A 7/7 NHS: what price equity?

Appleby, John

doi:10.1136/bmj.i404

Cited by 7 publications

(7 citation statements)

References 9 publications

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“…Increasing levels of medical staffing at weekends to those in the week is not possible without extra doctors and non-medical staff; 4 however, a recent economic analysis suggested that the extra expenditure that this would incur could be more efficiently spent in other areas of healthcare. 5 Our cost analysis is very conservative because we only used data on incremental bed day cost, and were unable to reliably model the extra savings in time avoided by not having to prepare and deliver intravenous medications. Hence, the true cost saving will be greater than our model predicted.…”

Section: Discussionmentioning

confidence: 99%

Frequency of stepping down antibiotics and nebuliser treatment is lower at weekends compared to weekdays: an observational study

et al. 2017

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We hypothesised that delays in providing non-urgent medication step-downs at weekends to medical management may be associated with increased length of stay. In a novel use of electronic prescribing data, we analysed emergency admissions from a busy acute medical hospital over 52 weeks from November 2014 to October 2015. The main outcomes of interest were switching from intravenous antibiotics to oral antibiotics and stopping nebulised bronchodilators. The rate of switching from intravenous to oral antibiotics was lower on Saturdays and Sundays compared with weekdays, and the rate of stopping nebulised bronchodilators was similarly lower at weekends (p<0.001). Median length of stay was shorter in those whose antibiotic treatment was stepped down at weekends compared with weekdays (4 days versus 5 days, p<0.001). Reduced medication step-downs at weekends may represent a bottleneck in patient fl ow. Electronic prescribing data are a valuable resource for future health services research.

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Section: Discussionmentioning

confidence: 99%

Frequency of stepping down antibiotics and nebuliser treatment is lower at weekends compared to weekdays: an observational study

et al. 2017

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“…More information is needed to understand the cause of the often quoted excess weekend mortality, and so identify the measures likely to keep these costs to a minimum. 9 Both managers and government must recognise and respect the contribution that only the professionals can give to individual patients. The current increasing attempts to de-professionalise clinicians must be reversed; they cannot be treated as technocrats, and until this is recognised and implemented, we believe that professional staff morale, and hence standards of care, will remain low.…”

Section: To Put Patients Firstmentioning

confidence: 99%

The NHS could do better

Thompson

Turner-Warwick

2016

J R Soc Med

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The National Health Service (NHS), mostly free at the point of need, is greatly valued by the UK population and is admired in many other countries. Lengths of stay in NHS hospitals have fallen and outcomes have markedly improved, even though there are fewer hospital beds, doctors, nurses and funding than in comparable countries. The continuing triumphs of the NHS should certainly be recognised. However, the gigantic machinery of the NHS is out of control, and the good intentions of Government and management to maintain quality of care and contain costs have failed. Thus, it continues to stagger from crisis to crisis. Advances in medicine and the increasingly elderly population make it likely that the financial demands will always exceed the available funding and so compromises will be needed. When the NHS cannot afford a service, then patients and the health professions, as well as management and Government, must all be involved.We make a number of suggestions to improve the NHS, which together could improve patient care, often at less cost, improve management and raise professional staff morale without any major new legislation. To put patients firstThe primary focus of the NHS is to serve patients in need. Thus, the mutually trusting relationship between the patient and doctor becomes critical. 1 Continuity of care should be a smooth pathway for patients between primary, secondary and tertiary services, but many complain of disjointed care between hospital, community and primary care. 2 Integration would also allow general practitioners (GPs) and hospital consultants together to improve transfers of care, exchange information and postgraduate experience and provide supervised experience for those in training.Patients want early diagnosis and referral for treatment, which can save short-and medium-term costs. 3 Often, specialised clinical experience and diagnostic facilities can only be organised cost-effectively in hospital centres. Current misguided attempts to save costs through limiting the number of referrals from primary to secondary care are fruitless and morally wrong. GPs should be facilitators rather than gatekeepers for access to secondary care.A serious and unresolved problem is the tight restriction on the working hours and rotas of trainee doctors imposed by European law 4 and by the socalled New Deal contract negotiated with the British Medical Association. 5 Clearly, tired doctors should not work excessive hours, but the restrictions have forced 'shift work', which damages the continuity of acute care. 4 Patients also recognise many distressing examples of poor care in both primary and hospital settings, many due to multiple failures of systems, equipment and staffing, rather than to a single individual. A more open culture of recording and learning from errors would help.Successive governments have been frustrated because they have little influence on what goes on in the workplace. Therefore, they fall back on unhelpful public criticism of the overworked professional staff, rather than partnerin...

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“…The closest thing to a formal evaluation of health policy in England is often an impact assessment reported by the Department of Health. Whilst at one point mandated for all new legislation and policy implementation (Shah et al ., 2012), it appears they are no longer compulsory as no assessment was performed for the recent 7-day services policy (Appleby, 2016). Even when performed, impact assessments rarely evaluate cost-effectiveness as defined by NICE (Shah et al ., 2012), with benefits seldom quantified in terms of quality-adjusted life years (QALYs).…”

Section: Introductionmentioning

confidence: 99%

Methods for the economic evaluation of changes to the organisation and delivery of health services: principal challenges and recommendations

Meacock

2018

HEPL

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There is a requirement for economic evaluation of health technologies seeking public funding across Europe. Changes to the organisation and delivery of health services, including changes to health policy, are not covered by such appraisals. These changes also have consequences for National Health Service (NHS) funds, yet undergo no mandatory cost-effectiveness assessment. The focus on health technologies may have occurred because larger-scale service changes pose more complex challenges to evaluators. This paper discusses the principal challenges faced when performing economic evaluations of changes to the organisation and delivery of health services and provides recommendations for overcoming them. The five principal challenges identified are as follows: undertaking ex-ante evaluation; evaluating impacts in terms of quality-adjusted life years; assessing costs and opportunity costs; accounting for spillover effects; and generalisability. Of these challenges, methods for estimating the impact on costs and quality-adjusted life years are those most in need of development. Methods are available for ex-ante evaluation, assessing opportunity costs and examining generalisability. However, these are rarely applied in practice. The general principles of assessing the cost-effectiveness of interventions should be applied to all NHS spending, not just that involving health technologies. Advancements in this area have the potential to improve the allocation of scarce NHS resources.

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A 7/7 NHS: what price equity?

Abstract: What are we willing to forgo to rectify unequal outcomes between weekend and weekday admissions? And, harder still, can the NHS justify spending the money to iron out these differences, asks John Appleby

Cited by 7 publications

References 9 publications

Frequency of stepping down antibiotics and nebuliser treatment is lower at weekends compared to weekdays: an observational study

Frequency of stepping down antibiotics and nebuliser treatment is lower at weekends compared to weekdays: an observational study

The NHS could do better

Methods for the economic evaluation of changes to the organisation and delivery of health services: principal challenges and recommendations

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