Quarter of hospital patients denied rapid review – even on weekdays

The information shows that on weekdays across all trusts, 73 per cent of patients see a consultant within the period, which is a key requirement under national “seven day service” standards.

The figure is even lower – 70.3 per cent – at weekends.

Another one of the four key seven day standards set out by national leaders is receiving ongoing review by a medical consultant.

For this requirement, the overall performance is higher – with 85.2 per cent receiving a daily review on average across seven days.

However, on this standard there is a very large disparity between weekday and weekend. Almost 91 per cent of patients see a consultant regularly during weekdays – but the figure is 69.7 per cent at weekends.

NHS England published 10 standards for seven day services in 2013, but later identified four 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.

In addition to seeing a consultant within 14 hours and daily consultant review, the four standards include access to diagnostic tests; and to consultant directed interventions such as emergency general surgery, critical care and urgent radiotherapy. The seven day average on these two measures is 96 per cent and 93.5 per cent respectively. There were differences of several percentage points between weekdays and weekends (see table).

Neither NHS England nor NHS Improvement would say whether this performance met expectations for progress so far, nor whether an improvement trajectory had been set. The rollout of seven day hospital services has been a priority for government, but has been the subject of huge controversy within the NHS and professional debate. Some have argued it should not be a priority, and pointed to evidence that they say shows weekend care standards are not causing worse outcomes.

Academy of Medial Royal Colleges chair Carrie MacEwen told HSJ: “The academy led the way in promoting seven day, consultant present care.

“We supported the 10 standards, which were based in part on academy recommendations and want to see progress on them across the board. The data shows we are going in the right direction but we appreciate the pressures and difficulties involved.”

NHS England brought in the targets as it said there was “a substantial body of evidence” to show there was a “significant variation in outcomes” if patients were admitted at the weekend, including its effect on mortality and readmission rates.

Health secretary Jeremy Hunt is also an advocate of seven day standards and they are included in the government’s mandate to the NHS.

However, a recent study by Manchester University’s centre for health economics said 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.”

National performance against the four key seven day standards