Dr Mark Porter: Calendar care is a tough call for doctors
As the British Medical Association proposes seven-day-a-week access to health services, Dr Mark Porter, elected chair of the Council of the British Medical Association, explains why he believes the NHS needs to change.
While people will be familiar with the idea of a "postcode lottery" when it comes to healthcare – a difference in the quality of care depending on where you live – there is increasing evidence of what you could call a "calendar lottery", or a variation in the quality of care received depending on what day, or time of day, a patient is admitted to hospital.
Mounting evidence shows some hospitals are not delivering the same high standard of care at weekends and nights as they are during normal working hours.
What this means in reality is that a patient admitted with a serious illness on a Sunday, for example, may not have access to the same specialist care they would if they were admitted midweek. At best this can mean a patient must wait until the next "working day" for their care to progress and at worst it can be the difference between life and death. It's simply not acceptable for the quality of care a patient receives to be determined by what day of the week it is.
I want to know that if a member of my family fell seriously ill, they would have access to the best possible emergency care, whatever time of the day or night.
That's why the British Medical Association has published a paper calling for seriously ill patients to have access to equally high quality care on a weekend as they do on a weekday.
Some hospitals are already working with staff to find ways of providing improved care across the week, but there is currently no agreed model for delivering this, something the BMA wants to change. Improving out-of-hours care will have a number of practical implications, not least on working patterns within the NHS. Many doctors already work out of hours but it is likely to mean more staff being in hospital during weekends and evenings.
To this end, the BMA is currently in discussions with the Government on how to develop work patterns which deliver emergency, urgent and acute services seven days a week while safeguarding the need for a healthy work-life balance for doctors.
It will also require other services to be available at evenings and weekends where they currently are not, such as diagnostics, social care and administrative support so a doctor can order a scan or blood test for example, and patients can be discharged.
So there is much work to be done on determining what exactly is needed to deliver high quality care across seven days. This is currently being looked at by Sir Bruce Keogh as part of NHS England's Seven Day Forum and we look forward to reading his report and findings, which will be published soon.
Improving patient care will involve system-wide change in the NHS, but doctors are committed to working with hospital managers, the Government and patients, to ensure we come up with a workable and affordable solution.
But why, you might ask, should only emergency care be rolled out? Why shouldn't what are called "routine" services such as knee or hip operations be available 24/7?
The answer is a simple one; resources. The NHS has to operate within a finite budget and workforce. While an NHS which operates a full service 24/7 is, understandably, an attractive idea, the reality is the current system is already buckling under enormous pressure. Stretching it further would lead it to breaking point.
Given the economic climate, the NHS simply doesn't have the funding, resources and workforce to provide a full service 24 hours a day. As such we have to prioritise what services we can afford to deliver seven days a week. And we believe ensuring patients have better access to the same high quality emergency care throughout the week must be the priority. Only then can the debate start as to what other services can be provided round the clock.
While much of the focus on seven-day services has been on hospital care, there have been some recent announcements about access to GPs, such as a pilot scheme to extend GPs' opening hours across seven days. We will be supporting GPs taking part and looking closely at the results of this pilot to see how it works in practice.
There is concern over whether stretching the current workforce across seven days could have an impact on the quality of weekday services so we will need to consider whether and how this could apply at a national level.
Doctors play a leading role in driving change in the NHS and we are determined to be part of the solution when it comes to delivering more seven-day services. The public rightly expects, and doctors want to deliver, high quality care when patients need it most. That's the principle behind our proposals and we're committed to working with stakeholders across the NHS to make it a reality.
Dr Mark Porter is a consultant anaesthetist at the University Hospitals Coventry and Warwickshire (UHCW) NHS Trust.
His special interest is in obstetric anaesthesia and the continual development of maternity services to improve the mother's experience.
In the past he has been a clinical director of his department, and the chair of the medical staff local negotiating committee.
Dr Porter is also the elected chair of the Council of the British Medical Association.
His previous roles in the BMA have included being the chair of the Consultants Committee from 2009-2012, and its deputy chair responsible for pay and conditions of service from 2006-2009.
He was closely involved in negotiating the 2003 consultant contract, and while he was a junior doctor he was the chair of the BMA Junior Doctors Committee from 1997-1998.