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Weekend hospital care: 'Seven-day week' for senior doctors
1 year ago

Sir Bruce Keogh says seven-day healthcare is "absolutely compelling, both clinically and morally" (video)

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Hospitals in England will have to ensure senior doctors and key diagnostic tests are available seven days a week under new plans.

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The measures form part of a vision unveiled by NHS England to tackle higher death rates at weekends.

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The changes, proposed by medical director Prof Sir Bruce Keogh, will be applied to urgent and emergency services over the next three years.

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Sir Bruce said the case for change was clinically and morally "compelling".

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The British Medical Association, which represents doctors, said the case for seven-day services had been made and the focus needed to shift to delivering it.

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'Expect more'

Research suggests death rates are 16% higher for patients with emergency conditions admitted on Sundays compared with those admitted on Wednesdays.

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Sir Bruce told BBC One's Andrew Marr show "society has moved on and people expect more and more from services at the weekend".

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"It seems strange in many ways that we should start to wind down on a Friday afternoon and warm up on a Sunday... and [in the] meantime people are waiting for diagnosis and treatment," he said.

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He said that, historically, the NHS had been good at providing a five-day-a-week service but medicine had advanced.

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Sir Bruce said junior doctors felt particularly stressed at weekends because of the complexity of cases, and often felt "unsupported".

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"We worry about that, not only because it may relate to the higher mortality rates, but also because it implies that we could be training the next generation of doctors better," he said.

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The proposals, which will be discussed by the board of NHS England on Tuesday, set out 10 new clinical standards for hospitals.

These include:

  • All emergency admissions to be seen by a consultant within 14 hours
  • Seven-day access to diagnostic tests, such as X-rays, ultrasound, MRI scans and pathology
  • Patients in intensive care and other high dependency units to be reviewed by a consultant twice a day
  • Weekend access to multi-disciplinary teams, which include expert nurses, physios and other support staff

Sir Bruce said organisations would need to be "absolutely transparent" about whether they were meeting these standards.

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He said the changes would be contractually binding. It is possible a clause in consultants' contracts stating organisations could not compel them to work at the weekend could be removed, he said.

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"These are pretty radical changes with some pretty hard levers behind them," he said.

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He had earlier said a system of incentives, rewards and sanctions would be built into contracts by 2016-17 to encourage hospitals to follow the new standards.

Breaches could cost hospitals up to 2.5% of their annual income of up to £500m, and they could face losing their right to use junior doctors.

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Sir Bruce told the Marr show the changes would cost about 1.5-2% of the annual running costs of the hospital and said he was confident about finding money from other parts of the NHS to pay for the plans.

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More consultants working weekends would stop inappropriate admissions and diagnoses would be speeded up, in turn helping hospitals run more efficiently financially, he said.

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"We believe the arguments for this are absolutely compelling both clinically and morally," he said.

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Page 1   http://www.bbc.co.uk/news/uk-25381319

1 year ago

'Calendar lottery'

Dean Royles, of NHS Employers, which represents hospitals, told BBC Breakfast the review "seals the deal" on the case for seven-day working.

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Dr Mark Porter, chairman of the British Medical Association Council, backed the changes, saying "there should be no calendar lottery when it comes to patient care".

He said the BMA was in negotiations with NHS Employers and the government to find an "affordable, practical model for delivering this care" while safeguarding doctors' work-life balance.

But Prof Chris Ham, of health think tank the Kings Fund, said there were concerns over funding because many hospitals were already struggling and financial pressures would only grow.

The Patients Association said: "Our lives and health are totally dependent upon this vital service and we look forward to its implementation with the least possible delay."

Health Secretary Jeremy Hunt has commended the move, while shadow health secretary Andy Burnham said the government needed to clearly set out how it will be paid for.

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The Welsh government has not ruled out seven-day working, while the Scottish administration has committed to having consultants in wards seven days a week.

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A review in Northern Ireland earlier this year found disparities in out-of-hours hospital care, compared to weekdays, and said specialist consultant ward rounds and formal weekend handovers were needed.

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Why do more patients die at weekends?

  • Variable staffing levels
  • Fewer decision-makers of consultant level and experience
  • Lack of support services, like diagnostics
  • Lack of community and primary care services to prevent unnecessary admissions and support discharge

Source: NHS England

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Analysis

Anyone who has been in hospital will be aware of the change of pace the weekend brings.

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Theatres lie empty, equipment is turned off and there are noticeably fewer staff around.

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It is, therefore, no surprise that many believe a truly seven-day service is long overdue.

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This review has provided a vision for what services could look like. But the big question now is how it can be implemented.

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The NHS is in the middle of its biggest savings drive in history and there remains much work to be done to get hospital consultants fully signed up.

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This promises to be just the start of a long process.

