Acute illness may strike at any time and the need for constant availability of acute services is self-evident. From time to time the inefficiency of using expensive infrastructure on only five days out of seven is highlighted. Newly re-elected UK prime minister David Cameron described a seven-day universal health service in a speech on May 18. Yet the proposed service expansion has been met with opposition by many who feel that the NHS is already struggling to provide high-quality healthcare five days a week and fear that an expansion to a seven-day routine care service would exacerbate ongoing funding and workforce crises.
A recent editorial in The Lancet agrees there is a compelling case for change.1 The off-hour effect of increased mortality and morbidity attributed solely to hospital admission at night or at the weekend is an ongoing problem. The editorial pointed out that the current strategy of staffing out-of-hours hospitals and general practices with a minimum number of often inexperienced staff is a drive for cost efficiency that benefits no-one. The NHS has run some pilot schemes to test ways of extending access to primary care in general practices; early results indicate that seven-day access can relieve the pressure on busy practices and free up more time for patient consultations. Expanded services at hospitals might also reduce long waiting times for appointments, investigation and treatment.
However, the aim to combine flexible access with clinical excellence on a nationwide scale is a challenge that will need realistic consideration of resources and efficiency. Most importantly, NHS staff must feel empowered to rise to the challenge, the editorial said.
In another commentary piece in the BMJ,2 the Nuffield Trust, a UK-based healthcare think-tank, said that the government’s ambitious targets would not be realised unless it “prioritises reconnecting with the NHS workforce and ensuring staff feel valued in their work”. It added that the NHS needed to reduce its reliance on agency staff. The trust warned that the growing reliance on agency staff, problems recruiting and retaining GPs, and the increase in the amount of sick leave taken by staff because of stress could undermine progress to the NHS’s goals. It said that these factors, combined with the continuing effects of pay restraint, were causing widespread disengagement and burnout among NHS staff.
Are there lessons here for Ireland? Certainly any elements that discourage doctors from staying in Ireland must be looked at. The European Working Time Directive has made working safer but has decimated the earning power of NCHDs. The Medical Council’s restrictions on registration of overseas doctors, especially to the trainee specialist division, puts Ireland at a disadvantage relative to other countries, especially the UK which is relaxing such restrictions in order to address its own medical staffing problems. Increasing demands on consultant supervision of trainees and a move towards a consultant-provided service are making the working environment less attractive and leading to disillusion and burnout among the very group that needs to lead change.
As pressure on healthcare workers rises and staff retention suffers, the need to value those delivering frontline care is paramount. Ultimately the quality of care is determined by these people rather than those engineering the process.
- A seven-day NHS. Editorial. Lancet 2015; 385:2122
- Lacobucci G. Staff burnout threatens plans for NHS. BMJ 2015; 350:h3004