‘Phoney war’ over extended working risks a damaging national showdown. Cameron’s speech was designed to test the public and political will, and to set the parameters for debate over coming months
The case for extending weekend working is overwhelming - the largely weekday rhythm of the service is a historical anachronism.
‘The reality of achieving a safer and more efficient working week will be won on the ground’
Research highlighting increased mortality for patients admitted at weekends is reason enough to act but if more is needed consider the patients who, caught between a Friday and Monday, and neither well enough to go home nor sick enough for urgent intervention, are forced to wait in hospital for the weekday machinery to resume. It creates unnecessary peaks in activity come Monday morning while assets sit unused for some 100 days each year.
This week’s statement of intent by David Cameron, and the strongly worded responses from unions, represent the latest episodes in the ‘Phoney War’ over seven day services and another step towards a damaging showdown.
The prime minister’s speech was designed to test the public and political will and to set the parameters for a debate over coming months. The battlelines have been clear for the past year but we may now be hearing the first shots and neither side is innocent of making exaggerated claims and misleading suggestions.
Exaggerated and misleading claims
The government ignores the need for additional investment and increases in workforce to deliver more weekend services, while the British Medical Association has danced between two positions; in principle supporting improved seven day services while simultaneously making vehement attacks against the policy on the front pages of national newspapers.
This stokes the fears of its members whose votes will ultimately decide whether a deal can be done.
‘The work is not without major difficulties and barriers’
Fortunately, the reality of achieving a safer and more efficient working week will be won on the ground, where the debate is shifting from whether change is needed to how.
Some trusts are improving services collaboratively with their medical consultant bodies, through better job planning and evidence based discussion. Results are encouraging: reduced lengths of stay, better outcomes and better experiences for staff as demand becomes smoother and they have more senior decision making support.
Elsewhere, some GP practices are already working together to offer more flexible appointments and efforts are being made to speed up discharge out of hours to hard pressed community care services.
The work is not without major difficulties and barriers. Concerns include GP recruitment amid unmanageable demand, and the difficulty of service centralisation.
Some things do need to be resolved nationally. For example, removal of consultants’ right to opt out of non-urgent care at the weekend is highly likely to need to be surrendered. Equally, doctors’ valid concerns about protections from being overworked must be adequately addressed.
‘Aggressive pursuit of anything more risks damaging industrial action’
These are only two of an extremely complex set of factors.
The government is also foolishly linking cuts to unsocial hours pay for Agenda for Change staff to the development of seven day services.
It is too soon after a damaging pay dispute, with this group of more than a million staff having made concessions in the last parliament. Ministers cannot hope to achieve anything more than modest savings now. Aggressive pursuit of anything more risks damaging industrial action, not to mention the annihilation of goodwill, the financial value of which has never been adequately measured.
A bullish government emboldened after its election victory and intransigent unions should beware of talking themselves into overheated industrial disputes, which could hinder progress locally and be a betrayal of patients.