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Thursday, 09 November 2017

Moves to tackle 'weekend effect' on NHS death rates based on 'misunderstanding'

Written by Ella Pickover

Measures to prevent the so-called "weekend effect" have not made any difference in curbing excess deaths on Saturdays and Sundays, experts have claimed.

Four priority standards for emergency care in hospitals in England were introduced in 2015 in a bid to reduce higher mortality rates at weekends.

Patients admitted to the hospital in an emergency at weekends have been found to have higher mortality rates than those admitted during the week, but the reasons behind this so called "weekend effect" are contested, the authors of a new study noted.

Focusing on the explanation that the effect could be due to differing levels of staffing and service provision, the NHS in England launched four new standards for emergency care - for all emergency patients being seen by a consultant within 14 hours of arriving at hospital, week-round access to diagnostic services such as x-rays, round the clock access to consulted directed interventions and set times for patient reviews.

Compliance with these standards is mandatory for all NHS hospitals by 2020 as part of the seven day services policy, the authors noted.

Their new study, published in the Emergency Medicine Journal, used publicly available data on performance against the standards between 2013/14 and 2015/16 for 123 NHS trusts in England.

They found that achieving the ongoing review standard and access to diagnostic services standard had small positive associations with the magnitude of the weekend effect in 2015/16.

And there were small negative associations with achievement of the other two standards.

But no association was statistically significant, found Dr Rachel Meacock and Professor Matt Sutton, from the University of Manchester's Centre for Health Economics.

Dr Meacock said: "We found no association between Trusts' performance in relation to any of the Department's four standards and the death rates for patients admitted at weekends.

"This is not surprising given the lack of evidence linking mortality to consultant presence and service provision at weekends.

"Previous research has shown that mortality rates are higher at weekends because the patients admitted to hospital at weekends are sicker.

"The NHS has rushed to fix a perceived problem that it doesn't fully understand.

"The policy is based on a misunderstanding of why death rates are higher among patients admitted at weekends. We're not criticising the Government's desire to improve patient care. But that should be a general aim over seven days - not just at weekends. It's about getting the best use out of NHS resources."

Prof Sutton added: "Implementation of these standards is unlikely to result in any direct harm to patients, but the policy may divert care away from the patients who need it most. Blanket standards like these limit doctors' abilities to prioritise patients based on their professional judgment."

A Department of Health spokesman said: "There is clear evidence of a 'weekend effect' - a recently published study, one of the largest ever, showed the risk of mortality was 19% greater for weekend admissions versus weekday admissions.

"We know this problem will not be solved overnight, but the four clinical standards will help improve the consistency of care at weekends, and we make no apology for tackling this."

Earlier this year a row errupted between Health Secretary Jeremy Hunt and renowned scientists Professor Stephen Hawking over the 'weekend effect'.

Prof Hawking accused the Health Secretary of "cherry-picking" scientific research to justify the creation of a seven-day NHS and the imposition of a new junior doctors' contract.

But Mr Hunt accused Prof Hawking of making a "pernicious falsehood".

Copyright (c) Press Association Ltd. 2017, All Rights Reserved. Picture (c) Dominic Lipinski / PA Wire.