Cllr Dr Kathy Smethers: Seven Day NHS

I must first say how much I approve of the plans for 7 day working in the NHS. It is clear that treatment in many areas is not as effective on the weekend and the government’s efforts to improve this are commendable.


A lot of routine work can be done by auxiliary staff e.g nurses providing triage, chronic disease clinics and paramedics working in GP surgeries doing home visits. This takes the pressure off doctors so they can deal with more complicated cases only and to manage a practice of support workers. If primary care is more effective at the weekends A&E would not be so overused. If a facilitator was present in A&E who was not medically trained but trained to direct people to the correct service e.g GP surgery, walk in clinic, with a phone number to call this would help ensure people get the right treatment. I heard an example of a patient ringing 999 because she broke a nail. Clearly redirection advice and reassurance were all that was required and if the ambulance service could redirect such a call quickly it would reduce pressure on the service.

Hubs are being postulated of ambulance, social care and voluntary organisations which help the elderly cope at home, all being available in one centre based in hospitals. This could help with coordination of care and give a better service while reducing costs.

I have been a junior doctor in A&E myself and know how hard doctors work. I am suggesting that contracts remain the same, but Saturday and Sunday be counted as normal days for pay only and the 6th and 7th consecutive days of work be paid overtime as Saturday and Sunday are paid now. If you have a day off no overtime is paid. This makes it possible to stagger timetables so days off might be Friday and Saturday or Wednesday and Thursday. If teams are staggered there is no reason why doctors need do many more weekends than now preserving the special nature of the weekend by timetabling and ensuring 7 day a week services. With more support from nurses, phlebotomy, x-ray etc at weekends, timetabled in a similar pattern, doctors would be able to do their job effectively throughout the week with no change in hours . More doctors will be required to fulfil 7 day a week treatment but with support from auxiliary staff this could be kept to a minimum.

The principle of 7 day working must be in line with the Hippocratic Oath and doctors are morally obliged to ensure patient care is not dependent on which day of the week a patient is seen. With the change suggested in this article there could be room for negotiation with junior doctors to get a 7 day service while supporting the needs of doctors.

Kathy Smethers is a Councillor in Eastbourne, and also serves as a school governor. She previously worked as an A&E doctor in London before retiring to bring up her two daughters.

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Showing 23 reactions

  • Crawf
    commented 2015-12-10 18:01:13 +0000
    YES! The Weekend Effect is clear. You are actually LESS likely to die if you are in hospital on a weekend day. So actually in hospital and immediate management of patients on the weekend must be excellent.

    Don’t confuse this with the PseudoWeekend Effect which shows that if you are admitted on a Fri, sat, sun or mon then you’re more likely to die within 30 days of admission. There is no clear reason identified for this but anybody who is familiar with hospital work can tell you that people admitted over the weekend tend to be more ill on admission.

    Also worth noting is the Hunt Effect whereby people have been lied to and falsely told that urgent and emergency care does not exist on the weekend. This means that sick people present even later and may well increase 30 day mortality.

    If you are ill please go to hospital asap. The NHS will look after you. At least it will up until the point where it’s privatised and in that case bring a credit card, health insurance docs and solicitor.

    Privatisation of the NHS is the greatest threat to health in the UK. Please help stop it.
  • Chetna Kohli
    commented 2015-12-10 17:39:37 +0000
    Show me a roster that is overall time compliant and doesn’t drastically increase the number of weekends one works per cycle AND doesn’t overstretch an already struggling workforce during traditional weekdays. And do you have any comment on how continuity of care should be maintained. All government-led changes in recent years has destroyed this cornerstone of the doctor-patient relationship and this takes it a step further, into the hospital.
    NO GOOD!

    Thank you at least for not propagating the Tory spin/LIES about increased weekend mortality. To the gentleman below with a chip on his shoulder (doctos are not all privileged elite) THERE IS NO PROVEN WEEKEND EFFECT.
  • Jonathan Ballard
    commented 2015-12-09 21:22:15 +0000
    My disappointment is with the responses from people purporting to belong to the medical profession but so obviously uncaring about the weekend-effect and of the fact that people die as a result of being unlucky in the ‘day-of-the-week-lottery’ by becoming ill on a day these respondents would rather be relaxing.

    How it is that any medical practitioner can reconcile themselves with their own personal denial of genuine attempts to fix health care and prefer to put their personal gain before the interests of their patients is bewildering.

    Yes we need a 7 day health service that gives the same chance of recovery to all, on any day of the week – of course we do.

    Not one of these “knowledgeable” respondents have offered anything by way of positive suggestion or alternative. Their replies are merely the moaning of a privileged elite who already have some of the best jobs in society.

