Is “Monday to Friday” culture in the NHS putting lives at risk?

On behalf of Attwaters Jameson Hill posted on Thursday, November 24th, 2016

Health Secretary Jeremy Hunt hit the news headlines recently with a proposal to impose a seven-day working week on NHS doctors, stating that 6,000 people die each year as a consequence of parts of the NHS developing a "Monday to Friday culture". Whilst his comments caused controversy in some quarters, a case recently settled by James Sherwin in our medical negligence team clearly illustrated the dangers of a lack of consultant cover at weekends.

 

Mr P was taken to hospital on a Tuesday by ambulance, having suffered a severe coughing fit, and was admitted as an inpatient as his sodium levels were low. During his admission his haemoglobin (Hb) levels began falling and it was noted his abdomen was distended but, despite these warning signs, he was discharged home after nine days.

Two days later, on Saturday, Mr P was readmitted to the same hospital having collapsed at home. Despite his Hb levels continuing to fall very rapidly, no action was taken and no input sought from the gastroenterology team.

No investigations were undertaken to identify the cause of the falling Hb levels, and whilst the alarmingly low Hb counts were being recorded in his notes, no treatment was provided and he was effectively “parked” on the ward. Sadly, Mr P had a sudden collapse in the early hours of Monday morning and he vomited fresh blood. Mr P had in fact been suffering from gastrointestinal bleeding throughout the weekend and, despite resuscitation attempts, died that morning.

Our independent gastrointestinal expert confirmed that Mr P’s symptoms and clinical signs when he was readmitted to hospital on Saturday should have prompted an immediate referral to the Gastroenterology Department to consider an upper GI endoscopy. Had this referral been made, Mr P would have undergone a simple therapeutic upper GI endoscopy, the cause of the bleeding would have been identified and treated and, he would have survived. However, the expert stated that many hospitals only run a gastroenterology service from Monday to Friday.

James Sherwin, who acted for Mr P’s family in this case, comments “Sadly, this is just the latest example of the many tragic cases we come across here in the medical negligence team at Attwaters Jameson Hill, in which patients have died or suffered devastating injuries in hospital as a result of a lack of consultant cover at weekends. Mr P’s death was completely avoidable, and I believe that if he had been admitted during the week while the gastroenterology team was on shift his death would have been averted. This must be a devastating thought for his bereaved family”.

Although Mr Hunt’s proposals to enforce weekend working by imposing a new contract for all new consultants if a deal with the British Medical Association (BMA) cannot be reached by September has sparked criticism for being draconian, the statistics seem to support the case for change. “This is not a new problem” James continues. “As well as anecdotal evidence from our experience of these cases, research from three years ago published in the Journal of the Royal Society of Medicine showed that death rates were higher for weekend admissions – compared with admission on a Wednesday they were 11% higher for Saturday and 16% higher for Sunday”. As long ago as December 2013 Prof Sir Bruce Keogh, Medical Director of the NHS, proposed changes to ensure senior doctors and key diagnostic tests are available seven days a week to tackle this problem, and the BMA themselves acknowledged at that time that a seven day service was vital to ensure patient safety. Dr Mark Porter, chairman of the British Medical Association Council, backed the proposed changes in 2013, saying “there should be no calendar lottery when it comes to patient care”, but they are yet to be implemented.

“Everyone deserves to have access to effective medical treatment in a modern day health service irrespective of what day of the week they happen to fall ill, and it is shocking that your chances of survival can depend on whether you are taken in on a Monday afternoon or a Saturday morning” says James. “Under the current system, senior consultants can opt out of weekend shifts, which incidentally is an option not available to nurses, paramedics or midwives, and it leaves many hospitals unable to provide senior consultant cover. This has to change. No one is criticising the doctors themselves, the vast majority of whom provide excellent care to patients, but this is a systemic problem and in the 21st Century we should have the best care available whenever a patient has to attend hospital”.

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