BMJ 2013;347:f7555 doi: 10.1136/bmj.f7555 (Published 16 December 2013)
Page 1 of 2
News
NEWS NHS medical director sets out detail of seven day working Nigel Hawkes London
Plans to move the NHS in England to a new pattern of seven day working have been published by a committee set up by Bruce Keogh, the national medical director. The case had already been accepted in principle, but the report of the NHS Services, Seven Days a Week Forum sets out for the first time detailed plans for achieving it in secondary care.1
between £1bn and £2bn, at a time when the NHS was already struggling to break even. One source of money, Keogh suggested, would be the £3.8bn Better Care Fund, which consists of money shared by the NHS and local government with the aim of improving the integration of care.
Patients who are admitted to hospitals at weekends show significantly different death rates, experience, length of stay, and readmission rates, the forum reports. Nor is the problem unique to the NHS, affecting most healthcare systems in the world.
Keogh said, “There are encouraging examples for NHS organisations that have moved to making healthcare services more accessible seven days a week. We need to accelerate the pace and spread of these changes. It seems inefficient that in many hospitals expensive diagnostic machines and laboratory equipment are underused at weekends, operating theatres lie fallow, and clinics remain empty.
“More than 50 years of accumulated custom and practice have failed to put the interests of patients first,” Keogh said. “As the custodians of £97bn [€115bn; $160bn] of public money, we must buy the health services patients deserve. We know that patients and the public want us to act now to make seven day services a reality in all parts of the NHS.”
The causes include variable staffing levels in hospitals at the weekend; fewer decision makers of consultant level and experience; a lack of consistent support services such as diagnostics; and a lack of community and primary care services that could prevent some unnecessary admissions and support discharges.
To achieve a seven day system the forum laid out 10 clinical standards. These include an undertaking that every patient be reviewed by a consultant within 14 hours of admission to hospital; improvement and standardisation of care handovers; seven day a week availability of diagnostic services and interventions; and twice daily reviews by a consultant of patients in intensive care or high dependency units. The report also includes targets for mental healthcare, discharges, and reviews of outcomes. Keogh recommended that the standards be adopted by the end of the 2016-17 financial year and should be part of the five year strategic plans being developed by clinical commissioning groups.
A similar set of standards is already being developed for primary care, with pilots planned across England during 2014-15 aimed at improving access for at least 500 000 people. NHS England will evaluate these pilots and identify ways to improve access to routine primary care in 2015-16. No estimate of the likely cost of the changes has been given, but Chris Ham, chief executive of the health think tank the King’s Fund, told the BBC that he estimated the cost would be For personal use only: See rights and reprints http://www.bmj.com/permissions
The standards will be backed by sanctions, such as fines levied through the hospital payment system. Results will be openly published so that patients know whether standards are being met, and the Care Quality Commission will be asked to monitor compliance. Education contracts will be reviewed by Health Education England to ensure that consultants are available seven days a week to provide supervision of doctors in training.
“This while access to specialist care is dogged by waiting lists, and GPs and patients wait for diagnostic results. We should also consider whether, in the 21st century, it is still acceptable for the NHS to expect people to always take time off work to access healthcare or to support a relative or friend to do the same. This has an economic impact as well as an impact on patient and family experience.”
The Academy of Medical Royal Colleges welcomed the report. Its chairman, Terence Stephenson, said, “It is unacceptable that, for a patient admitted as an emergency, the chances of dying may be 11% higher on a Saturday and 16% higher on a Sunday. The academy recognises that moving to successful seven day care will not be easy to achieve but has led the argument for this principle.” Mark Porter, the BMA’s chairman of council, said that NHS care should be of the same high quality across the seven days of the week. “There should be no calendar lottery when it comes to patient care,” he said. “The BMA is in negotiations with NHS Employers and the government to find an affordable, practical model for delivering this care while safeguarding the need for a healthy and productive work-life balance for doctors.” Dean Royles, chief executive of NHS Employers, said that the terms and conditions of doctors often got in the way of progress. “We are now facing a once in a generation opportunity to change how the NHS works. Patients, employers, medical royal Subscribe: http://www.bmj.com/subscribe
BMJ 2013;347:f7555 doi: 10.1136/bmj.f7555 (Published 16 December 2013)
Page 2 of 2
NEWS
colleges, and the government all want to see seven day care. I hope this report will help accelerate progress and we make the ambition a reality.”
1
NHS England. NHS Services, Seven Day a Week Forum: summary of initial findings. Dec 2013. www.england.nhs.uk/wp-content/uploads/2013/12/forum-summary-report.pdf.