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Page 2  http://www.bbc.co.uk/news/uk-25381319

Comments
1 year ago

There is 495 comments on the BBC Website concerning this report, I am posting 3 of these, 

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alr 

COMMENT NUMBER 58 IS AN EDITORS' PICK
15TH DECEMBER 2013 - 11:44

As an Anaesthetist / Intensive Care doctor I already work up to 7 days per week. However my contract says covering emergencies instead of routine work is not equivalent in hours to normal Monday-Friday working. At the same time, there are fewer nurses, labs, paramedical and support staff at weekends - this would also need addressed

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keepsmiling 
15TH DECEMBER 2013 - 11:47

We in Emergency Medicine (which has proper 24/7 shift patterns) have been calling on this for years

It is dispiriting for me and others when med students/junior doctors say they don't want to work in EM due to 'the hours'. There seems to be an expectation amongst some coming through that medicine is a 9-5 Mon-Fri job. It isnt! 

If you want a 'lifestyle' be a dentist!!!

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Violet Mildred 
15TH DECEMBER 2013 - 11:30

It is self evident that people get sick seven days a week and so they need care for the time when they are ill. Consequently, doctors need to be working in rotas which ensure that there is full cover at all times.

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Page 3 http://www.bbc.co.uk/news/uk-25381319



This post was modified from its original form on 17 Dec, 12:20
1 year ago

Ray, if I understand this right they are going to require that hospitals have a senior doctor available in the emergency room or the hospital itself 7 days a week, correct?  In the US they have interns (doctors that have not yet done their residency) in the Emergency room and the hopsital 24/7/365 and they then contact the patient's regular doctor to discuss what the person has presented with as their symptoms, etc. if it requires more than regular care, i.e., stitches, casting a broken leg, arm, etc., or just basic care.  There are senior doctors that are available to come to the hospital and if the person needs surgery, etc. they immediately contact their physician of record and then a surgeon is contacted, etc. or if the can't get the patient's physician of record, they just contact a surgeon, usually there is someone on call at the hospital outside normal office hour time.

So I am interested in this and what it will require.

1 year ago

Ray, give us more on this when you find the time.    Thank you!

1 year ago

Diane, here in AZ our emergency staff has a hospital Dr.(a full degree doctor) to call upon if needed.  These doctors only work in the hospital on regular shifts.  There is always one available and many attend patients if their own dr. is not available.

Ray, I was surprised to learn that there was such a need for complete care in the U.K.  I hope they listen to the doctors and don't botch it like has been done here with the ACA.

1 year ago

I am sorry for responding so late, been very  busy writing my letter to Santa Obama, however, I am back with youselves again,

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I will explain what lead upto this move, I yourselves may or may not be aware, between 2004 and 2009, the death rate at the mid-Stafford Hospital was very high, in so much that it was runing into the 1000's, an inquiry was carried out during this time, but the full outcome was covered up,

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Once David Cameron came into power in 2010, the first thing he did was to order a full public inquiry, which was to start in the November of the same year Stafford Hospital inquiry ends after 139 days at cost of £10m 

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the outcome is that Stafford Hospital: Hiding mistakes 'should be criminal offence' 

NHS staff should face prosecution if they are not open and honest about mistakes, according to a public inquiry into failings at Stafford Hospital. Years of abuse and neglect at the hospital led to the unnecessary deaths of hundreds of patients. But inquiry chairman, Robert Francis QC, said the failings went right to the top of the health service. He made 290 recommendations, saying "fundamental change" was needed to prevent the public losing confidence.

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Responding in the House of Commons, Prime Minister David Cameron apologised to the families of patiets. 

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Previous investigations have already established in harrowing detail the abuse and neglect from 2005 to 2008. This inquiry looked at why the system did not prevent the problems or at the very lest detect them earlier. 

In particular, it recommended:

  • The merger of the regulation of care into one body - two are currently involved
  • Senior managers to be given a code of conduct and the ability to disqualify them if they are not fit to hold such positions
  • Hiding information about poor care to become a criminal offence as would failing to adhere to basic standards that lead to death or serious harm
  • A statutory obligation on doctors and nurses for a duty of candour so they are open with patients about mistakes
  • An increased focus on compassion in the recruitment, training and education of nurses, including an aptitude test for new recruits and regular checks of competence as is being rolled out for doctors

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Final report The final report of the Mid Staffordshire NHS Foundation Trust Public Inquiry was published on Wednesday 6 February 2013. Please use the links below to access the executive summary and a full copy of the report, along with the Chairman's public statement on the day. 

