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Strong association between weekend hospital deaths and consultants not working weekends

View profile for Judith Thomas-Whittingham
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Studies have shown that the chance of dying in hospital is between 10 and 14 per cent higher if admitted as an emergency at the weekend, rather than during the week.

Why is this?

According to a report published last week by the Royal College of Physicians (RCP) and the Society for Acute Medicine, there is at least an association between these statistics and consultants sometimes being ‘reluctant’ to work weekends.

Dr Chris Roseveare, president of the Society for Acute Medicine told the Telegraph how important consultant involvement is. He said: “Clearly, when you go to hospital as an emergency you are vulnerable.  You need to be cared for by someone with the skills to deal with the acute problem. Consultants have those skills”.

The report will put pressure on hospitals to achieve what they call the ‘gold standard’ in their acute assessment units, those being the wards for medical and emergency patients who have been referred by their GP or A&E to undergo further assessment and where admission usually does not extend beyond 48 hours.

The gold standard would be achieved if there was a consultant on these wards for 12 hours a day, 7 days a week. Currently only 4 in 10 hospitals meet the gold standard.

The commonplace position in most hospitals is that all departments, except for A&E and intensive care, rely on consultants being on call.  This mean means they give advice over the telephone and only come into hospital in emergencies.

The report advises that hospitals will need to switch more consultants from weekday to weekend rotas and where that is not enough, they will have to employ more of the senior doctors. 

Of course the benefit of a seven-day-week would be to the patient’s health, as Sir Bruce Keogh, the NHS medical director, commented on consultants being present on hospital wards. He said: “It will mean better support for junior doctors and key decisions - like what tests to run, what treatment to give and whether to operate - can be made more quickly."

Even if we accept the view of Dr Mark Temple (from the RCP), that consultant-led care is “key” to delivering the highest quality care, there still remains the time old obstacle of money.

Earlier this year Dr Mark Porter, now chairman of the British Medical Association, said a seven-day-a-week NHS was “unaffordable.”

Dr Paul Flynn, chairman of the BMA’s consultants’ committee, said it was unrealistic to expect all NHS hospitals to move to seven-day consultant-led acute care immediately, as the doctors did not exist. The change could take years.

Whether it’s the consultants not wanting to work weekends, a shortage of consultants or a lack of funding, it seems that the gold standard will remain for some time, beyond the grasp of the NHS.

By Charlotte Goonan

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