[Lund]

I don't know.  But from what I can see, the weekend effect IS real.  There seems to be study after study after study noting its existence.  I'm not mixing correlation and causation up here, haha, been given a slapping for that from someone in the past.

The weekend effect = a higher proportion of people admitted at the weekend die. 
Fewer people are admitted.  Same number die.  Proportion is higher.
Doesn't really prove anything, which is why people start using statistical adjustments liked weighting of death rates.

If you think about it - someone is admitted late on a Friday, "the weekend effect" states they have less chance of dying, even though they are then cared for by the supposedly reduced weekend cover.  Equally someone admitted late on a Sunday is more likely to die, even though they have the "increased" weekday cover.

Nonsense.

http://www.nejm.org/doi/full/10.1056/nejmoa063355#t=articleResults

This paper says that

Patients admitted on weekends were less likely to undergo invasive cardiac procedures than were those admitted on weekdays. Also, the time between admission and performance of procedures was longer for patients admitted on weekends. The percentage of patients who underwent a procedure on the day of admission (possibly reflecting primary PCI) was also lower on weekends. Quaas and colleagues found that patients admitted on weekends were one fourth as likely to undergo coronary angiography as were those admitted on weekdays.21 Observational data and randomized trials have shown a survival benefit of both PCI and CABG in at least some subgroups of patients.8,22-25 In our study, invasive procedures were also associated with a lower adjusted 30-day mortality. Our finding that the increase in mortality was no longer significant after additional adjustment for invasive procedures implies that the worse outcome of weekend admissions may be due in part to a lower rate of invasive intervention.

That seems to me to be entirely against the spirit of what you're saying.

So you're saying that

* during a weekday, 10 people are admitted, 4 die.
* on a weekend day, 8 people are admitted, 4 die.

This accounts for the increased percentage of deaths due to weekend admissions.

The paper above doesn't comment on the above, but it does say that (with different numbers obvs)

* During the weekday, the 10 that are admitted - 50% of them have a procedure that could save their lives.  (5 people).
* During the weekend, the 8 that are admitted - 25% of them have a procedure that could save their lives (2 people).

They can find no reason for the fact that we would have expected two more of the admitted people on a weekend day to have the procedure.  It's something about it being the weekend that they haven't been able to adjust for.

Oh, and the also say that if you change the numbers to correct for the difference between 50% and 25% in terms of that procedure - the difference in the number of people dying who were admitted goes away.

Seems to me like they are saying if you rock up at the weekend, you have a lower chance of getting a procedure that might save your life, and that will give you a higher chance of dying.

No?

Or is that too, nonsense?

[Lund]

You and your wife chose to have a kid and everything that entails, deal with it.

 

BRILLIANT.

[Lund]

Tan S, Mays N. Impact of initiatives to improve access to, and choice of, primary and urgent care in the England: A systematic review. Health Policy (2014)

Isn't that about GPs and A&E - not "elective" junior doctor type stuff?

I certainly would agree that making it easier to got to A&E or to your GP = more people going... but that's not the issue at hand?

BTW - just so that we get this out of the way - I've hopped off the fence, and I'm all for the junior doctor strike.  But just so that the safeguards stay in place and they get more money for the changes in Ts and Cs.  Not because I'm against a seven day NHS.

[slackline]

You and your wife chose to have a kid and everything that entails, deal with it.

 

BRILLIANT.

Do you really expect the world to bend over backwards because you've got kids and work? 

You're not the only ones and everyone else manages.  I can't quite believe that...

My wife looks after the child.  To attend a clinic during the week, I have to take time off work to look after the child so that she can go.  If that were at the weekend, then I wouldn't have to.  And the world would be a better place for us as users of a service.

...what you seem to be saying is that you'd make your wife delay attending clinic so she can go on a weekend so you don't have to take time off of work.

I hope I've interpreted that incorrectly though because thats a whole new level of selfishness I've not encountered before.