Read the report 

Please note: the above links are the complete reports in full and are PDF Files. there is a video on this website also, http://www.midstaffspublicinquiry.com/report

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but this is not the only hospital, this why I have always I always said there more behind this, another 5 Hospital were to be investigated, but this was not the end, this went upto 11 Hospitals that high death rates, I could accept the fault of one hospital, but when there is 11 hospitals, I can only say what part did the Blair and Brown Labour Governments play in all deaths also, 

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Please note: this is the first part of a long post I will continue later today

 



This post was modified from its original form on 18 Dec, 6:46
1 year ago

Ray, I will wait for the rest of your information but this did help a great deal. I have a good friend that is a Registered Nurse. She took her schooling in Canada and when she came to the US to work as a traveling Registered Nurse (she registers with a company and they rill nursing shortages around the Country on short term basis) she actually had to go to a U.S. nursing school and take almost a year of classes and then do an "internship" before they would approve her to work as a nurse in the US. Her educational background was more than sufficient in Canada but fare below the standards expected for nurses in the US; we require a much more detailed and extensive education and training while in school. She told me that the UK was much the same in their requirements as what she had had to achieve in Canada. So I can see that if this is true that there might be room for improvement in the UK, as there certainly is in Canada.

I do feel that the educational standards and proficiency testing for people in all paramedical professions as well as doctors and nurses should be exceedingly high as we are talking about people's lives. What I would like to see more in the US is where the local and national medical societies would monitor the doctors in their locations more than they do and stop the "good 'ole boy" mentality; stop covering for each other. There is a degree of that that takes part and it is wrong. A doctor is afraid to speak out about another doctor as it will often blackball him with the doctors in his local medical society.

My family had a person experience in this when my mom passed away; there was not reason for her death and it was complete medical incompetence of her attending physician that overturned the treatment of the cardiologist that actually did the angiogram and attempted angioplasty and took over her care. He ordered a medication that was not necessary and completely counterproductive to her actual condition, her heart burst and she bled to death internally and it was too late for the cardiologist to save her.

As a family we were told by the cardiologist that it was definitely medical malpractice and that he would willingly testify in court, give statements, evidence, etc. to help us if we wished to file charges and sue the other doctor. We decided against that as it would not bring mom back, but we did ask this doctor to help us to insure one major issue. We asked him to go to the medical association, present the case to them and ask that this doctor be put on strict supervision, investigation and whatever else necessary to see that no other patients suffered similar circumstances. Believe it or not, we found out that this was the first time this had happened, they listened and within 4 months of investigation this doctor was asked by his partners to step down from the practice, go back to take a new internship and a few other personal things such as drug rehab. The last I knew he was working as an Emergency Room doctor at one of the local hospitals and under supervision of the hospital's full time doctor.

So I do know that there are some hospitals that do have a senior physician on duty. At this particular hospital the local surgeons and doctors share duty at the hospital on a rotation basis; there is a physician and a surgeon on duty 24/7.

1 year ago

Part  2 

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Once Robert Francis QC, gave his finding and made them public, there was of concern within the British Public, as you may expect, on the 26th March 2013, The Government promises to foster a "culture of zero harm and compassionate care" in the wake of Robert Francis QC's report. Speaking in the Commons, Health Secretary Jeremy Hunt said a number of changes would be introduced, including a rating system for hospitals and care homes, and changes to nurse training. No more covering up errors, NHS told

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The board of Mid Staffordshire NHS Trust has said it is essential that acute services stay at Stafford HospitalResponding to the Contingency Planning Team Report by the regulator Monitor, it said the proposed downgrading of service provision is "dramatic". the fight was on to keep the Hospital open, we in Stoke-on-Trent was indeed in full support for keeping the Hospital Open even if the A&E was closed as this is what the Puublic at Stafford wanted, in addition, by closing Stafford Hospital this would but a added burden of the Hospital of North Staffordshire. 

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On the 15th April 2013, the Hospital had so much debt, the Trust to be put into administration It is announced the trust which runs Stafford Hospital is to be put into administration by the health regulator Monitor. Mid Staffordshire NHS Foundation Trust will be run by two specially appointed administrators to "safeguard the future of health services" currently provided. 

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On the 20 April 2013 ,there was plans drawn up, however, Local people protest new plan Up to 30,000 people march in opposition to plans to downgrade Stafford Hospital's services. 

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A few days later 24th April the Hospital executives' evidence under spotlight
The former chairman and chief executive of Stafford Hospital are referred for investigation over the hospital's death rates scandal. Stafford Borough Council wants the Crown Prosecution Service to examine whether Martin Yeates and Toni Brisby misled its health scrutiny panel. 

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However, On the 19th May 2013, the Public from Stafford carried on with their fight to save their Hospital, and Protesters stage late-night rally More than 1,000 people hold a night-time demonstration to save services at Stafford Hospital. Campaigners light hundreds of lanterns at the "Night of Light" event on Cannock Road in Stafford. 

