Keogh announces clinical standards for seven-day working

Steps to implement seven-day working across the NHS have been set out by Sir Bruce Keogh, medical director at NHS England. Services would start with urgent care and supporting diagnostics, and roll out over the next three years.

The move follows several pieces of research highlighting the significant variation in outcomes at the weekend, with increased mortality, longer stays and higher readmission rates. Variable staffing levels, fewer senior decision-makers and a lack of diagnostic support services all contribute to this variation in care.

Sir Bruce has set out ten clinical standards to describe the care all patients should be able to expect, any day of the week. The standards include a process for handovers between clinical teams, which diagnostic services should always be available and how quickly hospital patients should be assessed by a consultant.

To deliver seven-day services, he recommends that NHS England should incorporate the standards in hospital contracts with sanctions for non-compliance, should publish information on how the standards are being met, and use the £3.8bn Better Care Fund to drive improvements.

The CQC should consider how to assess implementation of the standards, and NHS England should agree with HEE that education contracts should include consultant availability to provide adequate supervision of doctors in training.

NHS Improving Quality could also introduce a transformational change programme for local commissioners, and pilots should look into improving access to general practice for at least 500,000 people over 2014/15.

Sir Bruce said: “There are encouraging examples for NHS organisations that have moved to making healthcare services more accessible seven days a week to avoid compromising safety and patient experience.

“We need to accelerate the pace and spread of these changes. In doing so, we can ensure the NHS leads the world in providing equality of access to consistent, high quality healthcare, seven days a week.

“There is increasing evidence that mortality rates for patients admitted to hospitals on both sides of the Atlantic are higher at weekend; our junior doctors feel clinically exposed and unsupported at weekends; and hospital chief executives are worried about clinical cover.

“It seems inefficient that in many hospitals expensive diagnostic machines and laboratory equipment are underused at weekends, operating theatres lie fallow and clinics remain empty. This while access to specialist care is dogged by waiting lists and GPs and patients wait for diagnostic results.

“We should also consider whether, in the 21st century, it is still acceptable for the NHS to expect people to always take time off work to access healthcare or to support a relative or friend to do the same? This has an economic impact as well as an impact on patient and family experience.

“This is not just about hospitals but the whole NHS system. One part cannot function efficiently at the weekend if other parts don’t.

“If people are to experience genuine seven-day treatment and care, we must look beyond emergency services and beyond the services offered to hospital inpatients. We need to make similar improvements across primary, community health and social services, removing barriers between organisations.”

Dr Peter Carter, chief executive & general secretary of the Royal College of Nursing said: “The evidence has been increasingly clear for some time that the way parts of the NHS operate at the weekend simply has to change. It can be very worrying for patients and families to see such stark figures, and we want to get to a position where fears around provision at weekends are very much reduced.

“What is required is a whole system change. It is not simply a question of changing the way some consultants work, there is a level of complexity which needs to be addressed, taking in everyone from porters to radiographers to technicians, all of whom provide vital services which help keep patients safe.”

Dean Royles, chief executive of NHS Employers, said: “Seven day working is probably the most important issue facing the NHS at the current time, and movement in this direction is essential if we are to ensure its sustainable long-term future. 

“We are increasingly seeing hospitals and community-based health services develop innovative services that anticipate and respond to patient needs, but all too often NHS employers find the terms and conditions of doctors are getting in the way of progress.

“We are now facing a once in a generation opportunity to change how the NHS works. Patients, employers, medical royal colleges and the government all want to see seven day care. I hope this report will help accelerate progress and we make the ambition a reality.”

Dr Alistair Douglas, SAM president said: “Providing seven-day services across the hospital and community will require a major culture change. Delivering this will be a huge challenge, which should not be underestimated. Staff working in acute areas are already under enormous pressure which is reflected in recent difficulties with recruitment in some parts of the UK.

“Continued investment will be needed to ensure sustainable long-term working patterns and attract the best staff to deliver high quality care at the weekends without sacrificing weekday services or continuity of patient care.”

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