Seven-day NHS could lead to changes in care standards

Seven-day NHS could lead to changes in care standards Reorgansied health services might mean better specialist care.

Professor Norman Williams is leading efforts by the Academy of Medical Royal Colleges to reorganise the NHS and create a "seven-day health service". Such reorganisation is essential if we are to achieve the highest possible standards in care at the point of delivery.

While the public may want their local hospital to be open 24 hours a day and be a 15 minute drive from their own door, they need to understand that services organised on that basis cannot provide the highest quality of care at every local hospital. Williams is arguing that a reorganisation of services could provide a more consistent, higher standard of care to all.

The hospitals in question are those currently regarded as providing lower standards of 24 hour care. There has been debate as to whether a risk of death at the weekend is significantly higher than on weekdays for some hospital procedures. However the difference needs to be understood between care standards which are lower than those available elsewhere in specialist centres, but still acceptable, and a negligent service.

Treatment provided is deemed legally negligent if it does not reach the standard of care considered 'proper' by a responsible body of relevant clinicians at the time. What is considered appropriate is determined by the circumstances in which care is provided. Medical care is a rapidly changing environment. Treatment considered acceptable 20, or even 10 years ago may be negligent by today's standards.

In circumstances where a local hospital receives a patient suffering a heart attack, the hospital's failure to provide treatment with the latest technology available is not negligent if a responsible body of A&E consultants agree that the treatment was 'proper' in that context. That may include the need to stabilise the patient and arrange a timely transfer for more specialist care. The legal test is not a question of what the best hospital in the country could feasibly have done.

If Williams' vision is realised and NHS services are reorganised, patients suffering a suspected heart attack would only be taken to an emergency department which specialises in treating heart attacks. This may involve a longer journey but increase the prospects for successful treatment.

As a result, definitions of 'proper' and negligent will change. In the meantime, it is accepted that many hospitals have to provide the best treatment they can without access to the specialist knowledge and equipment which may be available elsewhere.

Such treatment is not automatically negligent simply because it is not the very best that is possible.

The NHS needs to be transparent with the public about the improvements that can be achieved by reorganising service provision.

In turn, the public needs to decide what it wants. We cannot realistically expect our local hospital to have a specialist unit for all the many possible ailments brought to its door. Do we want the best care or the just the care that can be made available in the shortest distance?

The impetus is there to raise standards within the NHS; there remain a range of services provided in different care settings throughout the NHS which do not reach the ideal standard that the NHS and Williams aspire to. They are, however, far from negligent. Tony Yeaman is head of healthcare at law firm Weightmans LLP Guardian Professional.