How Jeremy Hunt derailed clinician led progress towards a seven day NHS

It may be hard to believe from the vantage point of this week’s industrial action, but from 2011 to 2015 plans for a seven day NHS were progressing well (table⇓).

Unusually, for a policy change of this sort, there was an evidence base. Several studies in the United Kingdom and elsewhere, though observational and so unable to do more than show associations, sent a consistent message: an association between admission to hospital at weekends and a higher risk of death.1 2

In 2011 the medical director of the NHS in England, Bruce Keogh, said that the NHS must “aim to be offering a seven day a week service across the board.”3 He was clear that a move to seven day services should be driven by clinicians, not politicians. “This is not an imposition,” he said, but a desire to “open a sensible debate among clinicians about the pros and cons, the merits, of running a seven day service.”4

Keogh continued to work on gathering data and developing plans for seven day services. In 2012 an analysis he worked on concluded that admission at the weekend was associated with an increased risk of death within 30 days.5

In 2013 a forum that Keogh set up concluded that the higher mortality was likely to be a result of several factors, including lower staffing levels at weekends, a lack of senior decision makers, and unavailability of diagnostic and community services.6

This forum also drew up 10 clinical standards to monitor whether weekend services were up to scratch. These included time to consultant review and access to diagnostics, consultant directed interventions, and ongoing review.6 These were ready to roll out for individual trusts to assess the extent to which their weekend services were up to scratch.7

By the end of 2013 senior doctors were on board with Keogh’s plans, royal colleges were in support,8 patients’ representatives had been closely involved, and work was under way to look at the costs and possible funding mechanisms. Keogh continued to examine the evidence base, updating his 2012 analysis with data from 2013-14,9 and he looked at which of the 10 standards were most likely to affect patient outcomes.10 Four standards were identified, and a self assessment exercise was planned so that hospitals could judge how they performed on these measures.10

So far, so good.

But in March last year seven day services became a Tory re-election pledge. At the Conservative Party’s spring conference David Cameron announced that, by 2020, there would be “a truly seven day NHS.”11

With no firm definition of what “a truly seven day NHS” actually meant,12 and no additional money for delivering it, England’s health secretary, Jeremy Hunt, has nonetheless chosen seven day services as the stick to beat doctors with.

Hunt has portrayed doctors as the sole barrier to change and propelled junior doctors to strike for the first time in 40 years. In the process he has derailed four years of a painstaking and productive, clinically led initiative that was set to deliver improvements to patient care.