Intended for healthcare professionals

Feature Briefing

Seven day working: why the health secretary’s proposal is not as simple as it sounds

BMJ 2015; 351 doi: (Published 05 September 2015) Cite this as: BMJ 2015;351:h4473
  1. Helen Crump, fellow in health policy, Nuffield Trust, London, UK
  1. helen.crump{at}

Health Secretary Jeremy Hunt’s recent declaration that he wants to see most hospital doctors on “seven day contracts” to enable weekend working provoked the ire of many NHS staff, who have been using the Twitter hashtag #iminworkjeremy to show they already work at weekends. Helen Crump explores the evidence behind the proposal and its financial implications

What is the health secretary proposing?

The rationale for expanded seven day working set out by Jeremy Hunt was to improve the quality of care at weekends and, in particular, to tackle higher mortality among people admitted on Saturdays and Sundays.1 It is not clear whether he had in mind emergency or elective procedures, or both, when he made his comments, but he called for speedier diagnostic test results, timely consultant review when a patient is first admitted, consultant directed interventions, ongoing consultant review in high dependency areas, and proper assessment of mental health needs.

These points echo several of the 10 clinical standards set out by NHS England’s seven day working taskforce in 2013.2 The clinical standards focused mainly on process improvement and ensuring provision was appropriate for urgent and emergency patients. Following Hunt’s speech NHS central bodies wrote to trusts asking them to prepare to be monitored against four of these standards, focusing on consistent provision for inpatients at the weekend: time to consultant review, access to diagnostics, access to consultant directed interventions, and ongoing review.

What is the evidence behind increased weekend death rates?

With the important caveat that excess deaths are a contested measure for gauging the quality and safety of services,3 some studies have identified a relation between the day of the week a patient is admitted or a procedure is carried out and the probability of dying within 30 days. These trends have been found in both elective and emergency patients.

Aylin and colleagues found that the adjusted odds of …

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