Save 11,000 lives
If I said you had the chance to help save 11,000 lives a year, how would you react?
I am writing this blog on a Saturday, in my hospital office, on one of the thousand weekend days I’ve worked since I became a doctor.
Yes, #ImInWorkJeremy, as the facile hashtag goes.
But it’s not work as I’d do Monday to Friday, not really. I’m writing a blog for goodness sake, having already seen all the patients under my care. Some consultant colleagues mill about, some as busy as usual, some much quieter, some getting down to business, some dressed like Jeremy Clarkson in ill-fitting jeans. The place feels different and it is different.
Clinical deterioration
And one big difference is that for many patients, being reviewed by a consultant just doesn’t happen at a weekend. 
Seeing a clinical deterioration in these patients depends on others being alert and usually that’s good enough, but I’ve now read too many incident reports of people who died unnecessarily and too many heart breaking complaints to think we’re anywhere close to being ok at this.
The truth is that within the systems we created, despite the best of intentions, there are black holes for some of our most vulnerable patients, particularly those admitted as emergencies. Often these people were admitted during the week and treatment started but then the weekend comes, the medical staffing contracts and has to prioritise the new emergency patients, AHPs are scarce, nurses are busier and risk appears, risk of our making.
So what are the answers?
Frankly, I don’t know.
Now, that may seem a surprising statement in a blog but the stark reality is I don’t.
What I do know though, to come back to my initial question, is that accepting the challenge to provide safe services over seven days and reducing the 11,000 preventable deaths should be compelling for everyone in healthcare. We should be energised by the opportunity to make a real difference and our reaction should surely be how we help fix this, not why.
Instead, as witnessed over the last few months, we see the faux outrage, the hashtags, the nonsense about how we all do this seven day working anyway and how dare politicians suggest otherwise, like politicians never work a weekend or the heroic weekend consultants featured on social media aren’t actually getting paid while they have their picture taken. We see the unions posturing and positioning themselves, defences being raised and old arguments about resources being dusted off, most disappointingly from the medical profession, surely the group with the most absolute vested interest in the status quo.
And the backdrop to all this noise? People still, and always, becoming ill every day of the week and being admitted and needing care.
So, really, what are the answers?
In the clinical teams we work in and in our caring colleagues who want to improve this, are the answers but, at the moment, their voices aren’t being heard in all the political discourse.
What people tell me is that we need to clarify that the care of the unscheduled patient is our priority and we align our specialists’ scarce time to that need. We say that we can’t do absolutely everything, everyday with our current resources, as we plainly can’t; really, who would think we could?
But neither do we draw artificial, political lines around the weekend as a healthcare no-man’s land.
We put elective working at the weekends as a long-term objective, and we start to find the resources to fund it and we insist it should happen. Why? Making the weekend normal by having fully staffed clinics and theatres every day would be transformational for our safety culture, not to mention the better access for patients and more efficient use of our expensive resources like theatres.
It’s where we must end up.
What about six days?
And if we look at this carefully and decide, for the next while, we can’t stretch to seven day working can we manage six? 
What would six day working mean in terms of rearranged services and isn’t it likely that we’ll see huge benefits on the Sunday, if Saturday becomes business as usual?
So the really challenging Mondays we’re all familiar with, as we try to get back up to speed after a weekend will be less chaotic and safer.
Is that doable? Who’s asking that question?
The key is our mindset. The question I pose is do we want to help fix this? Or do we prefer to try to pick apart the data in the pretence of understanding it, create specious debate, bring our own petty agendas to the discussion and ultimately, do a disservice to this generation of patients by putting as many obstacles as possible in front of the change that is needed?
Now you know you have the chance to help save 11,000 lives a year, how do you react?
This week’s blog was by @Andrew_AMD (Andrew Murray), Associate Medical Director, University Hospital Ayr, NHS Ayrshire & Arran.
I work a 7 day week unpaid as a blogger, activist and campaigner in mental health matters. I am now a pensioner, basic monies, while still giving carer support, unpaid, to two sons who are on Disabled Living Allowance due to mental disorder diagnoses/labels.
I can understand this rant but it’s not doing anything for me, in terms of capturing my interest. Maybe others will identify with it. I don’t know. Just like this Associate Medical Director blogger.
The difference being that he is getting paid and I ain’t. If he disnae have the answers then we’re all up the creek without a paddle.
Just saying.
