BY its very nature, emergency surgery is a risky business; indeed, one is apparently eight times more likely to die while undergoing an emergency operation than an elective one. Most patients and their families can understand and accept this.
What they are less likely to accept, however, is surgery being riskier simply because it happens to be undertaken at the weekend. That’s exactly what Conservative Health Secretary Jeremy Hunt has been claiming for the last two years, as he shifts the focus of the NHS in England and Wales towards “24/7” working, putting him on a collision course with doctors. Arguing for the need for change, Mr Hunt controversially claimed 11,000 people a year were dying due to a lack of medics on duty at weekends.
Doctors disputed both the numbers involved and the idea that the NHS was not already delivering round the clock care seven days a week.
A new study carried out by Edinburgh University on this very issue, funded by the Chief Scientist’s office of Scotland, is likely to please doctors and frustrate Mr Hunt. The research concludes that the day of the week does not affect the survival chances of those undergoing emergency surgery. In other words, weekend surgery has no impact on death risk.
Researchers studied more than 50,000 emergency cases over a three-year period, tracking patient outcomes and adjusting results to take account of other risk factors.
The results actually suggested patients admitted at a weekend were more likely to be operated on sooner.
Previous research, which, it should be pointed out, mainly focused on elective surgeries and involved a smaller number of cases, had suggested there was indeed such a thing as a “weekend effect”, with more deaths being noted on Saturdays and Sundays. The thinking around this was that with fewer senior staff on duty, there was restricted access to the sort of expertise needed when complications arose.
It was this Mr Hunt, who has shown a particular willingness to antagonise the medical profession since his appointment, pounced upon. He may wish to rethink his approach to the so-called 27/7 NHS in light of this study, which confirms much of what doctors’ groups have consistently argued for years: patients receive appropriate and high quality levels of care at weekends, just as they do on weekdays.
Indeed, this was the issue at the centre of Mr Hunt’s damaging dispute with junior doctors in England last year, which ended up in strike action over their refusal to accept new contracts. The contracts are now being imposed, and the junior doctors remain in dispute with the Government, a situation that is not helpful to patients whichever way you look at it.
As already pointed out by senior doctors, this research should also provide considerable reassurance to patients. During the trauma of an emergency admission, the last thing they and their families should have to worry about is what day of the week it is.
The data highlights that it is likely to be medical factors that will determine whether they survive, and in a modern healthcare system that is surely as it should be.
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