Key facts
- A review of London hospitals found that reduced consultant presence at weekends is associated with higher mortality rates.
- On-call consultant presence on site is significantly less overnight and at weekends than on weekdays.
- The hospital mortality rate in London was 0.32% higher for patients admitted at the weekend than among patients admitted during the week in 2009-10.
- Improved weekend consultant cover could prevent over 500 deaths annually in London.
- Some hospitals provided minimal on-site consultant cover for general surgery over the weekend, while others stated 24-hour on-call cover.
A review of acute medicine and emergency general surgery services in London has indicated that insufficient consultant cover during weekends is linked to a higher mortality rate among patients. The findings suggest that enhanced consultant presence could prevent over 500 premature deaths annually.
The review, which surveyed 31 hospital emergency units in London, revealed that on-call consultant availability is significantly reduced during weekends and overnight compared to weekdays. On average, admitting medical consultants were on site for only six hours per day during weekends, a stark contrast to the up to 14 hours available on weekdays. Similarly, on-call consultant emergency general surgeons were present for four hours daily on weekends, compared to ten hours on weekdays.
This disparity in staffing directly impacts patient care, with only half of patients admitted as medical emergencies over the weekend being seen by a consultant within 12 hours, compared to three-quarters on weekdays. The draft report, 'Acute Medicine and Emergency General Surgery: Case for Change,' highlighted that the hospital mortality rate in London was 0.32% higher for patients admitted on weekends than during weekdays in the 2009-10 period. The report concluded that reduced service provision at weekends is directly associated with this elevated mortality rate.
Andy Mitchell, medical director at NHS London, stated that the issue is not financial or due to staff shortages, but rather current working practices that fail to provide a high-quality, seven-day emergency service. Richard Thompson, president of the Royal College of Physicians, echoed these concerns, writing in a letter to The Independent that inadequate cover by junior doctors, compounded by consultant unavailability, puts patients at risk of substandard care. He emphasized the urgent need for hospitals to ensure consultant physicians provide direct input to medical in-patients every day of the week, with on-site presence for at least 12 hours daily.