7Seven working – is that what you really want?

So the world and his wife is demanding seven day working from the NHS.  NHS workers, doctors, nurses, journalists and patients alike are jumping on to Twitter to tell us that “it is the least we should expect” and they tell us about very real experiences of sub-standard care received at a weekend. 

Why shouldn’t we be using the expensive NHS infrastructure 7 days a week? After all that would be maximally productive… we could all be operating, doing clinics, and holding multidisciplinary team meetings. 

As it stands, dedicated nurses (who already work 7Seven shifts by the way) say they can’t find a doctor to review their patients; the doctors complain that they can’t get the x-rays and CT scans that they need; everyone moans that there aren’t enough physios and occupational therapists  (if any at all) – and that’s just in hospital.  Try getting to see a GP who actually knows something about you on a Sunday,. And as for social services, well at one stage last week over 100 patients were in a local hospital, medically fit for discharge with nowhere to go…

There are islands of hope within this sea of weekend confusion.  I was on-call last weekend for surgery in my own hospital and there were 3 other consultant surgeons in the hospital seeing patients and helping me out.  We are not alone, and many other trusts provide an equally good, if not better weekend service.

This is fine in a teaching hospital, with lots of senior staff divided into teams of specialists who can provide their own weekend rotas.  But what if you work in a small district general hospital with 4 surgeons?  I don’t think anybody in their right mind would expect them to be in the hospital every weekend… would they?

And surgery doesn’t get it bad.  My wife is an Emergency Medicine (A&E to you and I) consultant in one of the busiest departments in the country.  They are already asked to work more antisocial hours than anyone else in healthcare, and seem to get all the blame for the 4 hour target breaches, despite having no control over patient flow through the hospital.

This really is quite a simple concept – if the back door is shut and the front door stays open, there will very quickly be “no room at the inn”, the Emergency Department queue is just a manifestation of the systemic failure of the NHS and social care to provide a joined up service. At weekends… nothing moves.

I will venture onto dangerous ground now, but before reading on be assured that I am not asking for sympathy because I decided to do what I do because I love it.

Somewhere amongst our noble desire to demand and provide the best quality care the first time, every time, no matter what time of the day, or day of the week, we forget that it is human beings that do the caring.  We have families. Our children go to school (during the week) and sometimes like to see us at weekends.  Our friends do things at weekends and occasionally invite us along.  We might even have a sporting interest that helps keep us normal and healthy; most teams play at weekends.  Between us, my wife and I give 15 weekends a year to the NHS (21 if you count Friday night into Saturday morning), I think this is enough..?

So the care system is complex, but it should not be beyond the wit of man to work things out.

Perhaps the answer is to finally grasp the nettle of centralisation, and do it properly.  Not every town will have an A&E as we currently know it.  Doctors, nurses, managers, politicians and patients will have to get over their parochial attachments, and accept that – for the sake of their own health, and that of their patients – they will have to work with the hospital down the road and not against it.  It is inevitable that complex surgery and interventional medicine will centralise further – if I have a heart attack at 3am, I want my angiogram and stent straight away – and I don’t care if you a have to fly me there to get it.

Some hospitals will have to close… and probably more than you think.

Here is the rub: the population seems to want world-class 7Seven care on their doorstep, but fail to realise that this is impossible.  Whilst they might agree with the arguments in principle, they don’t think it is “their” local hospital that should close  (look what happened to the children’s cardiac surgery review). Politicians are perhaps the worst offenders, it is seen as career suicide to support the closure of a local facility (even if it makes sense) and, as the general election looms, they will all be out insisting that they will “never” let the local hospital shut.

And when smaller trusts try to do something sensible, the special interest groups (NIMBYs in my opinion)  get their knickers in a knot and make referrals to the competition commission… assuming they have any idea about the best way to run a complex health care service, that is a MONOPOLY provider by the way.

So are we ready for what 7Seven will really look like?

Fewer acute hospitals, further apart, using doctors and nurses from around the region to make their working life bearable.

Patients and relatives travelling that bit further for the best care, with the emotional, time and financial demands that this brings.

Small hospitals closing, merging or changing shape completely.  This is happening for trauma care right now and outcomes are better… much better.  It could be coming to the rest of medicine sooner than you think.

And what if we don’t change… well the scandal of Emergency Medicine recruitment gives us the answer.  Nobody wants to train to be an A&E doctor right now because it’s all antisocial high-pressure working.  The shifts are terrible, their leave is dictated to them, and they are blamed for the failings of the health service as a whole… I wouldn’t do it and I am proud and amazed that Mrs U does.

