Potential unintended cosequences of a 7 day NHS

Reposted from Open Democracy - Our NHS LINK, author Dr David Wrigley, under Creative Commons terms LINK. No changes have been made from the original text.

“We can become the first country in the world to deliver a truly 7-day NHS”, David Cameron used his ‘first major speech’ of his brand new Conservative majority government to tell us.

It sounds appealing - but does it stand up to scrutiny, or is it just more spin from the former spin doctor?

With 5 years of unconstrained power ahead of him, Cameron will now be expected to deliver on this key Tory manifesto promise.

If Cameron really wants to achieve a 7-day NHS he needs a 7 point plan. 

1. Get the 5 days right first.

If the government wants to make the NHS work safely and efficiently 7 days a week, then it might be a good idea to get the 5 days of Monday-Friday working well beforehand. At the moment the NHS is in dire financial straits – and its demoralised doctors, nurses and other healthcare professionals are leaving or retiring early. What was the adage Cameron likes to use – fix the roof while the sun is shining? Well the sun isn’t shining much in the NHS these days - but you certainly need to fix the roof Mr Cameron, and pretty sharpish. 

2. Invest in your NHS staff 

Nurses got years of 0% or (at best) 1% pay increases during the coalition years. They effectively ‘donated’ over £1.5bn a year of unpaid overtime to keep the NHS afloat amidst the cuts. They were pilloried for failures that were not of their making. Blamed for scandals that were often due to hospitals chasing Foundation Trust status at all costs, their eye only on the bottom line. Many health professionals are becoming unwell now because they cannot give any more to the job they love. The number of nurses off with stress soared by up to 48% last year.

How are they going to feel now the government tells them that in a 24/7 NHS it will be “archaic” to pay supplements for working “unsocial hours”? Many nurses rely on these payments to boost their stagnating income.

3. Get your workforce planning sorted 

Cameron claimed last week that “We are training and hiring many more GPs right now”. But in fact one third of GP training places are empty. And one in three GPs plan to retire in the next 5 years, leading to a workforce time bomb fuelled by 5 years of unpopular NHS policies and huge cuts (known as ‘efficiency savings’).

4. Sort out social care and community healthcare

The huge cuts to local authorities has meant social care being cut to the bone, with budgets being slashed by up to 35%. Many elderly and vulnerable patients are being left alone or with haphazard 10 minute visits from zero-hour contract workers who have to dash from client to client in order to make any sort of living. These patients are becoming increasingly unwell and needing more NHS care. Inadequate community healthcare services (district nurses have been cut by 40% in 5 years) mean they languish in hospital beds, unable to be discharged safely to the community.

5. End the dog eat dog competitive market in the NHS 

We are wasting billions annually on administering an unwanted healthcare market where providers fight each other for contracts and NHS managers spend their lives refereeing and sorting this all out. No one (except the private health industry) has asked for this. The money saved from scrapping this market system could fund decent social care for all the elderly and vulnerable people in our society.

6. Make all NHS services available 7 days a week 

But tell us – as Cameron has so far refused to – what it would cost. Doing it properly would cost billions. As a GP if I see a patient on a Saturday or a Sunday I need the full range of services available to me in order to treat my patients effectively. I need a fully functioning hospital laboratory with blood collection services twice a day over the weekend. I need access to NHS physiotherapy for my patients with urgent musculoskeletal problems. I need access to health visitors to refer children needing their input. I need access to a fully functioning radiology department offering x-rays, CT scans, MRI scans, ultrasound and other investigations. 

7. Beware of the unintended consequences

Increasing the NHS to a full 7 day service will increase demand – and therefore cost. Cameron’s promised ‘extra’ £8bn would merely plug one small gap in the black hole opening up at the centre of the Department of Health. To stretch already overstretched services more thinly will lead to a poorer service in coming years – and no doubt, the electorate to blame the government for a failing NHS. Cameron may have already said he will be leaving Downing Street before 2020, but is this really the legacy he will want to leave for his successor?

A 7 day NHS service is attractive to patients and attractive to politicians seeking votes. But no other western health economy has managed to provide it, as Cameron said himself. With the NHS already struggling many really doubt this government can do it properly. I hope it won’t be imposed on already beleaguered NHS staff and they are forced to provide the 7 day service against their professional advice. 

Be careful of what you wish for Mr Cameron and Mr Hunt. This one could come back and bite you very hard indeed.