Image: Jeremy Hunt, Health Secretary
There is no doubt that people admitted to a hospital as an emergency on a Saturday or a Sunday are statistically more likely to die than people admitted during the working week. The difference varies according to the type of emergency and the individual hospital but on average it is large – up to 16% higher on a Sunday.
We know something about the cause. Patients admitted at the weekend are sicker on average so a difference could be anticipated. There are fewer emergency admissions at the weekend and one would expect that the missing emergencies are the less ill ones who can wait until Monday.
But even after accounting for this the differences remain. If you look at hip fractures, which happen in equal numbers every day of the week and always needs immediate admission to hospital the historical death rate in some trusts is 10% higher for patients admitted at the weekend and it is known that this difference can be eradicated by operating immediately to repair the fracture rather than leaving patients for the next working day list.
Nobody would argue that the quality of care for emergencies should not be the same every day of the week and few would claim that it is currently.
So what is the problem with Jeremy Hunt’s ultimatum to the medical profession this week?
Yes, it is his job to encourage consultants to work weekends in order to improve quality of care. What he should have done was engaged with clinicians of all disciplines in a discussion to decide the best approach and then made efforts to facilitate implementation of the plan and to mobilise the necessary resources.
What he actually did was launch a high profile attack on the whole consultant body, making best use of a scandal hungry media and with little regard to the facts. The assertion that 6000 patients die each year because consultants refuse to work weekends is disingenuous and wrong. I am a hospital consultant and have never come across a colleague who has used the terms of the new contract to avoid working weekends. All consultants in emergency specialties do weekend work as a routine.
He accused doctor of being overpaid and lazy – putting their best interests above that of their patients. Talk of a big pay rise in 2003 is a bit irrelevant when we have had a pay freeze for the last four years and the promise of the same for four more years to come (and a bit ironic when politicians have just awarded themselves 10%).
In my own organisation every ward is visited by a consultant every day of the week and this has been the case for the last 5 years.
We do this as an extra duty over and above our job plans but are paid very little for it. The on call supplement for consultants is between 2 and 8% of the basic salary depending on intensity so works out at an hourly rate not much above the minimum wage.
Mr Hunt’s plan – to force us to do shift work and have days off in the week rather than weekends – will add very little to patient care over and above what we do now, but will be hugely disruptive for our family lives. Most consultants are in middle age with partners and children who are at home only at the weekends. Taking consultants off the wards during the week when the rest of the multi-professional team are present makes no sense.
A consultant alone can add little without the support of the rest of his team. We need physiotherapists, OT, pharmacists, junior doctors, radiographers, pathologists and the rest. If you look in a hospital staff car park at the weekend you will see 75% of the spaces empty – but many of the cars that are there will belong to consultants. Proper 7 day working with a full team of people, not just a consultant, will need a massive investment of cash and a huge recruitment drive. This will not happen quickly and probably never under the current government.
Why would Jeremy Hunt take on the BMA in such a high profile way?
So the ultimatum to the BMA this week was bound to be rejected because it completely unworkable and pointless. Mr Hunt is not stupid – he must have known this.
I can only conclude that this attack on senior doctors had the primary purpose of trying to discredit them and reduce their status in the eyes of the public. He needs to do this because he knows what the government has got planned for the NHS – commercialisation and gradual progression to an insurance based system – and he also knows the consultant body will be amongst the strongest opponents of this. He is getting in his retaliation first. This is all about politics and nothing about patients.
So what if this is a political act – he is a politician after all? Consultants are grown-ups and they should be able to take it. Maybe so, but there are consequences to these high profile spats. Patients hearing the scare stories will be frightened and their experience of care will be damaged. Staff will be further demoralised and care quality could actually be worsened.
Political games of this sort can cause real harm to real people. By picking a public fight to score political points he has demonstrated cynicism, callousness and a lack of respect for the NHS and the British public.
He should apologise for the pain and suffering his actions will cause NHS patients and staff and if he had an ounce of conscience he would resign.
This piece first appeared on 'Big Up the NHS'. and is cross-posted with kind permission.