Abstract
BackgroundThe cause of adverse weekend clinical outcomes remains unknown. In 2013, the “NHS Services, Seven Days a Week” project was initiated to improve access to services across the seven-day week. Three years on, we sought to analyse the impact of such changes across the English NHS.MethodsAggregated trust-level data on crude mortality rates, Summary Hospital-Level Mortality Indicator (SHMI), mean length of stay (LOS), A&E admission and four-hour breach rates were obtained from national Hospital Episode Statistics and A&E datasets across the English NHS, excluding mental and community health trusts. Trust annual reports were analysed to determine the presence of any seven-day service reorganisation in 2013–2014. Funnel plots were generated to compare institutional performance and a difference in differences analysis was performed to determine the impact of seven-day changes on clinical outcomes between 2013 and 2014, 2014–2015 and 2015–2016. Data was summarised as mean (SD).ResultsOf 159 NHS trusts, 79 (49.7%) instituted seven-day changes in 2013–2014. Crude mortality rates, A&E admission rates and mean LOS remained relatively stable between 2013 and 2016, whilst A&E four-hour breach rates nearly doubled from 5.3 to 9.7%. From 2013 to 2014 to 2014–2015 and 2015–2016, there were no significant differences in the change in crude mortality (2014–2015 p = 0.8, 2015–2016 p = 0.9), SHMI (2014–2015 p = 0.5, 2015–2016 p = 0.5), mean LOS (2014–2015 p = 0.5, 2015–2016 p = 0.4), A&E admission (2014–2015 p = 0.6, 2015–2016 p = 1.0) or four-hour breach rates (2014–2015 p = 0.06, 2015–2016 p = 0.6) between trusts that had implemented seven-day changes compared to those which had not.ConclusionsAdverse weekend clinical outcomes may not be ameliorated by large scale reorganisations aimed at improving access to health services across the week. Such changes may negatively impact care quality without additional financial investment, as demonstrated by worsening of some outcomes. Detailed prospective research is required to determine whether such reallocation of finite resources is clinically effective.
Highlights
The cause of adverse weekend clinical outcomes remains unknown
In December 2012 National Health Service (NHS) England published “Everyone counts: planning for patients 2013/ 2014” [1], where plans for seven-day access to NHS services in the United Kingdom were outlined. This led to the establishment of an “NHS Services, Seven Days a Week” Forum chaired by the National Medical Director aimed at initially improving access to diagnostic, urgent and emergency services across the seven-day week
Given the three-year interval from the original Forum report, we aimed to review changes in clinical outcomes across the English NHS between 2013 and 2016, comparing NHS Trusts that had introduced seven-day
Summary
The cause of adverse weekend clinical outcomes remains unknown. In 2013, the “NHS Services, Seven Days a Week” project was initiated to improve access to services across the seven-day week. In December 2012 National Health Service (NHS) England published “Everyone counts: planning for patients 2013/ 2014” [1], where plans for seven-day access to NHS services in the United Kingdom were outlined This led to the establishment of an “NHS Services, Seven Days a Week” Forum (the “Forum”) chaired by the National Medical Director aimed at initially improving access to diagnostic, urgent and emergency services across the seven-day week. The need for these changes were argued to be fourfold – to improve excess weekend mortality, to increase costefficiency, to move the NHS in line with the retail sector, and to improve the patient “customer” experience [1,2,3].
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