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Keogh: ‘Providers should federate to fix seven-day care’

3 January 2014

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NHS providers and commissioners should work together if seven-day care is to become a reality, NHS England’s Sir Bruce Keogh has claimed. 

The results of Sir Bruce’s review into seven-day care could “undo more than 50 years of… practice that have failed to put the interests of patients first”, he claims. 

He recommends that NHS providers and commissioners explore new ways of working, such as in networks, collaboratives and federations in order to make seven-day working financially and clinically sustainable. 

He said: “As the custodians of £97 billion of public money, we must buy the health services patients deserve. We know that patients and the public want us to act now to make seven-day services a reality in all parts of the NHS.”

Recent reviews of over 14 million hospital admissions have found the risk of mortality at the weekend increases by 11% on a Saturday and 16% on a Sunday. 

Sir Bruce’s review cited variable staffing levels in hospitals, fewer decision makers at consultant levels and a lack of community and primary care services that could prevent unnecessary admissions and support timely discharge as a cause of increased mortality rates.  

Ten new standards revealed in the report describe the standard of urgent and emergency care all patients should expect throughout the week. For example, the standards describe how quickly people admitted to hospital should be assessed by a consultant and the process for handovers between clinical teams. 

According to Sir Bruce, NHS England should back the standards with incentives, rewards and sanctions with the aim of implementing them  by the end of the 2016/17 financial year.

The Care Quality Commission will be asked to consider how implementation of the standards can be assessed.  

Dean Royles, chief executive of the NHS Employers organisation, said: “We are increasingly seeing hospitals and community-based health services develop innovative services that anticipate and respond to patient needs, but all too often NHS employers find the terms and conditions of doctors are getting in the way of progress.

“We are now facing a once in a generation opportunity to change how the NHS works. Patients, employers, medical royal colleges and the government all want to see seven-day care.”

Dr Mark Porter, chair of the British Medical Association council said: “Delivering more seven-day services will have a number of practical implications, not least on working patterns within the NHS and the vast majority of consultants already lead the delivery of urgent and emergency care at weekends. The BMA is in negotiations with NHS Employers and the government to find an affordable, practical model for delivering this care, while safeguarding the need for a healthy and productive work-life balance for doctors.

“As the report makes clear, doctors are only one part of the solution. Ensuring necessary diagnostic, support and community services are accessible across seven days is also essential to making this work.”