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​Second study to reveal ‘weekend effect’ is based on poor data

The health secretary’s claims that more patients die in NHS hospitals at the weekend could be based on flawed data that overestimated the severity of conditions treated during the week, a new study has found.

University of Oxford researchers have found that previous studies of the ‘weekend effect’ failed to check the accuracy of coding data, which meant low-risk patients admitted during the week were wrongly being recorded as having been admitted for stroke.

The lead researcher said that the ‘weekend effect’ was an ‘illusion’, but NHS England have said this study doesn’t change the need for patients to be seen by senior staff at weekends.

This is the second report questioning the so-called weekend effect within a week, following 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.

Jeremy Hunt has claimed that 6,000 patients have died a result of the lower levels of staffing in hospitals during the week.

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University of Oxford study of 92,728 stroke patients registered with nine practices in Oxfordshire - which is as yet unpublished - found that data for weekend admissions could be undermined by ‘inaccurate’ coding.

More than a third of patients recorded as being admitted for a stroke were actually in for other complaints – often low-risk, routine procedures carried out on Monday to Friday - the research found.

These coding mistakes distort mortality figures, making them appear better for patients admitted on weekdays.

Professor Peter Rothwell, the lead author of the report, said that low risk admissions don’t usually happen at the weekend so the outcome for weekend admissions look worse.

Professor Rothwell said: ‘Most studies of the weekend effect have used coded data – which are accurate for some things, like surgical procedures or clearly specified chronic diseases but much less so for acute medical conditions such as stroke, infection, vascular pain.’

The highest rate of inaccurate coding are found for acute medical admissions, said Professor Rothwell, partly because patients are often elderly and have multiple active problems.

He said the ‘weekend effect’ was an’ illusion created by poor data’.

An NHS England spokesperson said: ’This report about data collection covering one condition from nine GP practices in no way alters the wider issue that sick patients rightly should expect to be seen by a consultant within a few hours, have prompt access to tests and treatments and receive joined-up care, whatever day of the week they fall ill, as recommended by the Academy of Medical Royal Colleges.’

The health secretary 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, which found that patients admitted on Saturday or Sunday face an increased likelihood of death even when severity of illness is accounted for.

Another study published in the BMJ claimed that there were also higher risks for babies born at the weekend.

The row over the ‘weekend effect’

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.

The study concluded: ‘Patients admitted on Saturday or Sunday face an increased likelihood of death even when severity of illness is accounted for.’

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 University of Manchester study has found that although mortality rates are higher, this is down to fewer patients being admitted to hospital – refuting the basis of the whole policy.

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

Readers' comments (4)

  • Dear All,
    I just hope the juniors are reading all of this. Lets hope it steels their determination to oppose these bullies.
    Regards
    Paul C

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  • Vinci Ho

    The lesson of this story is very much to academics , which in this case to those in BMJ. While there is absolutely no question of freedom in study and publication . One has to 'think' before study: what is the telos(purpose) and potential consequences of the possible results of a study? While the academic telos was perhaps impartial , the subsequent political implication was not when politicians were ready to hijack the study result if it was favourable to them . That is simply the reality we are living in. Agent Hunt will not wait until there are 10 or 15 studies of the same kind so that one can do a meta-analysis drawing conclusions and explanations. Remember the so called 'pilot' on the pathfinders to form CCGs in the first place? Of course , we have wonderful pilots on the Vanguard sites for 7 days opening anyway now ! As I said before , populism is so often about how to educate the public with 'what'? I think even Hitler was 'surprised' with the popularity of Mein Kampf, My Struggle. Would be better to have the public to understand the truth of 'Our Struggle'........
    To all scholars (obviously excluding politicians) ,dedicate this from Sir Karl Popper:

    'Whenever a theory appears to you as the only possible one, take this as a sign that you have neither understood the theory nor the problem which it was intended to solve.'

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  • I will never apologize for the United States — I don't care what the facts are! -- GEORGE BUSH

    I will never apologize for my screwed up plan to push for 7 days services -- I don't care what the facts are! -- AGENT HUNT

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  • How about a study to find out whether people want a GP appointment at 7.00pm on a saturday, when they're settling down to watch Ant & Dec

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