Increased mortality associated with weekend hospital admission: a case for expanded seven day services?

BMJ 2016; 352 doi: (Published 29 March 2016) Cite this as: BMJ 2016;352:i1762

Further evidence relating to the study's background emerges

Further to my recent letter explaining how the full political context of the Freemantle study was not adequately declared(1), several other interesting pieces of information have come to light which I feel should be made available to the BMJ’s readers.

An email sent on the 3rd February 2015 by a Deloitte employee to officials at NHS England including Bruce Keogh reveals the intricate involvement of both Deloitte and Simon Stevens (Figure 1). The main questions arising from this meeting involving Stevens, Keogh and Deloitte included ‘What is the clinical case for seven day services, especially re mortality?’ and the resulting action was documented as ‘Bruce agreed to have the mortality analysis from 2008 updated’. It is interesting that the involvement of both Simon Stevens and Deloitte in the study’s inception was not documented anywhere in the Freemantle study(2).

It is also salient that another question arising from this meeting was documented as ‘what is needed from pay negotiations to improve affordability?’ which demonstrates a clear link between the 7 day reforms and doctors’ contracts. The email also stated another action as ‘Deloitte to run mortality bundle to show services needed to address mortality variation’. This implies that those involved, including Bruce Keogh and Simon Stevens, had already made the assumption behind closed doors that the mortality variation was ‘addressable’, despite the fact that it appears to contradict the gist of the authors’ clear statement that to assume this mortality variation was avoidable was both ‘rash and misleading’. A further email sent by Simon Bennet of NHS England to Deloitte on the 11th January 2016 states ‘Whilst I believe we shared with you high level mortality risk figures from a re-analysis of 2013/4 admission to help with your modelling…’ (Figure 2). Data presented to NHS England in 2014 confirms the recurrent theme of recent media stories regarding the government’s 7 day reforms, with it being stated that ‘the workforce costs need to be addressed’(3) (Figure 3).

In the context of recent media stories detailing the ‘airbrushing’ of the Freemantle study by the Department of Health(4), the incomplete manner in which the context and inception of the Freemantle study has been presented to readers has significant implications as to its overall meaning. The bottom line remains that doctors and patients want 7 day reforms, but only if the government is willing to adequately fund this service expansion so that it is properly and safely staffed; Chris Hopson, the CEO of NHS Providers, has recently spoken out about the ‘chasm’ which exists between the government’s promised delivery and current levels of funding(5). Given that widespread staffing problems that already exist, the government’s attempt to expand services by bullying poorer terms and conditions on staff appears misguided, counterproductive and dangerous.

1. Dean B. The full political context was not adequately declared. BMJ (Clinical research ed.). 2016;
2. Freemantle N, Ray D, McNulty D, et al. Increased mortality associated with weekend hospital admission: a case for expanded seven day services? BMJ (Clinical research ed.). 2015;351.
3. Campbell D. Secret documents reveal official concerns over 'seven-day NHS' plans. Guardian. 2016;
4. Sims A. Jeremy Hunt's department knowingly 'airbrushed weekend deaths study', according to email. Independent. 2016;
5. Hopson C. The gap between funds and delivery is a chasm in the NHS: something has to give. Guardian. 2016;

Competing interests: No competing interests

04 November 2016
Benjamin JF Dean
Orthopaedic Registrar