DON’T BE ILL AT THE WEEKEND
Patient safety fears as NHS staffing plunges on Saturday and Sunday
FEARS have been raised for patient safety and care after it emerged hospital staffing levels plummet at weekends.
An investigation into acute medical units – which assess and treat urgent and emergency patients – found far fewer doctors and consultants are on duty on Saturdays and Sundays.
The study has sparked concerns that the so-called ‘weekend effect’ of reduced services could compromise patient care.
A total of 29 acute medical units were assessed for the research, which was commissioned by the Royal College of Physicians of Edinburgh (RCPE) and the Scottish Government.
The authors warn that their findings have ‘potential implications for patient outcomes and quality of care’.
Last night, critics called for the NHS to become a truly ‘seven days a week operation’ – and said it was ‘completely wrong that a patient’s chances of recovery should depend on what day they happen to fall ill’.
But there are concerns about how hospitals can achieve better weekend cover given current staffing shortages.
The acute medical units investigated are a major part of the hospital system.
They receive patients from A&E departments or GP referrals for urgent examination and treatment before they are admitted to other wards or sent home.
The study found the number of consultants on duty at weekends was two-thirds
that of Mondays to Fridays. The number of non-consultant doctors working at weekends was only 70 per cent of the level on duty during the week.
For therapy staff, levels fell to 13 per cent at weekends – for pharmacists 2 per cent.
Nursing numbers were only slightly lower at weekends, however the study found there was less likelihood of a senior nurse being in charge at weekends to oversee and co-ordinate care.
Study author Dr Lindsay Reid, of the RCPE, said: ‘Acute medical units are a central component of the admission pathway for the majority of medical patients presenting to hospital.
‘A fundamental component of quality healthcare provision is the availability of a workforce to deliver that care.
‘There is a contrast between weekday and weekend staffing on the acute medical units, with reductions at weekends in total staff hours, the proportion of dedicated versus undedicated staff, and the seniority of nursing staff.
‘These findings have potential implications for patient outcomes, quality of care, hospital flow and workforce planning.’
Dr Reid added: ‘The difference in weekday and weekend staffing may be explained by difference in clinical demand on weekdays versus weekends. However, admission data are relatively consistent across the seven days in Scottish hospitals.
‘Difference in demand is unlikely to be
‘Work harder to find a solution’
the sole reason for the reduction of staff at the weekend.’
The study looked at daily ‘staff hours’ for nurses, doctors and other professionals, comparing weekdays with weekends.
Among doctors and consultants, it found that during the week there were more ‘dedicated’ staff – those working solely in the acute unit rather than also having responsibilities in other wards.
Concerns have already been raised about hospital patient care at weekends.
A landmark study published in 2015 found NHS patients are twice as likely to die after being admitted to hospital at weekends, with reduced levels of staffing and back-up services blamed.
The research looked at patients admitted on Saturdays and Sundays who had surgery, comparing their survival rate after 30 days with those of patients operated on through the week.
Last night, Scottish Tory health spokesman Miles Briggs said: ‘This is why it’s so important to try to make the NHS a seven-days-a-week operation.
‘It’s completely wrong that a patient’s chances of recovery should depend on what day they happen to fall ill.’
But he added: ‘It is unclear how seven-day working will be achieved given our current staff shortages. But the SNP Government should reflect on these findings and work harder to find a solution.’
RCPE president Professor Derek Bell said: ‘A truly sevenday NHS must be implemented across the whole system of care, with adequate support for all healthcare professionals to manage their workloads at any time throughout the full week.
‘This will ensure continuity of care at the highest possible level across the week and weekends.’
The study, carried out between 2014 and 2015, was published this month in QJM: An International Journal of Medicine.
Dr Peter Bennie, chairman of the British Medical Association Scotland, said: ‘Everybody working in the NHS works hard to ensure patients always receive the care they need at the time and place that they need it.
‘Achieving this requires adequate staffing and resources, something that is increasingly lacking as the gap between resources and demand in the NHS grows and significant recruitment gaps continue.
‘Without substantial additional investment and recruitment, attempting to increase weekend services risks undermining the quality of services delivered during weekdays.
‘It would also require support services to be available every day of the week, which is often not the case.’ The Scottish Government made a commitment towards seven-day NHS services in 2015. But 4.5 per cent of nursing posts are vacant, with 430 consultant posts unfilled.
The Scottish Government said: ‘We are supporting NHS boards to implement the findings of Sir Lewis Ritchie’s review of public holiday working.
‘It outlined a range of recommendations to support multidisciplinary working over a weekend, including ensuring that sufficient staffing levels and numbers of senior decisionmakers from all sectors are rostered to be on duty at all times.’
THE Mail salutes those NHS workers who strain every sinew to keep the monolithic service going and who make huge personal sacrifices to improve the lot of patients.
But we make no apology for repeating that we need to talk about reform of the service. Research shows that the number of key staff working at weekends dips alarmingly, with potential knock-on effects on patients’ wellbeing.
Now, everyone needs a break and wornout staff also present a real risk to patients. Yet the same study showed that the numbers of nurses is more even across the week. So if one element of the NHS can be set up for 24/7 cover year-round, why can’t the rest follow suit?
The answer, of course, is staffing levels. So can Health Secretary Shona Robison stop chanting her usual empty mantra about how much she is spending and instead consider how best to deliver better outcomes for patients?
Illness cares not what day of the week it is and it cannot be right that patients requiring treatment at weekends should be second-class citizens.