Can patient safety be guaranteed in a 7 day NHS?

In the Queen’s Speech earlier this week, we heard the new Conservative Government’s plans to create a ‘seven day NHS’.  Whilst on the face of it, most of us would welcome better access to care at weekends, the plan raises important questions of funding and patient safety.

Of course, parts of the NHS are already ‘seven days a week’.  Accident and Emergency Departments largely operate 24 hours a day, every day of the week.  However, the Government’s plan is to give patients access to a greater number of clinics and hospital departments both during the week and at weekends.  This will include not just hospitals but GP surgeries as well.

Studies have shown that there is a substantially higher mortality risk amongst patients who are admitted to hospital on Saturday or Sunday.  This is thought to be due to issues such as a lack of medical staff working at weekends together with less access to testing and diagnostic facilities which only operate during the normal working week.

However, in order to achieve the target of providing a seven day service, the NHS will have to effect substantial change from within.  Services will likely need to be reorganised and restructured.  It will be necessary to recruit a large body of extra staff in order to cope with the greater demand which will be placed upon those services.  Clearly this sort of change is going to be very costly.  In this time of austerity and continued cuts to public services, it is not apparent how such plans can or will be funded.  David Cameron may have promised an extra £8bn of funding for the NHS per year by 2020, but that amount will not go very far towards funding the sort of seismic change which has been proposed.

Speaking in March prior to the election, Dr Mark Porter, chairman of the British Medical Association, expressed concerns that current funding would not be enough to even maintain existing services, let alone an extended NHS.  He went on to say that a funding gap of £30bn per year was likely.

It is therefore foreseeable that an extra £8bn per year will only be enough (if that) to keep current services going by 2020 and that further substantial funds will need to be found to bankroll a seven day service.

The questions over funding have not been resolved and this inevitably then leads to doubts about the safety of patients in the proposed extended service. In January 2015, the British Medical Association highlighted this issue stating:

‘The BMA believes that without significant resource investment, a seven-day service will not be possible without compromising and/or re-evaluating existing service provision in the NHS. There is a real risk that patient safety could be compromised in the week if the government attempts to implement seven-day services without additional resource investment.’

Self-evidently, without proper funding, it will not be possible to recruit the extra qualified and specialist staff or to secure the additional facilities which will be needed to provide a seven day service.  If this is not done, already hard pressed services will be stretched even further across seven days and it is not difficult to see that the safety of patients will be compromised.  Poor resources and a lack of staff will lead to negligent treatment and medical mistakes.

If this proposed seven day service turns out to be an empty political gesture rather than a genuine and properly organised and funded attempt to provide medical services at a higher level, it will create more problems than it solves, both in terms of patient safety and in resulting negligence claims.

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