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More studies conclude so-called weekend effect is a ‘major oversimplification’

A further two new studies have undermined claims made by the health secretary about the ‘weekend effect’ that hospital staffing numbers have on mortality rates, bringing the total number of sceptical papers to four in less than a week.

The latest studies – both published in the Lancet today - state that the weekend effect is a ‘major oversimplification’ of a complex pattern of weekly changes in quality of care which are unlikely to be addressed by just increasing the availability of hospital doctors on Saturdays and Sundays.

The studies come a week after the publication of a report suggesting that weekend mortality differences might be attributable to the severity of patients’ conditions on admission, while researchers this week said that the data that had apparently showed a ‘weekend effect’ was flawed.

They follow claims by health secretary Jeremy Hunt that 6,000 patients have died a result of the lower levels of staffing in hospitals during the week, and the DH continues to claim that the ’weekend effect is the established consensus of the medical and scientific community’. 

But the latest papers dispute his claims.

The first paper, by researchers from the High-Intensity Specialist Led Acute Centre project at the University of Birmingham, collected data on senior doctor input into emergency admissions at 115 NHS trusts on Sunday 15 and Wednesday 18 of June 2014.

The research showed there were substantially fewer senior doctors present and providing emergency care on Sunday (1167) compared with Wednesday (6105), and found a slight increase in mortality rates associated with weekend admission,

But it also revealed that mortality rates differed between trusts and, when rates of death were plotted against senior doctor staffing levels, there was no evidence of a link between the two.

Professor Julian Bion, lead researcher for the University of Birmingham said: ‘Patients admitted to hospital over the weekend are likely to receive less time with consultants and do indeed have a slightly higher risk of death.

‘Both problems need to be addressed to provide consistent standards of high care. But to say that lower staffing is the cause for increased mortality is far too simple and not supported by the evidence.’

Bion added that policy makers should be ‘extremely cautious’ when attributing the ‘weekend effect’ directly to the lack of consultants at the weekend.

The second paper, by researchers from Kings College and University College London, looked at acute stroke care and found no weekend effects on survival, but revealed that there were many variations in quality of care throughout the week and even throughout the day.

UCL academic Dr Benjamin Bray said: ‘The weekend effect is a major oversimplification of the true extent and nature of the variations in the quality of care that occur in everyday practice. When solutions come at such high financial cost it is imperative that policy makers, healthcare managers and funders base their decisions on evidence.’

Bray said that ‘simply’ transferring doctors from weekdays to weekends would not be likely to improve quality of care.

Dr Mark Porter, BMA chair of council, said: ’These academics are the latest in a long line of health professionals and leading experts to challenge the government on its misleading use of figures. The past week has seen a flurry of studies which confirm what doctors have been saying all along: there is a lack of evidence showing that the “weekend effect” is linked to medical staffing levels.

’It is a far more complicated picture than the one the government has tried to portray. The health secretary should be very careful with his narrative and pay attention to proper investment and joint working with healthcare staff, rather than obsessing about medical employment contracts.’

A Department of Health spokesperson said: ’Once again, we are being presented with clear evidence of variation in care across the week — one study showing that on Sundays some hospitals have half the number of staff in key specialties than they do on Wednesday, and the other showing that care for stroke patients varies according to when they are admitted for treatment.

’This “weekend effect” is the established consensus of the medical and scientific community and the Government makes no apology for tackling the variety of factors that contribute to this, including staffing levels and access to diagnostics, to create a safer seven day NHS.’

The row over the ‘weekend effect’

Jeremy Hunt - online

Jeremy Hunt - online

Health secretary Jeremy Hunt has imposed a contract on junior doctors removing extra pay for working Saturdays in a bid to increase the workforce at weekends in a cost-neutral way.

The Government justified the push for seven-day services by using a study in the BMJ led by Professor Nick Freemantle, chair of clinical epidemiology and biostatistics at University College London.

