Does Jeremy Hunt think a consultant could do all this alone?

http://www.theguardian.com/commentisfree/2015/jul/16/hospital-consultants-jeremy-hunt-weekends

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The health secretary Jeremy Hunt says he’s ready to impose weekend working on hospital doctors. In pointing out that there is a greater risk of hospital patients dying at weekends, he told BBC Radio 4’s Today programme there would be “catastrophic consequences” if working patterns did not change. I’m a hospital doctor, but if I were to set up an idealised seven-day NHS hospital, making sure consultants were on duty at weekends would not be at the top of my list.

One of the most sobering moments in my career was when a GP asked us, as a group of junior doctors, whether we would allow close family members to be admitted at weekends. No one put their hand up. “Isn’t that ridiculous?” she asked. “Isn’t that sad?” This was a major flagship London hospital.

We had all started our medical training naively expecting the best of everything, but within a few months we were disillusioned. We could see how drastically bad the situation was on weekends, and out of hours. But the problem went far beyond the lack of consultants on Saturdays and Sundays.

We’ve heard all about safety reform before, without seeing any of the funding required

Hunt followed his radio interview with a speech today to the healthcare thinktank the King’s Fund, announcing that consultants will be given compulsory seven-day contracts with or without their union the BMA’s involvement. Apart from not answering repeated questions about how this will be funded, Hunt also failed to answer another important question: what about the other staff?

A consultant alone cannot do that much – they have a team working with them, giving them the information they need, filtering it, highlighting the important and excluding the unnecessary. In fact, a consultant alone can do very little.

But when consultants – and their salaries – are such easy targets, this ignores the many support staff who are as important for getting people treated. I’ve seen or heard of several different situations: in one, a man comes in on a Saturday with severe stomach pain. He needs a camera test, or OGD, to double-check he has no stomach ulcer. While he would immediately get an emergency OGD if the situation was life-threatening, if not he’d be admitted and would need to stay till Monday or later, for the next routine OGD appointment. But an extra consultant wouldn’t make any difference: they’d need nurses to help them with the procedure. So that weekend consultant would not be very helpful for the patient at all.

In another scenario, a woman might come in with a pneumonia during the week, and as part of her treatment require a tube to help with feeding. Unfortunately, it’s a bit tricky to insert for this patient, and the specialist nurse who’s brilliant at doing it isn’t available at the weekend. So the patient waits, without food, on adequate – but much less preferable – intravenous fluids until the nurse returns after the weekend. The consultant wouldn’t get a look-in.

Related: Jeremy Hunt gives NHS consultants ultimatum on weekend working

Or if a cricketer came in needing a CT scan after being knocked on the head by a ball. But if there is only one CT machine, and only one technician running it, the consultant can huff and puff all they want: the patient isn’t getting a scan any faster.

These kind of situations happen all the time. Doctors are only the tip of the iceberg of hospital care. The sheer numbers required to make a hospital work efficiently and safely are being ignored by the government in favour of turning on “work-shy doctors”. The truth is, we’ve heard all about safety reform before, without seeing any of the funding required – so perhaps asking for detailed plans before backing the proposals isn’t as blockheaded as it sounds.

Questions of what will happen on weekdays are important too. Shifting consultants to the weekend without the funding for extra staff means that services would have to be spread more thinly. So we could find that the danger period shifts away from the weekend. In the future we could be saying: “Don’t get admitted to hospital after 2pm.”