Leave seven-day services decisions to local leaders, says Confed

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Decisions about whether services should be extended over seven days a week are best left to local decision-makers, the NHS Confederation has said.

Local commissioners, providers and their partners, working with their local communities, are best placed to determine what’s needed in their area, the organisation argues in a new report.

“It is not in the interest of the long-term sustainability of the NHS for us to commit to providing services for which there is either insufficient demand or for which the costs outweigh the benefits,” the report says.

“In some instances, local factors such as demography, local health profiles and geography may mean that it is not appropriate or effective to commission and deliver particular services across seven days, however it is important that this decision is taken by local decision-makers.”

The argument is made in a comprehensive report digesting the evidence for and against the extension to seven-day services, produced for Confederation members.

Ahead of the 2015 general election, the Conservative Party set out its goal of delivering “a truly seven-day NHS.” In the period since the election, the government has reaffirmed its ambition to deliver this over the course of the current parliament.

24/7 ‘not the solution’

The Confederation's paper includes examples of instances where decisions have been taken locally not to extend services.

“One major acute provider opted for a six-day elective hospital, increasing enhanced provision on Saturday in order to maximise the use of its facilities. 

“It decided against extending provision across all seven days because it wanted to use Sunday as a ‘cooling down day’ and to address concerns about workforce supply.”

The report argues that everything open all of the time is not the solution.

“What is needed is careful consideration of the right balance of services across all seven days, with a strong initial focus on emergency and critical care.”

Sustainability and transformation plans (STPs) provide a prime opportunity for local commissioners, providers and non-NHS partners to determine this balance, the report adds.

Need for clarity

The publication also states that clarity is needed in the debate around seven-days services and that there needs to be more awareness of which services are already available seven days a week.

“Given the financial realities of the NHS and the wider system, our clear focus must be on those services which have the most impact in terms of outcomes for patients, rather than offering convenience.”

“We must be collectively clear with the public that what is being articulated is not a future in which all NHS services will be available 24 hours a day, seven days a week.”

The report, published on 17 November, also seeks to decouple the seven-day services debate from recent contract disputes over staffing contracts.

Detailed exploration

Commissioning and delivering enhanced seven-day NHS services aims to help Confed members and other stakeholders understand the evidence base for seven-day services and to support local decision-making.

It explores:

  • the political context 
  • the work that has already been undertaken by organisations such as NHS England to support the expansion of seven-day NHS services
  • the impact of seven-day service delivery
  • the financial costs of enhancing and expanding seven-day provision
  • public perceptions and attitudes to seven-day services
  • workforce implications of new ways of working
  • the degree to which NHS Confederation members are already commissioning and delivering key services across all seven days.

Share what’s happening where you are

The Confederation will continue to make the case that local decision-makers are best placed to decide on service provision locally.

To support its work on seven-day services, the organisation is keen to gather further examples of members’ decisions to extended services across seven days or not.

To share what’s happening where you are, simply get in touch with Phil McCarvil, deputy director of policy, at Phil.McCarvill@nhsconfed.org 

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