Professor Keith Willett, NHS England’s Director for Acute Episodes of Care, and who is also leading Professor Sir Bruce Keogh’s Urgent and Emergency Care Review, explains how and why 7-Day Services could be made to work across the NHS.
Having introduced 24/7 services with resident consultants while heading the John Radcliffe orthopaedic trauma clinic at Oxford, I have lived seven-day services for almost twenty years. I know it works.
It works from many angles: increasing early senior involvement improves decision-making which results in better care and resource use; patients and carers are reassured and there is less changing direction – a better healthcare experience. Junior medical and nursing staff are better supported and the opportunities for training increase. It also works for patient safety
We also showed in Oxford in 1994 how a seven day service could be highly efficient and cost effective. We reduced admissions and shortened length of stay– and we did it in a hospital that wasn’t really otherwise offering full seven day services.
We found that we were able to close down the number of beds – in fact it was reduced by 25 per cent – and that meant we released nursing costs, with that money going into the extra physiotherapy support we needed at weekends.
What the change did was to highlight the restrictions created by support services that weren’t offering equivalent a seven days service. If the diagnostics service – for example, scanning, pacemaker checks etcetera – aren’t there the patient simply has to wait until Monday or possibly even longer.
For the seven-day model to work well it has to involve all the professional groups – ranging from those in the Emergency Department, in-patient consultants, to allied health, diagnostics and scientists.
If it could be done in Oxford 20 years ago, it should be possible anywhere in 2013 … It is all about matching the allocation of human resource to the workload.
We did this by holding clinics on Saturdays and Sundays, as well as running similar numbers of urgent operating lists.
People always assume that for the staff it means doing more hours – but it doesn’t. And we found that from the family point of view, it made life better not worse. Being on call over a weekend can make consultants domestically “unpredictable”. They are waiting for the call that may never come, or working flat out, either way for those involved it’s disruptive and perhaps better to know for sure which weekdays or weekends days you are committed.
If you are working to a seven-day system, you are either on duty to work, or you are not. It is not like you are working more days – just different days.
We had an occupational psychologist interview staff and partners before and after the introduction of the Oxford model and what partners reported was of interest too. It was reported that Consultants thought it was important they were able to pick up their young children from school; something most consultants don’t do regularly until they have grandchildren and retire!
We know that seven day services are right for the patients who need urgent care– but they are also right for specialist inpatient services. At the moment we see patients taking up hospital beds at weekends essentially treading water with no progressive treatment or diagnostics and few options to be discharged.
In terms of cost efficiencies in designing seven day services, I believe the planned services must be looked at too – particularly for those specialties with lower demand of emergency work which wouldn’t alone justify senior presence. It may well be better to look at decompressing weekday scheduled clinics, diagnostic and operating lists so consultants are in the hospital and can also ensure decision making and advice continues over weekends, as well as being on site for any emergency cases that may come in.
All consultants recognise there is vulnerability in hospitals over the weekend, and I would challenge any consultant not to have a degree of anxiety if one of their own relatives was admitted to hospital at a weekend knowing the amount of current senior involvement there is.