Seven Day Working – Part 1 by @andrew_AMD

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.