Time to end the scandal of our 9 to 5 NHS: A top A&E doctor says it's outrageous patients suffer because his colleagues refuse to give up their weekends



07:15 GMT, 8 May 2012

The risk of dying if a patient is admitted to A&E on a Saturday or a Sunday is 9.5 per cent higher compared to the rest of the week, according to a recent study.

Here, one A&E consultant, working in a large city hospital, says the scandal is down senior staff not being made to work at weekends. This not only puts patients' lives in danger, but even costs the NHS more because of the extra treatment that is needed to deal with complications of inferior levels of care.

One Sunday evening I was busy looking after patients in intensive care when an emergency call came in from one of the surgical wards. A woman who’d had an operation on the previous Friday was ill with dangerously high blood-sugar levels.

Surgery triggers the body’s stress response, and as a result you produce more blood sugar. This is fine for most people because the body also increases its production of insulin to control the sugar levels. But if you’re a diabetic, as this patient was, this sugar surge needs expert management or you risk going into a coma, which can be fatal.

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Dr Nick Edwards warns that weekends are not the time you'd want to be in hospital

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Trauma: Anne Marie Culliney suffered a stroke after being given the wrong treatment for an irregular heart beat

Anne-Marie Culliney, 59, a former
special needs teaching assistant, lives in Redditch, Worcestershire,
with husband Peter, 57. She suffered a stroke in June 2009.

was a Sunday when I suffered a stroke while gardening. At A&E,
doctors told my husband that a CT scan would be carried out on the
Monday to assess the damage. He didn’t question the delay, but in fact
the 24 hours I waited for the scan meant my brain suffered further
damage which may have been prevented.

I was given a high-dose aspirin to thin my blood, there are drugs that
can actually dissolve blood clots. These can really help your recovery
chances, but you have to get them within three hours of a stroke.

before you can be given these drugs, you need a brain scan to check the
stroke was caused by a clot and not a bleed. But because scans weren’t
available on Sundays, I didn’t have these drugs.

scan on Monday showed my stroke had been caused by a clot that had cut
off the blood supply to the left side of my brain, affecting the areas
that control speech and coordination. As a result, I was unable to speak
properly — all my words came out jumbled — and I struggled to walk too.

My speech has improved, but I still can’t move my right hand and I suffer balance problems.

I feel sad that just because I was unlucky enough to have my stroke on the weekend, my chances of a full recovery were dashed.

Interview by Jo Waters

The fact is in many hospitals, on
weekends and bank holidays, there is only a skeleton staff of
consultants, with the majority of care being provided by junior doctors.

is just not acceptable. Whatever time of day you become ill, you should
get the same standard of care, 24 hours a day, seven days a week.

It is a fact of life that patients get ill outside 9 to 5 Monday to Friday. And however inconvenient that is for us who work in the NHS, patients don’t plan their illnesses around us. It’s we who need to plan our lives around them.

The lack of 24-hour working, seven days a week, can not only cause harm but is also inefficient. Take the example of a 85-year-old lady my colleague saw a couple of weeks ago.

She arrived at A&E on Saturday morning with a painful calf. The doctor thought she had a blood clot in her leg, a condition which needs anticoagulant medication to prevent pulmonary embolism — a clot on the lungs which can be life-threatening.

A simple ultrasound test is all that was needed to confirm the diagnosis. But at my colleague’s hospital, the radiologists are only available on call for emergencies on the weekends. And because this test is deemed not an ‘emergency’ test — as the patient could have the treatment for a clot while waiting for the ultrasound to confirm it — she didn’t count.

'The lack of 24-hour working, seven days a week, can not only cause harm but is also inefficient'

So the A&E team had to give her the injection on Saturday, arrange for a district nurse to go to her house and give her another injection on Sunday, and then for an ambulance to pick her up on Monday to take her for her scan during ‘office hours’ and then back to A&E for a review.

The scan turned out to be negative: she did not have a clot, just a torn muscle. She didn’t actually need the anticoagulant medication. In fact that medication actually put her at risk of making the torn muscle worse as it interferes with blood clotting in the damaged part of her muscle.

The cost to the NHS was great: the pointless injections, an extra ambulance journey and an extra visit to A&E. All because it was the weekend and there wasn’t a radiologist on site.