[Lund]

You and your wife chose to have a kid and everything that entails, deal with it.

 

BRILLIANT.

Do you really expect the world to bend over backwards because you've got kids and work? 

You're not the only ones and everyone else manages.  I can't quite believe that...

My wife looks after the child.  To attend a clinic during the week, I have to take time off work to look after the child so that she can go.  If that were at the weekend, then I wouldn't have to.  And the world would be a better place for us as users of a service.

...what you seem to be saying is that you'd make your wife delay attending clinic so she can go on a weekend so you don't have to take time off of work.

I hope I've interpreted that incorrectly though because thats a whole new level of selfishness I've not encountered before.

Keep going, you're doing really well.  More!  More!

[GCW]

http://www.nejm.org/doi/full/10.1056/nejmoa063355#t=articleResults

This paper says that

Patients admitted on weekends were less likely to undergo invasive cardiac procedures than were those admitted on weekdays.

That seems to me to be entirely against the spirit of what you're saying.

This paper specifically talks about the provision of PCI and allied procedures, which are not uniformly provided even on weekdays.  They need allied staff in theatre, radiology consultants, cardiologists, anaesthetists etc.  If you rock up at night you are no better off than on Sunday, so it's not a weekend effect at all.  And it has absolutely nothing at all to do with junior doctor provision, so I'm not sure why it keeps getting used to support the imposition of their contract.  The same could be said about thrombolysis for ischaemic stroke I expect.

Isn't that about GPs and A&E - not "elective" junior doctor type stuff?

That one is, but there are more that show if you increase access to secondary care and reduce waits, referrals increase in response.  I have plenty of evidence of this from the commissioning side, but can't share it.  There are various other papers that corroborate it.  Part of my point about posting that one (other than it's the only one I could remember details for) is that Mr Hunt's pushing for a seven day GP system will increase access, increase patients being seen, and therefore increase referrals to hospital.

Here are my thoughts:

1.  There is enequality of provision of service in the NHS, both geographically and across the week
2.  There isn't enough staff or money to provide the current level of service. This is clear since trusts are failing RTTs left, right and centre and going into tens of millions of deficit.
3.  Patient demand and expectation are both going up and up, partly stoked by politicians.

We can either:

1.  Create a truly 24/7 NHS by increasing staffing and putting an extra, say, £50 billion per year into it.
2.  Accept that what you get now is beyond the limit of what we can afford, and lump it.
3.  Force juniors to work more for less, try to balance the books and provide an extra 28.6% of service for the same money with fewer staff and still keep it safe.  Errr.......

BTW - just so that we get this out of the way - I've hopped off the fence, and I'm all for the junior doctor strike.  But just so that the safeguards stay in place and they get more money for the changes in Ts and Cs.  Not because I'm against a seven day NHS.

As above, the two are separate issues.  And as I said last week, I've been pushed past the point of really being that bothered if it all falls apart by the ongoing mistruths from the government mixed with bashing from the media.  All the goodwill that once made the NHS work has been crushed in recent times, which was the one thing holding it together - without that, it's falling apart.


The NHS was created as a safety net for those that couldn't afford private care - it has become a bloated behemoth trying to give everyone anything they want, whenever they want it.  For that reason, it isn't fit for purpose and that's also why it's falling apart.

[petejh]

I have to say, people saying that there isn't a weekend effect do sound a bit like greenhouse effect deniers, but what the fuck do I know.

There is the same provision for emergency cover throughout hospitals at weekends as there is in the week, so why would an increase in mortality at weekends be logical?

This is the nub of it for me. Your argument rests on the public being satisfied with having just emergency cover at weekends and having non-emergency issues seen to only on weekdays.

I'm not sure I get you Pete.

Your comment was that you thought it made sense that death rates increased at weekends.  This doesn't make sense to me for the above reason - cover is already the same as weekdays so the issue won't alter with the new contract.

The elective (7 day) comment you make still needs full elective cover for an extra two days every week.  For the same cost.  With the same staff.  Still doesn't add up.

