Analysis by trust: Large majority provide less consultant access at weekends

Seventy per cent of acute trusts continue to provide less access to medical consultants at the weekend than weekdays, the figures show.

The NHS England survey information shows that at 107 trusts – out of a total of 153 eligible – the share of patients receiving daily review on weekdays was at least 10 percentage points greater than at the weekend.

Daily consultant review is one of four standards for seven day care which NHS England has identified as “must dos” by 2020. NHS England put the latest data, based on self assessment surveys by trusts carried out in March, on its website last month but it was not publicised. There were responses from 97 per cent of 153 eligible trusts.

It shows some trusts are still far from meeting the targets. At 40 per cent of trusts, there is a 20 percentage point difference on daily consultant review between weekday and weekend, and at seven trusts the difference is 40 points or higher.

Some trusts with poor performance cited data problems or indicated the measures were inappropriate, for example for specialist hospitals. Others said their problems were due to staffing shortages.

Ten trusts with the biggest difference in the percentage of patients offered ongoing consultant review on weekdays and weekends

Trust	Seven day average	Weekday	Weekend	Difference between weekday and weekend
South Tyneside FT	79.9%	94.5%	41.5%	53.0pp
Peterborough and Stamford Hospitals FT	83.3%	96.0%	46.9%	49.0pp
Southend University Hospital FT	81.9%	95.0%	46.0%	49.0pp
Northern Lincolnshire and Goole FT	66.1%	79.0%	34.6%	44.4pp
The Rotherham FT	81.7%	93.1%	51.7%	41.4pp
Tameside and Glossop Integrated Care FT	55.6%	66.6%	26.3%	40.3pp
North Cumbria University Hospitals Trust	78.6%	89.2%	49.1%	40.1pp
Blackpool Teaching Hospitals FT	69.4%	80.8%	40.9%	39.9pp
Barnsley Hospital FT	85.2%	95.9%	56.6%	39.3pp
Southport and Ormskirk Hospital Trust	86.0%	98.9%	60.3%	38.6pp

Along with ongoing consultant review, by 2020 hospitals are also expected to improve access to diagnostic tests, consultant directed interventions and how quickly patients see a consultant after admission.

Neither NHS England nor NHS Improvement were able to confirm whether progress was in line with expectations. NHS England’s website said “both NHS England and NHS Improvement have been providing hands on direct support through regional teams” to help trusts improve compliance with seven day services. Neither regulator confirmed what type of support was offered.

Hospitals are generally performing better in ensuring patients see a consultant within 14 hours of admission. In 35 trusts, there was a 10 percentage point difference between weekends and weekdays on this. However, this differential is greater than 20 percentage points in just six trusts.

Ten trusts with biggest difference in percentage of patients offered a consultant review within 14 hours of admission on weekdays and weekends

Trust	Seven day results	Weekday	Weekend	Difference between weekday and weekend
Great Ormond Street Hospital for Children FT*	77.8%	86.7%	33.3%	53.3pp
Sheffield Children’s FT*	56.1%	64.1%	27.8%	36.3pp
Wye Valley Trust	78.6%	87.5%	51.7%	35.8pp
The Walton Centre FT*	50.0%	56.0%	28.6%	27.4pp
Aintree University Hospital FT	70.8%	74.4%	50.0%	24.4pp
Ipswich Hospital Trust	61.2%	67.1%	46.6%	20.6pp
Blackpool Teaching Hospitals FT	55.8%	60.6%	41.1%	19.5pp
Lewisham and Greenwich Trust	77.0%	82.1%	64.2%	18pp
Royal Liverpool and Broadgreen University Hospitals Trust	64.1%	67.9%	50.0%	17.9pp
Dartford and Gravesham Trust	65.9%	71.1%	53.7%	17.5pp
* = specialist trust

Weekday access

While the targets were devised to remove the disparity between weekend and weekday access to care, the data also reveals some trusts are struggling to meet the standards even on an average weekday.

Eighteen trusts are not offering a consultant review within the first 14 hours of admission to at least half of their weekday patients.

Weekday performance overall is better for ongoing consultant reviews. In only two trusts did more than 40 per cent of patients not receive a daily consultation Monday to Friday.

Ten trusts with the worst performance for offering ongoing consultant review during the week

Trust	Seven day average	Weekday	Weekend
The Christie FT*	48.6%	55.4%	31.1%
Moorfields Eye Hospital FT*	62.50%	57.1%	100%
East Sussex Healthcare Trust	54.6%	64.1%	32.9%
North Bristol Trust	61.3%	64.2%	52.5%
Guy’s and St Thomas’ FT	60.2%	65.9%	46.9%
Tameside and Glossop Integrated Care FT	55.6%	66.6%	26.3%
Milton Keynes University Hospital FT	60.6%	68.7%	41%
The Dudley Group FT	67.5%	68.9%	63.6%
Wirral University Teaching Hospital FT	61.9%	68.9%	43.8%
St Helens and Knowsley Hospital Services Trust	64.1%	71.4%	47%
* = specialist trust

Ten trusts with the worst performance for offering a consultant review within 14 hours of admission in the week

Trust	Seven day average	Weekday	Weekends
Liverpool Women’s FT*	25.0%	24.0%	33.3%
Southend University Hospital FT*	43.3%	41.6%	47.5%
Poole Hospital FT	46.3%	47.3%	42.9%
East Lancashire Hospitals Trust	52.5%	49.1%	60.9%
The Christie FT*	46.8%	50.0%	33.3%
Queen Victoria Hospital FT*	57.1%	50.0%	85.7%
Gloucestershire Hospitals FT	54.1%	51.6%	60.5%
Medway FT	57.5%	55.5%	63.8%
Dorset County Hospital FT	55.1%	55.7%	53.7%
Kettering General Hospital FT	57.1%	55.8%	61.5%
* = specialist trusts

Some of the trusts with low compliance with the standards attributed it to staffing or to data concerns, as well as questioning whether the measurement reflected patient need.

A spokesman from Guy’s and St Thomas’ said: “There are patients with less complex needs who are seen by a registrar instead of a consultant if appropriate – in line with guidance from NHS Improvement – however, we recognise that this decision to delegate is not always recorded as well as it could be within the trust.”

North Bristol Trust medical director Chris Burton shared similar concerns. He said his trust provided a “high standard [of service] 24 hours a day, seven days a week” and was reviewing its recording.

South Tyneside attributed its “significant drop” in meeting the standards at weekends to “very significant workforce challenges”. It concentrates its “limited consultant resource” on reviewing emergency admissions and the most ill patients. It said it is involved in regional plans to improve seven day standards.

A spokeswoman for The Christie said the patient pathways for specialist hospitals were not well reflected in the data, and that the trust “admits only patients who are registered with the trust for cancer treatment, and all unplanned admissions are triaged before the decision to admit. A number of these will be on well defined care pathways, for example to manage complications of chemotherapy or radiotherapy.” She added mortality analysis showed no spike in deaths at weekends.

Similarly, a spokeswoman for GOSH said urgent but planned admissions were seen by a mixture of consultants or registrars depending on patient need, but children admitted to critical care all received a consultant review within 14 hours.