NHS hospitals ‘should offer seven-day care’

A commission by the Royal College of Physicians (RCP) says that “hospitals are struggling to cope” with a rise in admissions and the presence of older patients with complex needs.

“All too often our most vulnerable patients – those who are old, who are frail or who have dementia – are failed by a system ill-equipped and seemingly unwilling to meet their needs,” the report says.

In all, the review makes 50 recommendations on the future of National Health Service hospital care.

Seven-day care

It calls for a shift to seven-day working, with consultants having a presence on wards and the full range of tests available every day of the week.

“Acutely ill medical patients in hospital should have the same access to medical care on the weekend as on a week day,” the report says.

“Services should be organised so that clinical staff and diagnostic and support services are readily available on a seven-day basis.

Acutely ill medical patients in hospital should have the same access to medical care on the weekend as on a week day. RCP report

“There will be a consultant presence on wards over seven days, with war care prioritised in doctors’ job plans.

“Rotas for staff will be designed on a seven-day basis, and co-ordinated so that medical teams work together as a team from one day to the next.”

Patients admitted to hospitals at weekends have higher death rates and poorer outcomes, several studies have found.

‘Hub and spoke’

The report, from Professor Sir Michael Rawlins, chairman of the Future Hospital Commission established by the RCP last year, notes that patients may have to move beds several times during a single stay at an NHS hospital.

It says this “results in poor care, poor patient experience and increases length of stay” and recommends that in future patients, once admitted, “will not move beds unless their clinical needs demand it”.

It also calls for a new model of “hub and spoke” hospital care where a number of acute general hospitals are surrounded by intermediate “local general hospitals” which contribute to “step-down inpatient and outpatient care, diagnostic services and increasingly close integration with the community”.

New hospital roles

Other recommendations included in the report are –

• development of effective alternatives to hospital admission, including better managing of people at home or other community settings
• creation of new roles in hospitals, including a chief of medicine who has ultimate responsibility for all adult patients
• organisation of resources so patients are reviewed by a senior doctor as soon as possible after arriving at hospital
• establishment of an “acute care hub” in the hospital, focusing on accommodating patients for up to 48 hours, where consultants spend time to offer expert opinion