18.11.13
Major new report backs seven day services in hospitals
Seven day services would create a “transformational shift in the way the NHS delivers medical care” according to a major new report by the Academy of Medical Royal Colleges (AoMRC).
The report says hospitals need to move to seven days services where patients in hospital over a weekend or bank holiday would get a daily care review led by a consultant.
Weekend patient reviews would often allow earlier discharge, freeing up beds for new admissions, as long as strong links between hospitals and community care are in place.
The AoMRC report, ‘Seven Day Consultant Present Care: Implementation Considerations’, comes after the BMA softened its stance on seven day hospital care, although it still believes there is a lack of resources for elective and routine services on evenings and at weekends.
Achieving seven day services will need more consultant appointments and a “reorganisation” of the current workforce, the AoMRC says, plus more integration of primary and social care.
It suggests seven day working would require more funding initially, but suggests it could save money in the long run through re-organising services and reducing morbidity.
The report also finds that:
- The majority of specialties surveyed in the report indicated the need for diagnostic radiology services including ultrasound, CT, MRI and access to an expert radiology opinion.
- Support services such as physiotherapy, occupational therapy, pharmacy, dietetics, specialist nursing, operation theatres, administrative and clerical support are also key to provide care over seven days.
- Currently, 11% of people occupying hospital beds do not have an on-going serious medical problem; their discharge is delayed by non-medical factors. The report states that early weekday engagement and advance discharge planning between hospital and community based staff would increase the ability to transfer care from the hospital at the weekend.
Professor Norman Williams, steering group chair and President of the Royal College of Surgeons, said: “It is not acceptable that over weekends and bank holidays, patients receive a lower standard of care than they would during the week.
“Using the findings of this report, we must work together to re-shape hospital services in a way that strengthens the quality of care given to patients regardless of when they are admitted. Ensuring that key staff and facilities are available to provide this support will come at a cost. However this is crucial for the full benefit of seven day consultant-led care to be realised.”
AoMRC chair Professor Terence Stephenson added: “Across the UK, there are already instances where successful seven day working has been introduced and we must learn from these examples.
“The Academy recognises that such recommendations will not be easy to achieve without significant reconfiguration at a time when NHS budgets are already stretched. What is important to remember is that in some cases money will be saved, as patients will improve more quickly and not face delays in receiving appropriate care over the weekend. The Academy is part of the NHS Seven Day Services Forum and is pleased to see the importance seven day service delivery is being given.”
NHS Employers chief executive Dean Royles talked of a “growing consensus” on seven day care, adding: “This gives greater impetus and urgency to the negotiations currently taking place about doctors’ terms and conditions of employment.
“The BMA recently confirmed their support for seven day care and that’s great. But while doctors highlight the complexity of introducing seven day care, employers believe there’s a simple message that must get through if we are to move from discussion to implementation – we need to change the elements in the doctors' terms and conditions that are getting in the way of progress. This includes changes to the veto consultants have regarding when they work, to bring them in line with other staff.
“Employers also want to see pay progression for our consultants linked more closely to local needs – just like we have for other staff. And we need to extend plain time working to facilitate seven day care.
“Other staff like nurses, support staff, cleaners and other health professionals have already accepted the importance of changes to terms and conditions of employment and we need consultants to accept that too. It’s not complex, it’s not hard, but it is urgent and NHS patients need it to happen. This is a good time for doctors to show leadership in the cause of patient safety every day of the week.”
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