More evidence that staff levels affect weekend mortality
Edmund Stubbs, 18 December 2015
The government’s promise of a seven-day NHS is in the difficult process of being realised. Health secretary Jeremy Hunt is trying to implement the Conservative party’s manifesto commitment to give more equal service provision throughout the week by focusing almost entirely on doctors’ weekend working hours, largely ignoring the necessary presence of many other professionals who are just as essential in keeping NHS services functioning.
The result has been an extremely disgruntled consultant workforce and strikes by the NHS’s junior doctor workforce only avoided by desperate last minute negotiations.
A growing body of research has revealed a higher probability of patient mortality amongst those admitted at weekends. Indeed, previous reports published by Civitas observed a similar situation existing in Germany.
An unfortunate spin-off from the debate about weekend mortality and efforts to make services more consistent over the week has been that some members of the public now wish to avoid being admitted to hospitals at weekends even when care may be urgently required. It should be remembered that any differences in mortality throughout the week are relatively small. On any day the personal hazard of mortality is minimal. Once ill and in need of treatment, hospital remains the safest place to be.
Recent research published in the British Journal of Anaesthesia analysed emergency admissions to 156 NHS hospitals. The lowest mortality rates were found in hospitals with the highest number of medical and nursing staff, and the highest mortality rates in those with the lowest levels. However, the report further looked at weekend mortality and observed significantly higher mortality rates for patients admitted to hospital at weekends in trusts with fewer general surgical doctors on duty and in trusts with lower nursing staff levels.
These findings seem highly relevant to the current doctor contract disputes. They suggest that, to address excess weekend mortality levels, staff numbers on duty will indeed make a difference and that the difference between weekend and weekday mortality cannot simply be caused by sicker patients being admitted at weekends. It also strongly implies that the government is mistaken in almost solely focusing on doctors’ contracts to implement consistent weekend care. This study reveals that nursing staff levels have a similar relation to both general and weekend mortality.
It would be helpful to see a follow-up study which might examine the employment of other types of specialists at weekends, for example radiologists, laboratory technicians, healthcare assistants, nutritionists, physiotherapists and speech and language therapists. The levels of administrative and managerial staff could easily also make a difference. Many such staffing groups carry out essential functions and support doctors in the rapid and accurate diagnoses of ailments. Even when seeing patients for various supportive roles they are likely to be immediately aware when something is wrong with a patient and refer them to nursing and medical teams.
We need accurate studies of staffing levels for all those working in hospitals to know precisely what might be causing the weekend mortality effect. Do we need an entire weekday team on duty at weekends to observe no increase in mortality? If so, Mr Hunt’s narrow focus on doctors’ contracts to the exclusion of other staff is unwise and unjust.