  • Gabriela Maria
    commented 2015-12-09 20:48:08 +0000
    You, as someone who left the profession to raise their family, surely must have some insight into the punishing way 12 hour days and weekends ruin family life? I can’t see how your proposals will make doctors working lives more manageable and you still give the underlying principle of a need for pay cuts (by removing anti-social pay). Would you still be working as a doctor in the system you propose?

    The only point I agree with is increasing use of auxiliary roles to help with workload, as there isn’t simply enough doctors. Even the routine work is a struggle for some departments. But these types of staff e.g. nurse practioners, specialist nurses etc are highly trained, and experienced and not a cost cutting or ‘efficiency’ measure. Salaries are usually comparable to a banded SHO, but for routine hours.

    The real issue is the Conservatives unwillingness to invest in the NHS and salaries which retain staff. The issues with staff shortages and use of locums is across all roles, not just doctors. I’ve worked night shifts where half the nurses were agency locums. When I had my antenatal scans, both times the radiographer was a locum. I’ve seen locum physios on weekends. The list goes on.

    Your proposals just won’t work where ALL professionals working in the NHS are being screwed over. We’ve had the pay freezes, we’ve had the pension changes, we already give unpaid work as an act of goodwill. There is only so much a worker can ‘give’ before they break. No doubt A&E broke you. You left to have a family life.
  • Neil Atkinson
    commented 2015-12-09 20:01:19 +0000
    Ridiculous article. I work on a neonatal unit which provides an excellent 24 hour service every day of the week. My rota does not recognise the weekend and usually includes stints of 3-4 × 12 hour shifts (days or nights) with days off in between. I work nights every 2-3 weeks. Your ill conceived idea would mean I do all these hours at a basic rate of pay and thus take a 33% pay cut. I am part of a 7 day NHS and your comments reflect at best a total lack of understanding and at worst the continued all out attack on our NHS. Keep your shameful ideas to yourself.
  • Tamara Hold
    commented 2015-12-09 19:57:09 +0000
    Sam R – spot on. I have nothing more to add.
  • Anand Sundaralingam
    commented 2015-12-09 19:01:26 +0000
    Err…ditto to the above. I can’t be the only one that sees the HYPOCRISY in Dr Smethers spouting the HIPPOCRATIC OATH to us with regards to 7-day working when she left her job as a doctor along with that valuable medical knowledge and skill that would have benefitted so many for a better work life balance?? I totally think it’s fine to leave medicine for personal reasons but I don’t think those who do should be reminding those who haven’t of what their duties ought to be, we know full well what are duties ought to be.
  • Sam R
    commented 2015-12-09 18:32:32 +0000
    Given your amazing idea for new NHS workforce planning, I expect you’ll be rushing out of ‘retirement’ and returning to the coal face with the rest of the front line staff who also have childcare and financial considerations.

    I look forward to seeing you in A+E shortly.

    NB. Remember to tell your children that they are unlikely to see you often given your new plans as they will be at school on your days off. Also, you might as well give up the school governor role as you won’t be making meetings/parent evenings/the school fete any time soon. Don’t make any plans for Christmas as there’s a 5 in 7 chance you’ll be working then for no extra pay too, but non of that matters because it’s a really good plan.

    Alternatively, stay away from the NHS, keep your public opinions confined to areas you have up to date knowledge about and don’t refer to yourself as doctor if you have neither a licence to practice nor a PhD as this is misleading.
  • Renee Hoenderkamp
    commented 2015-12-09 18:17:09 +0000
    My god…. Idiotic proposal by someone who opted out. No thanks Kathy. Saturday and Sunday are antisocial because its when everyone in normal jobs has their leisure time. As such it should be rewarded when you have to work it. Perhaps if you were now working the rota i would reapect the view more. Also; paramedics in GP surgeries doing home visits? I spent 13 years getting to GP… For a reason. Get real.
  • Victoria Thomas
    commented 2015-12-09 16:51:03 +0000
    Dr Smethers, how on earth do you propose that doctors with children pay for weekend childcare under your suggested system? A striking demonstration of ignorance and hypocrisy given that you state you left medical practice to care for your own children.
  • Sarah Galbraith
    commented 2015-12-09 16:11:08 +0000
    I was a junior doctor 25yrs ago, I am now lucky enough to work in an office hours medical advisory role. I haven’t forgotten how truly awful the 1980s were with days of sleep deprivation and continuous periods of duty 72 + hours.

    Unlike you I didn’t ’’retire’’ when I had children, that seems a luxurious thing to do and does leave you a target for derision as a doctor who couldn’t hack it advising every one else how to do it. Not good.

