outcomes of whole systems, instead of individual organisations.
According to papers leaked in August, the Department of Health has listed 13 risk factors for the seven-day NHS, including ‘workforce overload’ and a lack of robust plans.
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