Head to Head: Should the NHS work at weekends as it does in the week?

The NHS offers essential emergency care at weekends. Yet there is mounting evidence that patients are more likely to die if admitted to hospital on Saturday or Sunday. This has led to calls for greater consultant presence at the weekend and opened up a wider debate on whether regular routine services should also be available.

Two experts debate the issue on bmj.com yesterday.

NHS Medical Director, Sir Bruce Keogh, thinks extending the service would "offer the opportunity to improve clinical outcomes with the added benefit of a much more patient focused service."

He says that "the clinical, compassionate, and patient convenience arguments in favour of change are compelling."

He acknowledges that "there will be difficult problems to solve, not least around the economics" but he believes it is right to try "because it would enable us to be truly patient centred for the whole of the week, rather than two thirds of it, and we could improve access, shorten diagnostic response times, shorten hospital stay, and improve training."

Many doctors are worried that the NHS is being commercialised and that their professional values and commitment are being devalued, he adds, but "this should not detract from the recognition that healthcare is a seven day commitment, and this is something doctors feel, believe, and understand."

He explains that the new NHS Commissioning Board "has committed to looking at this matter in detail" and is "offering an opportunity for our profession to step forward to consider the challenge of delivering seven day healthcare purposefully and constructively to secure benefits for our patients, our society, and our NHS."

But Paul Flynn, Consultant Obstetrician and Gynaecologist and Chairman of the BMA Consultants Committee, sees little justification for elective (non-emergency) care at weekends and asks who's going to pay?

Drawing on his own experience, he refutes arguments that elective care over seven days is necessary to bring down waiting times or that the public expects it, saying "it flies in the face of all logic to reward a system that is not using its existing resources to best effect over five days by giving it the opportunity to mismanage them over seven."

He adds: "It is time the NHS listened to the doctors who can tell it how to solve these problems and stopped just throwing a longer working week at it."

Yet all of this debate ignores the most important question, he writes: who's going to pay for this?

Given the "dire financial positions" of many NHS providers, "it is inconceivable that they will be able to staff operating theatres and clinics seven days a week, let alone provide all the other resources that this activity will consume," he argues.

"I and my colleagues will always be willing to be there when patients need us, but we cannot be expected to have the same sense of commitment to addressing either management inadequacy or a small measure of public inconvenience," he concludes.