Comment / Seven-day realism

There is a world of difference between general election campaign promises and turning them into reality. All parties were guilty of over-simplifying their health-related pledges in the run-up to May’s
poll. But it is the Conservatives, having gained an unexpected
majority, who must now turn their promises into action.

Seven-day NHS services are perhaps the most high profile of these pledges – aside from commitments to deliver a minimum £8bn increase in funding over the next five years. And it is here that the new government started with its health plans in the middle of May.

Seven-day services have been promised before, as have moves towards 24/7 GP services, although the government has now pledged 5,000 new GPs as a downpayment, both to take pressure off existing services and increase access. Where these GPs will come from – given training lead times – and what the net increase will be after normal and stress-induced attrition have taken their toll remains to be seen.

But there needs to be complete realism about how quickly changes can be achieved and how much they will cost. And there must be far better links with the work on new models. These are not initiatives that can be taken forward in isolation from each other. Instead, the new model work needs to
explore how they can deliver the best care – which is likely to involve seven-day services in some cases.

The case for seven-day services is well made. At the primary care level, weekend GP services should reduce the number of inappropriate accident and emergency attendances. And more GP capacity may lead to early diagnosis of developing conditions, improving patient outcomes and reducing more costly interventions downstream.

At the hospital level, there is a link between seven-day services and better mortality rates and reduced length of stay – the latter have patient satisfaction and cost reduction benefits. But the service is overspending and facing extreme pressures on staffing costs in general and agency costs in particular.

Prime minister David Cameron may have said that people should ‘not automatically assume’ seven-day services would cost more. But not all providers will be convinced as they look to populate new rotas with staff covered by existing national pay contracts and terms and conditions.

In general, the move to seven-day services needs to be backed up with greater evidence if financially challenged providers are to make progress.

To date the only real study – at least the only one that has been published – which looks specifically at the costs of seven-day services in the NHS, is from the HFMA, undertaken for NHS England and released at the end of 2013.

Its conclusion was that seven-day services added 5%-6% to the cost of emergency admissions or 1.5%-2% of total income. It did observe though that investment at the front end of the hospital – more consultants and supporting diagnostics – can pay for itself.

Given the worsening financial conditions, this work now needs to be followed up with more detail on costs and where they arise and where providers will get the most value.  Perhaps there also needs to be a focus on whole health economy approaches to seven-day services and on the key outcomes.  Changes should be about improved outcomes and better patient satisfaction, but the simple reality is that they also need to be affordable – so perhaps we need to prioritise outcomes over convenience.

Moving to seven-day services is intuitively the right thing to do. But, now that the election is out of the way, the government needs to disband its teams of headline writers and get attention turned to the practical realities of transforming the health service.

Perhaps the key consideration is what else providers are being asked to deliver. If seven-day services are the right way to go, how can local health economies  be given the space to prioritise this and take the new model forward?