No, I don\’t know the answer: but I know where to start looking

Patients admitted to NHS hospitals for emergency treatment at weekends are almost 10 per cent more likely to die than during the rest of the week, according to a comprehensive new report.

Hmm.

I think we would start by looking at staffing levels, wouldn\’t we? They are the thing which is most likely to vary over such periods.

Many hospitals have far fewer senior consultants on site outside of normal office hours, the data show, and rely on junior doctors and nurses to treat critically ill patients.

And, if rumour is to be believed, many fewer junior doctors too.

It has prompted a strong response from the Department of Health, which wants trusts to find out why patients are not receiving the same standard of care around the clock.

Well, actually, I think I would start with the rules that limit the hours that doctors can work. You know, the EU ones which came in just a couple of years ago?

The way I would check and see if they\’ve had an effect is to run the same counting exercise over the death statistics from a decade or more ago. If we saw the same peaks in the death rate over the weekends then perhaps it isn\’t responsible: if we don\’t see the same peaks then perhaps it is.

As I say, I don\’t know whether this is the problem or not. But that is the place to start looking.

Hands up everyone who thinks they will actually look there though?

10 comments on “No, I don\’t know the answer: but I know where to start looking

  1. Probably not. Just heard someone on the Today programme blethering that senior staff work Mondays to Fridays, including in some places up to 10pm. Cor!

  2. It might also have something to do with the reasons for admission (drink driving more common at weekends, likewise brawling, etc), no?

    Tim adds: Deaths from brawling roughly equals murder/manslaughter rate, 800-1500 a year in total for both? Deaths from drink driving is 500 a year or so? Not enough to skew the stats when there’s 300,000 deaths a year or whatever it is.

  3. Gutbucket. But less injuries at work, traffic accidents……should balance.

    “….the rules that limit the hours that doctors can work……”
    In 70 odd years the NHS hasn’t worked out that hospitals are a continuous production process, not a nine to five office job? That folk don’t get sick by appointment? Who would have thought that?

  4. This is exactly what ex-blogger Dr Crippen predicted about the NHS “Hospital at Night” thing.

  5. bloke in spain – “In 70 odd years the NHS hasn’t worked out that hospitals are a continuous production process, not a nine to five office job?”

    In fairness I think this is a problem that pre-dates the NHS. That is why traditionally British hospitals have relied on brutalising trainees so much – it is so that the qualified doctors can go home to a warm dinner with the wife and children.

    Like most professions, the profession is mainly run for the benefit of the professionals. See the legal industry for instance.

  6. “In fairness I think this is a problem that pre-dates the NHS.”
    Yeah, should of thought of that. My bad. It’s only seventy years. Hardly past the shake down stage.

  7. It’s a cost/benefit question though. Normally you have to pay staff more to work unsociable hours. At Tesco’s, working 10pm-midnight attracts a £1.35/hr premium; midnight-6am attracts a £1.95/hr premium over daytime shelf-stacker wages.

    Skilled workers tend to demand even more. Train drivers get paid double-time just for working on Sundays. Taxi meters have a “night fare”. And virtually no amount of money will get a skilled lawyer or accountant to come out on a weekend.

    It could well be that the extra NHS deaths at the weekend are offset by fewer deaths in the week; and because weekday staff are cheaper, this is a sensible use of taxpayers’ money.

  8. A simple application of Occam’s razor would suggest that So Much For Subtlety has got it right – senior medical staff just can’t be arsed to work out of “normal office hours”.

    However, as I’m fond of pointing out, this is a problem with the medical profession as a whole and is nothing to do with either the EU or the NHS, as PaulB observes.

  9. Churm Rincewind – “senior medical staff just can’t be arsed to work out of “normal office hours”.”

    Although in fairness it varies. I know a guy who is a top brain surgeon in his area. Most of his work is done at 3 in the morning for obvious reasons. So he gets to spend a lot of time at home during the day, but he is frequently called out in the middle of the night.

    “However, as I’m fond of pointing out, this is a problem with the medical profession as a whole and is nothing to do with either the EU or the NHS, as PaulB observes.”

    Sure. But the NHS has long since been captured by its workers. So there will be no pressure on them to redress the problem. It is run by and for doctors and nurses. In other places, some people might sue or take their custom elsewhere. But not in Britain of course.

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