NHS: Seven-day Working

Lord Parekh Excerpts

Thursday 6th February 2014 Lords Chamber

[Lord Parekh (Lab)]

My Lords, I thank the noble Lord, Lord Ribeiro, for securing this debate and introducing it so well. A case for seven-day working in the NHS seems so overwhelming that I am surprised that it has taken us so long to raise it. I can think of half a dozen powerful reasons why seven-day working is an absolute must. As the noble Lord, Lord Ribeiro, has said, it reduces mortality, which can rise by as much as 16% for patients admitted over the weekend. In law—although I have not had the time to get this tested—it would amount to indirect discrimination to suggest that people who are admitted over the weekend receive less satisfactory treatment and invite death earlier than in other cases. That would constitute a case of indirect discrimination.

If we have seven-day working, it will amount to better use of diagnostic machines, laboratory equipment and operating theatres. It will also decrease the patient’s length of stay in hospital and thereby not only reduce pressure on hospitals but increase GDP because people will come out of hospital earlier and be able to work more days. The amount of patient satisfaction would also be considerable. For all these reasons, a case for seven-day working seems compelling.

I add an extra reason to assist the Minister in his negotiations with doctors who might resist this, but it is not the comparison with retail traders opening on a Sunday, as that is not a good analogy. We ask that our hospitals be open over the weekends, and that consultants and others be available, because these are issues of human lives. Where human lives are concerned, you cannot make a distinction between a weekend and a weekday.

Given that the case is so overwhelming, what are the objections? I hear three objections from many doctor friends who I am privileged to know. First, I am told it will impose extra burdens on consultants and senior clinical staff. The answer to that is, first, it need not be so because the workload can be properly distributed. Secondly, the same doctors who talk about the extra burden have absolutely no difficulty attending private clinics and private hospitals where they perform operations over the weekend. That is an argument of self-interest, which does not wash with me.

The second argument is that it will increase the cost. It could, and we have had figures bandied about. To that, my answer is: first, if you have better rota and shift planning, you need not employ a large number of extra consultants or senior clinical staff. You will also reduce the patient’s length of stay in hospital, which would mean a considerable saving. Hospitals under the same trust should be able to share clinical staff, so it does not necessarily mean each hospital having its own extra consultant. Equipment could be more effectively shared—that would mean a considerable saving—and, of course, there will be a reduction in the current payments for unusual hours that are paid to doctors. For all these reasons, I think that the objections based on cost can be addressed.

There is a third objection that many of my friends have made, which is that it could be hard on women. The noble Lord, Lord Ribeiro, said that many women consultants and others might welcome working over the weekend; but there are also many others who would find it difficult to work over the weekend and might resent being compelled to work in exactly the same way as their male colleagues would. There again, talking to consultant friends, I am told there is an answer: better rota and shift planning so that women need not necessarily be involved over the weekend. I suggest that there are enough reasons to go ahead, full steam, with this project.