I suspect within a couple of years it'll all collapse anyway, and I await the day with interest.

You don't get me.
I'm not that interested in the death rate weekend thing - like someone said it might be explained by the types of cases admitted on weekends versus weekdays and remains to be cleared up without political involvement.

I'm interested in the 7 day elective care.

Slackers - you can get your car fixed on Saturday, stock up on the week's supplies on Sunday, watch a film, relax with a pint in the pub, catch a plane or a train, go and do all sorts of activities on a weekend. Why the fuck shouldn't you, in principle, be able to sort out non-emergency healthcare issues on a weekend?
Of all the things it's possible to do on a weekend this would be the one that gives the greatest increase in quality of life for the general population who pay for their health service. But you don't think this is something worth aspiring to?

Other professionals such as lawyers, architects, engineers generally don't offer weekend service (or if they do it prohibitively expensive) and that's fine, they aren't central to one of the most important parts of quality of life - health. We don't have a national lawyer service or a national architect service.

Why isn't there 7 day elective care? Because it's too expensive... (or there isn't enough money, slightly different). Why is it too expensive?

GCW - all the goodwill etc. Times change. The UK's population has grown and in my opinion weekday only elective care isn't acceptable for a national service paid for by the people.

Final point - Will, GCW, if parts of the health service get privatised and the outcome is a decent national health system accessible to the public 7 days a week, is that bad becaseu it's private? Is it the public institution (a la British Rail) ideology you're so attached to, or is there an underlying reason why privatising parts of the nhs is so terrible?

[GCW]

As above, I'm not against 7 day elective care.

Why is it too expensive?  Because trusts are paid a tariff per clinic appointment, op, everything. This is set centrally and had nothing to do with doctors pay.

Times change, I know. But now the huge amount of extra work done by people just to make the service work will need to be picked up somehow.

And correct me if I'm wrong, but the last time I got my car serviced on a weekend I paid a couple of hundred quid for the privilege.

[slackline]

Slackers - you can get your car fixed on Saturday, stock up on the week's supplies on Sunday, watch a film, relax with a pint in the pub, catch a plane or a train, go and do all sorts of activities on a weekend. Why the fuck shouldn't you, in principle, be able to sort out non-emergency healthcare issues on a weekend?

Nothing stopping you, its called private healthcare, just as all the other activities you mention are services provided by private companies and are not provisions of the government (although public transport should be in my opinion, and on reflections pubs should give out free booze too).
 

Of all the things it's possible to do on a weekend this would be the one that gives the greatest increase in quality of life for the general population who pay for their health service. But you don't think this is something worth aspiring to?

Ah but as you say we already pay for healthcare don't we, see GCWs points in his post @15:39 under 'Either' and his closing sentence.  What to do?  Ok, lets push up taxes to fund the increased cost of seven day health care.  Hmm, can't see that happening, even though it could be applied to higher band taxes so the less well off aren't penalised.  Not going to happen is it. 

The current government are not interested in increasing the funding available for the NHS.

EDIT : I don't know why being able to have elective procedures at weekends would have a direct improvement on an individuals quality of life.  There are laws governing sick pay which means if you need time off for medical reasons you are entitled to it.

Why isn't there 7 day elective care? Because it's too expensive... (or there isn't enough money, slightly different). Why is it too expensive?

Yes its down to the economics, improving quality of life is expensive, look at the years of training required, the equipment, medical devices and drugs (both of which require years of investment by manufacturers to pass the standards required for them to be used in humans and they expect a return on that investment), support staff etc. etc. etc.

The NHS its struggling as it is and simply can't do more for the money it has available.  There is no will in the government to change the amount of money available, just the bullshit of "More for Less".

