6k Patients Die Every Year due to Monday to Friday Culture

Health Secretary Mr Hunt said a "Monday to Friday culture" in parts of the NHS had "tragic consequences" and said that 6,000 people die each year because of this. Research from three years ago, published in the Journal of the Royal Society of Medicine, showed about 11,000 more patients a year die within 30 days of going into hospital if they are admitted for treatment between Friday and Monday, than those who arrive on a Tuesday, Wednesday or Thursday.


An analysis of 14 million patients admitted to hospitals in England in 2013/14 found those who were admitted on a Sunday were 15% more likely to die than those admitted on Wednesday, while those admitted on Saturday had a 10% higher risk of dying.

Noticeably Increased Risk of Death

People admitted at the weekend with cancer, heart problems or after a stroke were at particular risk. They had a “noticeably increased risk of death”, along with cancer patients admitted on Friday or Monday.

The Royal College of Surgeons said that “in many hospitals, the levels of staffing and access to diagnostics are worse for all patients, including those requiring emergency treatment over the weekend”. For example, just 41% of patients needing life-or-death emergency bowel surgery after midnight had both a consultant surgeon and a consultant anaesthetist present at their operation.

The BMA has argued that to improve care at weekends you also need more support services such as diagnostics and pathology. MRI and CT scans, and specialist procedures like urgent radiotherapy, endoscopies, together with complex dialysis and heart treatments, are difficult to access at weekends. While they don't all need a consultant to carry them out, they do often need consultant input and oversight, and this is where the problem lies. This means vital tests and procedures sometimes cannot take place until Monday and patient care may be being hampered.

Lack of Services in the Community

The BMA report another factor could be the fact that people with a greater severity of illness may be admitted at weekends because of a lack of services in the community, particularly for those at the end of life.

Mr Hunt said: "The problem dates back to 2003 when the then government gave consultants the right to opt out of working at weekends and that has created a Monday to Friday culture in many parts of the NHS, with tragic consequences for patients.

As the system is currently set up, consultant cover drops significantly at weekends. A recent “Freedom of Information” request by the Daily Telegraph found in general medicine it fell five-fold.

Mr Hunt promised to enforce changes if necessary by imposing a new seven-day working contract on newly-appointed consultants. Jeremy Hunt believes that there will eventually be enough senior doctors in place to drive up standards at weekends.

The BMA pulled out of talks last year amid concerns over workload in response Mr Hunt, replied that "We are not asking any doctor to work longer hours or unsafe hours, but there will be times where we do need senior consultant cover at weekends."

The BMA has also released a survey of 2,000 adults which found two thirds did not believe the NHS could afford seven-day services.

The Royal College of Emergency Medicine said it was pleased the Health Secretary was pushing ahead with seven-day services. They reported there appeared to be “unfairness” in the current system in that some specialities, particularly emergency medicine already have to provide a seven day service. The result of this is that the consultants in work are stretched more thinly, and junior doctors have to do more.

Another area of concern is the loss of regular review and quick assessment by specialist consultants to ensure those being admitted get the right treatment from the start. Junior doctors can always refer to the consultant but this does not always happen, as they don’t want to bother the consultant at home.

Senior Nursing Roles Would be Vital

The Royal College of Nursing believe that senior nursing roles would be vital in the proposed seven-day drive.

Official data also shows the number of nurses employed in the two most senior grades, ward sisters and senior positions such as nurse consultants that lead teams, have fallen by 3% since 2010.The Department of Health said extra money was being provided to train up a "new generation" of nursing leaders.

While the overall workforce of nurses has been growing, the number filling senior band seven and eight roles fell by 2,295 over the past five years to just over 64,000.

Peter Carter the RCN Union's General Secretary believes that "nursing staff, and above all, senior expert nurses, are a huge part of the solution to delivering seven-day care. Many nurses working as ward sisters or clinical experts are able to make decisions, supervise teams and educate and mentor their junior colleagues.

The Department of Health report that “ensuring we have the right number of nurses is vital. That's why we're taking the issue of nursing recruitment seriously and have prioritised and invested in frontline staff, so there are over 8,000 more nurses on our wards.”