D+87 - "Eight Days A Week* "

Got a call at 11.30 on Saturday morning to book a sigmoidoscopy. I was offered a choice of days and times. I've opted for Wednesday 21st, six days after the request was made. What a fantastic service and on a Saturday morning as well. Jeremy Hunt said in July that the NHS was locked into a Monday to Friday mentality, what a load of rubbish.

All junior doctors and nurses on wards and A&E etc work a seven day rota. There is only a tiny minority of consultants who have opted out of weekend working. Patients kept in hospital over the weekend have a lower mortality rate than those discharged, a figure the government chooses to ignore. People admitted on a Sunday have a higher mortality rate than those admitted on a Wednesday. The reason for this is not clear. In some specialities (stroke units and ITU) it seems that the number of nurses is critical. It may be that people admitted on a Sunday are sicker. Just to blame it on a lack of consultants seems like a political move. We need to understand the reasons for the differences in order to sort this out.

Jeremy Hunt makes two assumptions, that fewer doctors at the weekend is the cause of the differences in mortality and that the excess deaths are avoidable. Describing an association between two events is not the same as finding that one event causes the other event. The original researchers who published the article in the BMJ say very clearly that they found an association between admission on different days and mortality but that they didn't address the question of causality. This is an urgent and important problem but vilifying the consultants and the rest of the service isn't the answer.

This is not a problem unique to the NHS either. Research done around the globe shows that most if not all health care services share a very similar problem.

In haematology my experience has been that the on call consultant goes round the wards at the weekend as a matter of course. Juniors, nurses, cleaners, cooks, porters etc are all present. The outpatient unit is routinely open on Saturday mornings. So much for a Monday to Friday mentality.

There is also the 'junior' doctors dispute. The 'normal' working week will rise from 60 hours to 90 hours. The government says that average earnings won't change but it seems doctors will work longer for this same pot of money. Doctors working shorter hours are likely to see there income increase a little and those working long hours in specialities like A&E and anaesthetics will see their incomes fall.  'Junior' doctors (many of whom are actually pretty senior) are the future of the service. It is normal for most of them to put in unpaid extra hours when the job demands it. This is part of the culture of the NHS, a culture the government doesn't seem to understand or value.

If you want to read more about the seven day working dispute  and the weekend effect see the BMJ 12th Sept  - 'The Editor's Choice' at the beginning and the articles on pages 14 and 22.

* Beatles - 'Beatles For Sale' track 8