Patients need safe care 24 hours a day, seven days a week: Fire services do not operate with slimmed down crews on Saturdays and Sundays, so why should hospitals?
Two stories. First, a man suffers a ruptured aortic aneurysm. This is when a major blood vessel in your body bursts and starts bleeding. It happens to about 5,000 people a year in England. Most of them die. But, for those who get to a hospital in time, there is a 50:50 chance of surviving. Well, usually that is true. It rather depends on what time all this happens: if it's at 7pm on a Saturday, the odds are rather worse.
Treating a ruptured aneurysm is complex, and time is of the essence. If you are lucky enough to turn up at a hospital that has nursing staff who are familiar with the situation and a surgeon who performs the operation frequently, your chances are higher. But, on a Saturday evening, what are the odds of that?
The second story. A patient in the terminal stages of cancer is discharged from hospital because he wishes to die at home. Community nursing care has been arranged to support him and his family. His wife wakes up on Sunday morning to find her husband in a coma. She calls the community nurse but gets an answer machine. In a panic, she calls an ambulance. The patient is taken to hospital, but there is nothing that can be done. He dies later that day on a hospital ward in circumstances very different to those he had hoped for.
Figures produced by Dr Foster show how the death rate in hospital at weekends is higher than on weekdays. But the level of increase varies considerably by diagnosis. The differences between diagnoses reveal some of the underlying issues that cause this phenomenon.
There has been much debate about the reasons for high weekend mortality rates in hospitals as evidence of the problem has accumulated. In some cases, it is due to lack of care in the hospital. In others, it is due to lack of care outside the hospital. But, in almost all cases, it is down to the fact that our health services do not work as a 24/7 operation.
There is no really good reason for this. Fire services do not operate with slimmed down crews on Saturdays and Sundays. Why should hospitals?
The challenge of providing safe services 24/7 is made harder at a time when demand is rising and NHS budgets are being kept flat. Improving services in every hospital is not a financially viable option. However, reorganising services is equally difficult because the public are very reluctant to give the NHS permission to change things.
We have seen this recently in a number of fierce public battles. An example was the fight earlier this year over keeping Pontefract A&E open overnight. Pontefract is a town in West Yorkshire with a population of 28,000. That makes it about the same size as Trowbridge in Wiltshire or Spalding in Lincolnshire. Unlike these other towns, through historical accident, Pontefract has its own hospital, with its own accident and emergency department.
In September 2011, the NHS announced that the A&E would cease to open overnight because the hospital did not have the necessary medical staff to provide cover. The decision produced uproar. Yvette Cooper, the shadow home secretary and local Labour MP, weighed in behind the campaign to keep the A&E open 24 hours a day. There were calls for army medics to be brought in to save the day. In January, the chief executive of the trust resigned. Two months later, the chairman left. Finally, in October 2012, the trust announced it would re-open the A&E 24 hours a day.
Pontefract is 10 miles – or a 15-minute drive – from Pinderfields general, a large hospital with a fully staffed A&E open 24 hours a day. Pontefract A&E sees on average about 15 patients per night, most of whom are not seriously ill.
Keeping this unit operating 24 hours a day makes no sense. The cost of it directly reduces the ability of the local NHS to find resources to look after seriously ill patients. Pontefract will never be able to provide the level of service that people would get from a larger hospital.
The problem is that the people of Pontefract, like most people, are sceptical that a reduction in their local services will result in money being used to provide enhanced services elsewhere that they can benefit from. A commitment to providing safe care 24 hours a day, seven days a week – both in and out of hospital – would give people confidence that reorganisation of services is a necessary process and one that will directly benefit all of us. Roger Taylor is co-founder and director of research at Dr Foster Intelligence.Guardian Professional.
See also: Weekend admissions more likely to be fatal for stroke and kidney patients
Two stories. First, a man suffers a ruptured aortic aneurysm. This is when a major blood vessel in your body bursts and starts bleeding. It happens to about 5,000 people a year in England. Most of them die. But, for those who get to a hospital in time, there is a 50:50 chance of surviving. Well, usually that is true. It rather depends on what time all this happens: if it's at 7pm on a Saturday, the odds are rather worse.
Treating a ruptured aneurysm is complex, and time is of the essence. If you are lucky enough to turn up at a hospital that has nursing staff who are familiar with the situation and a surgeon who performs the operation frequently, your chances are higher. But, on a Saturday evening, what are the odds of that?
The second story. A patient in the terminal stages of cancer is discharged from hospital because he wishes to die at home. Community nursing care has been arranged to support him and his family. His wife wakes up on Sunday morning to find her husband in a coma. She calls the community nurse but gets an answer machine. In a panic, she calls an ambulance. The patient is taken to hospital, but there is nothing that can be done. He dies later that day on a hospital ward in circumstances very different to those he had hoped for.
Figures produced by Dr Foster show how the death rate in hospital at weekends is higher than on weekdays. But the level of increase varies considerably by diagnosis. The differences between diagnoses reveal some of the underlying issues that cause this phenomenon.
There has been much debate about the reasons for high weekend mortality rates in hospitals as evidence of the problem has accumulated. In some cases, it is due to lack of care in the hospital. In others, it is due to lack of care outside the hospital. But, in almost all cases, it is down to the fact that our health services do not work as a 24/7 operation.
There is no really good reason for this. Fire services do not operate with slimmed down crews on Saturdays and Sundays. Why should hospitals?
The challenge of providing safe services 24/7 is made harder at a time when demand is rising and NHS budgets are being kept flat. Improving services in every hospital is not a financially viable option. However, reorganising services is equally difficult because the public are very reluctant to give the NHS permission to change things.
We have seen this recently in a number of fierce public battles. An example was the fight earlier this year over keeping Pontefract A&E open overnight. Pontefract is a town in West Yorkshire with a population of 28,000. That makes it about the same size as Trowbridge in Wiltshire or Spalding in Lincolnshire. Unlike these other towns, through historical accident, Pontefract has its own hospital, with its own accident and emergency department.
In September 2011, the NHS announced that the A&E would cease to open overnight because the hospital did not have the necessary medical staff to provide cover. The decision produced uproar. Yvette Cooper, the shadow home secretary and local Labour MP, weighed in behind the campaign to keep the A&E open 24 hours a day. There were calls for army medics to be brought in to save the day. In January, the chief executive of the trust resigned. Two months later, the chairman left. Finally, in October 2012, the trust announced it would re-open the A&E 24 hours a day.
Pontefract is 10 miles – or a 15-minute drive – from Pinderfields general, a large hospital with a fully staffed A&E open 24 hours a day. Pontefract A&E sees on average about 15 patients per night, most of whom are not seriously ill.
Keeping this unit operating 24 hours a day makes no sense. The cost of it directly reduces the ability of the local NHS to find resources to look after seriously ill patients. Pontefract will never be able to provide the level of service that people would get from a larger hospital.
The problem is that the people of Pontefract, like most people, are sceptical that a reduction in their local services will result in money being used to provide enhanced services elsewhere that they can benefit from. A commitment to providing safe care 24 hours a day, seven days a week – both in and out of hospital – would give people confidence that reorganisation of services is a necessary process and one that will directly benefit all of us. Roger Taylor is co-founder and director of research at Dr Foster Intelligence.Guardian Professional.
See also: Weekend admissions more likely to be fatal for stroke and kidney patients
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