Is a Seven-Day NHS Sustainable?

What the health secretary's plans fail to realise is that there are bigger issues that need to be addressed, other than the contracts of consultants, to achieve an effective seven-day NHS.

During his speech last month at the King's Fund, health secretary Jeremy Hunt announced his plans to reform the NHS with the aim of creating a seven-day service. This would see new contracts imposed on consultants, which would require them to work compulsory weekend shifts and would also scrap overtime payments.

As the contract currently stands, consultants can chose not to work outside the hours of 7am to 7pm during Monday to Friday with regards to non-emergency cases, which means that they can opt out of working weekends. Hunt argues that there is a greater risk that patients will die at the weekend compared with the middle of the week, as a result of inefficient services on Saturday and Sunday. His argument suggests that the inflexibility of consultants leads to more deaths, with the risk of a patient dying being 15% higher at the weekend.

A seven-day NHS would be beneficial to patients based on the idea that they may receive quicker referrals and appointments with more becoming available at the weekend - which is great for those patients who work Monday to Friday themselves. And the length of hospital stays may possibly be reduced, as there will be more consultants on duty on Saturday and Sundays to deliver test results. Hunt puts forward the example that if you are admitted into hospital for testing on a Friday, currently you will have to wait until a consultant is available on Monday to deliver your results and tell you if you're fit to be discharged. A seven-day NHS would speed up this process and comes across as a positive step forward.

However, looking at this from the view of those on the frontline of the NHS, it is actually true that many already work seven days a week as standard. Evident from the hashtag that has been recently trending on Twitter, #ImInWorkJeremy, many NHS workers feel patronised by the proposals. An anonymous letter from a NHS nurse highlighted that she already works 60 hours a week on average and the extra shifts usually go towards supporting the family. Staff members are already struggling to cope with the rising pressures, and resources are being pushed to the limit. The British Medical Association, the union for doctors, accuses Hunt of using the contract debate as a distraction from the real issue of proper investment in resources, and states that 89% of consultants are already regularly on-call at weekends.

What the health secretary's plans fail to realise is that there are bigger issues that need to be addressed, other than the contracts of consultants, to achieve an effective seven-day NHS. The system is currently under a lot of pressure to keep up with the rising demand for healthcare, and forcing the service to becoming truly 24/7 with the existing resources would just add to the strain.

Personally, I fail to understand how the government plans to fund the move, particularly when the NHS is already facing a budget deficit. Over the next five years, the government is working to plug the £30 billion gap in funding by investing an extra £8 billion into the service whilst also aiming to make savings of £22 billion. But while employing more staff members to cover the additional working hours of a seven-day service is crucial, this will require much of the extra funding. So how will the expense of expanding the current services fit in with the need to reduce spending? This is something that Hunt and the government are yet to address and make clearer. Recruiting enough GPs, nurses, paramedics and A&E doctors is already a big challenge and I think there needs to be strong reassurance that there will not be a reduction in mid-week services or the number of staff on duty to cater for the contract changes. Is there going to be a budget set aside specifically to ensure that more staff members will be recruited?

Over the past 12 months, the NHS has faced some difficult challenges and the issue of staff shortages has been a recurring problem, which the government has failed to tackle. My fear is that overstretching the current resources to deliver the seven-day service will result in more mistakes being made by overworked, exhausted and stressed medical professionals, with more patients falling victim to medical negligence. This is extremely concerning as the welfare of patients should be of the highest priority. Frontline staff members are constantly expected to manage crippling workloads in stressful environments, and the government has been called on several times to sit up and take note. Back in October last year, staff from seven different unions staged the first strike in over 30 years - this just goes to show how severe the situation for the NHS has become. It will only get worse unless considerable investment is made to recruit more staff and reduce the strain on the current workers.

Creating better access to healthcare is obviously of vital importance as no one can chose when they are going to be ill and people need to know that the care is available whenever they need it. Having said this, the service needs to be sustainable to ensure that the level of resources can safely support the needs of the nation. Staff shortages and crippling pressure on services greatly impede the quality of care that is delivered, whilst also putting the safety of patients at risk. Maintaining the NHS's high standards is crucial throughout these changes and should be a serious consideration during discussions.

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