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Excess deaths at weekends ‘a statistical artefact’, finds major new study

Fewer patients die after being admitted to hospital at the weekend, say researchers, who claim the Government’s push for a seven-day service is ‘fixing a perceived problem that doesn’t exist’.

The study, by researchers from the University of Manchester, looked at data on 12,670,788 A&E attendances and 4,656,586 emergency admissions in greater detail than ever before, and found that mortality rates of patients admitted at the weekend were higher than those admitted during the week.

But they said this was because ‘hospitals apply a higher severity threshold’ at the weekend, and that the overall number of patients dying within 30 days of being admitted on a weekend day was lower than on a week day.

Pulse has also learnt that despite the size of the study it was rejected by the BMJ after it was peer reviewed by the author of a previous analysis used by health secretary Jeremy Hunt to justify his imposition of a new junior doctor contract.

The previous study in the BMJ led by Professor Nick Freemantle, chair of clinical epidemiology and biostatistics at University College London claimed that 6,000 lives could be saved by increasing the workforce in hospitals at the weekend. Another study published in the BMJ claimed that there were also higher risks for babies born at the weekend.

But Pulse understands this latest study was rejected by the BMJ after being reviewed by Professor Freemantle and was subsequently published today in the Journal of Health Services Research and Policy.

The study concludes that the ‘so-called “weekend effect” is a statistical artefact and extending services will not reduce the number of deaths’. The lead author told Pulse that routine GP seven-day access was likely to lead to more admissions, but this would not necessarily lead to better health outcomes, only extra costs for secondary care.

The new study – published in the Journal of Health Services Research and Policy – found that there was an average of 378 deaths within 30 days of patients who attended A&E on an average weekend day compared with 388 on an average weekday, which the authors said was significantly fewer.

It added that attending A&E at the weekend was not associated with a higher probability of death either.

Rachel Meacock, lead author of the study and research fellow in health economics at the University of Manchester, said: ‘The so-called “weekend effect” is a statistical artefact and extending services will not reduce the number of deaths.’

She told Pulse: ’I think the plan for seven-day services has got a bit ahead of the evidence. People looked at the mortality rates for the admitted population and tried to fix a problem they didn’t really understand. Our study shows that higher mortality rates are not a reason to extend services at the weekend because no lives are likely to be saved.’

’It seems that more availability of GP services would increase admissions at weekend… It will probably just push up hospital costs.’

The study only looked at mortality rates and not overall health benefits, she added, but said: ‘The issue is that there is no evidence around it.’

Professor Matt Sutton, professor of health economics at the University of Manchester, who led the research, said: ‘Hospitals apply a higher severity threshold when choosing which patients to admit to hospital at weekends – patients with non-serious illnesses are not admitted, so those who are admitted at the weekend are on average sicker than during the week and more likely to die regardless of the quality of care they receive.

’As a result, the figures comparing death rates at weekends and weekdays are skewed. The NHS has rushed to fix a perceived problem that further research shows does not exist.’

A Department of Health spokesperson said: ‘Disputes about precise methodology risk obscuring the established consensus of a weekend effect. Of course, we’ve always been clear that death rates are higher following admission at the weekends – this is in part because some patients are sicker, but even adjusting for that experts have been clear that other factors including staffing levels and diagnostic availability are part of the problem.

‘Eight studies in the last five years show clear evidence of the weekend effect and the Government makes no apology for tackling the problem to create a safer seven day NHS.’

A BMJ spokesperson said: ‘We are unable to comment in detail on a specific article, even to confirm whether it was submitted to the journal as this is a confidential matter. However, we can say that in general articles are considered on matters of methodology, potential importance, interest to our broad readership and on what they add to the established literature.’ 

Pulse approached Professor Freemantle for comment, but he did not respond in time for publication.

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.

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.

But this latest 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’