Doctors in the Neonatal Intensive Care Unit - always there for your baby

Doctors in the Neonatal Intensive Care Unit – always there for your baby

We’ve all been hearing a lot about the need for the 7-day NHS since Jeremy Hunt started to conflate the issue with the Junior Doctor Contract. As a piece of rhetoric, claiming that the NHS shuts down at the weekend or implying that all the lazy doctors just head home for Saturday and Sunday is an interesting one, being demonstrably untrue, but its repetition seems to be changing public opinions.

At this week’s Socialist Health Association AGM, both Andrew Gwynne MP and a GP member were enthusiastic about how progressive the idea of a 7-day NHS is, and how the Labour Party should support it. The phrases ‘the NHS should be there when people need it’ and ‘it will reduce health inequalities’ were used.

I believe those arguments are false. I believe that the weekend is different, special, and that supporting the Conservative government’s ideas is regressive for both staff and patients.

The first issue is about what we mean by ‘7-day NHS’. It is quite obvious to anyone who has been in or visited hospitals at the weekend that the NHS is up-and-running 24/7/365. Emergency and urgent care is provided around the clock by doctors and other healthcare professionals already. You will never find an Emergency or Maternity Department closed because it is the weekend. People in hospital over the weekend do not languish alone without medical care. So we already have an emergency 7-day NHS. The NHS IS THERE when people need it.

What the government are talking about is elective care. Routine appointments. Non-urgent surgery. Diagnostic services. The figures used to back this are claims that the lack of these services at the weekend causes higher death rates and unsafe care for patients – the ‘weekend effect’. This inequality needs addressing. Other people have debunked these figures more successfully than I can.

So what arguments are there against the new 7-day elective service?

Implementing the plan for 7-day elective services would in theory require more doctors, nurses, diagnostic and admin staff. Without more staff magically appearing fully trained, or more money to employ those staff, the work must be done by existing staff – either moved across from weekday care or working longer hours. Neither option is safe and forms one of the core issues in the junior contract dispute. Another key issue is the push to make Saturday ‘plain time’ – ie cheaper for hospitals.

However, if the ‘weekend effect’ isn’t real, we must ask what the motivation for creating cheap weekend elective services is. Two possible explanations which have not received much air time are the reduction of paid sick leave for 9-5 weekday workers, and the concept of ‘sweating the assets’.

Evening and weekend elective services are explicitly aimed at ‘hard-working people’ who currently have to take time off for routine appointments at hospital during the working week. Removing this type of employee sick leave from the books would result in large savings for some employers. Some would pressure employees to only accept weekend appointments. More would give positive bias to employees who managed to leave health maintenance outside the workplace, changing the culture of what it is acceptable to miss work for. Our patients with chronic health problems and disabilities would be worst affected, finding their lives outside work shortened by the need to attend appointments in this time. This time that otherwise they might spend with their friends and family, crucial social support.

Sweating the assets is the act of extracting the largest possible amount of work from your existing resources, whether they be human, financial, space or equipment resources. With hospitals currently providing very little elective care at the weekend, there is plenty of room for lucrative work to be done in this time. The hospital’s resources are not being used most efficiently unless they are operating 24/7, like a factory. With hospital trusts now allowed to make 49% of their income from private practice, there is opportunity to bring in wealthy customers in this time. With the private sector circling above our NHS like vultures, already picking off the more profitable bits, this could be the windfall that allows viable takeover.

Neither of these reasons is progressive.

Weekends are special and do deserve different treatment – unions have fought for them over centuries and we should not give them away so easily. For health workers, this is the time that would otherwise be spent with children or friends. It is the time we miss weddings in. It is the time when childcare is far more expensive. To work at the weekend is to give up more of yourself than during the week, and that should be recognised.

If we want to address health inequalities, then it is the social determinants of health – poverty, poor education, poor housing quality – that we should be attacking, not NHS staff.