One thing that seems to have been lost in all of this "I want my healthcare at the weekend" bitching is that actually for the cost of the current system the performance is  pretty good, some even go as far as to say it is world class, despite not provisioning for weekends  .  I've posted links and infographics on this before but heres a report from last year, the NHS comes out pretty good...

http://www.commonwealthfund.org/~/media/files/publications/fund-report/2016/jan/1857_mossialos_intl_profiles_2015_v7.pdf


You ask...

is there an underlying reason why privatising parts of the nhs is so terrible?

If you look at private health care systems such as those employed in the US they cost more per capita and have worse outcomes (see above plus links/figures etc. posted waaaay back in this thread).

[a dense loner]

Are you impotant slackers?

[Fultonius]

Final point - Will, GCW, if parts of the health service get privatised and the outcome is a decent national health system accessible to the public 7 days a week, is that bad becaseu it's private? Is it the public institution (a la British Rail) ideology you're so attached to, or is there an underlying reason why privatising parts of the nhs is so terrible?

Erm...profiteering, lack of control of care quality - this is not just based on idealogical fear of privatisation, just on the results of the fiascos that have occurred.

There's no reason why quality of care couldn't be better under a privatised system. But better or worse, it will be more expensive.

[Oldmanmatt]

I've spent most of my adult life living in countries with private healthcare systems.

They have never been accessible without considerable financial resources; at least not beyond the most basic care.

I cannot for even a moment imagine that a privatised system in the UK would be anything other than elitist and discriminatory; it has been in every other jurisdiction I've witnessed.

I'm sure it will all be very nice for those who can afford it, available 7/7 and top notch; as it already is for those who can afford it.


Sent from my iPhone using Tapatalk

[GCW]

Final point - Will, GCW, if parts of the health service get privatised and the outcome is a decent national health system accessible to the public 7 days a week, is that bad becaseu it's private? Is it the public institution (a la British Rail) ideology you're so attached to, or is there an underlying reason why privatising parts of the nhs is so terrible?

Sorry, missed that bit.

What do you mean by privatised?  A lot is already provided by private providers. Or do you mean that if you need a hip doing it has to be done privately I've a two tier system where elective and emergency are separated?

The problem is there is a lot of cross over and grey areas. I think a private system would provide an excellent service...  for those that can afford it.

[tomtom]

As above, I'm not against 7 day elective care.

Why is it too expensive?  Because trusts are paid a tariff per clinic appointment, op, everything. This is set centrally and had nothing to do with doctors pay.

Times change, I know. But now the huge amount of extra work done by people just to make the service work will need to be picked up somehow.

And correct me if I'm wrong, but the last time I got my car serviced on a weekend I paid a couple of hundred quid for the privilege.

As GCW said, you've got to pay people to work the weekend...

Pete - by extension of the same logic - shouldn't you be able to demand to get elective care at 2.30 am if you want?

Me, having to wait in all day today (and not go climbing) for a fecking parcel to be delivered is a classic example. I didn't want to spend the extra £15 to have it delivered at 8pm on Thursday evening... Maybe that will be the future.. pay a bit more, go out of office hours, or pay a bit more and jump the que...

That seems to be the way Barnet Council are going (EasyBarnet as they are now nicknamed) - want your planning application dealt with sooner then pay etc...

[Will Hunt]

I work in the water industry. We make profit out of providing people with clean drinking water and sanitation. I don't like that.
However, in 1989 the water industry was crap. Rivers were in a terrible state and the network didn't work well. With a large amount of investment we've since cleaned up the rivers (still more to do but they're in a very good place at the moment by and large), leakage is down to an all time low etc etc. We've really reaped the benefits. Privatisation can drive efficiency but we shouldn't fool ourselves into thinking that this comes at no cost. Investors will always want their cut in the end. The question is (much like with a mortgage I suppose), is the asset worth the long term increase in cost?
Healthcare is a different market so not entirely comparable. We do have to ask ourselves whether we need to take the long term hit of privatisation when at least one well regarded independent report (somebody care to link?) has named the NHS as the best healthcare system in the world. It seems like a stupid idea to me. If the Tories, who are wedded to the ideology of the small state, suggest privatisation on the sole motivation that it will lead to improvement in service then you'd be a mug to take them at their word.
And then there's the example of privatisation from the rail sector which seems to have produced a shit outcome.

