Why not 24/7 quality care?


Via 82% more chance of dying in surgery at the weekend: Shock finding of report into NHS operations | Mail Online.

Patients who undergo planned operations at the weekend rather than a Monday are 82 per cent more likely to die.

Shocking findings show that death rates for elective procedures increase throughout the working week.

This will add to mounting concern about NHS patients receiving poor care during ‘antisocial’ hours when consultants are off duty.

See also The Telegraph’s spectacularly titled, “Death risk lottery of NHS surgery“.

One of the reasons I am constantly given for the centralisation of NHS services is to improve quality. It turns out the NHS does not achieve consistent quality through the week, never mind at the weekends.

The study is reported by the BMJ here. This is the video abstract:

Listen closely and it turns out the variability is large but at a low level and the statistics are complex. For example, it appears the people who have operations at weekends tend to be more seriously ill. The  article’s results and conclusion are:

Results There were 27 582 deaths within 30 days after 4 133 346 inpatient admissions for elective operating room procedures (overall crude mortality rate 6.7 per 1000). The number of weekday and weekend procedures decreased over the three years (by 4.5% and 26.8%, respectively). The adjusted odds of death were 44% and 82% higher, respectively, if the procedures were carried out on Friday (odds ratio 1.44, 95% confidence interval 1.39 to 1.50) or a weekend (1.82, 1.71 to 1.94) compared with Monday.

Conclusions The study suggests a higher risk of death for patients who have elective surgical procedures carried out later in the working week and at the weekend.

I imagine that the NHS response to this study will be to propose further centralisation to achieve consistent 24/7 staffing with adequate throughput to maintain clinical skills. Via The Telegraph, my courageous colleague Dr Philip Lee MP calls for “larger units, with a greater number of staff”. Where would that leave the local services which the public prize?

As ever, there is a tension between quality of service, which is difficult to measure, and easy, local access to healthcare, which is easy to identify. That is bound to lead to further tension between clinicians, politicians and the public. As it is the public who bear the costs in both cash and consequences, I’d like to see a much more direct role for public decision making.

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