We are likely to be hearing a lot about poor care in NHS Hospitals at nights and weekends during the days to come. This is an issue which has received too little attention in the past. Last year a report by Dr Foster (an NHS Performance Analysis Body) found that death rates were higher at weekends in a number of hospitals.
The experience of our clinical negligence team is that a disproportionate number of our most serious claims arise from poor care at nights and weekends.
Generally staffing levels are too low and often it is only the less experienced staff on duty. Consultants may be on call but not actually present at the weekend. Decisions are made by junior doctors who may not recognise a problem requiring senior input or be reluctant to trouble their boss at the home.
Examples we have dealt with recently include:
• A woman who died on a Monday morning after developing septicaemia and then septic shock over the weekend. No one noticed.
• Another woman who died when nursing staff forgot to check on her overnight, despite her being at known risk of internal bleeding after surgery. She bled to death during the night and was found dead at 7am.
• A 40 year old man who developed a stroke after failures to manage his infection. He was admitted on a Friday evening and instead of having an infected fluid aspirated from his hip that evening was left until Monday, by which time he was in septic shock and atrial fibrillation (his heart not functioning properly).
• Another man who had a serious knee injury and whose blood supply to the lower leg was disrupted. He also went into septic shock over the weekend as the tissues of his leg died. Again no one noticed until Monday morning. He had to have his leg amputated above the knee.
The government recently proposed a full 24 hour 7 day per week NHS service. But we neither need nor can afford that. What we need is planned procedures to be done during the working week but proper levels of nursing and medical care at the weekend, so that if people need proper treatment then they get it.
The alternative is massive personal cost to patients and their families from these devastating serious injuries and even death. There is also the enormous financial cost of both of having to deal with seriously disabled people and in some cases pay them damages. It would be better for everyone to provide proper weekend and night-time care in the first place.