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Some thoughts about the NHS Seven day service debate….

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In a speech about the future of the NHS earlier this year, Health Secretary, Jeremy Hunt claimed that a ‘Monday to Friday’ culture existed within the NHS and warned that flatline contracts would be altered to allow seven-day services. To say the least, this provoked a strong reaction from NHS staff, particularly doctors and consultants who resented that implication that weekend care was substandard. Rather than explore the implications of the potential contract changes from an employment point of view here, we’d just like to air the views of a junior doctor who is married to one of our members of staff. As with all media panics, there is more than one point of view, but we thought this explained some of the complexity of what goes on, ‘at the coalface’ and brings some insight to the debate:

Dear Jeremy,

I am a junior doctor at one of the “Keogh” hospitals you have discussed in your most recent speech and, despite spending eight of my first 12 months as a doctor at one of these ‘failing’ hospitals, I have found it to be an incredible experience. Working here has actually inspired me to commit myself to hospital medicine for the foreseeable future. I love hospital medicine but, like every other doctor from first year to consultant; I hate it when I cannot do my best for my patients.

It goes without saying that I understand the need to reduce the 6,000 unnecessary deaths a year that occur within the NHS and I want to be a part of the solution. What I don’t need, and what the NHS doesn’t need, is a ‘quick fix’ of more consultants in hospital on a weekend. What we need instead is more of every member of the hospital team, because as clichéd as it sounds everyone within the health care profession has a role to play in the patients’ journey.

The “help” these patients need is from every single member of the inspiring and powerful team that I am so proud to be one very small part of. Every day of the week we need doctors, physician associates, nurses, nursing assistants, physios, occupational therapists, pharmacists, radiographers, and lab technicians. The list goes on. Just as important, but often unfairly overlooked, are the support staff that allow us the medical professionals to work; porters, cleaners, and catering staff, to name a few, are equally vital. Patients, families, and staff all need somewhere to get a cup of tea and a sandwich – do you know how many hospital canteens open at weekends Jeremy? Not enough.

You will struggle to find a doctor that does not agree with you when you say patients do not choose when they get sick, or sad, or scared, but the “help” they need rarely comes in the form of the hospital consultant; the group you want to force in to signing a seven day working week contract and by taking on the BMA “road block”.

At the weekend it is not the lack of consultant that makes a difference to these patients’ outcomes. At the hospital I work, the way you are admitted is the same seven days a week; three junior doctors admit patients who are then seen by a consultant within the national target of 12 hours. It is what happens after this admission process where the problems lie.

Take for example a patient who has had heart trouble in the past and has presented with a similar picture this time. We have assessed him and done our blood tests. Then:

Test results take longer to return because the lab runs on a skeleton staff over the weekend.

He needs a cardiac monitor but less porters and stores support staff mean it takes longer to find so we don’t see when his heart goes into an abnormal rhythm.

He has specialist medication that he didn’t bring in from home in the rush but because the pharmacy shuts at lunchtime, that will have to wait until the morning.

Fewer radiographers mean the chest x-ray we asked for takes hours so we don’t know for longer that his lungs are also sick.

He is a bit unsteady on his feet now and ideally needs a physiotherapy assessment before the nurses get him out and about on the ward but because they are busy doing a discharge assessment he doesn’t get one so adds a fall to his problem list.

His elderly wife came with him in the ambulance and missed dinner, but the canteen is closed so she is on a bench in the corridor with tea and biscuits provided by the nursing team.

These are the causes of the unnecessary deaths and discontent in the NHS, not the lack of consultants in the hospital. These are the unnecessary and avoidable deaths that the NHS team can see happening but are powerless to stop.

I hope you realize Jeremy that even if you manage to navigate the “roadblock to reform” that you suggest the doctors’ union, the British Medical Association (“BMA”), has thrown up, then you will still need to go to battle with the unions of each and every one of the other varied and wonderful professions that make up hospital medicine before we can truly have a seven day NHS.

The NHS is often criticised for protecting its own, but if you work as closely together and see some of the things that we see on a daily basis you would understand why. Without that full team we cannot and will not function. So instead of criticizing our lack of dedication and pride in our vocation, which is still strong, instead help us celebrate it. Work together with us to recruit more caring and inspirational people. Support us as we dedicate our lives to the profession, changing our personal plans and goals to fit around making other peoples lives better. Promote us so that people want to be part of our team, rather than break our already crumbling morale and lose even more of our NHS family.

Yours sincerely

A Junior Doctor

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