24/7 healthcare:

Staff views on the future provision of hospital services in England.

Please note: This session is being run by Salford Research and Development Dept., with the aim of gaining further
input about the provision of 24/7 healthcare provision across England, from a staff perspective and is not about
changing the structure of existing practice at Salford Royal.
The national debate about providing a full range of hospital based services seven days a week has regularly been in the
news since the election, but it is not clear how this would benefit patients and what hospitals would have to do in
practice to make this a reality.
This session will provide an opportunity to hear a range of perspectives, before inviting you to share your thoughts on
some of the key issues identified and to provide insight into a staff perspective of the potential benefits and challenges
of the provision of 24/7 hospital based healthcare.
Background
The quality of care provided in acute hospitals across the country varies throughout the working week. At night and
during the weekends, staffing levels are lower, clinical support services are unavailable or are functioning on a request
basis, and senior clinical staff are often located off site.
Current evidence* suggests that patients presenting to health services at these times suffer higher complication and
mortality rates than patients admitted at times when services are fully operational. Extending the hours for which the
NHS is fully operational could potentially improve access, increase the use of inputs by health service providers and
improve outcomes for patients. However, extending fully operational hours could also decrease efficiency by raising
input costs and providing services that are relatively under-utilised.
Local health systems and healthcare providers have responded to these trade-offs in different ways. Some have reconfigured hospital services internally in order to increase the availability of senior clinicians and decision-makers
and/or to increase the availability of services that support direct patient care, such as point-of-care testing and
diagnostic services. Others have re-configured services externally, to re-direct demand or to increase the availability of
post-discharge support.
These re-configurations have been made within the constraints of the current climate, in addition to considerations
relating to staffing terms and conditions. These constraints impact on services: working anti-social hours attracts
additional remuneration or compensation in other forms, such as reduced weekly working hours and the reduced
availability of staff willing to work anti-social hours.
Research into the implications of 24/7 hospital based services
Funded by the National Institute for Health Research (NIHR), Professor Tim Doran, University of York, together with
research colleagues from the University of Manchester is conducting research in this area, which will contribute to
existing evidence about the future of healthcare provision. Working in partnership with Salford Royal and across a
number of other Trusts, the research will provide greater understanding about the benefits and challenges of 24/7
health care provision.
In order to understand how extending fully-operational hours will affect costs and outcomes, the research will take
into consideration the relationships between staffing levels, costs, patient access and quality of care/outcomes.
Currently, these relationships are poorly understood, as the rich information routinely collected in patient healthcare
records is not linked to the data collected by employers on staff inputs and costs.

Salford Royal is an ideal NHS Trust for this research to take place, having gradually extended its hours of full operation
since 2007, culminating in the implementation of the Emergency Village 2012 and providing consultant-led care from
7am to 11pm, seven days per week;
The research project aims to answer four key questions:
What is the impact of changes to fully-operational hours on access to services for different population groups?
How do service re-configurations affect quality of care and patient outcomes for different population and
patient groups?
How should staff be best deployed to deliver care throughout the week?
What balance of fully-operational hours represents the most cost-effective use of NHS resources?
Reference
* Freemantle N, Ray D, McNulty D, et al. Increased mortality associated with weekend hospital admission: a case for
expanded seven day services? 2015;351:h4596. doi:10.1136/bmj.h4596