Don’t get ill at the weekend!

Recently there have been several initiatives looking at the difference between weekend and weekday cover in hospitals. It is estimated that 500 deaths can be avoided annually if staffing levels and access to hospital services were improved at weekends.

Approximately 25,000 deaths in hospitals annually are associated with emergency admissions.  Clearly it is these emergency cases that cause the difficulties arising from reduced service provision at the weekend.

Most people have little idea of how limited experienced staff can be at weekends.  Some hospitals inLondononly require resident surgeons to be in the vicinity (that is essentially on call and near by) for four hours during the whole weekend.  At those times it is more likely than not that a patient admitted with an emergency situation at the weekend would not be able to access a consultant surgeon on admission.

This has to contrast with the weekday provision which usually allows for at least 10 hours where surgical teams have to be in the vicinity or usually directly on site.

There are a number of reasons why the provision is poor.  Historically medical staff run their private practices mostly at the weekend, there have been changes in working regulations overall and there have been usually experienced registrars on or around.  However since the system of training has changed, medical staff are getting less hands-on experience and are reaching more senior levels of the profession with considerably less experience than those of 10 or 15 years ago.

There are many competent mid-ranking doctors but they lack the expertise of their consultant colleagues not least because they have completed fewer hours practical in-hospital training than those who went before them.

Does this impact on clinical negligence?

The provision of weekend care is a particular issue in clinical negligence cases.  It is not just that people die as a result of clinical negligence but many tests and investigations are delayed.  There may be a provision for urgent scanning at the weekend but often it involves travelling to a different hospital.  TheNationalHospitalfor Neurology and Neurosurgery, for example, assists with the urgent MRI scanning for a number of hospitals in the region.  Many hospitals do not routinely have scanning facilities available on a Sunday.  Transfer to another hospital in an emergency presents of course its own risks and delay in diagnosis.

Unfortunately the development of a life-threatening condition does not take into account the need to transfer to a different unit or the time waiting for the ambulance.

I recently settled a case where my client was admitted at the weekend on a bank holiday and did not receive proper care until the following Wednesday when she was finally scanned and an observant radiologist noted a slight problem with the cervical spine at the back of the neck.  During that time she was seen by a large number of doctors.

She was predominately treated by nursing and junior medical staff who failed to detect the problem and in fact tried to discharge her. The result has been that she has an ongoing neurological problem which will not now be resolved and will deteriorate such that she is likely to be in wheelchair at the age of 60 to 65.

Liability was fought throughout and one of the issues raised was that of the weekend care.

The argument for the trust went both ways.  Firstly, they argued that my client had good care and a consultant did see her, albeit that the consultant was a gastroenterologist and her problem was neurological. However in case that failed, the hospital’s second argument was that she could not really have expected to see a doctor with the requisite expertise at the weekend.

Ultimately the matter was not tested at Court but I remain unconvinced that a Judge would have been satisfied with the suggestion that because you are ill at the weekend you should expect considerably less care.

There is no doubt however, that in the days of cutbacks and financial constraints this argument is going to be raised more and more.  The Royal College of Physicians have suggested that there should be considerably more working time on site or in the vicinity during the weekends but have also confirmed that they did not feel that private practice is to blame for the shortfall.  Whether or not it is, the issue does remain that if a patient wishes to get proper treatment and not to be involved in the clinical negligence matter they should try and organise their illness Monday to Friday. Then they can be sure to get more senior and experienced practitioners looking after them and less likely to be given the excuse that the investigation they need is not available until the following week.

No one wants to be ill. But if it does arise – do try and be ill during the week! I wish you luck!