Tim

2 thoughts on “7Seven working – is that what you really want?

  1. What’s new?
    From 1952 to 1985 my Father worked an half day every Saturday and every Sunday year-round including Christmas.As Consultant Pathologist to the RSH/SUH had he not done so the bodies in the Hospital and Public Mortuaries would have been stacked six up instead of just two deep !
    In between he found time to create the Duthy Building,sit on Ministry committees,lecture on Zoonoses for the RSPCA,organize Technician training,conduct research, pursue his Fellowships and serve in the Royal Naval Reserve……………..
    You never had it so good.
    JCG

  2. As it seems more and more nowadays are medicine and time not always compatible. And not only in the UK but also in Belgium and other nations on this globe. My dad, who was a general and vascular surgeon, loved working in the A&E. A place were he got constantly challenged and were he could be the best doctor he possibly could be. That spot became his second home and he did spend long days and nights in there. He was one week out of two on call. What meant we were on call together with him. Phone calls with friends had to be kept short&sweet, no family outings in those weekends and we did hear numerous times during the night the starting engine of my dad his car. And yes, he did miss out on many significant moments in our lives. That he in the mornings was after some peace and quiet was so natural to us but it wasn’t always easy on us.

    The surprising thing is that I can not remember him complaining about it. At least not openly. I guess that when he took an oath as a doctor he kind of knew what was heading his way. He loved to try out new things (I will never forget when he for the first time helped to plant in a pacemaker), he liked to guide residents through their first weeks of training and make them also try out new things, he liked to fix the health problems of this patients as fast as possible and he did have tons of respect for the team he worked with. They were the backbone of the hospital he worked in. So he did seem to love the jog he had.

    There was just one tiny issue: it was a rather small hospital ,one that could not offer all the medical care patients in the 21st century are after. So like many hospitals it had to merge. He had a very personal opinion about this new trend but in a way he did knew that in a challenging world we do call for a different kind of medicine. He just did wonder at what cost and not only financially but also emotionally. Not only doctors and nursing staff have to work harder. We all do in order to make it to work for us and being able to have the healthy and happy life we are after. Many of people around me send me out signals that they feel so much more challenged and that there is a lack of respect.

    I am now in the situation that I can compare my dad his professional status to a younger doctor his current working conditions and not much has changed. What a surprise? Nah, not really. In a way I knew what I got myself into but still. So, it is Saturday morning and I just had my first cup of coffee, our son is at art academy and my other significant one is at work… I would rather have him at home in a weekend because we all deserve some quality time with him after a school&work week but the issue is that there are & always will be people who need health care. I have to be honest that I do now understand my mother so much more but I guess that her medical background (ICU-nurse) made it a bit easier to travel into the mind of a doctor.

    So that I now sometimes face many days and evenings without the one who has got the medical degree in this house does make it less fun. But then if I would be the one in pain I would for sure want to have a doctor on standby and a well equipped hospital. It like a ever lasting dilemma that I face as a partner. Yes, I am envious of those people who are home together in the evenings. But I also know that there are more people like me out there and that it are not just doctors who face long days.

    The challenges that medical world faces are complex and not always seem to be fixed with one straight forward plan. Because the wish list of many involved is long. The wishes doctors call for are better working conditions for residents and young trainees (hey, we all want a doctor who is still awake and fully aware of what he or she is doing), better healthcare for all including the chronic diseases,elderly and mentally diseased patients, doctors are calling out for a well equipped ICU for the younger patients and not just in seven places in this nation, doctors wish that the government would make sensible decisions when dealing with their training and studies, doctors wish that hospital are not only ran by managers who consider their hospital big business where money has to be spend wisely, doctors wish more money for research, research that can save their patients if not in the short run then in the long run, doctors do wish that medical companies are honest with their medical research results so that can make an honest prognosis in the best intrest of their patients, doctors have got many wishes and to be honest there is not one single wish that I don’t understand. All of these demands/wishes are in the best intrest of us, the patients but also to make the working conditions of doctors and nursing staff a bit easier to all of us. If this then includes that my other significant will have to work longer days and more hours then I am willingly to pay the prize. But if this means that doctors can’t wish for at least one day peace&quiet then count me out because I doubt that this will benefit any of us.

    So yes, we are after a challenge of a life time in the years to come in order to create a more transparent health care and it won’t be easy. This is a global challenge and sooner or later we will all have to face it. The debate we are facing won’t be easy and it will cause distress and frustration and not on one side. Still, it will be a more peaceful debat if it will involve mutual respect.

    C.S, Belgium

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