The new junior doctors’ contract is unlikely to decrease the number of weekend deaths, suggests new research.
Experts say the ‘weekend effect’ – which apparently shows patients admitted to hospital at the weekend are more likely to die – overshadows a complex pattern of weekly changes in quality of care.
But the research does show that patients admitted over the weekend are likely to spend less time being treated by a consultant than if they are admitted during the week.
Jeremy Hunt, Secretary of State for Health, has often used the ‘weekend effect’ to make the case for his proposed contracts for junior doctors.
A study by researchers at the University of Birmingham, found no link between weekend senior doctor staffing levels and mortality.
In another paper, by King’s College London and University College London, researchers studied acute stroke care.
The scientists found no so-called ‘weekend effect’, but identified many variations in quality of care throughout the week.
The two studies, published in The Lancet, are not the first to reveal weakness’s in the health secretary’s case.
The Birmingham research team gathered data on senior doctor input into emergency admissions at 115 NHS trusts over a four day period.
Hospital consultants completed a survey recording the number of hours they spent caring for patients who had been admitted as an emergency.
The team then compared the findings with national hospital mortality figures.
While there were fewer senior doctors on a Sunday, 1667, compared to a Wednesday, 6105, other important factors became apparent.
Researchers noted that doctors spent about 40 per cent more time on caring for emergency admissions on Sunday, around 5hrs 45 minutes (5.74 hours) , compared to Wednesday, just under four hours (3.97 hours).
When the total number of admissions per hospital was taken into account, results showed emergency admissions on a Sunday collectively receive on average less than half the input of senior doctors compared to Wednesday patients.
And while there was a 10% relative risk increase in mortality on weekends compared to weekdays, a study of mortality data for all 115 trusts showed this varied between trusts.
Furthermore, when mortality risk was plotted against senior doctor staffing levels, there was no evidence of an association between the two.
However researchers stressed the study did not include data on staffing of junior doctors, nurses or information about how ill patients were.
Author Professor Julian Bion, from the University of Birmingham, said: “Patients admitted to hospital over the weekend are likely to receive less time with consultants, and do indeed have a slightly higher risk of death.
“Both problems need to be addressed to provide consistent standards of high quality care. But to say that lower staffing is the cause for increased mortality is far too simplistic and not supported by the evidence.”
Professor Bion added: “Policy makers should be extremely cautious when attributing the weekend effect directly to the lack of consultants at the weekend.”
Meanwhile the second study, conducted by King’s College London and University College London included care data from over 74,000 stroke patients admitted to 199 hospitals.
They then calculated the number of patients surviving 30 days after being admitted for day admissions both during the week and on weekends.
They found there was a wide variation in the quality of care delivered, both by days of the week and time of day.
For example, patients admitted on a Monday had the lowest odds of being admitted to a stroke unit within four hours.
Author Dr Benjamin Bray, from University College London, said: “Our study shows that the ‘weekend effect’ is a major oversimplification of the true extent and nature of variations in the quality of care that occur in everyday practice.
“Our findings apply to stroke care in particular but are likely to be reflected in many other areas of health care.”
He added: “When solutions come at such a high financial cost, it is imperative that policy makers, health-care managers and funders base their decisions on evidence. Simply transferring doctors from weekdays to weekends is highly unlikely to have the intended effect of improving quality of care.”
Professor Nick Black, of the London School of Hygiene & Tropical Medicine, said of the findings: “Jumping to policy conclusions without a clear diagnosis of the problem should be avoided because the wrong decision might be detrimental to patient confidence, staff morale and outcomes.”
