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Views And Reviews Acute Perspective

David Oliver: Seven day service standards in NHS hospitals: thorny problem or blooming success?

BMJ 2017; 359 doi: (Published 05 December 2017) Cite this as: BMJ 2017;359:j5552

Re: David Oliver: Seven day service standards in NHS hospitals: thorny problem or blooming success?

The article by David Oliver on the seven-day service standards highlights the importance of reaching beyond conventional metrics towards softer measures of prioritisation and optimal care delivery with an outcomes focus. There is much more to seven day a week service than a daily consultant ward round of patients and access to tests. Without a sharp focus on appropriate and necessary investigations, timely and safe medication administration, interdisciplinary communication and coordinated discharge from hospital, true patient centred care is difficult to achieve.

Provision of after hours services presents many challenges. Staffing numbers and profiles are reduced, access to the full spectrum of investigations restricted and allied health services are often limited. In addition there is usually a significant diminution of clinical education and supervision. Unsurprisingly in this context, the implementation of a comprehensive seven-day service model has eluded most healthcare organisations.

We do agree that having the capacity to provide senior clinician decision making seven days a week has substantial benefits for care delivery. Our organisation has operated a seven day a week model of care in general medicine and we have realised important benefits in terms of length of stay and bed days without compromising on traditional quality indices such as high severity incidents, readmissions and mortality. Softer measures of patient experience provide reassurance that the continued senior clinician leadership throughout the week is the right way forward.

Maturation of our model has appreciated that a seven-day service needs to strive for more than simply senior medical decision making. Opportunities are now being realised in providing a more robust environment for teaching and supervision to better train and supervise junior staff and create exceptional future consultants and clinical leaders. It maximises occasions of connecting with the patient, their family and the broader multidisciplinary team to ensure that we continue to truly deliver the best possible patient centred care. Having seven days senior clinical input is an important but the first step in a true sense. We agree with Oliver that success cannot simply be defined by our ability to meet targets for attendance and times to clinical review. Instead, we need to look much deeper to ensure that meeting what we consider to be important indicators today actually leads to a better outcome for our patients tomorrow.

Competing interests: No competing interests

07 December 2017
Vikas Wadhwa
Director of General Medicine, Maroondah Hospital, Eastern Health
Evan Newnham, Executive Clinical Director Acute Medicine, Eastern Health
Arnold Street, Box Hill, Victoria 3128, Australia