Healthcare leaders have concluded that it will be financially impossible for the NHS to run seven-day services as planned by the government.
The NHS Confederation has issued this warning ahead of Health Secretary Jeremy Hunt’s meeting with medics.
This is the first time that Hunt has convened with healthcare professionals since the bitter industrial dispute with junior doctors came to an end.
Yet the report by the NHS Confederation will be something of an embarrassment to Hunt, with the text concluding that NHS trusts are simply too financially challenged to invest in a wholesale expansion of services.
“Given the financial realities of the NHS and the wider system, our clear focus must be on those services which have the most impact in terms of outcomes for patients, rather than offering convenience. We must recognise the costs involved in delivering seven-day services and tailor our ambition accordingly,” the report asserts.
The NHS Confederation believes that NHS trusts must instead concentrate resources on existing needs.
Existing attempts to improve access to services have proved inconsistent, and Phil McCarvill, deputy director of policy at the NHS Confederation, outlined some of the problems experienced by NHS institutions.
“In some areas hospitals have offered diagnostic tests on Saturdays and Sundays only to find there is not much take-up. Meanwhile, we’ve found really high take-up of ante-natal first scans at weekends, because often at that early stage women didn’t want to book time off work before their employers knew they were pregnant.”
Last year, the Conservative manifesto promised everyone access to a GP seven days a week, from 7am to 7pm.
But the new report highlights poor uptake of appointments in some areas, and warns of funding shortages.
“Given financial pressures on all NHS and wider health and care organisations it is important that we focus on ensuring consistency of outcomes in key parts of the health and care system, starting with those who require urgent and emergency care and those currently in hospital,” the NHS Confederation stated.
A Department of Health spokesperson suggested that the report would have little impact on government policy.
“We are committed to seven-day services so patients get the same high standard of urgent and emergency care throughout the week – this is about safety, not convenience. That’s why we’re backing the NHS’s own plan for the future by investing £10 billion to transform services.”
Dr Mark Porter, BMA council chairman, though was adamant that the government plans are untenable.
“Patients should have access to high-quality care seven days a week, and NHS staff work around the clock to deliver this. With services and frontline staff under more pressure than ever before, we need at look at how patient care can be improved across the week in a sustainable way. As the report makes clear, it is vital that we deliver the right care, based on clinical need and that we look at the system in the round, making sure that all areas – from general practice, to hospital, community and social care – are adequately resourced and supported.”
A leading doctor has suggested that there are insufficient qualified doctors to run the desired seven-day NHS in England.
The Royal College of Physicians president Prof Jane Dacre has warned ministers that the issue must be addressed if their policy is to work.
Dacre highlighted research which suggests that GP posts in the NHS are not being satisfactorily filled, with gaps in rotas being common across the whole service as a whole.
This will be considered particularly worrying for the government considering that it is presently locked in an ongoing dispute with junior doctors over pay and conditions.
Last week thousands of medics went on strike over the government’s decision to impose a new contract on them, designed to make it cheaper to rota on staff at weekends.
Dacre raised her particular concerns on the subject at the annual conference of the Royal College of Physicians in Harrogate.
She emphasised that NHS trusts all over the country are struggling to locate enough staff in order to cope with the existing demand, let alone would they be able to address an expanded service.
Research by the RCP showed last year there were just over 13,000 consultant physicians across the UK – one in four of all consultants.
Yet 40% of vacant posts advertised during the last 12 months were ultimately unfilled, while 20% of consultants reported gaps in the rotas of junior doctors.
With many junior doctors threatening to leave the profession or transfer their skills overseas, there must be serious concerns that the problem could get worse before it gets better, unless an impasse is found in the ongoing conflict.
Prof Dacre commented that the situation is extremely serious, and simply must be addressed sooner rather than later.
“I feel sorry for NHS trusts, I really do. Across the country, they have created a raft of new posts to meet the rising demands for patient care, only to find that there is no-one to fill them. If we have neither enough trainees nor consultants to run the service now, how are we going to implement a safe seven-day service?”
But a Department of Health spokeswoman pointed out extra money was being invested during this Parliament – £8bn more by 2020.
She suggested this would help “make sure the right staff and support is available to create a safe NHS seven days a week”.
A leaked report has indicated that the plans of Jeremy Hunt to introduce a seven-day culture to the NHS may be completely misguided.
The report in question suggests that it is impossible to prove that more staffing at weekends will reduce the number of patients that die.
There have been question marks about the ability of the government to implement this supposed scheme, with many healthcare professionals believing that the culture of the NHS is really one of a seven-day nature already.
Indeed, the report also admits it will be “challenging” to meet the government’s promise to recruit 5,000 more GPs by 2020, a Conservative pledge during the election campaign, and that 11,000 new staff will be needed to run a seven-day service in hospitals.
Considering the reduction in expenditure that the Conservative party has instigated in the NHS, with £22 billion worth of efficiency savings targeted, it would seem to be impossible to recruit this number of staff to key positions.
Additionally, the Tories are also facing ongoing rows with junior doctors and nurses over funding and pay issues.
The increased numbers of deaths among patients admitted at weekends has been the cornerstone for Hunt’s argument in favour of a seven-day health service.
Yet an internal Department of Health draft report indicates that it is impossible for the department to “evidence the mechanism by which increased consultant presence and diagnostic tests at weekends will translate into lower mortality and reduced length of stay”.
This will only strengthen the opinion of those who have been critical of Hunt’s plans, which have been strongly challenge in terms of ethos, but now also seem to be completely impractical and even fundamentally flawed.
