With the waiting list of patients waiting for planned NHS care at over 7 million, up from 4.4 million before the pandemic, and performance against cancer and A&E targets at a record low, the idea that the NHS should be working flat out seven days a week to increase activity is once again being voiced. Andrew Stein, a consultant in renal and general medicine, told BBC Radio 4’s Today news programme:
“The NHS simply won’t work unless we work seven days a week. No individual has to work seven days a week, but there’s no reason why we couldn’t have two shifts, for example, with one team working Monday to Thursday and the other one [working] Thursday to Sunday.”
Stein likened Friday afternoon in an NHS hospital as being like the ‘Mary Celeste’, with people starting to head to the car parks at 12 and by 2pm it’s all quiet.
Reacting to Stein’s comments, Vishal Sharma, chair of the BMA’s Consultants Committee, said:
“Hardworking doctors and NHS staff will not recognise the description of the NHS being like the Mary Celeste on a Friday afternoon. These comments are hugely disrespectful and very disheartening when the truth is that the NHS is under extreme pressure and staff are routinely having to work above and beyond to provide care for their patients.”
Who knows what happened to the crew of the unfortunate Mary Celeste, but the NHS staff that Stein talks about leaving by 2pm, will be leaving after having worked a full week and may well have also done several hours overtime. The issue is not the staff leaving, but that there are not enough staff to replace them and as a result the NHS can not do as much elective and non-urgent work over the weekend. Sharma noted that:
“The fundamental issue is that there are not enough staff during the weekdays, let alone across seven days. Stretching an already overstretched workforce across a seven day window will not increase the number of patients that get treatment but would arguably be even more damaging to patient care as a result of diluting the number of staff available each day.”
Chief executive of the NHS Confederation, Matthew Taylor, also told the Times that it’s not because the NHS does not want to carry out non-urgent work over the weekend, there is just not the staff to do so:
“The NHS is there for everyone who needs it every day of the year, including primary care carrying out well over one million appointments most Fridays and urgent and emergency care services routinely being busier over weekends than during the week. While many trusts would like to provide more non-urgent services over the weekend like some elective care, they simply lack the staff to do so.”
And why isn’t there enough staff to do weekend working, well Taylor places the blame firmly with the government:
“the failure of successive governments to provide a fully funded workforce strategy to help tackle the NHS’s 132,000 vacancies, to address the maintenance backlog of £10 billion, and to provide proper support for social care, with local communities and frontline staff all paying the price”.
The Conservatives made a manifesto promise to recruit 50,000 more nurses, but despite ministerial claims to be on track with nursing recruitment, the target will be missed by 10,000 according to the latest predictions. And as Dr Kevin O’Kane, a Consultant in Acute Internal Medicine, wrote on Twitter:
“We don’t have enough doctors for a fully-staffed five day service. This is because staff are leaving in droves because of a decade of pay cuts & a perverse pensions tax system whereby we have to pay to come to work.”
In July 2022, the health and select committee within Parliament also placed the blame for the staffing shortage with successive governments. The report confirmed what everyone working in the NHS has known for many years, that the NHS has a major staffing crisis and the Government has shown “a marked reluctance to act decisively” and produce a meaningful workforce plan.
Not only has the government not produced a workforce plan, they voted against an amendment to the Health & Social Care Bill 2022 that would have required the government to publish independently verified forecasts of the workforce numbers needed across the NHS to ensure that services are safely staffed.
The lack of staff means that if staff worked at the weekend then shifts on weekdays would be empty. To fill those places to ensure patient safety the trusts would have to employ more and more locum and agency staff.
The cost to hospital trusts of locum and agency staff is already astronomical, in 2021/22, the cost to the NHS of agency staff was up 20% to £3 billion. Trusts spent a further £6 billion on bank staff, when NHS staff are paid to do temporary shifts, taking the total spent on additional staff to around £9.2 billion.
Research undertaken by the Labour Party found that some hospital trusts have had to pay over £2,000 for a single agency nurse shift; out of 60 responses from trusts, 10 reported the most expensive shift cost over £2,000, and for another 13 it was between £1,000-2,000. The Royal Cornwall Hospitals Trust has been particularly badly hit by nursing shortages and paid £16.4 million to agencies who provide NHS staff on short notice in 2021/22.
Employing more staff to enable weekend working would seriously impact on trust budgets, which are already being eroded by escalating inflation.
There is also the issue of capacity. If elective surgery increases at the weekend where would the patients be looked after post-surgery? In September it was reported that more than 13,000 of the 100,000 NHS hospital beds contain “delayed discharge” patients. This has resulted in A&E units becoming full and long delays in ambulance handovers. If it is extremely difficult to find a bed in a hospital for an emergency case, how would a bed be available for a patient post-elective surgery?
The government has promised to tackle this issue. Back in September, ministers announced a £500m emergency fund – a new adult social care discharge fund – to get thousands of medically fit patients safely discharged home or to a care home. This was part of the government’s Plan for Patients. The NHS Confederation noted that the quicker the money was released and allocated “the quicker the NHS and local government partners can invest it to tackle what the Care Quality Commission is calling ‘gridlock’.”
Finally on 17 November, the DHSC announced that the NHS will get 60% of the funding via integrated care boards (ICBs) and 40% allocated to councils, who will then have to agree how the funding is used. The funding will appear in December and January.
Social care leaders have criticised the delay and are sceptical of the funding’s impact on the issues of the social care sector, with several social care leaders referring to it as a “sticking plaster” for the sector’s problems. The Association of Directors of Social Services (ADASS) has warned that 94% of directors did not believe they had enough money or workforce to meet needs this winter, according to its latest survey.
In 2021-22, the number of vacancies across adult social care rose by 55,000 (52%), while the number of filled posts fell by 50,000. Several councils plan to tighten eligibility to receive social care and two of England’s biggest councils, Hampshire and Kent, have said they risked bankruptcy as a result of “12 years of austerity”, inflation and mounting demand for adults’ and children’s social care. The massive funding and workforce problems faced by social care, means that the fund will have little impact on the issue of delayed discharges.
It is clear that until the government addresses the workforce issues in both the NHS and social care with pay awards and a sensible workforce plan, then weekend working will remain impossible if patients are to be cared for safely.
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