Letters Debate on weekend working

Whether the NHS works at weekends as it does in the week is a question of cost effectiveness

BMJ 2013; 346 doi: http://dx.doi.org/10.1136/bmj.f1861 (Published 28 March 2013) Cite this as: BMJ 2013;346:f1861
  1. Fiona Lecky, clinical professor of emergency medicine1
  1. 1University of Sheffield/Salford Royal Hospitals NHS Trust, Health Services Research, School of Health and Related Research, University of Sheffield, Sheffield S1 4DA, UK
  1. f.e.lecky{at}sheffield.ac.uk

I agree that the increase in mortality out of hours is an association and not necessarily an indictment of current out of hours hospital services.1 We analysed this association in trauma cases some years ago, using robust adjustment of data from the Trauma Audit and Research Network, and found no difference in case fatality out of hours. However, given current junior doctors’ shorter training periods—hence reduced exposure to severe illness and injury—close supervision and hands-on consultant care for patients with life threatening conditions needs to be the norm.

This would require reconfiguration of services into major trauma, stroke, myocardial infarction, obstetric, and paediatric centres rather than all hospitals providing a 7/7 resident consultant service for all specialties. Emergency ambulances would need to bypass general hospitals or hospitals would need to rapidly refer patients on. This has happened or is happening to a large degree.

The question is really a cost effectiveness one regarding elective and semi-urgent care being extended to seven days. Would the health gains from shorter waiting lists and the reduction of NHS fixed costs per elective procedure justify the increased staff costs? Even if modelling suggests it might, could public sector revenue afford it before 2020? It is a health economic exercise worth undertaking with circumspection.


Cite this as: BMJ 2013;346:f1861


  • Competing interests: None declared.