What is a "seven-day NHS"?

We’ve looked at what the government has said about the "seven-day NHS", the reasons behind the policy and the reaction to the plans.

The Conservative party manifesto for the 2015 general election committed “to increase spending on the NHS, provide seven-day a week access to your GP and deliver a truly seven-day NHS—so you know you will always have access to a free and high quality health service when you need it most.”

MPs in the Health Committee have said that the wording of this was “broad” and has perhaps been the cause of some confusion about what the scope of a seven-day NHS might be. The government has since clarified that the plans are focused on emergency and urgent care, along with extended GP services.

Of course some NHS services do run all week round and the government isn’t proposing that you could see your GP at midnight. This debate is about what is available, at what level, where and when.

So what has the government said about it?

The plan for a seven-day NHS set out in the Conservative manifesto was to ensure that by 2020 everyone can see a GP seven days a week, from 8am-8pm. It also said that it wanted “hospitals properly staffed, so that the quality of care is the same every day of the week.”

Since then, the Department of Health has now said that “by the end of this parliament, anyone who needs urgent or emergency hospital care will have access to the same level of consultant assessment and review, diagnostic tests and consultant-led interventions, whatever day of the week it is.”

It has also said that this urgent care should be available 24 hours a day, and has reiterated the intention to improve weekend and evening access to GPs.

What the government has said the plans don’t include is any intention to introduce pre-planned (elective) care seven days a week.

The government has backed four key standards to be met by the plans:

• all patients must be seen by a “senior decision maker” within 14 hours of arriving in hospital
• patients must have seven-day access to certain hospital tests and results, with a one-hour turnaround for the most critically ill patients
• inpatients must have 24/7 access to treatment directed by consultants
• all high dependency patients must be reviewed by a consultant twice a day and once transferred to a general ward they should be seen once a day, every day of the week.

What services are currently available?

The Nuffield Trust has said that “Implementing a seven-day NHS will mean significant changes to the way services are run, it will require a critical mass of specialist staff to be recruited, and it may mean closures or mergers of local services”.

There are some services which the NHS provides “out of hours” which the NHS describes as being between 6.30pm and 8am during the week, all day at the weekend and on bank holidays.

GPs can choose to provide 24 hour care if they want or direct their patients towards the NHS’s “out of hours” service, which patients usually access through the NHS 111 24-hour non-emergency number. Walk-in centres, urgent care centres and minor injuries units are also available, though their opening hours vary, as well as Accident and Emergency units and ambulances.

The government has said it wants to change consultants’ ability to opt out of weekend working at the moment. It has been suggested that the vast majority of consultants haven’t used the existing clause to opt-out, though the data backing this up is incomplete and may exclude any informal negotiations.

Why a “seven-day NHS”?

The government claims that “patients currently get a poorer service at weekends” and those admitted to hospitals at weekends are more likely to die than if they were admitted on a weekday.

It has said in the past that thousands of excess ‘weekend deaths’ can be attributed to under-staffing in hospitals, which the evidence did not support. Full Fact has twice requested that the Health Secretary correct the record on a specific version of this claim. To date he has not done so.

Some experts have also recently called into question the evidence which highlights a weekend effect. We’ll be looking into this.

What has the reaction been in the sector and from the public?

A number of health bodies and experts have voiced support for expanded NHS services. That said, many have also questioned whether or not a seven-day NHS could be delivered with the staff and funding available at the moment.

NHS Providers, the membership organisation for NHS service providers, has said that “a very strong case” has been made for seven-day services but that “it seems to us it’s impossible to deliver it on the current level of staff and the current money we have available.”

The British Medical Association, which represents doctors, has said it has “consistently stated our support for better patient care across every day of the week.” But it has also said it wants to know how the services would be “funded and delivered”. Specialist think tanks the Nuffield Trust and King’s Fund have issued similar statements.

Health consumer organisation Healthwatch has said that the public wants more flexible care and that “they very clearly see the need” for more expanded GP services. It  noted that while the idea of Saturday morning services was popular, there appeared to be less demand for GP services to be available on Sundays.

Some polls have suggested that the public is in favour of seven-day access to NHS services, but many (48%) think these services aren’t possible with the levels of funding and staffing at the moment. 42% thought it was possible.

The government says the money will come from £10 billion already going to the NHS during this parliament. Experts at the Nuffield Trust have said the NHS will struggle to fund the seven-day NHS through this money alone. They have also pointed out that the spending increase is less when health spending outside of NHS England is included. 

Image courtesy of Lydia