UK hospitals need a proper seven day system, consensus conference concludes

BMJ 2013; 347 doi: (Published 18 November 2013) Cite this as: BMJ 2013;347:f6933
  1. Bryan Christie
  1. 1Edinburgh

Further support has emerged for an overhaul in the way hospital services are organised in the United Kingdom, including a move to “genuine seven day working.”

A consensus conference on patient flow in acute medicine, held at the Royal College of Physicians of Edinburgh, echoes findings of the recent inquiry into acute care led by the Royal College of Physicians of London and the findings of the Academy of Medical Royal Colleges.1 2

The main recommendations from the Edinburgh conference are that the NHS must reorganise care to provide seven day working, with senior clinical decision makers being available at all times.

It should set an ambition to eliminate the practice of “boarding” patients in any available ward, rather than those specifically designed for their needs. This has become accepted practice in response to overcrowding, but evidence indicates that it worsens outcomes among patients.

The conference also agreed that every acute medical unit should have a multidisciplinary team. This team should undertake an appropriate assessment of all newly admitted patients within 14 hours of admittance and produce an individualised care plan within 24 hours.

Nigel Edwards of the health think tank the King’s Fund, who chaired the consensus panel, said, “It is clear that in seeking to respond to the urgent care needs of the population, fundamental change is required. This will involve changing how the NHS configures and delivers acute medical services and, in the post-Mid Staffordshire era, having the ambition to eliminate established practices which are known to have adverse effects on patients.”

Mike Jones, vice president of the Royal College of Physicians of Edinburgh, said the consensus statement had the potential to significantly change how urgent medical care was delivered. He said, “We urge the Scottish and UK governments to support the implementation of these recommendations into practice.”

The findings were welcomed by Alistair Douglas, president of the Society for Acute Medicine. “We are pleased to see a call for rebalancing the needs of emergency and elective patients,” he said. “Recognition that the whole system needs to change to avoid the serious consequences of overcrowding and also a commitment to eliminate boarding is timely.”


Cite this as: BMJ 2013;347:f6933



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