Exclusive: weekend hospital arrivals up to 16pc more likely to die - DH

The dramatic finding is the result of the first study of the controversial subject for the DH itself. It will put pressure on hospitals to increase senior medical staffing and run diagnostic services at the weekend. It echoes the report published by Dr Foster today identifying problems with poor weekend hospital care.

NHS medical director Sir Bruce Keogh, who commissioned the work earlier this year, said it should begin a debate on how to address the problem, including more weekend working.

He told HSJ: “The rest of the world has moved on. Twenty years ago nobody worked at the weekend – you couldn’t go to the supermarket. Now you can. What you can’t do is get regular, consistent access to healthcare services.”

The work, led by Domenico Pagano, a consultant cardiothoracic surgeon at University Hospitals Birmingham Foundation Trust, looked at all admissions during 2009-10 and deaths in hospital within 30 days of admission.

A summary, seen by HSJ and due to be distributed to NHS medical directors, says: “Admission on weekend days was associated with a considerable increase in risk of subsequent death compared with admission on weekdays.”

Analysis found patients admitted on Sundays were 16 per cent more likely to die than those admitted on Wednesdays. Those admitted on Saturdays were 11 per cent more likely to die. There is also slightly higher risk for those admitted on Mondays. A similar pattern was seen in data from US hospitals.

The research does not look at the reasons but Sir Bruce said “availability of diagnostics and availability of senior experienced staff” were believed to be major factors.

He is setting up a discussion group to consider the reasons for the problem, and barriers to weekend working, in more detail.

Sir Bruce said there were “unanswered questions” about how to make necessary changes without increasing cost. He said that if done correctly weekend working could improve productivity, in some cases reducing length of stay and making better use of buildings and equipment. “What other industry leaves such expensive plant unused for two or two and a half days a week?” he added.

Service closure at the weekend also left “people who feel sick, frightened and worried” waiting for treatment or diagnosis unnecessarily, Sir Bruce said.

He said: “The most important thing for me is it is one step towards putting systemic compassion back in the NHS.”

A letter from Sir Bruce to strategic health authority medical directors and due to be circulated more widely this week, says: “A growing body of evidence suggesting where there is a lack of access to clinical services and senior leadership… patients do not always experience parity of access to the optimum treatment or diagnostic test, which can contribute to less favourable outcomes.”

The research found for patients already admitted but staying in hospital at the weekend, there is slightly lower risk of death, which is due “at least in part [to the] current weekly arrangement of services and concentration of procedures in higher risk patients towards the beginning of the week”.

A report by NHS London obtained by HSJ in September linked 500 avoidable deaths a year in emergency care in the capital to “stark” differences in consultant hours in hospitals at evenings and weekends. The issue was also due to be highlighted today in the Dr Foster Hospital Guide 2011.