Seven day service doesn’t improve clinical outcomes, researchers find

BMJ 2017; 358 doi: (Published 11 August 2017) Cite this as: BMJ 2017;358:j3874
  1. Abi Rimmer
  1. The BMJ

Reorganising hospital services to create a seven day NHS would not improve clinical outcomes, researchers have concluded.

The paper, published in BMC Health Services Research, said that adverse clinical outcomes at the weekend might not be lessened by large scale reorganisation designed to create seven day services.1

In December 2012 NHS England outlined plans for seven day access of patients to NHS services.2 In 2013 the national medical director, Bruce Keogh, and his colleagues at NHS England drew up a set of 10 clinical standards for trusts to work towards in their implementation of seven day services.3

In the new study Hoong-Wei Gan, from University College London, and colleagues looked at data from 159 trusts in England, 79 of which had made changes in 2013-14 to move towards a seven day service. The researchers considered all forms of service reorganisation, including weekend outpatient clinics and implementation of seven day services in mental and community healthcare.

Their analysis of outcomes in 2014-15 and 2015-16 found little difference between trusts that had made changes to create seven day services and trusts that had made no changes.

The researchers said that crude mortality rates, the average length of stay in hospital, and rates of admission to emergency departments were similar across both groups of trusts. They also found that breaches of the four hour target to be seen in emergency departments were “not apparently different between trusts which had and had not implemented seven-day changes” and that these had in fact worsened across all trusts.

They added, “In some organisations, despite active restructuring of services around seven-day care, there was a worsening or no change in mortality, length of stay and A&E outcomes.”

The researchers posited several likely reasons for a lack of improvement. “Service reorganisation without sufficient additional investment or a cost-neutral budget could result in weekday care worsening at the expense of increasing weekend service provision so that overall outcomes through the seven-day week are worse or unchanged,” the researchers said.

“Additionally, the association between poorer weekend clinical outcomes and service provision may potentially be non-causal, and therefore increasing weekend services may not result in improvement.”

The researchers concluded that the reorganisation of health services aimed at mitigating any “weekend effect” should be put on hold until there was “more solid evidence” that changes would be effective.


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