[tomtom]

I work in the water industry. We make profit out of providing people with clean drinking water and sanitation. I don't like that.
However, in 1989 the water industry was crap. Rivers were in a terrible state and the network didn't work well. With a large amount of investment we've since cleaned up the rivers (still more to do but they're in a very good place at the moment by and large), leakage is down to an all time low etc etc. We've really reaped the benefits. Privatisation can drive efficiency but we shouldn't fool ourselves into thinking that this comes at no cost. Investors will always want their cut in the end. The question is (much like with a mortgage I suppose), is the asset worth the long term increase in cost?
Healthcare is a different market so not entirely comparable. We do have to ask ourselves whether we need to take the long term hit of privatisation when at least one well regarded independent report (somebody care to link?) has named the NHS as the best healthcare system in the world. It seems like a stupid idea to me. If the Tories, who are wedded to the ideology of the small state, suggest privatisation on the sole motivation that it will lead to improvement in service then you'd be a mug to take them at their word.
And then there's the example of privatisation from the rail sector which seems to have produced a shit outcome.

Water industry is possibly not the best comparison - as there is no competition... if the water companies had to bid for the franchise every 5 years (like in the rail system) then it might..

Thats a moot point (sorry Will - I'm being picky) in relation to the Health service. All my recent dermatology appointments in Manchester are being dealt with by a private company (in London) subcontracted by the local NHS - and then the private company hires local doctors to do the work, that the NHS would formerly have done... Its kind of working for me (in this case) but seems a bit crazy to have to add an extra layer. I once had an argument with one of our local MP's (a Tory) about privatisation and he said theres no such thing as bad privatisation, just bad regulation.. He was (and still is) a bellend - but he has a point.

Anyway, the day to day operation of the NHS is being passed along to companies (next time you go to hospital play spot the Serco or G4S uniform among the non nursing/clinical staff)...

[Will Hunt]

I made the points about the water industry more to demonstrate to Pete that I  don't just make the last assumption that all privatisation is all bad and that I can see the potential benefits of privatisation in some circumstances. I don't think our healthcare system would benefit from further privatisation though.

[Footwork]

I made the points about the water industry more to demonstrate to Pete that I  don't just make the last assumption that all privatisation is all bad and that I can see the potential benefits of privatisation in some circumstances. I don't think our healthcare system would benefit from further privatisation though.

Sticking to water as an example of privatisation and profit. As far as I'm aware, I pay a water bill for water. I know what I'm getting, water. Yorkshire Water aren't saying, hang on a second you also need to buy this kind of other water.

When health care is privatised unnecessary testing becomes a problem. Operations might be offered when they shouldn't be because there's money to be made. Additional blood tests/ lumbar punctures etc might be pushed even though a patient doesn't need them. The problem is that the man on the Clapham Omnibus doesn't know what's best for him medically and would trust the consultant. I wouldn't trust Will as far as I could throw him and he doesn't weigh very much! 

I say this from past experience. I needed braces when I was a kid. First orthodontist said I would need train tracks, retainers, headset at night (  ), the lot over 2 and half years. My young self said no thanks and went away. Seeing as my teeth were proper mashed my mum convinced me to try again. We went back to the same place but saw someone else. Train tracks for a year and retainer for 6 months. Why was there such a difference? Well probably because the orthodontist was getting paid for the add ons. (I may be wrong!)

Another example. Had a lump in my breast when I was a teenager. Pretty scared (men get breast cancer too). Turns out it was some kind of gynecomastia. One (private) consultant was pretty pushy about operating on me and getting the lump removed. I got a second opinion which was "don't worry it will go away", which it did. The private consultant was pretty rude when I phoned him I wasn't getting the op.

