• Weekend working plans for NHS cause controversy

  • 17 Dec 2012
  • Comments 21 comments

NHS proposals to increase weekend working for staff have divided doctors’ groups in a row over who should come first, patients or staff.

The NHS Commissioning Board will issue guidance to health bodies this week about the introduction of routine scans and hospital procedures at weekends.

Sir Bruce Keogh, the medical director of the NHS, said that the health service should move towards a seven-day model, and drew on Tesco as an example of “complex” round-the-clock working.

He suggested that the current working pattern had been designed around staff rather than patient needs, adding that closing operating theatres and clinics at weekends was a waste of funds.

“Our system has been based around providing as good a working environment as you can for the people who work in the health service, which isn’t necessarily matched with what the people who want services have,” he told the Sunday Times.

“If you wanted a day case operation, and you didn’t want to take a day off work, why can’t you have it on a Saturday or Sunday?”

“Tesco have had to go through this – it was a complex issue for them,” Keogh added. “As we think this through, we will need to look at the terms and conditions of service of people – employment conditions.”

But the British Medical Association (BMA) said that the UK’s largest supermarket chain was a bad example to cite.

A BMA spokeswoman said: “The health service is not Tesco — I don’t think that is a good comparison. As doctors, of course we want to improve services we offer patients, but there has to be investment in sources that underpin that.”

She advocated a flexible approach. “There are some clinics that are already providing a weekend service,” she explained. “What works for one might not work for another. It will be important to learn from best practice.”

But the Royal College of Surgeons agreed that more consultants needed to work outside business hours.

“Well, it is true there is a problem at weekends, there is no question about it,” its president, Professor Norman Williams, told The Telegraph.

“I feel we have to do something about that. It [weekend services] is not across the country, it is in patches. The issue is more consistency throughout the system.”

The NHS Commissioning Board is issuing guidance to health bodies this week regarding the introduction of routine scans and hospital procedures at weekends.

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  • NHS - do we forget what this stands for? National Health SERVICE - of course patients come first! The police and fire services work 24/7 so as health/illness is also 24/7 shouldn't they be required to work 24/7 also?! Why are we paying Tax and NI for their over inflated salaries and part time work?!

  • Have your say...No one commenting actually knows anything about the way the NHS works clearly, doctors nurses and NHS staff DO work round the clock! They are have a rotational on-call system. The hospital does not just shut down on the weekends, the consultants are present at the hospitals on saturdays. Operations that NEED to go ahead DO go ahead. I think that people need to educate themselves on the facts before commenting.

  • Another example of how the NHS has lost sight of what it is there for in that it appears to be set up for the convenience of its employees rather than the needs of its patients.  The evidence about increased mortality rates over weekends is a matter of record. I have yet to hear anything in support of patients from either the BMA or RCN about this or other recent concerns about standards of care in the NHS.  Reform, reform and more reform.

  • I've got only one question, are we patients or customers of a supermarket? When you guys go to Tesco, you don't get anything for free; you pay every time you shop! With hospitals, we do expect to receive the best possible care/treatment and etc., but our NI doesn't cover this, especially when we are talking about serious health problems. There are so many people who even do not pay NI so how do you believe the costs should be covered. Have you ever worked 20 hours operating a patient without break and knowing that somebody's life depends on you? And you won’t be paid, it’s most unlikely you would have a day off, because of short staff? Sound quite unfair but we patients, we don’t care. We only want the best possible care and treatment, and we don’t care about feelings of medical staff, because we think only about yourselves and our rights. Do you know how many hours hospital registrars and consultants work in reality, mostly it is twice longer but it doesn't fit EU 48 hpw law, and they are not allowed to claim extra pay or to get days off in lieu. They are half-paid for weekends and nights shoft. Would you like to work night and get only 50% of your normal salary?  Doctors are not shop assistants, they spend up to 20 years for their education and training, so they deserve their salaries. (why do  bankers deserve their salaries and bonuses? They nearly bankrupt us). Let’s be honest. We could force them to work, your government is really good in this, but do you believe that we still would have well-qualified doctors or they would leave the NHS. By the way, we’ve got A&E for emergency cases, we need to improve this part of NHS first, and let’s care about medical staff, not managers. We’ve got so many managers with huge salaries who have no managerial skills and can’t do their work properly.

