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‘No evidence’ seven day hospital policy cuts weekend mortality

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By Angela Sharda
8 November 2017

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A policy which gives patients access to consultants and diagnostics at weekends to help cut death rates could be squandering up to £1.4bn, according to a new study.

The research, by a team from Manchester University’s Centre for Health Economics, is the first to measure trusts’ performance against clinical standards brought in to reduce the deaths associated with the ‘weekend effect’.

A policy which gives patients access to consultants and diagnostics at weekends to help cut death rates could be squandering up to £1.4bn, according to a new study.

The research, by a team from Manchester University’s Centre for Health Economics, is the first to measure trusts’ performance against clinical standards brought in to reduce the deaths associated with the ‘weekend effect’.

These  standards are  the time to first consultant review, access to consultant-directed interventions, access to diagnostics and on-going consultant review.

Researchers looked at the odds of dying for patients admitted during the weekend, compared with people arriving midweek.

Dr Rachel Meacock said: ‘We found no association between trusts’ performance in relation to any of the Department’s four standards and the death rates for patients admitted at weekends.

‘This is not surprising given the lack of evidence linking mortality to consultant presence and service provision at weekends.’

The findings cast doubt on the success of the seven day policy in cutting deaths of people admitted at weekends.

However the Department of Health said there is 'clear evidence' of the weekend effect.

Researchers said focus on these four priorities may divert effort from other quality improvements, or to low-risk patients.

‘Implementing seven day services has been estimated to cost £1.07-1.43bn, most of which relates to recruitment of additional medical staff, yet there is currently no evidence that this initiative has resulted in any patient benefit,’ according to the study.

Two years ago  Health Secretary Jeremy Hunt said: ‘It is incredibly inefficient to have a service that cranks up on a Monday morning (and) starts to wind down after lunch on a Friday.’

The study used data for emergency admissions from My NHS and NHS Digital from 2013-2016 for 123 NHS trusts in England.

Dr  Meacock said previous research showed weekend mortality rates are higher as patients are sicker.

She added: ‘The NHS has rushed to fix a perceived problem that it doesn’t fully understand. The policy is based on a misunderstanding of why death rates are higher among patients admitted at weekends. We’re not criticising the government’s desire to improve patient care. But that should be a general aim over seven days – not just at weekends.’

A Department of Health spokesman responded: 'There is clear evidence of a ‘weekend effect’ – a recently published study, one of the largest ever, showed the risk of mortality was 19% greater for weekend admissions versus weekday admissions.  We know this problem will not be solved overnight, but the four clinical standards will help improve the consistency of care at weekends, and we make no apology for tackling this.’

 

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