[Oldmanmatt]

I made the points about the water industry more to demonstrate to Pete that I  don't just make the last assumption that all privatisation is all bad and that I can see the potential benefits of privatisation in some circumstances. I don't think our healthcare system would benefit from further privatisation though.

Sticking to water as an example of privatisation and profit. As far as I'm aware, I pay a water bill for water. I know what I'm getting, water. Yorkshire Water aren't saying, hang on a second you also need to buy this kind of other water.

When health care is privatised unnecessary testing becomes a problem. Operations might be offered when they shouldn't be because there's money to be made. Additional blood tests/ lumbar punctures etc might be pushed even though a patient doesn't need them. The problem is that the man on the Clapham Omnibus doesn't know what's best for him medically and would trust the consultant. I wouldn't trust Will as far as I could throw him and he doesn't weigh very much! 

I say this from past experience. I needed braces when I was a kid. First orthodontist said I would need train tracks, retainers, headset at night (  ), the lot over 2 and half years. My young self said no thanks and went away. Seeing as my teeth were proper mashed my mum convinced me to try again. We went back to the same place but saw someone else. Train tracks for a year and retainer for 6 months. Why was there such a difference? Well probably because the orthodontist was getting paid for the add ons. (I may be wrong!)

Another example. Had a lump in my breast when I was a teenager. Pretty scared (men get breast cancer too). Turns out it was some kind of gynecomastia. One (private) consultant was pretty pushy about operating on me and getting the lump removed. I got a second opinion which was "don't worry it will go away", which it did. The private consultant was pretty rude when I phoned him I wasn't getting the op.

Yep, a trip to the American Hospital in Dubai, with a sniffle, could quite easily end with a couple of CAT scans, an MRI and several specialists; just to rule out a few things...

[monkoffunk]

Isn't that about GPs and A&E - not "elective" junior doctor type stuff?

What does this mean? Quite a confusing statement!

[slackline]

We do have to ask ourselves whether we need to take the long term hit of privatisation when at least one well regarded independent report (somebody care to link?) has named the NHS as the best healthcare system in the world.

Don't know if this is what you're referring to....

One thing that seems to have been lost in all of this "I want my healthcare at the weekend" bitching is that actually for the cost of the current system the performance is  pretty good, some even go as far as to say it is world class, despite not provisioning for weekends  .  I've posted links and infographics on this before but heres a report from last year, the NHS comes out pretty good...

http://www.commonwealthfund.org/~/media/files/publications/fund-report/2016/jan/1857_mossialos_intl_profiles_2015_v7.pdf

[monkoffunk]

A few days ago I posted this:

The BMA believes patients should receive the same high quality of care every day.

The royal colleges have developed quality standards for the care of acutely ill patients that set out a clear aspiration of what should be achieved in all NHS hospitals. However, there are significant resource and ways-of-working implications that require close examination.

The BMA believes that urgent and emergency services should be the priority for investment to bring the standard up to the very best, every day. Only when we have improved the quality of care for acutely ill patients can the debate start as to whether a weekday service can also be afforded at nights, weekends and bank holidays.

I think it's very interesting to see some evidence as to the cause of the weekend mortality effect and the debate as to whether services should be offered equally throughout the week.

Personally I have no problem with the same level of care and services being offered throughout the week. It does need to be funded and planned however, and spreading the current workforce of doctors out to provide less weekday cover, and more weekend cover is so far from the answer to this as to be absolutely laughable. To suggest that the same number of patients will be seen and we will all just chill a bit more during the working day is laughable.

Providing weekend care is expensive. It's expensive, not because our pay should be increased to work more weekends, but because you need more doctors to provide that care. You need to maintain safe, workable rotas that provide an adequate work life balance that will attract people to the profession and keep them in it, and in this country. I've already mentioned my 3/4 weekend A&E rota that almost broke me. Sure it gets a little better as you progress through the ranks but it's put me off A&E for life; no way will you see me back there. (I work in intensive care now BTW).

