The government is committed to working with the NHS so that 7-day services are available in all hospitals. Patients should get the same high quality, safe care on a Saturday and Sunday as they do on a weekday. This means having enough consultants available to assess and review patients, providing access to important diagnostic tests and ensuring that consultants are there to make crucial clinical judgements.
Hospitals and community services are already working together to create a better service 7 days a week, but we want to go further and faster to deliver safer care in this Parliament.
1. Why we need 7-day services
1.1 Patients currently get a poorer service at weekends
There is a clear link between poorer outcomes for patients and uneven service provision at the weekend:
- Patients are 16% more likely to die if they are admitted on a Sunday compared with a Wednesday.
- The risk of death for patients admitted on a Sunday compared with a Wednesday is 37% higher for acute and unspecified renal failure, 8% higher for urinary tract infections and 7% higher for a fractured neck of femur.
- Survival rates following a broken hip are much higher if patients are treated quickly, ideally within 2 days. Patients are 24% more likely to have to wait longer than 2 days for a broken hip replacement on weekends.
- There is not always access to the right treatments or diagnostic tests at weekends, which can result in delays and worsen the outcomes and experience for patients.
MRI scans, CT scans, ultrasound scans and other important diagnostic tests are not consistently available in all hospitals at the weekends.
1.2 Consultants can opt out of non-emergency work at weekends
The vast majority of hospital staff, including junior doctors and nurses, already work shifts across all 7 days of the week. Consultants can currently opt out of non-emergency work at weekends and in the evenings, which means that some only work weekends in emergencies or if they choose to, rather than it being the norm, as for other staff.
The British Medical Association (BMA: the doctors’ union) negotiated this right for consultants in 2003. No other hospital staff can opt out, including nurses, midwives and junior doctors, or senior public sector professionals who work in services required to keep the public safe, such as police officers, firemen and prison governors.
The average salary for a hospital consultant is £118,000. This is in the top 2% of earners in the country. The NHS often has to pay very expensive rates for weekend work on top of that to consultants who have no contractual obligation to do non-urgent work at weekends. In 2013 the Public Accounts Committee criticised this arrangement:
The contract allows consultants to refuse to work during evenings and weekends. As a result, hospitals struggle to provide the appropriate level of consultant-led care for patients.
Some trusts even pay up to £200 an hour for additional work which is done at weekends.
The last government attempted to change this in order to improve patient safety, but negotiations broke down when the BMA walked away from talks in October 2014.
The Review Body on Doctors’ and Dentists’ Remuneration (DDRB) and the NHS Pay Review Body (NHSPRB) recently published reports identifying the consultant opt-out as a major barrier to 7-day services, so the government has announced it would like to negotiate again with the BMA to remove the opt out from non-urgent weekend and evening working by April 2017.
1.3 The new proposals
Under the proposals, consultants will not be expected to work increased hours or work any more than 13 weekends (approximately 1 in 4) in a year. Doctors will still continue to receive a significantly higher rate for working unsocial hours.
In addition, doctors working in some of the toughest areas in the NHS, such as A&E and obstetrics, will receive increased pay and benefits, and there will be faster pay progression for all consultants early on in their career. Under the new proposals, the highest performing consultants could be able to receive up to £30,000 a year in bonus payments, on top of their base salary. The average pay for experienced consultants could rise to £130,000 under these proposals.
The government is also working to remove other barriers to 7-day services such as:
- access to weekend diagnostic services
- providing out of hospital care so that people can be discharged at weekends
- making sure there is adequate staffing cover among other clinical groups
1.4 Support from across the health sector
There has been support for 7-day services from across the health sector.
The Academy of Medical Royal Colleges said:
The Academy and Colleges have led the way in promoting the need for seven day services. We said when our report “Seven Day Consultant Present Care” was published in 2012 that it was not acceptable that patient outcomes should depend on when they are admitted to hospital and this variation is insupportable.
Chris Hopson, Chief Executive of NHS Providers, said:
We welcome the Secretary of State’s announcement today that reform of the consultant contract will take place as a matter of urgency. Reform is long overdue. Provider trusts have consistently told us that the consultant contract, in particular the right to decline non-emergency work outside of core hours, is a barrier to the delivery of more seven day services. We also welcome the commitment to much needed reform of the junior doctor contract and, for both consultants and juniors, a strengthening of the link between pay progression and performance as opposed to time served. We call on all parties to now work together to take forward these reforms as soon as possible. Read more
Danny Mortimer, Chief Executive of NHS Employers said:
We welcome the observations of the NHS Pay Review Body in today’s report. Patients and employers want to see improved and better seven-day services, and employers have consistently told us that the national pay and conditions of service for all NHS staff, need to continue to adapt in order to make them affordable and sustainable.
In order to support the move to delivery of more services over 7 days, as well as other ambitions for a better NHS, employers want to review conditions of service to give them greater scope to address their local patient care and affordability challenge. Read more
The Royal College of Anaesthetists said:
The RCoA welcomes the measures set out by the Health Secretary to introduce high quality 7-day NHS services. The College supports the need for consultant-directed care every day of the week to improve the quality of care for patients, improve safety and to make more efficient use of hospital resources. Read more
Read the Health Secretary’s speech in which he talks about 7-day services.