Live in Care

3,000 heart attack and stroke victims suffer delays after falling ill at weekends

3,000 heart attack and stroke victims a year are suffering delays being admitted to hospitals after falling ill at weekends, because NHS services are not working round the clock, a new report suggests. Senior doctors last night warned that patients are dying needlessly because of poor access to GPs and out-of-hours services failing to detect emergency cases which should be sent to hospital. New analysis of national NHS data shows a steep drop in the number of cases being admitted to hospital as an emergency at weekends, and a still sharper fall in the number who were sent there by GPs. The figures suggest that each year, 3,144 patients suffering from heart attacks and strokes end up suffering a delay of at least 24 hours being admitted to hospital, because their case was not identified as an emergency.

Dr Cliff Mann, President of the Royal College of Emergency Medicine, said the statistics demonstrated the risks posed to patients by a “two-tier” service in the NHS, which meant it was far less safe to fall ill at the weekend. He said: “The fact is we are running a two-tier operation, where if you fall ill between 8am and 8pm Monday to Friday you get one type of service, but if it happens at night or weekends you are basically looking at a skeleton service.” While patients with clear signs of heart attacks and strokes would be likely to go to straight to A&E, those with more subtle symptoms could end up suffering life-threatening delays because of a lack of GP services at weekends, he said. “For patients who are suffering from time-critical illnesses – sepsis, stroke and heart attacks – delays mean opportunities to intervene are lost, which can mean lives lost,” the A&E consultant said.

Previous research has found hospital death rates are significantly higher at weekends. Dr Mann said that while some assumed this meant hospitals were providing worse care at weekends, the new data suggests it could be because those who fall ill at weekends have to be much sicker to get admitted to hospital. “We know that mortality is higher at weekends,” he said. “This shows it could be because a lack of services in the community, which means patients have to be much sicker to get referred to hospital.”

Katherine Murphy, chief executive of the Patients Association, called for a "complete overhaul" of NHS out-of-hours care, which she was said was currently "completely inadequate". "People don’t choose when they are going to be ill. When a serious illness strikes that requires emergency treatment, it is essential that the NHS is able to provide a 24 hour a day, 7 day a week service. It is simply unacceptable that patients are being offered different standards of care on different days of the week," she said. "Unless we see proper investment, lives will continue to be put at risk."

David Cameron has pledged to improve access to GPs at weekends, promising at the last Conservative party conference that all patients should be able to see a family doctor seven days a week by the end of the decade. Both Labour and the Conservatives have said they will increase the number of GPs, so patients are able to get care more quickly, closer to home, and reduce pressures on A&E.

Sir Bruce Keogh, NHS medical director, has said the NHS must provide routine services seven days a week, in order to be “patient-centred, compassionate and convenient”. However, the question about how to fund such care remains hotly debated, with a breakdown in talks between the British Medical Association and NHS Employers about what doctors should be paid to provide more weekend care.

The new analysis, from healthcare information analysts CHKS shows a 20 per cent drop in the number of patients being admitted to hospitals as an emergency at weekends. Daily averages show 11,623 emergency admissions on Saturdays and Sundays, compared with 14,582 on weekdays. The same data, for the 12 months ending last July, show a 59 per cent drop in the number of emergency admissions at weekends which resulted from referrals from GPs and out-of -hours services. In total, 15 per cent fewer victims of strokes were admitted at weekends, and 11 per cent fewer heart attack sufferers, the analysis reveals. Analysts said that in total, it suggests that each year, 1,514 patients suffering heart attacks and 1,630 having strokes at the weekend are not being admitted to hospital until the following week. Meanwhile the numbers turning up to A&E departments remained relatively constant, suggesting the actual numbers falling ill do not vary markedly from day to day.

Experts said many patients in need of urgent care struggled to access GP care at weekends, while others assumed it would be too difficult to see a doctor, or thought they should “hang on” to see their own GP in the week. In other cases, elderly people living on their own could suffer a heart attack or stroke at the weekend, but not be found until carers visited on a Monday, researchers said.

A spokeswoman for NHS England said: "We are determined to make it easier for people to get help when they feel unwell. "This is why, through the Prime Minister’s Challenge Fund, we have taken steps to improve access to GPs and spark innovative ways of delivering services. We are also reshaping the urgent care system so it is easier for patients to get the right care in the right place at the right time."

The Telegraph – 22nd February 2015

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