NHS weekend culture has to change

One of the main issues that was evidently clear on my visit to UHW A&E last Monday, was the problem of capacity – something touched on in my last post.

Central to this problem is the juxtaposition of concepts; the idealism of a 24/7 acute healthcare system, meeting with the reality of delivery – which is in fact a Monday to Friday service, often time limited.

One of the greatest barriers to staff on the ground was that patients were not being brought through the system but were either clogging up or being forced through the system because of problems of capacity.

For example, there were patients who had been waiting on trolleys in A&E or in the Medical Assessment Unit all weekend because there was no system of planned discharge over the weekend. This I found bizarre, as many were well enough and wanted to return home. However, because there was a lack of senior consultants working weekends who could make final discharge decisions or because there was no social care package in place so they could return home safely, they were left, stuck in the system, until at least Monday morning.

The other thing I found very strange was that the patients discharge lounge, where patients would wait to be picked up by loved ones, was only open during the working week from 8am-5pm. If pick-up arrangements fell outside those times, then patients could not be discharged – again they were left stuck the system.

This clash of concepts is a real concern and something WAG must face up to as a matter of urgency. The Government must get tough and change a culture that allows consultants, pharmacists and OTs not to work weekends. A 21st century acute healthcare system cannot be constrained by old fashioned notions of working patterns nor should it be constrained by lack of resources. There are many examples of PCTs in England who have successfully adopted flexible models of acute healthcare planning that has ensured the publics expectations of a 24/7 service is realised on the ground.

WAG has set aside money to reduce bed-blocking in each of the health boards. My recommendation is that this be spent on alleviating unnecessary pressure points in the system by ensuring key staff are present throughout the weekend to discharge patients appropriately.

This entry was posted on Thursday, October 29th, 2009 at 2:30 pm and is filed under Senedd Shorts. You can follow any responses to this entry through the RSS 2.0 feed. Both comments and pings are currently closed.

2 Responses to “NHS weekend culture has to change”

  1. Paul Flynn Says:
    November 2nd, 2009 at 9:55 pm

    The current consultant contract does not prevent consultants working planned sessions at evenings and weekends and some of us already do.

    When I have suggested doing evening sessions, for example, I have been told that the problem is the support services. When I did get an evening clinic off the ground, many of my patients were unhappy as the public transport provision where they lived was poor after 6pm and we sometimes had to pay for a taxi to get them home.

    Likewise with discharges, you can have as many consultants around as you want but unless you also have the social workers and the ambulance service running a full service all week then very little will change.

  2. jon osborne Says:
    November 9th, 2009 at 8:27 pm

    Running a weekend non emergency service will be expensive in terms of hiring all the support staff required at weekend rates and employing more doctors. At the moment we understand NHS Wales is in serious deficit, with beds being cut like topsy. Wheres all the extra money coming from?