A new study claims the ‘Weekend Effect’, the reason behind the formation of the NHS 7-day plan, is a flawed concept. The study published in the BMJ on the 6th May, 2016, states the rate of patient deaths, who were admitted in the hospitals over the weekend, isn’t as high as a previous study had led us to believe.
The large analysis also contradicts the reliability of claims made by the UK Health Secretary Jeremy Hunt to justify the NHS 7-day plan. Hunt had asserted more patients are likely to die during the weekend than during the weekdays as a result of medical negligence and used the unreliable claim to propose a new working plan for junior doctors.
“About 6,000 people lose their lives every year because we do not have a proper seven-day service in hospitals,” said Hunt during a NHS Reform Parliamentary speech in July 2015. “Someone is 15% more likely to die if they are admitted on a Sunday than if they are admitted on a Wednesday. That is unacceptable to doctors as well as patients.”
For those who don’t know the ‘Weekend Effect’, it refers to an imaginary phenomenon in which the weekend death rate in UK is higher compared to the weekday’s death rate. The new study contradicts the claims and instead states a smaller number of people die after being admitted into hospitals over the weekend than during the week and has nothing to do with doctor mistakes.
The claims by Hunt had caused quite an uproar in England’s medical community at the time, and subsequent events even led to the coining of the term the ‘Hunt Effect’. After the ‘Weekend Effect’ was endorsed by Hunt, it led to half of Britain believing their life would be in grave peril if they were seeking medical advice from hospitals over the weekend. A survey carried out by the Observer/Opinium poll in England found a large number of patients had delayed seeking medical attention, especially on Saturday and Sunday. The survey had also found 21% of people in England started believing the quality of care is lower in hospitals over the weekend as a result of Hunt’s comments. The fact that 35% of adults were scared of going to the hospital and delayed visiting a doctor in case of minor illnesses, led to the creation of the term the ‘Hunt Effect’.
The study which started the entire saga was also originally published by the BMJ and written by Nick Freemantle. In his study, Freemantle claimed “11,000 more people died each year within 30 days of admission to hospital on a Friday, Saturday, Sunday, or Monday than those admitted on other days of the week.”
After Hunt’s propositions led to a junior doctors strike in England, even the Editor in Chief of BMJ Fiona Godlee, called out the Health Secretary for misusing Freemantle’s article. Godlee outlined her concerns that Hunt had misrepresented their academic article.
Mark Sutton is the lead author of the study which was first published in the Journal of Health Services Research and Policy. According to the study, the death rates in hospitals over the weekends may seem higher because the number of patients admitted are lower when compared to the weekdays. Only the very sick ones are admitted into hospitals on Saturdays and Sundays. The study observed data on all the patients visiting the emergency department throughout the entire seven days of a week.
A substantial number of documents were collected from 140 non-specialist acute hospital trusts in England for the analysis. The research team examined data on 12,670,788 emergency attendances cases and 4,656,586 emergency admission cases. The researchers were from the University of Manchester’s Center for Health Economics and analyzed data collected from April 2013 to February 2014. The death rate of patients after 30 days of a medical counsel in hospitals was observed and the difference in the rate was compared on the basis of weekdays with weekends.
“Hospitals apply a higher severity threshold when choosing which patients to admit to hospital at weekends—patients with non-serious illnesses are not admitted, so those who are admitted at the weekend are on average sicker than during the week and more likely to die regardless of the quality of care they receive,” said Sutton.
Rachel Meacock, another author of the new study stated that “the so called ‘Weekend Effect’ is a statistical artefact and that extending services will not reduce the number of deaths”.
The results showed the same number of people visited hospital emergency departments on weekends and weekdays and the same number of patient deaths occurred on weekends and weekdays. The death rate of patients over the weekdays was 378.0 against 388.3 over the weekend. The results also found hospital attendance over the weekend is not related to increased probability of death with only a 1.01% risk factor.
Proportionally the results showed even though the visitation rate to the emergency department over the weekend was the same as over the week, a smaller number of people were actually admitted into the hospitals. The weekend admission rate was found to be 27.5%, compared to the 30% over the weekdays. So basically only the very sick individuals are admitted into hospitals over the weekend and they already have a higher probability of dying i.e., 21% higher risk of mortality, regardless of the weekend admittance.
“As a result, the figures comparing death rates at weekends and weekdays are skewed. The NHS has rushed to fix a perceived problem that further research shows does not exist,” said Sutton.