Should we be sick of being told not to be sick at the weekend?

It is becoming increasingly obvious that being admitted to hospital over the weekend is not good for patients. A number of studies have shown that patients admitted as an emergency to hospital over the weekend or on public holidays have repeatedly shown that the death rates are higher than during a the working week.

This has largely been blamed on the way hospitals are staffed, with not enough consultants available over weekends and a lack of diagnostic and support services. It is called the weekend malaise.

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But now a new study has revealed that it is not just riskier for emergency admissions. Patients who have elective surgery at the end of the week or at weekends are also at greater risk of dying than those who are operated on at the beginning of the week. In fact, the study shows that Monday is the very best day to choose for surgery. This is patients who have a planned admission for anything from heart surgery to hernias.

Paul Aylin, a clinical reader in epidemiology and public health at Imperial College London, studied the records of 4.1m elective surgeries carried out in England’s hospitals over three years between 2008-09 and 2010-11 and the deaths of 27,582 patients within 30 days of their operation. The research, published on the British Medical Journal’s website, shows that the risk of death within 30 days of a planned operation increased with every day that goes by so that by Friday or the weekend it is 82 per cent higher.

The Royal College of Physicians has been warning for sometime that working practices need to change. Their report last September – Hospitals on the Edge – said that having skeleton staff of doctors was, quite frankly, dangerous. The College recommends among other things that a consultant physician dedicated to the care of acutely ill patients is available on site at least 12 hours a day, seven days a week. And that includes bank holidays.

But is it as simple as that? Sir Bruce Keogh, the Medical Director of NHS England, said that as a cardiac surgeon he had often left his more complex, more ill patients until the end of the week so that if they needed him he was not in an operating theatre. Of course, not all consultants are willing to visit their patients in the evenings or at weekends. And it was pointed out by the Royal College of Surgeons that if consultants worked at weekends they would need to have a day off, so in the end Mondays would become the most dangerous day.

It must be said that the Royal College of Surgeons also said that it was not acceptable that there should be such a wide variation in the death rates. But it does also add to the debate on the reconfiguration of hospitals and whether it would be safer to have larger super specialist units and the need, of course, for more NHS staff.

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