Cite this as: BMJ 2013;347:f7555 © BMJ Publishing Group Ltd 2013
For personal use only: See rights and reprints http://www.bmj.com/permissions
Subscribe: http://www.bmj.com/subscribe
Page 1 of 2
News
NEWS NHS medical director sets out detail of seven day working Nigel Hawkes London
Plans to move the NHS in England to a new pattern of seven day working have been published by a committee set up by Bruce Keogh, the national medical director. The case had already been accepted in principle, but the report of the NHS Services, Seven Days a Week Forum sets out for the first time detailed plans for achieving it in secondary care.1
between £1bn and £2bn, at a time when the NHS was already struggling to break even. One source of money, Keogh suggested, would be the £3.8bn Better Care Fund, which consists of money shared by the NHS and local government with the aim of improving the integration of care.
Patients who are admitted to hospitals at weekends show significantly different death rates, experience, length of stay, and readmission rates, the forum reports. Nor is the problem unique to the NHS, affecting most healthcare systems in the world.
Keogh said, “There are encouraging examples for NHS organisations that have moved to making healthcare services more accessible seven days a week. We need to accelerate the pace and spread of these changes. It seems inefficient that in many hospitals expensive diagnostic machines and laboratory equipment are underused at weekends, operating theatres lie fallow, and clinics remain empty.
“More than 50 years of accumulated custom and practice have failed to put the interests of patients first,” Keogh said. “As the custodians of £97bn [€115bn; $160bn] of public money, we must buy the health services patients deserve. We know that patients and the public want us to act now to make seven day services a reality in all parts of the NHS.”
The causes include variable staffing levels in hospitals at the weekend; fewer decision makers of consultant level and experience; a lack of consistent support services such as diagnostics; and a lack of community and primary care services that could prevent some unnecessary admissions and support discharges.
To achieve a seven day system the forum laid out 10 clinical standards. These include an undertaking that every patient be reviewed by a consultant within 14 hours of admission to hospital; improvement and standardisation of care handovers; seven day a week availability of diagnostic services and interventions; and twice daily reviews by a consultant of patients in intensive care or high dependency units. The report also includes targets for mental healthcare, discharges, and reviews of outcomes. Keogh recommended that the standards be adopted by the end of the 2016-17 financial year and should be part of the five year strategic plans being developed by clinical commissioning groups.
A similar set of standards is already being developed for primary care, with pilots planned across England during 2014-15 aimed at improving access for at least 500 000 people. NHS England will evaluate these pilots and identify ways to improve access to routine primary care in 2015-16. No estimate of the likely cost of the changes has been given, but Chris Ham, chief executive of the health think tank the King’s Fund, told the BBC that he estimated the cost would be For personal use only: See rights and reprints http://www.bmj.com/permissions
The standards will be backed by sanctions, such as fines levied through the hospital payment system. Results will be openly published so that patients know whether standards are being met, and the Care Quality Commission will be asked to monitor compliance. Education contracts will be reviewed by Health Education England to ensure that consultants are available seven days a week to provide supervision of doctors in training.
“This while access to specialist care is dogged by waiting lists, and GPs and patients wait for diagnostic results. We should also consider whether, in the 21st century, it is still acceptable for the NHS to expect people to always take time off work to access healthcare or to support a relative or friend to do the same. This has an economic impact as well as an impact on patient and family experience.”
The Academy of Medical Royal Colleges welcomed the report. Its chairman, Terence Stephenson, said, “It is unacceptable that, for a patient admitted as an emergency, the chances of dying may be 11% higher on a Saturday and 16% higher on a Sunday. The academy recognises that moving to successful seven day care will not be easy to achieve but has led the argument for this principle.” Mark Porter, the BMA’s chairman of council, said that NHS care should be of the same high quality across the seven days of the week. “There should be no calendar lottery when it comes to patient care,” he said. “The BMA is in negotiations with NHS Employers and the government to find an affordable, practical model for delivering this care while safeguarding the need for a healthy and productive work-life balance for doctors.” Dean Royles, chief executive of NHS Employers, said that the terms and conditions of doctors often got in the way of progress. “We are now facing a once in a generation opportunity to change how the NHS works. Patients, employers, medical royal Subscribe: http://www.bmj.com/subscribe
BMJ 2013;347:f7555 doi: 10.1136/bmj.f7555 (Published 16 December 2013)
Page 2 of 2
NEWS
colleges, and the government all want to see seven day care. I hope this report will help accelerate progress and we make the ambition a reality.”
1
NHS England. NHS Services, Seven Day a Week Forum: summary of initial findings. Dec 2013. www.england.nhs.uk/wp-content/uploads/2013/12/forum-summary-report.pdf.
Cite this as: BMJ 2013;347:f7555 © BMJ Publishing Group Ltd 2013
For personal use only: See rights and reprints http://www.bmj.com/permissions
Subscribe: http://www.bmj.com/subscribe
