David Wood: NHS needs to be there for us – all day and every day

0
Have your say

THEY are very different services of course, but the NHS needs to follow the lessons of supermarkets and shopping centres if it is to survive.

The announcement of a planned seven-day-a-week hospital service shows the Government knows that care should not be restricted to working hours – but there remain huge question marks over resourcing it, both in terms of cash and expertise.

This has been evidence by the arguments voiced in the election campaign this week.

Historically the NHS has been very good at providing treatments and care for patients on a Monday to Friday 9am to 5pm basis, but less good at providing the same level of care and treatment outside those hours.

However society has changed in recent years – indeed most supermarkets are now open from 7am or 8am until 10pm or 11 pm, as are many shopping centres and leisure facilities. They are expected to provide the same level of service, regardless of the time of day.

NHS England has been looking into the provision of seven-day-a-week treatment, and care in hospitals, following concern over higher mortality rates at weekends.

Mortality rates are 11 per cent higher on a Saturday and 16 per cent higher on a Sunday, for those patients admitted to hospital with an emergency condition compared with those patients admitted mid-week.

This has been followed by an announcement by the Government that hospitals will be properly staffed for urgent and emergency care seven-days-a-week by 2020, known as the 2020 promise.

The NHS does provide “out of hours” cover, but it probably needs to change with society and provide more services as standard at least 12 hours a day, seven days a week. illness doesn’t respect particular days or times – the NHS needs to provide the same level of care.

Key decision-makers need to be on site and diagnostic tests including X-rays, ultrasound, MRI and CT scans, and laboratory work should be available in the evenings and at weekends, with employees being on site and the machines up and running.

Of course senior cover is provided on call, but is it any longer appropriate to pay someone to sit at home and call them in if they are needed?

The level and amount of senior cover is very important. If more consultants were working at weekends, then junior doctors would receive greater levels of support and some inappropriate admissions may be prevented, and diagnosis and treatments may be speeded up.

This would help hospitals to work more efficiently and patients to receive a higher quality of service.

There are huge discrepancies across England in access to treatment and care in the NHS at weekends, and in the evenings. Some NHS organisations already provide a full weekend service, others are moving towards a seven-day-a-week model, but some are not.

NHS England has made the case for a seven day service and the British Medical Association is apparently in talks with NHS employers and the Government in order to come to an agreement on weekend working.

There are of course contractual issues that may need to be resolved.

This principle of seven-day-a-week care should also be extended to GP surgeries.

Although some GP surgeries are open on a Saturday morning or for some evenings in the week, many surgeries 
are not.

There may well be arrangements in place for cover out of hours, but whether these are sufficient – and whether patients know about them and are prepared to use them – is debatable.

The challenge will be in finding either additional resources or moving resources from elsewhere in the NHS. As an organisation, the NHS may need to be smarter in the way money is spent.

Since they came to power in 2010, the present Government has ring-fenced money for the NHS.

This means that the money going into the NHS has not been subject to the cuts experienced by some other government departments.

However other challenges such as an ageing population, mean that these resources are being stretched.

As the general election approaches on May 7, several political parties have promised to continue to protect the amount of money going into the NHS and indeed increase it.

The parties seem to be trying to outdo each other. However it seems doubtful that an extra £2bn a year, which has been promised, will be sufficient. Difficult decisions may need to be taken.

Maybe a discussion needs to take place to explore what sort of NHS we want in the future, what level of treatment and care the NHS will provide and, equally as importantly, what it won’t.

The plan to provide seven-day-a-week treatment and care by 2020 is a significant step in the right direction, but these promises need to be fully financed so that they can be delivered.

David Wood is a principal lecturer in Adult Nursing and Public Health at Sheffield Hallam University.