Time to end that Monday feeling
Posted on 21 January 2013 by Patrick Cadigan
‘I am relieved on Monday that nothing catastrophic has happened at the weekend…’
Most members of the public would be shocked by this quote from a consultant physician working in a busy district general hospital. The RCP (Royal College of Physicians) recorded it while gathering evidence for our Hospitals on the Edge? document , and it powerfully underlines the need to move to a consistent seven-day working pattern for acute services.
Physicians, on the other hand, would not be surprised at all, and recognise this as a fair description of how care varies when traditional working patterns continue.
The RCP made its first statement on seven-day services in 2010. Since then, the Academy of Medical Royal Colleges and NHS medical director professor Sir Bruce Keogh have also called for equality of care ‘out of hours’.
Some of these calls have been for the provision of more elective services at the weekend, on the ‘John Lewis is open on Sundays’ model. But if choices have to be made, the priority is clear.
We must first correct the fatal disparity in acute service provision that has led to increases in mortality at weekends, and to do that we might need to reconfigure.
One of the problems with reconfiguration is the term itself, which seems to have become inextricably linked to a scenario of closure due to cuts. We need to find a word that captures the concept of change for clinical benefit, and which recognises that this is not just about buildings but involves many areas of the way we provide services. (‘Transformation’ is a candidate, but other suggestions would be gratefully received.)
To achieve high-quality, seven-day acute services, we will need to reconfigure in a number of ways that are unrelated to buildings and locations.
There will certainly need to be a cultural change about the weekend being a time for rest. New contracts and terms and conditions might have to be devised, and new flexible ways of working involving skill shifting might have to be considered. Smaller units will struggle to fully populate rotas, and will need to consider network and telemedicine arrangements. And all of this is likely to be difficult practically and politically.
But we should surely support change that will benefit patients, even if it is politically difficult. Loyalty to local institutions is admirable and understandable, and has financed many CT scanners but should not be allowed to trump high-quality care.
Professional bodies, hospital trusts and politicians will all need to show courageous leadership if positive change is to occur. The RCP’s current contribution is the Future Hospital Commission, which has been asked to review the way that the skills of physicians are deployed in hospital and the community.
Patrick Cadigan is Royal College of Physicians registrar
royal college of physicians of london