NHS: Seven-day Working

Baroness Brinton Excerpts

Thursday 6th February 2014 Lords Chamber

[Baroness Brinton (LD)]

My Lords, I, too, thank the noble Lord, Lord Ribeiro, for securing this key debate. It is shocking that your chances of receiving prompt treatment and, indeed, of surviving are worse if you are admitted to hospital over a weekend or on a bank holiday. The 2011 Freemantle report provided the evidence that more than 500 deaths could be prevented in London each year purely by increasing consultant cover in acute medical and surgical units.

The good news is that there are early adopters and pathfinders who are demonstrating that it can be done. I hope your Lordships’ House will indulge me with a personal anecdote. I was very unwell over Christmas and had the good fortune to be admitted to the acute admissions unit at Watford General Hospital. The unit was set up in 2009 to help reduce pressures on A&E and the main hospital. The £12 million 120-bed unit shares the building with A&E but all referrals have to come from a GP and the maximum length of stay is 72 hours, although stays are usually much shorter. Consultants are on duty 24 hours a day and see patients as they are admitted so care is tailored very quickly. The AAU and A&E share their own MRI scanner, X-ray and ultrasound unit, a catheterisation unit for angioplasty, blood testing facilities and pharmacy. My experience of the care was outstanding: tests, scans, monitoring and observation and treatment were all prompt, and I felt that the entire clinical team worked smoothly as one unit. I know that I am not alone in my praise for the unit.

Seventy-two hours seems to be about the right length of time. I have seen reports of other acute units where the time is only 36 hours. Recently a Leeds hospital reported that there is still pressure on the main wards from this shorter timescale.

The briefing from the Royal College of Surgeons states:

“Seven day services may also reduce pressure and stress on doctors. For example, consultants can spend much of Monday morning dealing with weekend admissions that are waiting for review or discharge”.

However, this does not affect just doctors: radiologists and many other clinical support staff are similarly affected by the Monday morning catch-up that impacts on an already busy week. Can the Minister assure the House that the NHS will provide robust modelling and review structures using the examples of early adopters to ensure that seven-day working is introduced carefully and effectively?

There needs to be a realistic timetable and a full understanding of the workforce issues—not just consultants or contracts and payments, but also appropriate staffing levels right through the NHS. It therefore seems sensible to move ahead on urgent and emergency care first and then reassess for wider clinical services, rather than rushing ahead with elective care at the start.

Many people are concerned about the costs of adopting a seven-day working system. With careful modelling—and with units such as the one I described earlier—in addition to inevitable new costs, we will find that there are some cost savings. Overall, the biggest change will be in culture and attitude. The NHS heart is willing. We all need to use our heads and energy to make it happen.