Costs of being ever ready
Posted on 7 January 2013 by Shree Datta
NHS medical director Professor Sir Bruce Keogh wants 24/7 healthcare to meet the needs of patients in our ‘increasingly consumer-based society’.
His aim is to ensure more hospital services are available all day, every day and he believes the NHS has much to learn from private sector companies such as Tesco.
There is no doubt that we should strive to improve the service we offer patients at all times, let alone at evenings and weekends. The evidence suggests that patients don’t do as well if admitted as emergencies out-of-hours. And there is an emerging consensus that patient outcomes are improved by ensuring senior doctors are available in hospital for patients who are in the greatest need.
A quick glance at the newspapers suggests the solution is simple. The Daily Mail reported 'NHS doctors to be forced to work weekends for the first time in push for improved seven-day a week care'. The problem is, this plan assumes consultants do not currently work evenings or weekends.
I’m a newly qualified consultant obstetrician and gynaecologist, and my daytime schedule is pretty full, doing the things you would expect a consultant in my specialty to be doing. My time is split between covering clinics for scans, ward rounds, colposcopy, team meetings, teaching and time in theatre.
On top of the daytime work, I am on call every other Wednesday between 5pm and 8.30am and do regular on-call work at the weekend. This means that after leaving the hospital at 8pm, like my colleagues, I can get called in to work overnight on the wards, before resuming my day duties the next day.
Although, like me, many consultants already do evening and weekend work, to staff hospitals with senior doctors 24/7 will require a massive expansion in consultant numbers. This is not something that can happen overnight. And a drive to increase the hours that consultants are required to work at weekends and evenings will have an impact on the service on weekdays — we will need time off in the week to rest.
Providing better care out-of-hours must be a priority. But promising 24/7 healthcare in the current economic climate seems at best overly ambitious and at worst doomed to failure. Instead of looking to mimic Tesco (who have to close on Sunday evenings, not to mention Christmas), we should focus on ensuring services are properly staffed and appropriately organised to meet the needs of patients — whenever they happen to be in hospital.
Shree Datta is member of BMA Council
NHS system reform
hours of work
on call rotas
out of hours services