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BMA rejects argument for seven-day routine care in hospitals

Debate over NHS offering all services at weekends

Adrian O'Dowd

Monday, 25 February 2013

The BMA has rejected the idea of the NHS offering all routine services seven days a week as unworkable, expensive and unrealistic, in a debate published in the BMJ.

In the experts’ debate, the question of whether or not the NHS should operate and provide all routine services seven days a week was posed.

Currently, the NHS only offers essential emergency care at weekends, but there have been reports that patients are more likely to die if admitted to hospital on Saturday or Sunday, prompting calls for greater consultant presence at the weekend.

England’s NHS medical director, Sir Bruce Keogh, arguing for extending the service said this would “offer the opportunity to improve clinical outcomes with the added benefit of a much more patient focused service”.

“The clinical, compassionate, and patient convenience arguments in favour of change are compelling”.

Professor Keogh acknowledged that there would be difficult problems to solve, not least around the economics, but he believed it was right to try “because it would enable us to be truly patient centred for the whole of the week, rather than two thirds of it, and we could improve access, shorten diagnostic response times, shorten hospital stay, and improve training.”

Progress towards this goal would depend, he argued, on improvements in primary and social care services at weekends as well as dealing with workforce planning issues.

Many doctors were concerned the NHS was being commercialised and their professional values and commitment devalued, he said, adding: “This should not detract from the recognition that healthcare is a seven day commitment, and this is something doctors feel, believe, and understand”.

The NHS Commissioning Board was planning to look at this matter in detail, he added.

However, Paul Flynn, chairman of the BMA consultants committee and a consultant obstetrician and gynaecologist, arguing against the proposal, said there was little justification for elective care at weekends.

From his own working experience, Dr Flynn disagreed that elective care over seven days was necessary to bring down waiting times or that the public expected it, saying: “It flies in the face of all logic to reward a system that is not using its existing resources to best effect over five days by giving it the opportunity to mismanage them over seven.

“It is time the NHS listened to the doctors who can tell it how to solve these problems and stopped just throwing a longer working week at it.”

Dr Flynn asked who would pay for routine services to be offered every day, given the “dire financial positions” of many NHS providers.

“It is inconceivable that they will be able to staff operating theatres and clinics seven days a week, let alone provide all the other resources that this activity will consume,” he said.

“I and my colleagues will always be willing to be there when patients need us, but we cannot be expected to have the same sense of commitment to addressing either management inadequacy or a small measure of public inconvenience.”

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