Daily Insight: 24/7 controversy

Weekend woes

Patients are not getting the access to consultants that is expected under the key requirements of the national “seven day” standards, the latest data from NHS England shows.

Less than a quarter of patients see a consultant within 14 hours of admission – even on weekdays.

Another one of the four key seven day standards set out by national leaders is receiving ongoing review by a medical consultant. The data revealed a very large gap between hospitals being able to meet this standard on weekends compared to weekdays. Almost 91 per cent of patients see a consultant regularly during weekdays – but the figure is 69.7 per cent at weekends.

The rollout of seven day hospital services has been a priority for government and is part of its mandate to the NHS. In contrast, NHS England’s response to the data has been a lot less vocal.

Acute trusts are meant to be 100 per cent compliant with the four key seven day standards by 2020 (the other two are around diagnostics and access to some treatments) but it is not clear if NHS England is worried about progress or the challenges that trusts face meeting them.

Both NHS England and NHS Improvement refused to confirm if progress to date is in line with expectations or if any improvement directory has been set. The data was also published on its website last month without any publicity.

What is clear is that some trusts are struggling much more than others to consistently deliver the targets across the seven days.

Some that had low compliance with the standards told HSJ about the concerns they had meeting the targets. “Significant workforce challenges” and data problems were raised but there was also questions as to whether the measurement reflected actual patient need.

Specialist trusts especially felt that the seven day standards did not reflect specialist patient pathways, with many people admitted for urgent yet planned treatment.

An academic study earlier this month added to concerns over whether the standards will actually improve care quality. It found access to consultants and diagnostics over the weekends has “no association with weekend death rates”. One of the researchers, Professor Matt Sutton, said: “Implementation of these standards is unlikely to result in any direct harm to patients, but the policy may divert care away from the patients who need it most.”

Don’t expect the controversy around seven day services to die down any time soon.

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