For the patient herself, it was a pretty jolly experience. She told my colleague she’d actually had a great weekend: she normally gets out very little and has no visitors, so seeing the district nurse and the extra visit to hospital actually cheered her up! But those weekend inefficiencies aren’t always so benign.

Last month, I saw a woman who came in on the Saturday of a bank holiday weekend. She was ten weeks’ pregnant and was bleeding — she was probably suffering a miscarriage.

She told me she was desperate for a child and, after four miscarriages already, was distraught. I examined her and there was nothing to suggest she needed emergency treatment. Her health wasn’t at risk so she couldn’t be given an urgent scan.

For her psychological wellbeing she needed one, but the next ‘Early Pregnancy Clinic’ appointment was in three days’ time — the clinics only run during office hours — and she would have to wait.

If this woman had come in on a weekday, it’s more than likely she would have been seen that day or the next. Instead, I had to discharge her with neither of us knowing if she had miscarried or not. It was awful. I found out later that she had in fact lost the baby. Her distress can only have been compounded by the delay in getting the diagnosis. And all because it was the weekend.

Changes needed: Dr Edwards argues that patients don't plan their illnesses around NHS rotas

Changes needed: Dr Edwards argues that patients don't plan their illnesses around NHS rotas

These are just three cases among many.
As A&E doctors who work nights and weekends, my colleagues and I
see first-hand the problems of a lack of senior staff for the most
vulnerable of the NHS’s patients.

instance, in many smaller hospitals there are treatments such as
clot-busting drugs for strokes that are only available between 9am and
5pm. Outside of these times, patients have to go to the nearest big
hospital, or get inferior treatment.

And in hospitals where they have been able to have more consultants working outside 9 to 5, improvements have been significant.

A paper in the Emergency Medical Journal showed that by having more A&E consultants working antisocial shifts, patient care improved. However, also of importance in these days of austerity was that the senior doctor presence reduced the number of patients being inappropriately admitted by 11.9 per cent, as they were on hand to discuss difficult cases — hence saving money.

These figures were backed up by a study this week from Wrexham Hospital, which showed similar advantages, with 16.8 per cent fewer patients being admitted.

is just not acceptable. Whatever time of day you become ill, you should
get the same standard of care, 24 hours a day, seven days a week'

The conclusions from the authors of the study, recommending 24-hour consultant cover seven days a week, make stark reading.

‘We recommend this model … so that necessary consultant expansion is urgently funded to make this sustainable. We would rather be treated by an emergency medicine consultant ourselves — our patients deserve no less.’

But it is not just in emergencies that we need the NHS to be a seven-day service. What about the empty operating theatres, endoscopy suites and scanning equipment left idle at the weekend

There are people waiting for operations, and diagnostic tests for cancer, and we have all these facilities which are unused two days a week This is madness.

And yet the NHS has spent billions of pounds on privately-run surgical and diagnostic centres when we have perfectly good ones in our NHS hospitals sitting idle for two days.

This skewed view that medicine is really a 9 to 5 job is particularly irritating when it comes to seeing a GP. Why is it so hard to get a GP appointment at the weekend

I can see an optician, dentist, get my car fixed, have a haircut, do my banking, go shopping or do practically anything else I need to do. But a planned GP appointment They do exist, but they are certainly not that easy to get.

We are living in a 24/7 society — and the NHS needs to fit in with that. The NHS needs reform. Not the ideological nonsense that Andrew Lansley has implemented (privatisation by stealth), but changes so that we work when patients need us, and not when is best for us.

Consultants, GPs and other health care providers, and managers, need to work together to see how we can best provide a truly 24 hours a day, seven days a week service. Managers also need to look at how hospital resources are best utilised seven days a week, instead of just five.

Many of the consultants won’t want this; nor will other specialists. GPs aren’t going to be mad keen on a 24/7 approach, either.

But this is not about the needs of politicians, managers or staff. It’s about what patients need.

Dr Nick Edwards (not his real name) is an A&E consultant working in a large city hospital. His book, In Stitches, The Highs And Lows Of Life As An A&E Doctor, is published by The Friday Project (HarperCollins, 7.90) and is also available as an ebook.