On cost, I'm sure you are aware this is much more than junior doctors. Elective care requires mostly consultant input and so of course we need more consultants to cover the weekends as well, and this still all pales in comparison to the rest of the rotas for other professions and infrastructure required.


On the weekend mortality figures. Is there any reason why death rates should go up? Truth is there is not a clear answer to this. It seems highly probable that patients presenting to A&E at weekends are more ill and therefore will have a higher death rate. Jeremy is doing his bit to smooth this out by scaring patients into delaying their presentation til Monday, which should have the effect of 1) reducing the weekend peak in morbidity and 2) increasing that individual patient's chance of death. Maybe not enough patients will be effected to change the stats but I'm sure we will see.

Are there reasons asides from patient characteristics? Obviously this debate is about elective work because emergency care is already equal?

Well no.

The BMA believes that urgent and emergency services should be the priority for investment to bring the standard up to the very best, every day. Only when we have improved the quality of care for acutely ill patients can the debate start as to whether a weekday service can also be afforded at nights, weekends and bank holidays.

We absolutely do not have equal emergency cover 24 hours a day 7 days a week. We quite possibly don't need it (certain times of day on A&E tend to be more quiet than others), but we certainly don't have it. Certainly weekend cover could be improved. When I worked in A&E there were less of us at weekends. If you wanted to provide adequate and safe care for the patient in front of you this meant waiting times would be higher on average. Does this have an effect on mortality? It's small percentages and obviously emergencies were seen with the same level of urgency, with the waiting time passed on to the less urgent and non life threatening. But these percentages can add up.

Certainly providing emergency weekend cover for the medical wards as a medical FY1 you felt the pressure. During the week each team had an entourage of junior doctors at every grade. Just looking at the most junior lets say two FY1s on gastro, two on resp, three on elderly care, one on haem, one on cardio. Call it that, I think it was possibly more. And the weekend only one of us would cover every ward. You fight fires. During the week every patient was seen on a ward round. During the weekend you were seen if you became unwell. Did it feel safe? The worst weekend of my life so far (not just working life) was covering the medical wards, working two 13 hour shifts in a row after/before the normal working week. On the first day I didn't stop to even drink a sip of water in those 13 hours. A certain amount of that can be explained by inexperience, but a great deal came down to the huge pressure I was under to see multiple patients becoming unwell at the same time as well as a vast array of minor and often unnecessary jobs I was being asked to do. I didn't feel safe. I think it's impossible to pretend that ward patients are getting the same level of emergency care at weekend as during the week.

All of this bull about elective services is so misdirected. There isn't the funding or staffing to provide equal emergency cover at weekends, let alone elective work. You just can't do it by spreading out what you have, and robbing Peter to pay Paul. If we want a true 7 day NHS we need to pay for it. Frankly the last thing we need is Jeremy Hunt encouraging people to quit or emigrate. It's going to be hell for those of us left.

[GCW]

When we talk about funding the seven days fully, my guess of £50 billion is probably low. Now remember the population of England is around 53 million. So every year it needs an additional £1,000,000 per head of population (I think, Jeremy and George never seem sure which billion they mean).

Can that be raised via increased taxation?

[GCW]

You don't get me.
I'm not that interested in the death rate weekend thing - like someone said it might be explained by the types of cases admitted on weekends versus weekdays and remains to be cleared up without political involvement.

I'm interested in the 7 day elective care.

Mr Hunt told MPs that the Government’s seven-day NHS secondary care agenda is ’not about elective care’ but about ’improving urgent and emergency care’.

 

[Lund]

Isn't that about GPs and A&E - not "elective" junior doctor type stuff?

What does this mean? Quite a confusing statement!

GCW was talking about a paper showing that increased availability of A&E and GP meant increased load - i.e. more people.  I was contending that the paper wasn't obviously relevant to the junior doctor, elective stuff discussion - because you can't just rock up to get an elective procedure: access to junior doctors is protected by e.g. referrals by GPs.

It's not a major point.