Seven-day services would not improve clinical outcomes, study finds

Service reorganisation without enough 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.

St Mary's hospital, Imperial College, London

A seven-day-a-week NHS would not improve adverse weekend clinical outcomes, a new study suggests.

A paper published this month (10 August 2017) in
BMC Health Services Research
 found there was little difference between trusts that had made changes to create seven-day services and trusts that had made no such changes.

“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 report stated.

“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,” it said.

In 2013, NHS England (NHSE) initiated the
NHS Services, Seven Days a Week 
project to improve access to services across the seven-day a week. Its 10 recommendations included highlighting the importance of pharmacy services as being ‘crucial to make sure that care can progress without delay’.

To analyse the impact of such changes across the NHS in England, researchers from University College London, examined data from 159 English trusts, 79 of whom had made changes between 2013–14 to move towards delivering a seven-day service for patients.

Researchers examined the outcomes for the different types of service reorganisation, which included trusts that had implemented seven day mental and community healthcare services, and weekend outpatient clinics.

Their analysis of outcomes in both 2014–15 and 2015–16 found little difference between trusts that had made changes to create seven-day services and those that had not. Crude mortality rates, admission rates to emergency departments, and the average time patients stayed in hospital were similar across both groups of trusts, researchers found.

According to the study, there were several reasons why moves by trusts to change to a seven-day NHS service had still not improved outcomes.

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.

“Such changes may negatively impact care quality without additional financial investment, as demonstrated by worsening of some outcomes,” the report warned.

Detailed prospective research is required “to determine whether such reallocation of finite resources is clinically effective”, the study concluded.

The study followed a
2016 NHS report
that highlighted the role pharmacists could play in delivering seven-day healthcare services. Authored by Rahul Singal, clinical fellow to the chief pharmaceutical officer at NHS England, the report stated that unnecessary variation in hospital pharmacy services on weekends could be avoided through the best use of medicines, workforce, and technology.

Source: Rahul Singal

Rahul Singal authored a report in 2016, proposing better use of medicines, workforce and technology for minimal variation in hospital pharmacy services on weekends.

The report also advised hospital chief pharmacists to look at terms and conditions when employing staff so they could work over a seven-day period.

The report suggested that by co-commissioning clinical pharmacist posts, commissioners also have opportunities to help ensure access to expertise in medicines seven days a week. Some of these posts should be at consultant-level working between hospitals and primary care services in both generalist and specialist areas, researchers said.

Last updated
Citation
The Pharmaceutical Journal, August 2017;Online:DOI:10.1211/PJ.2017.20203429