Hunt threatened last July to impose a new contract on consultants to help bring about the seven-day NHS, if they did not resume negotiations.
Yet disputes have not found a resolution in the process, with the general public seeming to support the position of junior doctors increasingly strongly.
The Conservative party had previously made it a major manifesto pledge to create what it described as a truly seven-day NHS by the end of this decade.
But these plans would now seem to be increasingly tenuous.
Dr Mark Porter, the British Medical Association’s chair of council, was scathing in his assessment of the leaked report.
“This leaked document makes clear that more seven-day services will require not only thousands of extra doctors, nurses and support staff but an additional investment in both the NHS and community care. Its findings also show no proven link between weekend mortality rates and consultant presence, and suggests that other investment is more necessary.”
A Department of Health spokesperson naturally defended the position of the government.
“There is clear, independent clinical evidence of variation in the quality of care across the week and, working together with the NHS, we are determined to tackle this problem. Making sure the right staff and support is available for all patients seven days a week is a key part of our approach.”
An Ipsos MORI poll has indicated that there is considerable public confusion regarding the supposed need for seven-day NHS services, but that the concept is broadly supported.
A majority of respondents to a survey carried out by the polling institution indicated that they believed seven-day services are being implemented for reasons of convenience.
In fact, the government has asserted that this new ethos needs to be put in place in order to improve weekend mortality rates.
A more positive sign for the Health Secretary, Jeremy Hunt, is that the poll indicates that the public generally considers the notion of a seven-day NHS culture to be important.
Ipsos MORI interviewed a representative sample of 1,123 adults in England on a face-to-face basis between 14th and 23rd August, 2015.
And their survey indicates that a significant percentage of the population (25 per cent) believe that some services not being available at the weekend is one of the biggest problems facing the NHS.
However, the biggest concern that emerged from this survey remains an issue that has plagued the health service for many years.
44 per cent of respondents indicated that long waiting times are still a massive problem for NHS patients.
But although a lack of resources and the problems with dealing with an ageing population are also considered serious problems, responses indicated that the public do support the concept of a seven-day NHS.
Ipsos MORI found that 79 per cent of adults in England think that the NHS should provide the same standard of service to patients at the weekend as during the week. And only one-in-ten disagreed with the notion
The convenience of such a service was identified by respondents as the key reason for instigating a new seven-day culture.
59 per cent of those surveyed cited this as the primary reason for developing a seven-day culture, while quality of servicee (43 per cent) was also widely considered to be of importance.
Commenting on the findings from the survey, Anna Quigley, Head of Health Research at Ipsos MORI, said: “While a seven-day health service is generally something that the public would welcome, it’s not clear they yet grasp the main motivation for doing so. The public are in favour of weekend services that match week-day ones, but at the moment their main interest is in convenience rather than safety.”
Until the government outlines more details about the so-called seven-day scheme there will still be doubts regarding how the plan will be implemented, and its consequences for the future of the NHS.
As the debate regarding seven-day care in the NHS rumbles on, the British Medical Association (BMA) have had their say on the subject.
Analysis has recently been published in the British Medical Journal which suggests that weekend admissions lead to fewer but sicker patience than during weekdays.
The discussion on the topic follows Prime Minister Mr David Cameron’s assertion that the NHS must develop a seven-day culture in order to meet the demands of a contemporary health service.
Responding to the issue, Dr Mark Porter, BMA council chair, indicated his support for the concept:
“Doctors want the care we provide for sick patients to be of the same high standard, seven days a week. Urgent action on this has been undermined by calls for the entire NHS to be delivered on a seven-day basis without any clear prioritisation,” Porter commented.
Porter also underlined that the British Medical Association is fully committed to the concept of seven-day care, and indeed suggested that this will even become a priority for the organisation in the foreseeable future.
“The BMA wants better access to seven-day urgent and emergency care to be the priority for investment. This will ensure seriously ill patients receive the best care at all times. Nine in 10 consultants already work around the clock delivering this care,” Porter pointed out.
But despite the support for the concept from the British Medical Association, there are still question marks over the logistics of the concept according to Porter.
Numerous senior health figures in the United Kingdom have already queried the practicality of what Cameron is suggesting, and Porter is certainly no exception to this rule.
“Additional services will require not just more doctors, but extra nurses, diagnostic and support staff,” Porter not unreasonably asserted.
The BMA council chair also suggested that the government must resolve to flesh out the details of this particular scheme as quickly as possible.
Although David Cameron has indicated his belief in a truly seven-day NHS, there has been insufficient detail to back up the concept, let alone any information regarding how it will be delivered.
Porter critiqued this aspect of the concept, and placed the issue into a wider context.
“David Cameron promised a ‘truly seven-day NHS’ but there has been no detail to define what he means, how he plans to fund and staff it, and its impact on weekday services. Given the current funding squeeze on NHS Trusts, the only way for many hospitals to increase the number of doctors over the weekend would be to reduce the number providing care during the week,” Porter stated.
Porter concluded his comments on the matter by delivering something of a mild ultimatum to the government.
“If the government really want to deliver more seven-day services then they need to show patients, the public and NHS staff their plan for how this will be delivered at a time of enormous financial strain on the NHS and when existing services and staff are under extreme pressure.”
A BMA Survey of consultants found that 80 per cent currently work evenings and weekends in addition to the normal working week. Only 1 per cent of existing consultants utilise the so-called ‘weekend opt-out’.
These figures indeed suggest that the opinions of Porter are entirely sound, and that the government will have to make considerable changes to the NHS, not least with regard to recruitment, in order to even come close to achieving its supposed vision.