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Seven-Day Vision Must Recognise Present-Day Reality

04/06/2015 11:25 BST | Updated 03/06/2016 10:59 BST

In his first major speech since the election, David Cameron spoke of his belief that we can become 'the first country in the world to deliver a truly seven-day NHS'.

We know from physiotherapy that there is often a sound clinical case for what the Prime Minister is seeking to expand.

In stroke rehabilitation, for instance, seven-day services deliver immediate and intensive rehabilitation that is uninterrupted by the weekend and enhances the recovery of patients.

The same is true following surgery for something like hip fracture where we know that when patients must wait for that initial rehabilitation, the outcomes are not what they could be.

Offering continuous care across the week also offers great potential for getting on top of delayed discharges and freeing up pressure points across the system.

Furthermore, as patients come to see themselves as consumers and demand the same level of service they get from, say, their bank, it raises the question of how we respond to that.

But before we get ahead of ourselves, we must remember one thing: we're not starting from scratch.

The NHS faces extraordinary pressures with an ageing population, increasing numbers of people living with a long-term condition and budgets that remain extremely tight.

Its brilliant staff, who continued to deliver outstanding care during the toughest of times, feel close to breaking point having endured years of pay restraint and rising workloads.

And the ramifications of the major reorganisation in the last parliament will continue to be felt in this one.

That backdrop cannot simply be ignored as we seek to make five go into seven; it's not that straight-forward.

From our experience, successful services have been created through a commitment by employers to two key principles.

Firstly, the services were appropriately funded to run over seven days.

This means not only the numbers of people delivering the service, but also what they are rewarded with for doing so.

Any move to cut unsocial hours pay will be strongly opposed by health unions, including my own, given the cost, upheaval and inconvenience, such as finding childcare, that working at weekends will bring for staff who did not previously do so.

But secondly, where it has worked there has been a genuine collaboration with staff and their trade unions and professional bodies when designing the changes.

This process delivers insight from staff on what patients actually need and want, but also ensures that the solution to meeting that demand takes into account the rigours of doing so.

Experience shows when this does happen, quality services with good outcomes for patients, staff and the system can follow.

At South Tees Hospital NHS Foundation Trust, for example, a seven-day physiotherapy service across all surgical specialties has reduced average inpatient length of stay by two days.

Some 426 cardiothoracic surgery bed days have been released, which reduces waiting times for operations, and patient satisfaction is high.

Elsewhere, however, trusts have sought to press ahead without proper consultation and by simply stretching five days of resources over seven.

Paying no regard to the people delivering these new services was ultimately to the detriment of patient care.

So what Mr Cameron should have said was this: 'We can have, where clinically-appropriate and fully resourced, a truly seven-day NHS, assuming, of course, we can ensure that staff are fairly rewarded and also fully involved in designing the specific services that patients actually require, and desire, all week-round'.

It wouldn't have been quite so catchy for his audience.

But it would have offered a more nuanced and realistic roadmap for how it could be done.