Het weekend-effect: brrrrr.....
'The weekend effect' means 11,000 extra NHS deaths a year
Research finds that NHS patients are twice as likely to die after being admitted to hospital at weekends, with significant differences in mortality even when greater number of emergencies are taken into account
Doctors unions have been told that a new contract will be imposed for new consultants unless they agree to remove a weekend opt-out clause
By Laura Donnelly, Health Editor
6:30AM BST 06 Sep 2015
Up to 11,000 extra patients are dying each year after being admitted to hospitals over the weekend, a major study suggests.
Experts said reduced levels of staffing and backup services could be blame for the surge in deaths.
It comes with just days until a deadline for doctors’ unions to agree changes to consultants’ contracts, in a bid to increase levels of weekend cover, or see them imposed.
The study of 15 million hospital admissions, published in the BMJ, found a significant “weekend effect” affecting patients admitted between Fridays and Mondays.
Overall, patients admitted on Saturdays and Sundays were twice as likely to die within 30 days of surgery, the study found.
Some of this was because patients admitted at weekends are likely to be sicker, given that less hospital treatment is planned for this period.
A man holds his chest as he suffers from a heart attack (posed by model)A man holds his chest as he suffers from a heart attack (posed by model) Photo: Alamy
But the study showed that even when this was taken into account, those who were admitted to hospital at weekend were still significantly more likely to die.
The highest death rates were among those admitted on Sundays, with 15 per cent more deaths, once figures were risk adjusted, and 10 per cent more on Saturdays.
Overall, that amounts to an extra 11,000 deaths a year among those admitted between Fridays and Mondays.
Prof Sir Bruce Keogh, NHS medical director, one of the authors of the landmark study, said it revealed an “inconvenient truth” which could no longer be ignored, and required an overhaul in the way services are run.
The research by University Hospital Birmingham NHS Foundation Trusts and University College London, examined the effect of hospital admission day on death rates across NHS England hospitals for 2013-2014.
Prof Keogh said: “The idea that patients are being harmed because of the way we organise our services is quite simply beyond what any of us can regard as acceptable.
"The moral and social case for action is simply unassailable.”
"Change always brings practical difficulties that must be tackled but we cannot duck the facts,” said Prof Keogh.
“It is my job here to point out an inconvenient truth – doctors are trying their best but I have to think about the way that we can redesign services to address this issue.”
Overall, mortality rates from Tuesday to Thursday were 1.6 per cent, creeping up to 1.75 per cent on Fridays, 2.64 per cent on Saturdays and 3.4 per cent for those admitted on a Sunday, before dropping back to 1.7 percent by Mondays, the figures show.
When these figures were adjusted, to account for patients’ higher levels of sickness, there was still a relative difference of up to 15 per cent.
Complaints about delays and cancelled appointments have risen by almost one fifth in a year Complaints about delays and cancelled appointments have risen by almost one fifth in a year Photo: PA
The research said: “Appropriate support services in hospital are usually reduced from late Friday through the weekend, leading to disruption on Monday morning. This could go some way towards explaining our finding of a 'weekend effect' extending into Friday and Monday."
The Royal College of Surgeons said patients needed better access to senior staff and key tests at weekends.
Its president, Clare Marx, said: “Patients that need treating at the weekend are less likely to be seen by the right mix of junior and senior staff and experience reduced access to diagnostics.
“Many doctors and NHS staff already work at nights and weekends and they should be valued and thanked for continuing to provide care during those unsocial hours. “However the evidence shows that this is not currently standard practice even in high risk emergency care. This has to change.”
Last week an investigation by The Telegraph found that in some specialities there were six times as many consultants working during the week compared with weekends.
Even in Accident & Emergency departments, there were twice as many senior doctors working during the week, compared with weekends.
A study of heart attack patients presented to cardiologists last week found those who were admitted on Saturdays had death rates 20 per cent higher than those who arrived at hospital during the week.
The BMA has been given a deadline of Friday to agree changes to consultants’ contracts – with the removal of the right to opt out of non-emergency weekend work – or see changes imposed.
Dr Mark Porter, chairman of the BMA, has accused the Government of failing to provide detailed plans, and said weekday services would be damaged if doctors were spread too thinly.
Last night he said: "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.
"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."
He said as well as extra doctors, there needed to be greater investment in more nurses, diagnostic and support staff.
"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." http://tinyurl.com/puofh8q via http://tinyurl.com/nw8bosj