  • Good comment Bob, I just need to clarify a few points particularly with regards to Doctors and Nurses . The NHS is  struggling to  man the present system, because there are not enough Doctors and Nurses.I definately know that in some areas Nurses are currently working 3 - 4 days night duties, and then get less than 24 hrs rest only to return back to day duty. All the figures from the HSE and related bodies show high levels of stress amongst hospital workers. It is a highly complex buisness,it takes years to get a Doctor or Nurse to be trained to specialist level. To elevate this requires alot of finanacial power can the NHS or govt afford it?.Until there is a consensus on better staffing levels, the 24/7 question in my view should take back stage, otherwise we risk embarking on an ambitious process that will not be favourable to anyone. Dealing directly with human lives as in the NHS has a whole complex ethical, professional and legal dimension that is not comparable to working in any way for Tesco (not withstanding all good Tesco does).

  • In reply to "David 17 December 2012 17:54".<br/><br/>I don't think any one is actually suggesting that individual staff should work 24/7 only that the service be available outside M-F 9-5. Doctors, nurses, technicians, admin staff and all the other trades too numerous to mention would still only work their contracted hours/week just like everyone else that does not work M-F 9-5. <br/><br/>And..if we are considering the effects of lack of attention to detail and alertness perhaps you should think about that the next time you fly in an aeroplane (run by an airline that operates 24/7 across the world) with hundreds of people miles above the ground relying on the crew to get them safely to their destination or the next time you are on the motorway and the 30 ton Tesco truck (loaded with groceries for NHS staff to buy at the weekend) passing you in the other lane manages not to hit you, then just be thankful that at least one Tesco employee is bucking your assumption and is alert.

  • I have been working to obtain 24/7 productivity & care in the NHS through my local MP since Nov. 2010 & I am pleased to see that positive steps are now being taken to achieve this. Having obtained facts from hospitals PCT I am able to answer some of the objections being made by the BMA & other NHS staff.  There will be no extra strain on medical staff  or extra hours as rota systems could be worked & at present many seniour clinicians work in private hospitals at weekends.  Lack of beds & lack of Finance are stated to be the main restrictions but the facts I have obtained from hospitals in East Anglia & the PCT  prove the following. If 24/7 working is introduced ,patient releases at weekends will increase by 75% this not only creates thousands of extra bed days but also saves millions of pounds. It will do away with waiting lists and save patients having to be transferred to private hospitals to meet targets.  I have found that 27% more procedures would be achieved & operating theatres would no longer be empty at weekends .The figures I have given relate to the year 2010/2011 in which the total cost of the NHS was £101.9 billion .  If there was no savings , 24/7 working would cost another £5 billion approximately but taking the huge savings made by 75% more patient releases at weekends and patients not being transferred to private hospitals would result in the hospitals I have audited achieving 24/7 working including all the benefits mentioned above and even finish with a small  profit.    With 16% of patients who are seriously ill dying unecessarily just because they entered hospital on a Saturday or Sunday it is time seniour clinicians had their contracts changed to include 24/7 working on a rota basis.<br/>I

  • NHS is a service to people; people require health care 24/7.  A full w/e service is long overdue in a world where most people are working.  It would overcome in a stroke the, at times, thoughtless push to empty beds at w/es

  • I agree with comments above.  The fact that the debate on "who should come first patients or staff" is even taking place would be laughable if it were not so tragic.  The notion that public services should not be as customer centric and flexible as we expect private enterprise to be (and for something so crucial as health matters) is entirely outdated.  The current system puts the burden on the citizen being flexible and available rather than the service - for which we pay.  This needs to change.

