By Richard Johnstone | 3 December 2012
A coalition of medical royal colleges has urged the government to prioritise improving patient care outside office hours after finding that some care provided at weekends was ‘unacceptable’.
The Academy of Medical Royal Colleges, which brings together 20 colleges and faculties, called for three new standards to be introduced to ensure high quality care is provided seven days a week.Seven-day consultant present care found the availability of consultants and senior doctors in evenings and weekends varied widely across the UK, and across different areas of medicine. Patients admitted to hospital at weekends were more likely to die during their hospital stay than those admitted during weekdays, it concluded.
The academy backed a number of reforms after saying it was unacceptable for hospitals to not provide consultant-led care at weekends if evidence suggests that this is best for patients.
It called for a commitment for all hospital inpatients to be reviewed by a consultant at least once every 24 hours, including weekends and bank holidays, unless there were good reasons not to.
Consultants should also be available to supervise medical interventions every day where the results would change the status of the patient’s overall care before the next ‘normal’ working day. This includes anything leading to an immediate discharge from hospital, or a shortened length of stay.
The report also recommended that support services – both in hospitals and in the community – should be provided out-of-hours, so that the next steps in a patient’s treatment can be taken straight away.
Although the academy stated it ‘does not see these standards as a panacea’, Norman Williams, chair of the steering group which produced the report, said it would make a large contribution to improving the consistency and quality of care for patients.
Williams, who is also the president of the Royal College of Surgeons of England, added: ‘The standards we recommend in this report reflect the importance of daily consultant-led care and the support that needs to accompany this to ensure that patients receive the very best treatment. It cannot be right that over weekends and bank holidays, patients may receive a lower standard of care than they would during the week.
‘Clinical staff and managers must work together to re-shape hospital services in a way that strengthens the quality of care given to patients regardless of the time of day they are admitted. Ensuring that key staff are available to provide this support will come at a cost. However, this is crucial for the full benefit of seven-day consultant-led care to be realised.’
Responding to the report, health minister Dr Dan Poulter said ‘patients need the NHS every day – not just Monday to Friday’.
Ministers are already working with hospitals and professional organisations, including the Academy of Medical Royal Colleges, to make this a reality, he added. ‘Offering easier access to hospital consultants, GPs and routine hospital services seven days a week will reduce delays and ensure that patients get seen and treated by experienced health are professionals.’
The director of the NHS Employers organisation Dean Royles said the proposal for a new code was ‘an excellent initiative from the academy’.
He added: ‘It’s clear that we need working practices to be different to be a truly seven-day service. We now need some pace to make it happen to bring huge benefits for patients and improve the safety and quality of care.
'We know there will be significant challenges and we can expect some resistance to change. A different way of working requires a pay system that recognises weekends and evenings as normal working times. It needs to be patient care, not overtime rates, that drive this change forward.’
