Seven Day NHS Care

The British Orthopaedic Association gives a cautious welcome to moves for seven day a week care, under the principle that ‘The right patient should receive the right treatment at the right time’, but highlights important considerations.

This week the NHS Commissioning Board produced ‘Everyone Counts: Planning for Patients 2013/14’, its planning guidance for 2013/14.  One of the five central themes of this is ‘NHS services, seven days a week’. The report explains:

“The NHS will move towards routine services being available seven days a week. This is essential to offer a much more patient-focused service  and also offers the opportunity to improve clinical outcomes and reduce costs.”

In addition, the Academy of Medical Royal Colleges (AMRC) produced a report ‘Seven Day Consultant Present Care’ earlier this month on the same theme.

The British Orthopaedic Association fully supports the Academy of Medical Royal Colleges’s (AMRC’s) three standards of patient-centred consultant led care set out in this report, namely that:

• Hospital inpatients should be reviewed by an on-site consultant at least once every 24 hours, seven days a week, unless it has been determined that this is not necessary for the patient.
• Consultant-supervised interventions and investigations along with reports should be provided daily if the results will change the outcome or status of the patient’s overall care before the next ‘normal’ working day. This should include interventions which will enable immediate discharge or a shortened length of stay
• Support services both in hospitals and in the primary care community setting should be available daily to ensure that the next steps in the patient’s treatment, as determined by the daily consultant review, can be taken. It also acknowledges that it is outside its scope to look in detail at community services.

These are entirely consistent with our six guiding principles for trauma and orthopaedic surgery that:

• The right patient should receive the right treatment at the right time.
• Investigations should only be undertaken if needed. They should be based on good evidence and should not replace a considered and informed clinical assessment.
• The choice of surgical intervention should be appropriate to the condition of the patient and to its severity.
• Patients, rather than clinicians or commissioners, should be able to choose their treatment for a non-urgent disorder, having been provided information on a variety of alternatives from multiple sources.
• Each treatment must be accompanied by:
  • A good evidence base.
  • An assessment of its expected duration and magnitude of benefit.
  • A risk assessment.
  • A clear definition of the required inpatient and outpatient care.
• Any changes, including those in service delivery, must:
  • Improve the quality of care.
  • Be effective.

However, the BOA considers that there are a number of important caveats that will need to be considered in relation to 7 day provision of services:

• Levels of staffing need to be considered – for example if a Consultant’s ward round is to be effective, they must have the backing of a comprehensive team.
• Support facilities need to be considered – for example, access to scanning, tests and rehab facilities are required.
• It is important that the practise does not become a tick-box exercise and that quality of service remains the priority.
• While care must be consultant-led, the consultants have to be able to delegate work to colleagues.
• Discharge of patients at weekends is an issue that gives cause for concern, and relies on the availability of social/community care services, which should also be factored in.