The annual Dr Foster Hospital Guide has always reported on several issues surrounding our country’s hospitals, and one of those areas explored this year was that of weekend clinical care in the NHS. As weekends are considered outside of normal working hours, the care patients receive at these times can differ greatly to the level of care they experience in the week. So what did the 2013 report find out regarding weekend care in the NHS?
What was being analysed?
The report looked at several factors concerning levels of clinical care for patients both at the weekends and at the very end of the week, where care was likely to be carried over into Saturday and Sunday. It also gathered information regarding emergency operations, post-operative periods of recuperation, hospital returns after being discharged and the likelihood of receiving diagnostic tests on the day of admission over a weekend. All of these things were then compared to the level of clinical care being provided during weekdays (or ‘normal working hours’).
What did the report find?
Generally, the results varied, as some of the findings were based on perceptions of patient care. For example, 68% of doctors (as interviewed by Dr Foster and Doctors.net.uk, the largest professional network of UK doctors) believed that at their hospitals, patients admitted at the weekend did indeed suffer from lower levels of care than those admitted on weekdays.
Statistically, emergency overall mortality rates are 20% higher when a patient is admitted at a weekend, and in terms of routine surgery, operations performed at weekends have a 24% higher patient mortality rate. If we look at more specific treatments, emergency endoscopies – taking place on the day of admission – are 40% lower at weekends, with emergency MRI scans being 42% lower at weekends.
Patients are also more likely to have longer waiting times for hip replacements at weekends. But how many hospitals do these statistics actually apply to? Eight hospital trusts have improved their mortality rate for weekend patients, with another eight having ‘low’ mortality rates for both weekend and weekday admissions. On the other hand, eight trusts are still experiencing higher weekend mortality rates compared to patients who are admitted during the week.
What does this mean for the NHS?
Overall, it is clear that there are still problems with patients experiencing substandard weekend care, and while some trusts have improved on these levels of care, there is still a lot of work to be done. It is simply unacceptable that patients who have emergency operations on weekends are less likely to survive the treatment, or that patients seen over the weekend are more likely to need to return to the hospital once discharged because they weren’t properly cared for the first time round.
There is also still a big difference in the best trusts and the worst trusts. It should be noted that some improvements have been made over the past twelve months, but most trusts need to address this problem quickly and thoroughly. As public debates about NHS standards continue, Sir Bruce Keogh (Medical Director for NHS England) is looking at improving weekend hospital care as a top priority.
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