By: Chrys Muirhead on October 14, 2015
at 08:02
I have worked in the health service for over 30 years and have allways questioned why some departments are closed at weekends with an on call service provided as back up, and thousands of pounds worth of equipment lying un used all weekend and in some cases from 5pm untill 08.am weekdays, this is a mindset that most are programed to work in, and our politicians decide the funding based on that very same mindset. whilst I appreciate the stance taken by Chrys on a personal basis, the bigger picture is not wages persay but overall funding and managing of that funding in a more targeted way, beter care in the community can clear bed blocking, more flexible consulting hours by GPs can avoid unnessasary A+E visits, the soloutions are there if someone is prepared to step outside the bubble and look, its time for a radical reform not only of the service but of the people who provide that service. Rant over.
S Donlon
By: Steve Donlon on October 14, 2015
at 09:44
I love these can-do attitude folks. I’d like to think I’m one too. I think that seven days of equal effort would indeed improve patient care. I am old. So old that when I was at school O Grade arithmetic still existed. I do hope that there is no expectation that we work seven days a week but rather any five of seven? Were I younger I might wonder whether I’d be able to get “weekend” quality time with my kids on my wednesdays and thursdays off, i.e. will the schools be on seven days a week too? The point being that weekends ARE different in our society. Arithmetic also comes in when adding all the wages up for the new staff required to fill all these hours – I doubt NHS A&A could afford to pay the parking wardens for the weekends let alone the rest of us. It is far more realistic to look to better systems to make weekends safer for patients. That should be do-able but will still need a willingness to change among senior as well as junior staff. My last arithmetic query is over the 11000 lives to be saved. Stats like this can mean almost anything, or nothing and in this usage looks like a moral bludgeon to a staff doing its best with too many patients each. Now that’s arithmetic.
It’s where we must end up? Frankly I don’t know.
Steven Lawrie
By: Steven Lawrie on October 14, 2015
at 15:28
Ok. So.
There is no doubt that Monday-Friday 8-5pm are drastically different from weekends and holidays in our acute hospitals, GP surgeries, IJB hubs, pharmacies, community hospitals…etc. It’s great to shout #iminworkjeremy but just stand in the car parks and the difference is obvious. The solution however, is much less clear.
Our patients and carers need more. We need more. As you say, Monday’s would be much less stressful if we had true and equal 7 day working. But here’s the problem. It will cost. And cost lots. We can’t even afford 5 day care it seems. And if our acute hospital demographic continues the way it has, the people needing our services will be even more complex and they will need complex community provision when they are ready to leave. Jeremy Hunt and his allies have chosen to shine a light on the medics as the obstacles to a 7 day NHS. Those of us with any knowledge of who our patients are know that medics are but a small link in a very long chain. Our frailer and older patients need all the links to be connected for a successful outcome. That means Drs, nurses (the only link that does actually provide a 7 day service in ED and in the wards), technicians, AHPs, pharmacists and of course, the elephant in the room….social care and its decision makers. Integration helps but will it really change entrenched working patterns?
All that we can realistically offer within current resources is an equal service across 7 days. The hard sell would be that this would be a reduced service across 7 days because there simply isn’t enough money and there aren’t enough of us (and by ‘us’ I mean all of us in health and social care) to extend all that we currently provide 5 days to 7 days a week.
And I’m not sure that the public, politicians or indeed healthcare professionals would be willing to buy this.
By: Rowan Wallace on October 15, 2015
at 00:33
Absolutely agree that 7 day working needs to be adopted by everyone who has a role to play in caring for and supporting our frailer and older people. Delighted to say North Ayrshire Health and Social Care Partnership already provide a seven-day-per-week Care at Home service that does just that and helps individuals to return home from hospital at weekends, just as we do during the week. We are looking to build on this by piloting 7 day working in our equipment store to ensure anyone who needs an aid or piece of equipment to stay at home or return home can access it without delay. Developing services in this way is vital to ensuring we fully meet the needs of local people.
By: David Rowland on October 18, 2015
at 03:17
Great blog Andrew. I respect your courage in saying.. you don’t know the answer.
I am sure no one person will have the answer … surely collectivley we can come up with some ideas and workable solutions.
By: drivethroughsuccess on October 15, 2015
at 17:30
The cynical view would be you want your cake AND you want to eat it!
Its not a difficult argument – in fact its quite simple. If we want our health service to deliver over 7 days then we need to fight for it and make the difficult choices as a society that currently we seem unable to make.
I don’t care to try and count how many times we’ve all agreed that “working differently” is required and that currently how we do things is unsustainable. I get that. What I can’t get is that we are still stuck going round in circles on this and with little sign of a solution in sight.
If we truly want it then I suspect something has to give at the moment and that might mean paying for it. Are we willing to pay for it? Tax rise anyone?
Adrian
By: Adrian Carragher on November 4, 2015
at 12:51