Mr Hunt claimed that the study revealed there were 6,000 preventable deaths due to fewer staff working at weekends – although the BMJ editor Fiona Godlee said he was ‘misrepresenting’ the data.

The new reports in the Lancet today come just a week after two studies were published questioning the so-called weekend effect.

A University of Manchester study, published in the Journal of Health Services Research and Policy, that found that in fact fewer patients die after being admitted to hospital at the weekend.

Meanwhile, a new University of Oxford study of 92,728 stroke patients registered with nine practices in Oxfordshire - which is as yet unpublished - found that data for weekend admissions could be undermined by ‘inaccurate’ coding.

Please BMJ, no more studies on the ‘weekend effect’

Readers' comments (11)

  • Vinci Ho

    The level of arrogance and bullying to preserve personal crusade(s) amongst this bunch of politicians,wasting no time to latch on unconfirmed evidence to gain political capital.
    Agent Hunt , in fact , is just a carbon copy of this kind of conduct and behaviour. Lord Vader's caught off-guard , 'fantastic' comment on 'fantastically corrupt' countries(even though the Archbishop of Canterbury disagreed to the generalisation to all leader personalities) and his implication of immediate threat of war if Britain is to leave EU(of course , BoJo would waste no time to call it Third World War) , all demonstrate the total disrespect of the scholar's way of seeking and applying knowledge. The consequences can only be disastrous .
    Nick Triggle's today BBC Health news article is certainly highlighting the recipe of disaster:

    NHS short of front-line staff after bad planning, say MPs
    By Nick Triggle
    Health correspondent
    From the section Health
    Nurses walking in a hospitalImage copyrightScience Photo Library
    ''Bad planning and cost-cutting have left the NHS in England short of vital front-line staff, MPs are warning.
    The Public Accounts Committee said the shortfall in doctors, nurses and midwives could even get worse if ministers did not get a "better grip".
    The group also warned there had been "no coherent attempt" to work out the staffing needed for a seven-day NHS.........''

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  • This man- Mr Hunt- is using the electorate for the legitimate purpose( called manifesto) for political gains to keep torys in power. There has been just U turns on so called manifesto promises, surely this has to be a U turn.

    He should resign and halt his ideology of a "safe" "world class"- 7 Day NHS - a sheer fallacy. Nhs is understaffed and seriously underfunded. Deluded and duped.

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  • One has to be Sick of faceless and nameless spokeman/woman from DOH doing all the spin(end of this articles). These spokespersons are the spin doctors well paid from our taxes. when the health ministers and MR Hunt never asked to comment and hide behind these spokespersons.
    the media please stop accepting comments from 'spokespersons' the government's spindoctors.

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  • Manipulation and corruption across the board from PM to NHSE whether it's government policies, PMs offshore dealings, NHS survey and statistics or even GP Exeter statements - one corrupt heap of dung. The PM who can't even control NHSE shenanigans calls other countries corrupt and shares a joke with the Queen on TV. Pity JH was missing from the party coz' his quips would've been worthwhile listening to

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  • I don't know how these DoH spokespeople live with themselves.

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  • "This “weekend effect” is the established consensus of the medical and scientific community"

    absolute BullS*** from Mr Hunt's office

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  • " the government makes no apology"
    Oh you will be sorry soon, very soon.

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    To consistently carry on against all reason and evidence implies either insanity or the worst sort of self serving deliberate arrogance
    Can he seriously think not wishing to be proved wrong to preserve a tough image for his own
    political advantage justifies the huge damage he is doing to the NHS ?
    This incompetence is worse than unacceptable

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  • “Jeremy Hunt misleading voters over NHS budget increase, says thinktank “– the Guardian.

    This man is a liar galore.
    If asked why lie, He will tell you the reason why he lies is simply because that is what the public wants to hear. So why not lie!

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  • It's perfectly understandable when viewed through the lens of privatisation . It wouldn't be the first time politicians have deliberately sidelined inconvenient evidence . weapons of mass destruction etc

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