The Government has set out its intention to negotiate a working weekend contract for consultant doctors. It has been suggested that refusal to negotiate will lead to legislative implementation.
The Health Secretary, Jeremy Hunt, has made it abundantly clear that he is willing to enforce consultant NHS doctors to work weekends if an agreement is not reached with the British Medical Association Union (BMA) regarding their contractual hours in hospital.
Mr Hunt has ordered the BMA to discuss a radical overhaul of hours and pay or face the enforcement of new terms, suggesting this will help the Government achieve its target of making the NHS a full seven-day service by 2020.
At present, all but Accident and Emergency consultants can opt-out of non-emergency work outside the hours of 7am to 7pm Monday to Friday.
A report by the National Audit Office has shown that 71% of additional work carried out by consultants who have opted out of weekend work, was paid at locally negotiated rates, sometimes costing up to £200 an hour.
The last time these working contracts were negotiated was under the Labour government in 2003.
Supporters of the Government’s intention will point to the disparity between the standards of hospital care during the week compared with at weekends.
They will suggest that people are more likely to experience a lower standard of service and care at the weekend. This is supported by statistics that indicate patients have a 15% higher chance of dying if they are admitted to hospital on a Sunday rather than a Wednesday.
Has the inflexibility of consultants not working on the weekends had an adverse effect on the NHS? It is argued that not only is the mortality rate higher at the weekend but efficiency is impaired due to the absence of consultants to make critical decisions.
Furthermore, evidence of hospitals such as Salford Royal and Northumbria, who have seen improvements in care and staff morale having previously implemented the seven-day working week, adds weight to the Government’s arguments.
The Government has allowed a six-week negotiation window with the BMA before they legislate if an agreement is not reached. Although ministers are powerless to alter the terms of existing contracts, the Government is demanding that the majority of NHS hospital doctors work a seven-day contract by the end of the parliamentary term, starting with new consultants.
In addition, they hope to crack down on overtime pay given to consultants who work at weekends, arguing that this will make substantial savings. In contrast, the Government propose that the pay system will be linked to levels of responsibility and performance instead, improving terms for those consultants with the most demanding and unsocial work patterns.
The opponents of these plans will argue that these reforms are a distraction from the real issues affecting the NHS, including the refusal by the government to invest properly in the emergency services.
The BMA has described these proposals as a “wholesale attack on doctors”. It is suggested that this proposal is a populist attack on consultants’ salaries, as opposed to considering the stress and pressure put on these highly trained and experienced professionals. Arguably, forcing consultants to work unsocial hours might have a negative effect on their morale and ultimately their performance.
On the contrary, Mr Hunt is quoted as saying, “Around 6,000 people lose their lives every year because we do not have a proper seven-day service in hospitals.” Although this statement appears unqualified, whatever side of the debate you fall, it is indisputable that NHS patients having higher odds of dying at the weekend is a disturbing point of concern that needs to be addressed.
I have just settled a clinical negligence claim for £3m for a client who suffered devastating injuries due to the poor standard of care he received in hospital on a weekend. He was admitted on a Friday with an infection in his hip. He should have undergone surgery to wash out his hip that evening, but nothing was done.
Over the weekend he gradually developed septicaemia and septic shock. Septicaemia is another term used to describe blood poisoning due to an infection caused by large amounts of bacteria entering the bloodstream. Septic shock is a potentially fatal condition that occurs when a patient suffers a serious reaction to infection affecting their vital organs and causing their blood to clot.
Tragically it was not until late on the Monday that anyone took my client’s symptoms seriously. But by then it was too late - he suffered a stroke which left him seriously brain damaged and unable to use one side of his body.
There were two problems here. The first was that the doctors treating my client made the wrong decision on the Friday evening. The second is that nursing staff failed to interpret their observations over the weekend and consult a doctor despite having an ‘Early Warning Score’ system readily available which they failed to use. If they had, my client would not have suffered his stroke and, instead, he would now be working and living a normal and independent life.
Poor weekend care is a serious issue. But, it is not simply down to whether consultants are present in hospitals over the weekend. Forcing consultants to work weekends is not the whole answer. It should not have taken a consultant on a ward round to realise my client needed urgent treatment. He only required adequate nursing management.
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If you would like to read a previous blog I wrote on poor weekend care in NHS hospitals, please click here.