    Things may have improved a bit but our young doctors need to have a good work life balance, as you and I have. It is simples if you need more Drs at weekend you will have fewer in the week when the elective work occurs. We have half the number of doctors compared with other developed countries. Unless we provide this generation with a decent balance they will leave and we won’t attract the brightest into th profession.
  • Gaj Sivadas
    commented 2015-12-09 15:48:54 +0000
    OMG, Stop all the press- this genius, an ex junior doctor has solved it. My god it was staring right at us all the time. I raise my hat to your Marm. Please allow me to buy you a drink when I’m passing through Eastbourne. Maybe by being in your vicinity I can soak up some rays of genius. Please tell me the next time you are out and about and I will try and be on the same road as you
  • Sid Sinha
    commented 2015-12-09 15:32:58 +0000
    Mind-bogglingly idiotic.

    Thanks for your input Kathy. It’s particularly reassuring to know that the “seal of approval” of 7-day elective services and no overtime for weekend work comes from someone who couldn’t hack the current system (which by your own supposition is less onerous than the one you propose) and quit because it wasn’t compatible with a family life.

    Don’t worry though – I’m sure Jezza approves and will give you a pat on the back when he sees you next.

    You utter imbecile.
  • Fabian Wong
    commented 2015-12-09 13:59:34 +0000
    I applaud your sentiment about a 7-day elective and emergency services in the NHS. I would also assume you could fully appreciate difficulty to raise children while working as a Junior Doctor.
    From your position as a school governor, could you give me reassurance that your school will provide equal quality 7-days classes for my child so that he / she can attend any 5 consecutive days and then have 2 days off, without potentially being disadvantaged by the presence of parents to support studying and learning?
  • Henry Knott
    commented 2015-12-09 13:20:50 +0000
    A non medically trained facilitator trained to guide people to the right services? What training do you suggest to fast track this facilitator to make the challenging decisions that an EM consultant or a GP have to make?
  • Crawf
    commented 2015-12-09 12:55:28 +0000
    Just BTW:

    A non medically trained person to direct people to the correct service. Is that not EXACTLY what happened with NHS (Re)Direct – AKA NHS111 helpline. That was in 2013. Have you learned nothing?

    After its launch it was noted

    “You need the right people and if they cost money that’s what you have to spend.

    We could see this coming, it was so obvious it was going to happen and we said over and over again and in public ’don’t do this, get it right, test it, make sure it’s ok.’"

    Another epic fail. Almost certainly had morbidity and mortality associated with it so where is YOUR moral obligation to YOUR Hippocratic Oath?
  • Crawf
    commented 2015-12-09 12:47:56 +0000
    There are so many ridiculous statements in this article that al I can think is it is more propaganda nonsense designed to further undermine the NHS and it’s patients and staff.

    Rather than endlessly criticise the article I’ll try and give you some insight beyond your limited hospital experience, skewed party outlook and a divine revelation you seem to have had.

    David Cameron should stop lying and actually fund the NHS properly (instead of making subtle reductions in funding and spooning them as increases). He should stop breaking his promises (“we are the party of the NHS”, “there will be no top down reorganisation” “there will be no privatisation”). All LIES.

    Jeremy Hunt should stop lying. He has told so many now I couldn’t possibly list them all. The main one is the absolute lie about causation of increased mortality in patients admitted at the weekend – weekend patients are by definition more unwell – trauma, alcohol, delayed presentation. His lies have now acted to make people delay even longer to come
    to hospital – perhaps he will take responsibility for patient deaths/poor outcomes in future through his LIES.

    There is every service anyone could ever need 5 days a week. For specialities that have routine urgent emergency work they’re rotas are consistent and continuous 24/7. There are urgent and emergency services for ALL specialities 24/7.

    Your toenail anecdote is hardly a revelation – it may have been an urgent care case in a vascular or diabetic patient BTW and that patient has the absolute right to have it triaged by an appropriate person. The patient may well have been advised to present if they had a minor
    peripheral injury. Don’t let reality get in the way of your propaganda. So you propose full 7 day services – so a non urgent toenail could be “done” on the weekend by podiatry? Well there’s an oncall system at the moment or at least a route through A&E for urgent care if needed. If not needed the patient gets an appointment for a mon-fri slot. The hasnt enough paramedics, nurses, doctors – in fact most staff to provide a regular 5 day + emergency (2 day and 7 night) service.. To provide a regular 7 day and emergency (7 night) service the NHS would need 30% more staff. Where exactly is that funding going to come from? It’s just a minor omission from your propaganda statement.

    If privatisation is your aim then just come out an state it. If demoralising NHS staff is your aim – congratulations you have achieved it by continually insulting them (BTW the Hippocratic Oath should morally oblige doctors to make sure the government stops lying and privatising the NHS. It should morally oblige doctors to call you and your cronies out for having taken the Hypocrasy Oath to money and elitism to the detriment of common people. It should morally oblige doctors to stand up for what they believe in and protect patients from this unprecedented assault of evil)

    It is shameful that you should use your Title as a doctor to justify this outlandish spin of lies and deceit. If you could think back to your days before becoming a party mouthpiece back when looking after people was your priority perhaps you might embarrass your former self by what you have become.