  • You only need to look at this NHS Report to see why the NHS needs to have better cover 7 days a week.<br/>www.nhs.uk/.../weekend-hospital-death-risk.aspx

  • Have your say...<br/><br/>The patients are the "customers".<br/>Having to wait around for the so called consultants to finish their weekend, has a knock on effect,it costs more money for employers from all industries,to allow the "ill member of staff/patient" to attend hospital procedures during the working week, on full pay or sick pay  & provide extra cover for lost hours of work by paying overtime.<br/>This is a standard scenarios withing retail i.e. Tesco; or any other high street retailers or manufacturing industries.<br/>I am sure it costs the NHS more to keep a patient over the weekend under observation, waiting prepped for a possible operation for extra 2 days.<br/>Wake up call needed,we have become a 24/7 society.We have NHS managers don't we? Why not manage all the resources better including the speedy service of patients even through a weekend.The majority of employment contracts now run from Sunday to Saturday.<br/>Priest work weekends, the doctors of the soul so why not the doctors for our bodies?

  • I do not agree with the comparisms made with the NHS and Tesco. Employees (particularly clinicians) in the NHS deal with life and death cases, they therefore require time to rest and recuperate. The level of attention to detail or alertness necessary to function as a clinician in the NHS is far greater than what is required when working for TESCO. The consequences of making any mistakes whilst working as a clinician are far greater than that of when working for TESCO.

  • Have your say...Some years ago now the NHS  introduced a new job evaluation scheme and even  poorly paid partimers received back dated pay  rises - basically for nothing! I complained to my MP at the time that the issue of weekend working-and indeed overtime payments for it- should have been addressed then and said I would have been sacked for introducing such a deal in the private sector without any productivity gains. <br/><br/>Tesco is a actually a perfect example of where the NHS needs to go!<br/><br/>NHS staff expect to buy food on a Sunday afternoon in Tescos without paying a 50% or 100% premium to the staff serving them.<br/><br/>My mother was always kept in hospital longer than she needed to be - wasting bed space - because testing etc.always  came to a halt at weekends!Their machinery costs millions and it is time it was properly utilised.

  • At last someone has had the nerve to state what has been blindingly obvious for years, hurrah!  The world is now a 24/7 business operation and it's about time these folks joined in.   Dare I say in the private hospitals it is pretty much 24/7 so this is long overdue.<br/><br/>Combine this with the statement by the head of nursing who wants to reintroduce 'care and compassion' into nursing the sick (now that's a novel idea), we could be on to a winner..... eventually.

  • Have your say...The NHS need to be 'open' at weekends.  No one should suffer inferior service just because of the day they fall ill.  Beds must not be blocked because there is no one to discharge a patient. Neither must borderline patients be sent home because there are not enough staff.  The situation needs sinsible negotiation not knee-jerk position-taking.

  • The NHS is there for patients, it is about time we recognise that, in the 21st Century, in an asset dense environment like the NHS 24/7 is the only sensible way to go.

  • Not that long ago politicians were resisting Sunday opening for supermarkets.  I agree with providing a service on a Saturday morning but to follow the Tesco example is bizarre

  • The NHS should adapt round the clock strategy ,'the best fit'.'patients focused' in order to correct thier skeletal weekend service.

  • I think this is quite the reverse - the Health Service should be operating 24/7 and commercial companies should be attempting to emulate its service delivery.  For the Royal College of Surgeons to talk about "business hours" is foolhardy: how many of these consultants work outside NHS "business hours" in private facilities with the skills they have developed through the NHS?  Are patients to be seriously ill during business hours only?  It is a similar case for nurses - how many other graduates are funded through their training, do not have student loans but yet receive equitable/better salaries to other graduates e.g. police officers, teachers, firefighters?  The adoption of some of the IT systems utilised in commercial life will relieve many medical professionals of the need to waste time taking partial histories from relatives rather than accessing a single IT system through the Government Gateway.

  • My GP works Monday to Friday with a half day on Wednesday with the surgery open from 9 to 6.  Although the Doctors are not available all these hours.  You seem to have to plan to be sick weeks in advance as appointments are hard to get.  They get a 6 figure salary.  Why would they want to work any weekends?  Hippocratic oath! What's that?

  • Aboslutely they need to move to weekend working, an I think to draw on the comparison of Tesco is absolutely right. Customers/patients should come first, people do not choose when to get ill so a 7 day operation is essential to improving the health service. Retail stores open 24 hours to maximise their assets (i.e. staff hours and equipment/rent etc) so why can't hosiptals take something from this?