healthmedicinet

• NHS’s top doctor said system ‘not built around patient convenience’
  
• Professor Sir Bruce Keough wants to introduce penalties for hospitals where patients experience poor care at weekends
  
• Follows research showing lives lost needlessly because of shortage of senior doctors on Saturdays and Sundays

By
Sophie Borland

PUBLISHED:

19:36 EST, 15 December 2013

|

UPDATED:

04:26 EST, 16 December 2013

Consultants could face the sack for refusing to work at weekends as part of a shake-up ordered by the NHS’s top doctor.

Professor Sir Bruce Keogh also plans to impose fines of around £12million on hospitals where patients experience poor care on Saturdays and Sundays.

The changes are being brought in after research published in the summer showed that 4,400 lives are being lost needlessly in hospitals every year because of a lack of senior doctors and because key scans and tests are not carried out.

Professor Sir Bruce Keogh plans to impose fines of around £12million on hospitals where patients experience poor care at the weekends

Patients are 16 per cent more likely to die if admitted on a Sunday rather than on a Wednesday, another study found.

But for certain operations it can be much higher. Other research showed that patients who have planned operations at the weekend rather than on a Monday are 82 per cent more likely to die.

At weekends, patients are usually left under the care of junior doctors who may only have a few months’ experience with one or two consultants ‘on-call’ answering their mobile phones from home.

Yesterday senior doctors refused to confirm whether they will ask for more money to work weekends although many believe they deserve higher hourly rates.

The British Medical Association, their union, is holding talks with NHS officials about changes to consultants’ contracts.

BMA chairman Dr Mark Porter would not discuss details of these negotiations but pointed out that hourly rates for nurses and other staff who work weekends is far more attractive.

Sir Bruce, the medical director of NHS
England, wants to remove a key clause in consultants’ contracts that
allows them to opt out of non-urgent weekend work.

Patients are 16 per cent more likely to die if admitted on a Sunday rather than a Wednesday and for some operations it can be even higher

This would mean they would be
sacked for refusing to work at this time, although officials said this
would only be in the worst circumstances.

Hospitals that fail to have enough
consultants working over the weekend or to provide X-rays, ultrasound
scans and other key tests could also be fined up to 2.5 per cent of
their annual income from the NHS. A typical hospital gets £500million a
year so the maximum penalty would be £12.5million.

The plans – which will be rolled out
over the next three years – will mean all patients admitted to hospital
will see a consultant within 14 hours. Some currently wait three days if
they come in on a Friday.

Critically-ill
patients will have X-rays, heart scans, MRI scans or blood tests within
one hour, urgent cases within 12 hours and everyone else within 24
hours.

Sir Bruce, NHS
England’s medical director who is also a heart surgeon, said: ‘It seems
strange in many ways that we should start to wind down on a Friday
afternoon and warm up on a Sunday while operating theatres are empty,
outpatient clinics echo, expensive diagnostic kit isn’t being used and
in the meantime people are waiting for diagnosis and treatment.

‘When those patients are admitted they get a diagnosis quicker and the appropriate treatment is started more quickly.’

MUM AND BABY DIED AFTER WRONG PART WAS REMOVED IN SUNDAY OP

Maria De Jesus died after surgeons removed her ovary instead of her appendix

Mother-to-be Maria De Jesus died after two trainee surgeons operating on a Sunday removed the wrong body part.

The 32-year-old – who was five months’ pregnant with her fourth child – was admitted to Queen’s Hospital in Romford, Essex with appendicitis but medics took out an ovary instead.

She was discharged but forced to return a fortnight later with severe abdominal pain after the untreated appendix caused the onset of the life-threatening blood infection sepsis. 

Mrs De Jesus suffered a miscarriage shortly after being re-admitted in October 2011. 

Just 48 hours later, the teaching assistant died of major organ failure on the operating table just as doctors were finally removing the infected appendix. 

Her husband Adelino, 53, said earlier this year: ‘My wife’s death could have been prevented, I am sure of it.

‘By the time they realised how serious the situation was – and they promised us all the best consultants – it was too late.

‘This is neglect, this is an unlawful killing.’

He
said on the BBC’s Andrew Marr show: ‘That means that patients spend
less time in hospital and the hospital as a whole runs more efficiently.

‘People
are still kept waiting at the weekend for a diagnosis. We have a system
that is not built around the convenience of patients and is not
compassionate to patients for part of the week.’

If hospitals are relying too
heavily on junior doctors at weekends, the NHS will force managers to
bring in consultants in their place. Patients will also be able to have
minor surgery at the weekend such as for hernias and on hips and knees
so they do not have to take time off work.

British Medical Association chairman Dr Mark Porter would not say whether it would ask for more money consultants to work weekends

Sir
Bruce added: ‘Why should somebody have to take time off work, why
should someone else have to take time off work to take them to and from
hospital, when, if they were to have their operations on a Saturday,
they could spend Sunday recovering and, in many cases, get back to work
sooner?’

