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A 'Truly' Seven-Day NHS Will Deliver Truly Shocking Care

12/07/2016 12:04 | Updated 12 July 2016

I watched as the skin around the joint in her middle finger started to swell and bruise. It had happened innocuously some time ago on a trip to a local climbing wall. The finger was definitely larger and the worrying thing was that my wife had lost the ability to flex the last joint of that injured finger.

I knew that a call to our friend, who was an orthopaedic surgeon, wasn't really necessary. She needed to somehow navigate her way into the local hospital Hand Clinic, which meant a trip to A+E. As a doctor working in a small team she didn't want to miss work on the off chance that her own GP could circumvent the system; and besides our orthopaedic friend, who we did end up calling for some almost impartial, informal advice, said it needed an X-ray to rule out a small fracture (where the tendon pulls off its anchoring bone) and an ultrasound scan to look at the tendon itself.

So the rest of "date night" that week was spent in the Emergency Department of our local hospital. I had plenty of time, about 4 hours to be precise, to consider the way that the hospital was working and how things might be different if it had been daytime or a weekend. Technically speaking the current government could argue that we attended during "normal" working hours; we arrived at 9:45 pm. It is proposed that the normal working weekday for junior doctors extends to 10 pm. However, we haven't yet reached that nirvana of 5-day working stretched over 7 days, so following an assessment by an emergency department doctor my wife was referred for the obligatory X-ray and onto the junior doctor cover the Hands and Plastic Surgery specialty overnight.

At some point just before 2 am, when we finally got home, it struck me that across the country, in many hospitals, the same sort of junior doctor was covering all the surgical specialties overnight; that is General Surgery (bowels and abscess), Ear, Nose and Throat, Urology (bladders, kidneys, genitalia), Plastic Surgery, Burns and possibly trauma and orthopaedics. The cover of surgical specialties, as well as other specialties, by junior doctors at weekends during the day is similar. As a junior doctor myself about 10 years ago, the small regional hospital I worked in would be run at the weekend by ten or eleven junior doctors; 2 each of surgical, medical, paediatric, obstetric and anaesthetist, plus the occasional orthopaedic trainee and a variable number of doctors in the Emergency Department. There would have been around four or five times that number on duty on a week day.

If the government wants to push ahead with the current iteration of the junior doctors contract to enable what it calls truly 7-day working, then at the weekend, during the day at least, each hospital will need to make sure there are 4-5 times the number of junior doctors than they have currently, in order to offer the same service as week days. One junior doctor for every specialty so that no-one has to cover for someone else. Either that or they downgrade the weekday service so that the Monday to Friday "normal working day" level of coverage is akin to the level that was available to my wife on a late Thursday night, at best a compromise of some intermediate level of junior doctor coverage.

If the NHS budget is stable, or even shrinking through efficiency savings, and if doctor numbers remain stable (a big "if") and if the number of hours they are allowed to work also remains safeguarded (less certain since the Brexit decision) then it is inevitable that the only potential solutions are to either downgrade week day services by spreading the workers more thinly or getting the work done by (cheaper) non-doctors. The "flying pig solution" would be to increase NHS investment to ensure that there were enough doctors to fulfil an expanded working week.

The promise of a "truly 7 day NHS" was made by David Cameron, before the 2015 General Election, when a predicted hung parliament meant that promises could be made in the hope that a coalition partner could be blamed when they were reneged upon. Now that Cameron is on his way out I hope the next Prime Minister will backtrack on his whimsical and ridiculous notion of "truly" 7-day working on a 5-day-a-week budget.

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