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  1. Ivan Benett says:

    The case for a seven day NHS is overwhelming. Indeed it is to the shame of the last Labour Government that it spent its years in power promoting and acceleration PFI, marketization and privatisation of the NHS. Instead it should have been focusing resources on providing an NHS that is available to all, seven days a week and not Monday to Friday. Yes it operates all week for emergencies but with reduced staffing levels at the weekend.

    The problem with a 5 day NHS, irrespective of the association with higher weekend mortality, is that illness and disease do not have calendars or hold diaries. People get ill anytime, including weekends. For planned services such as outpatients and diagnostics there is no reason why people in work, who have carers who work, or are in full time education should have to take time off work to attend, when these could be provided at other times. Having a 7 day NHS increases the capacity of the service to manage the increasing demand due to demographic changes. More people now have long term conditions and are living longer (a good thing), than in the last century, so we need an NHS that is appropriately up to date.

    Of course a 7 day NHS needs resourcing, and it also needs an expanded workforce to do the extra work. It is a pity that the Government have been slow to recognise it or acknowledge the case. However, it is even more regrettable that junior doctors have felt insulted and vilified. Certainly when I was a junior doctor I worked very long shifts, with 1:2 on call rotas sometimes. We were on the wards before 7.30 am and often didn’t leave until well after 6pm, as well as then covering urgent on-call problems. I’m not a junior doctor now, but have no doubt they have similar pressures.

    A seven day NHS is, or should be, a Socialist ideal. It is a shame that the original creators of the health service didn’t recognise it at the time. But things change and the NHS has to change too. A seven day service is progressive and meets the needs of our growing and aging population.

    As for the SHA AGM, two young people came from the south, were not introduced, and were very aggressive in their tone and questioning of both speakers and in their comments. I still don’t know who they are or from which organisation or standpoint they speak. I would be disappointed if the SHA went down the route of distancing itself from a seven day NHS because of a superficial link with the junior doctors strike. Certainly the BMA have never supported anything progressive in Health Care, and vehemently opposed the establishment of the NHS itself. My own view is that if the BMA oppose something, then its probably the right thing to do. Its position is hardly cause celebre or the class struggle that made me take up socialism as a young man. Junior doctors should be properly suported, but we should not be drawn into confusing their issue with a 7 day NHS.

    Finally, patients want a seven day NHS, indeed many assume there already is one. Unfortunately for my young friends and colleagues, the Government has a mandate for a seven day service also. So I would urge support for a 7 day NHS, but hold the Government to account for properly funding it, implementing appropriate safeguards and ensuring that it remains true to the founding principles of the NHS. We should not be distracted by opposing it, just because a Tory Government is introducing it.

    Dr Ivan Benett (in a personal capacity)

  2. Emma Runswick says:

    “There is no reason why people…should have to take time off work to attend” – yes there is. The two social reasons I explained about the burden of time currently falling on employers and the potential for private corporate taekover, and the reason that if these appointments are to exist we need people to provide them. People we don’t currently have.

    “Having a 7 day NHS increases the capacity of the service to manage the increasing demand due to demographic changes.” The demographic changes are older people with greater numbers of co-morbidities. These people are seen during the week, as often they are retired. We need more staff to deal with them during this time, as at the weekends they may have social things to do, perhaps with working or school-age family.

    I think I am one of the young people (being easily the youngest in the room at the AGM) but I am not from the South and I didn’t think I was aggressive. I did introduce myself – I am a medical student based in Greater Manchester, a socialist and a member of the Labour Party. Maybe I’m not the person you speak of. I don’t think it’s hugely relevant to the arguments I make.

    The BMA is it’s members. It currently supports the NHS Bill, an anti-austerity position, the better support of and protection for whistleblowers, better training for clinicians around care of trans patients, and the 7 day NHS.

    The current JDC position is to ‘hold the Government to account for properly funding it, implementing appropriate safeguards and ensuring that it remains true to the founding principles of the NHS’. They insist it should not be part of the ‘cost neutral’ deal being offered now, with no extra staff.

    Maybe you should rethink your opinion on the BMA.

    I assure you, my opposition to the 7-day elective service is on the grounds in this article, not because it’s a Tory idea.

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