The Care Quality Commission watchdog has been urged to check for levels of weekend care during routine inspections of hospitals.

NHS England – which runs the Health Service – estimates the plans will cost the NHS an extra £1billion a year. Its annual budget is about £105billion.

But BMA chairman Dr Porter said other NHS staff including X-ray specialists, administration staff and social workers also needed to work at weekends to ensure high levels of care.

He refused to comment on whether the BMA would ask for more money for consultants to work weekends as part of discussions about their contract. Nurses currently get time and a half for working weekends while doctors receive time and a third, he said.

A survey of 4,500 consultants by the BMA in September found that most were in favour of ‘increased financial remuneration’ for working in the evening and at weekends.

Health Secretary Jeremy Hunt said: ‘Patients should be at the heart of the NHS and be able to depend on it every day – not just Monday to Friday.’

Shake-up could save 4,400 lives a year

The weekend working shake-up follows a number of key studies which warned that patients are far more likely to die or suffer major complications if they are admitted at the weekend.

NHS England has calculated that 4,400 lives could be saved every year if hospitals offered the same level of care at weekends as they do during the week.

Patients undergoing planned surgery on Saturday or Sunday are 82 per cent more likely to die than if they have their operation on a Monday, according to a study by researchers at Imperial College London published in the spring.

Last year, scientists from University College London found patients are 16 per cent more likely to die if they are admitted on a Sunday compared to a Wednesday.

The figure for Saturday was 11 per cent. Other studies also revealed an alarming difference in weekend death rates between hospitals. 

Hillingdon in West London had a rate of 27 per cent, while it was 25 per cent at the Royal Cornwall, according to Dr Foster research.

Only last month, a report by the National Audit Office discovered that babies are 13 per cent more likely to come harm if they are born at the weekend than during the week.

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Comments (298)

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The comments below have not been moderated.

lynu,

Harare,

moments ago

When you take up medicine, or its related subjects, as a career you are well aware that people get sick 7 days a week not just 9-5 Monday to Fridays. There shouldn’t be extra pay for weekends just a fair roster for all staff for 24 hour service 365 days a year. Specialist’s widow.

Limpand Totheleft,

Winchester,

moments ago

Have I got this right? Hospitals can be struggling because they’re unable to fill Consultant posts, so they’ll sack some – and make the situation worse. And I simply cannot understand how hospitals which fail patients because they cannot afford support and nursing staff are supposed to improve their performance with a reduced budget. I’m not saying there aren’t problems, but these ‘solutions’ seem almost farcical.

Hardeep Singh,

Farnham Common, United Kingdom,

5 minutes ago

More proof that the NHS is there for it’s workers first and foremost and trailing not far behind it’s union sense of ideology and of course the Labour party for whom the NHS is an ace card.

Note the patient is merely tolerated and made to feel as if the NHS is doing them a big favour.

AuntiePegg,

Hertfordshire, United Kingdom,

8 minutes ago

why shouldnt they work weekend ?? People get ill 24/7 365 days a year…..

potsy70,

Greenwich,

9 minutes ago

As a junior AE doctor, on a weekend, if I want a CT scan for a patient, I have to ring the salaried radiologist – at home – and argue for it. Stressful for me; poor service for the patient. Yet after 9PM, scans are read by a private service who are paid per scan. And guess what? No problem at all getting the scan, as long as it is approved by a senior AE doctor first. Pay the radiologists, radiographers, GPs, phlebotomists, physios, consultants and, yes, we junior doctors a very basic salary, then a fee PER PATIENT SEEN, i.e. a publicly funded service, but with a business-like model and watch as the service improves. Attitudes would change overnight, patients would no longer be seen as ‘in the way’ but would be welcomed with open arms.

Basic psychology; someone should have the guts to do it.

Get Real,

Sheffield, United Kingdom,

12 minutes ago

Why fine them? It all comes out of taxpayers pockets.

Astounded,

England, United Kingdom,

15 minutes ago

What is the idea behind taking money away from hospitals in fines? Do our hospitals have so many millions tucked away that they don’t know how to spend it?

faithinothers,

london,

17 minutes ago

Wouldn’t it be nice, just for once, for an employer to ask, consult and negotiate rather than dictating?

The_Mutts_Nuts,

Hanging-Low_Exeter, United Kingdom,

20 minutes ago

So rather than inject money to improve the services they will fine them which guarantees worse service and eventual closure. It’s a short cut to privatisation.

chris,

liverpool,

27 minutes ago

While the yahoos applaud Keogh’s willingness to tear up contracts and defy fundamental tenets of civil law, consider that his actions will merely encourage the tranche of senior consultants whose services he so desperately needs to take early retirement, thereby depriving the NHS of their services for seven rather than two days each week. Of course, the more junior specialists who had hitherto been vacillating about revalidation, managerial and political control and all the other bureaucratic impediments to practicing medicine in the UK will just emigrate.

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