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10th June 2013 Police review deaths at hospital Police investigate about 300 deaths at Stafford Hospital, after evidence showed they could have been caused by neglect. Staffordshire Police have been reviewing documents from the Francis report, published in February. 

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Extra time for service plan Administrators running Stafford Hospital are given more time to plan the future of its services. Health regulator Monitor grants the Trust Special Administrators (TSA) an extra 30 days.

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Please Note: there will be a further post or maybe a further 2 Posts,  

1 year ago

Part 3

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the 18th July 2013 the Cost of government evidence revealed
It is revealed the government spent £6m on submitting evidence to the Francis inquiry into Stafford Hospital failings, Health Secretary Jeremy Hunt has revealed.

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24 July 2013, Nurses struck off register A former chief nurse at Stafford Hospital has admitted she could be "intense" with staff. At a Nursing and Midwifery Council (NMC) disciplinary hearing, Janice Harry denied bullying colleagues. Mrs Harry described herself as "firm but fair" but said her sometimes "very straightforward" manner could be misinterpreted as aggressive. 

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On the 30th July 2013, the Director of nursing to leave post It's announced that the director of nursing at Stafford Hospital is to leave and take up a similar role at another hospital trust. Colin Ovington was recruited in 2010 to help improve quality of care at Mid Staffordshire NHS Foundation Trust.

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On the 30th July 2013 the Administrators recommend an end to Trust
Administrators recommend that the Mid Staffordshire NHS Trust should be dissolved. Critical care, maternity and paediatric services should also be cut. A full report is to be put together for health watchdog Monitor,

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the battle to save Stafford Hospital was coming to the end, on the 21st October 2013 More time for report Administrators running Stafford Hospital have been given more time by the health regulator to submit a report on the future funding of services.

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Trust to be dissolved

A final report published by the administrators recommends Mid Staffordshire NHS Trust should be dissolved. Control of Stafford Hospital will go to University Hospital of North Staffordshire and Cannock Hospital will be run by Royal Wolverhampton Trust. The secretary of state is due to make a final decision in the new year. 

The proposals include:

  • Stafford Hospital losing its maternity unit but keeping its accident and emergency department, which will continue to open from 08:00 to 22:00, as it has since December 2011
  • Downgrading Stafford's critical care unit and losing some emergency surgery
  • No longer admitting seriously ill children to Stafford. They will instead go to Stoke-on-Trent
  • Both Cannock and Stafford hospitals will gain some minor operations and more patients will be sent to those hospitals to recover from complicated surgery
  • Introducing a "Frail Elderly Assessment service", which would mean different sources providing information on older people's needs when they are referred to hospital

The proposals will now go to a public consultation, which will end on 1 October.

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Please Note; there is one more post, to give yourselve a complete picture 



This post was modified from its original form on 18 Dec, 16:27
1 year ago

Part 4 

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due the what has been going from 2004 and there is suggestions before 2004 at the Stafford Hospital when Labour was in power, and the Briths Government had to do something to take away the Fear and the Concern that the British Pubic had inrelation to the NHS, 

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Linda you are correct, the hospitals will have senior doctor available in the in A&E and the hospital itself 7 days a week on the wards,

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there is still many more reforms of the NHS to come, Cameron wants both the NHS and the Private Health like BUPA working side by side with each other.

 

 

1 year ago

Quite a few hospitals are now going to staff doctors to treat both ER and inpatient patients especially in the general practice/internal medicine areas and are not using the person's regular doctors even for hospital rounds.  Depending on the area and the mix of specialists those are frequently doctors in private practices that are on call but not in all cases since some are also associated with the hospital as well even some as employees.   This trend is likely to continue and expand to many specialists under ObamaCare or its likely morphing into some form of "single payer" medical care.  

1 year ago

Margaret, Diane, Linda and John, the above is what you have when a Labour Party is in power, 

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the Stafford NHS Trust as now been dissolved. the Hospital will now stay open but under the control of the University of Hospital of North Staffordshire, a much bigger Hospital, which covers all Health matters within the NHS, we did suggest this from day one when the Staffordshire Public started their protest.

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I always believe their is 2 sides to any story, we have not as yet heard the Labour Government Side, what did they do wrong, so many unanswered questions, no doubt we will findout in the 20 year ruling, or the freedom to information act, whatever which one, we will findout what did go on and why. was the spending cuts before Cameron came into power, 

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I will leave this thread with a video, this video comes from a sit-com or is it, I would call it the truth, first shown on British TV in the 1980' called in Sickness and Health, the clip is called ALF GARNETT, WAITING FOR HIS DINNER. this is the NHS and Obamacare.  

1 year ago

Ray, please keep us informed as this progresses as I really wish to see the outcome.  Thank you so much.

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