NHS: Seven-day Working

Lord Warner Excerpts

Thursday 6th February 2014 Lords Chamber

[Lord Warner (Lab)]

My Lords, I congratulate the noble Lord, Lord Ribeiro, on securing this platform to enable us to discuss this very important issue. I declare my interest as an adviser to Synlab, a German pathology company.

There is not much to disagree about in principle on the idea of seven-day working in healthcare with such a large number of emergency admissions to hospital. The evidence is pretty clear that we need the most senior doctors working later in the day and at weekends in those places dealing with emergency conditions. The noble Lord, Lord Ribeiro, told us the scale of those admissions each year. The interesting thing is that the Academy of Medical Royal Colleges has made clear that patients with these conditions need on-site consultant inspection at least once every 24 hours. Those admitted on Friday may not be seen by a consultant until Monday. That is clearly a dangerous practice. I would be very interested to know whether the Minister accepts that in hospitals which have A&E departments they would expect there to be seven-days-a-week consultant cover to enable a person to be seen by an on-site consultant at least once every 24 hours. Is that now government policy or just an aspiration set by the Academy of Medical Royal Colleges?

We know all about the difficult practical issues of implementing this kind of policy. We have also heard from the noble Lord, Lord Ribeiro, the different financial estimates for doing this. It is very interesting that the BMA’s estimate of £32 billion for seven-day working overall is roughly the same size as NHS England’s estimate of a £30 billion funding gap by the end of this decade on present plans for the NHS. There is some symmetry and agreement around about £30 billion; it is just a question of whether it applies to the gap or the funding increase you would need for this kind of policy.

I do not disagree with anything the noble Lord, Lord Ribeiro, said, but I want to focus on the point he made about money. Before I do that, I pay tribute to the work he has been doing in his capacity as chairman of the Independent Reconfiguration Panel. The trouble with that work is that he has to wait for what is served up to him. He is not allowed to take the initiative. We know many of the failing health economies. The NHS Trust Development Authority was set up to deal with many of these bodies. We have a situation where we are thinking of dreaming up a highly desirable change in patients’ access to consultant cover on urgent admission to hospital when we know full well that we have a very large number of almost insolvent trusts carrying out A&E admissions day in, day out. They are propped up by handouts from other bits of the NHS. This is the reality that the NHS faces daily. I suggest that we can implement this policy only if we grasp the nettle of reconfiguring services rapidly and consolidate more of these specialist services on a single site.