7-day services: trying to make sense of all the noise
1 October 2015
A crucial campaign promise. An unachievable dream. A necessary step towards 21st century healthcare. The proposed policy of ‘7-day health services’ has been called many things by many people, but the recent appearance of Secretary of State for Health Jeremy Hunt before the Health Committee revealed just how much uncertainty persists in this debate. Many, including the Ministers who questioned Hunt, still wonder what the policy entails, what it will cost and if it is even necessary.
Do we already have 7 day services?
According to the Chief of the British Medical Association (BMA) Dr. Mark Porter, “We already know nine in 10 consultants work evenings and weekends for the NHS and that over 60% of GPs regularly work outside of their normal hours”. Figures also reportedly reveal only 1 in 1000 doctors are opting out of work and only 27 of 26,000 consultants have excused themselves from non-emergency weekend work. But how do we square these statistics with figures that show consultant cover at the weekend falls five-fold? Or that there are half as many consultants in A&E at the weekend? Or that the rise in risk of death rises by 10% for admissions on a Saturday and 15% on a Sunday? Or that almost half of patients said they could not see a GP in the evenings or at weekends? While the need to improve the NHS is undeniable, it is unclear what 7-day services will entail and whether it will be effective.
More of everything
Hunt explained to the Health Committee that 7-day services means, on the one hand, every practice offers its patients the opportunity to have routine appointments, eight till eight and at the weekend. But rather than every GP service open for these extended hours, he clarified that such appointments could be shared between practices and include telephone or skype calls, in order to reflect local demand. On the other hand, the government wants hospitals to provide a high standard of care every day of the week. Hunt admitted that this would ‘probably’ involve more staff beyond just doctors and nurses in order to provide more surgeries and diagnostic services. He also admitted that while there will be an upfront cost in the hundreds of millions, the government expects to recoup much of these costs as a result of efficiencies.
Are 7-day services really feasible?
This crucial question persists largely because the government has not detailed in full what this new policy will entail. Hunt recently highlighted a few details, including the forthcoming £750 million of capital funding to modernise general practice, plans to train more nurses and cancer consultants in pursuit of cancer diagnosis goals and the possibility of a central technology fund. But we will have to wait for the 7-day Hospital Care plan as well as the Avoidable Deaths report to find out more concrete details. In the meantime, Mark Porter insists that "doing more without extra staff or investment means something has to give…which could mean ‘scaling back’ week day services and relying on dangerously overworked medics". Rather than a culture of laziness, he insists that "there are fewer staff on weekends because the government does not provide the workforce, resources or infrastructure to maintain the level of service".
Some problems cannot be denied
While the particular details of 7-day services will continue to spark debate, there are undeniable challenges that do require an imminent response. Firstly, according to NHS Medical Director Bruce Keogh, it is abundantly clear that hospitals are not as well-equipped at the weekend to deal with very sick patients. He added that the idea patients are being harmed because of the way we organise our services is unacceptable. Secondly, many including NHS Chief Executive Simon Stevens condemn the confusing array or ‘alphabet soup’ of health services available outside of regular general practice hours. Stevens has said that we also need to look at the way we organise our services because the working poor suffer if they cannot get appointments outside working hours. Thus tackling the organisation of services is necessary as a means of tackling health inequality. The question is whether 7-day services are the best way to address health inequality and whether the government can afford to provide them.