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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.’

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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’