Doubts over NHS 7-day service plan

Evening Standard/London

It is “inconceivable” that NHS trusts will be able to operate a seven-day service while tightening their purse strings, a leading doctor has said.

Paul Flynn, chairman of the British Medical Association’s (BMA) consultants committee, asked how NHS bosses will be able to afford to staff operating and theatres throughout the week.

Research shows that patients are more likely to die if they are admitted to hospital at the evenings or weekends, which has led to calls for greater presence of senior doctors out of hours.

The NHS Commissioning Board (NHSCB) proposed that routine NHS services, including GP and hospital appointments, are to be provided on Saturdays and Sundays to “offer greater customer convenience”.

But in a letter published in the British Medical Journal (BMJ), Mr Flynn, who also works as an obstetrician and gynaecologist, argued that NHS providers have only a limited availability to seek out new revenue in the way that other businesses can.

“Who’s going to pay for this?” he asked.

“Many NHS providers are already in dire financial positions to the extent that some of them are consulting on making staff redundant.

“It is inconceivable that they will be able to staff operating theatres and clinics seven days a week, let alone provide all the other resources that this activity will consume.

“The public, I think, would rather such resources were focused on the sickest people who come to hospital.”

NHS medical director Professor Sir Bruce Keogh said the move would offer a more patient-focused service.

In December last year, the NHSCB announced that Sir Bruce was to establish a forum to find a way to implement a seven-day service.

Also writing in the BMJ, Sir Bruce said the move would enable the NHS “to be truly patient centred” for the whole of the week, rather than two thirds of it.

He said: “Extending the service would offer the opportunity to improve clinical outcomes with the added benefit of a much more patient focused service.

“The NHS provides essential emergency care but not regular routine services on Saturdays and Sundays.

“Yet we have hard evidence that mortality for patients admitted to hospitals on both sides of the Atlantic is higher at weekends, that our junior doctors feel clinically exposed at weekends, and that hospital chief executives are worried about weekend cover.

“This has led to calls for greater consultant presence in hospitals at the weekend.”

He added: “We must ask why, in many hospitals, expensive diagnostic machines and pathology laboratories are under-used, operating theatres lie fallow, and clinics remain empty.

“Yet, access to specialist care is dogged by waiting lists, and general practitioners and patients must wait for diagnostic results.

“Imagine finding yourself in need of a blood test result, a diagnostic test, or specialist advice but having to wait an additional two days - for what reason? Intuitively many of us find this frustrating and unacceptable.

“Imagine, also, a young woman who finds a breast lump at 4pm on a Friday. How easy is it for her to get a diagnosis and good advice before the beginning of the next week? What kind of weekend will she experience?”

Sir Bruce will report on his findings in the autumn.

Delays in treating some types of cancer could put patients’ lives at risk, a charity has warned.

Macmillan said hospital waiting times for lung, bowel and prostate cancer patients in England were “extremely disappointing”.

The statistics, released by the Department of Health, showed the proportion of patients who received “definitive treatment” within two months of being urgently referred by their GP.

The target for this criterion is 85%, and although it was met by the overall figures (87.9%), it was missed for certain categories of cancer. This included lower gastrointestinal cancers (79.9%), which includes bowel, lung cancers (80.4%) and urological cancers (84.2%), including prostate.

Mike Hobday, director of policy and research of Macmillan Cancer Support, said: “It is extremely disappointing that despite meeting the overall waiting times targets, hospitals are consistently missing this standard for treatment in cancer categories that include lung, bowel and prostate cancers.

“Getting into treatment as early as possible gives cancer patients the best possible chance of survival. Missing the targets for these types of cancer mean these patients’ chances are potentially being put at risk.

“The statistics are particularly worrying for lung cancer patients as the disease has such low survival rates. We are calling for hospital cancer specialists to work closely with Macmillan to help make changes to improve in this area.”

The figures covered the period from October to December last year.

A Department of Health spokesman said: “Cancer waiting times continue to remain broadly stable, with the vast majority of patients - 95.8% - being seen by a specialist within two weeks of referral from their GP.

“We want our cancer services to be the best in the world which is why every cancer patient should get quick and easy access to a specialist. Local NHS organisations should work hard to make sure this happens.”