In Defence of the Weekend

Doctors in the Neonatal Intensive Care Unit - always there for your baby
Doctors in the Neonatal Intensive Care Unit – always there for your baby

We’ve all been hearing a lot about the need for the 7-day NHS since Jeremy Hunt started to conflate the issue with the Junior Doctor Contract. As a piece of rhetoric, claiming that the NHS shuts down at the weekend or implying that all the lazy doctors just head home for Saturday and Sunday is an interesting one, being demonstrably untrue, but its repetition seems to be changing public opinions.

At this week’s Socialist Health Association AGM, both Andrew Gwynne MP and a GP member were enthusiastic about how progressive the idea of a 7-day NHS is, and how the Labour Party should support it. The phrases ‘the NHS should be there when people need it’ and ‘it will reduce health inequalities’¬†were used.

I believe those arguments are false. I believe that the weekend is different, special, and that supporting the Conservative government’s ideas is regressive for both staff and patients.

The first issue is about what we mean by ‘7-day NHS’. It is quite obvious to anyone who has been in or visited hospitals at the weekend that the NHS is up-and-running 24/7/365. Emergency and urgent care is provided around the clock by doctors and other healthcare professionals already. You will never find an Emergency or¬†Maternity Department closed because it is the weekend. People in hospital over the weekend do not languish alone without medical care. So we already have an emergency 7-day NHS. The NHS IS THERE when people need it.

What the government are talking about is elective care. Routine appointments. Non-urgent surgery. Diagnostic services. The figures used to back this are claims that the lack of these services at the weekend causes higher death rates and unsafe care for patients – the ‘weekend effect’. This inequality needs addressing. Other people have debunked these figures more successfully than I can.

So what arguments are there against the new 7-day elective service?

Implementing the plan for 7-day elective services would in theory require more doctors, nurses, diagnostic and admin staff. Without more staff magically appearing fully trained, or more money to employ those staff, the work must be done by existing staff – either moved across from weekday care or working longer hours. Neither option is safe and forms one of the core issues in the junior contract dispute. Another key issue is the push to make Saturday ‘plain time’ – ie cheaper for hospitals.

However, if the ‘weekend effect’ isn’t real, we must ask what the motivation for creating cheap weekend elective services is. Two possible explanations which have not received much air time are the reduction of paid sick leave for 9-5 weekday workers, and the concept of ‘sweating the assets’.

Evening and weekend elective services are explicitly aimed at ‘hard-working people’ who currently have to take time off for routine appointments at hospital during the working week. Removing this type of employee sick leave from the books would result in large savings for some employers. Some would pressure employees to only accept weekend appointments. More would give positive bias to employees who managed to leave health maintenance outside the workplace, changing the culture of what it is acceptable to miss work for. Our patients with chronic health problems and disabilities would be worst affected, finding their lives outside work shortened by the need to attend appointments in this time. This time that otherwise they might spend with their friends and family, crucial social support.

Sweating the assets is the act of extracting the largest possible amount of work from your existing resources, whether they be human, financial, space or equipment resources. With hospitals currently providing very little elective care at the weekend, there is plenty of room for lucrative work to be done in this time. The hospital’s resources are not being used most efficiently unless they are operating 24/7, like a factory. With hospital trusts now allowed to make 49% of their income from private practice, there is opportunity to bring in wealthy customers in this time. With the private sector circling above our NHS like vultures, already picking off the more profitable bits, this could be the windfall that allows viable takeover.

Neither of these reasons is progressive.

Weekends are special and do deserve different treatment – unions have fought for them over centuries and we should not give them away so easily. For health workers, this is the time that would otherwise be spent with children or friends. It is the time we miss weddings in. It is the time when childcare is far more expensive. To work at the weekend is to give up more of yourself than during the week, and that should be recognised.

If we want to address health inequalities, then it is the social determinants of health – poverty, poor education, poor housing quality – that we should be attacking, not NHS staff.