    I stand with Aneurin Bevan:

    “Illness is neither an indulgence for which people have to pay, nor an offence for which they should be penalised, but a misfortune, the cost of which should be shared by the community”

    Invest in the NHS to improve an already great institution. STOP giving private contracts out to put patients at the mercy of shareholders. STOP lying.

    Thanks for reading this far!
  • EmergencyDoctor
    commented 2015-12-09 12:31:31 +0000
    “Noone is disputing that NHS staff work hard. The intention is to find cleverer ways of working so people work the same hours but the service is more joined up and the money goes further”
    So you mean making better use of current resources. Like efficiency savings. Why is it tories seem to think there are infinite efficiency savings to be made?
    You have 17 apples in a bag. You can eat as many as you like during the week but will never have more than 17 as thats all your mother/HMG) will pay for. So you choose to eat 3 every weekday and 1 on each weekend day.
    Someone however decides you must eat the same on the weekend as the weekday. Which is fine. Except they also tell you if you eat less than 3 per weekday you risk starvation.
    How do you increase the number of apples you have for the weekend without reducing those available during the week or buying more apples.
    Answers on a postcard to Jeremey Hunt @ Houses of Commons…
  • EmergencyDoctor
    commented 2015-12-09 12:27:42 +0000
    OK Kathy, I’m assuming at some point inth e 20 odd years since you did a short stint as a doctor you have forgotten how the A&E rota works. Hell you might never have knowna modern rota as a lot has happened in the last 15 years.
    You would (i assume) know well that in A&E you ver rarely work more than 5 days in a row as fixed ‘off days’ get inserted into the rota. This is part of the EWTD and ‘new deal’ agreements. It is different on the wards of course.
    What you propose – without any indication that you have any experience or qualification would punish those doing the most out of hours (especially weekends) hardest financially. But you either don’t know or appreciate this.

    And before you or anyone else suggests that having previously worked in A&E makes you qualified – it doesn’t. No more than my previous school attendance allows me to pass comment on matters of education and school structures.

    You quit medicine in order to raise a family. And if people with views get your wish, then many many more will follow as working a s a junior doctor (especially in A&E) will become so challenging for those with families they all leave to become councillors or run a hotel.
  • Hamish Macdonald
    commented 2015-12-09 11:55:39 +0000
    What utter tosh.

    1. There is already a seven day emergency service. The current five day ejective service is barely staffed adequately, so rolling it out by an extra 5/7 requires significantly more staffing

    2. All days are not created equal. The opportunity cost of working at the weekend (in missed social events etc) is far greater than that of working midweek. This has to be recognised with increased remuneration

    3. A&E rotas are recognised as one of the major reasons that doctors do not want to enter this speciality despite its attractions. As a result there is a huge recruitment crisis and unaffordable locum bill. Unless you want to replicate this across the entire NHS, I suggest you find another model to copy (how about the health service of Australia or NZ?)
  • Kathy Smethers
    commented 2015-12-09 09:21:02 +0000
    Noone is disputing that NHS staff work hard. The intention is to find cleverer ways of working so people work the same hours but the service is more joined up and the money goes further
  • Rajpal Nandra
    commented 2015-12-08 13:47:44 +0000
    Doctors already provide a 7 day NHS, as do paramedics. Thus far, the weekend GP services pilots have failed because nobody turned up. The literature to date does not have evidence that weekend mortality is higher, the only measure uses mortality at 30 days. This implies patients would have been in hospital for more than a few days! Even then there is no causality just association.

    The limitations to a 7 day weeks are purely down to decreases in NHS funding by the Conservatives. Therefore reduced social care, theatre staff, admin staff and longer waiting times for surgery.

    There is no chance of a 7 day NHS without more funding.

    The conservatives by attacking the workforce they depend upon ( doctors and nurses) will achieve their goal in destroying the NHS and privatisation.
  • Rajpal Nandra
    commented 2015-12-08 13:44:15 +0000
    Doctors already provide a 7 day NHS, as do paramedics. Thus far the weekend GP services trailed have failed because nobody turned up. The literature to date do not have evidence that weekend mortality is higher, the only measure they have mortality is at 30 days. This implies patients would have bee in holdout all for more than a few days!

    The limitations to a 7 day weeks are purely down to decrease NHS funding by the Conservatives. Therefore reduced social care, theatre staff, admin staff and longer waiting times for surgery.

    There is no chance of a 7 day NHS without more funding.

    The conservatives by attacking the workforce they depend upon ( doctors and nurses) will achieve their goal in destroying the NHS and privatisation.