Weekend working not the solution to backlog

Health and social care secretary Steve Barclay appeared to support this argument last November when he urged hospitals to question ‘what is within their control’ as they tried to free up beds, adding ‘consultants at the weekend – what can they do?’

But the confederation has argued that many parts of the NHS already work 24/7 – including ‘enhanced access’ appointments in primary care and increased sessions of outpatient, diagnostic and elective surgical lists, designed to address the elective backlog.

But extending this further would hit a number of obstacles it added. These included:

• Workforce shortageswith the same number of staff being spread more thinly over seven days. Staff shortages in some areas would be an impediment to moving to more out-of-hours working – and would mean increased weekend working could lead to fewer staff working on weekdays.
• Issues with NHS pensions are already deterring senior doctors from taking on more hours, as they may incur tax penalties. This problem has existed for some time, but was not addressed in October’s autumn statement.
• Overall hospital costs could increase by 1.5% to 2% from seven day working. Many groups of staff are paid enhanced rates for weekend working which would increase costs – although reducing length of stays in hospitals could partly offset this. For primary care, opening premises for longer could increase costs – for example, for heating and lighting.
• Staff morale and preference could also be important, as asking them to change to less sociable hours could disrupt their work-life balance further and could lead to some leaving the service. It could also make working in some parts of the NHS harder for parents with childcare responsibilities.

Instead, the confederation suggested that aspects such as the NHS pension scheme, the promised workforce plan and capital investment to address the £10.2bn backlog of NHS maintenance work – which inhibits efficiency – should be addressed. ‘Significant increases in out-of-hours working alone is not a cost-effective or realistic solution to tackling the backlog,’ it concluded.