UK nurse taking a woman's blood pressure

commentary

(The RAND Blog)

May 24, 2013

NHS 24/7: An Effective Way to Improve Quality of Care?

by Christian Van Stolk

Why shouldn't England's National Health Service (NHS) be as fully available to patients at the weekend as on any other day of the week? In a recent article in the British Medical Journal, NHS Medical Director Bruce Keogh sets out his support for new proposals (PDF) for a 24/7 NHS. The main motivations seem to be efficiency and quality of care — but our analysis suggests those proposals could actually make the quality of care worse.

Keogh is concerned about medical equipment and facilities standing idle over the weekend. In addition, he cites evidence to suggest that a patient's chance of dying is higher at the weekend than during the week. The hope is that having more doctors and nurses working weekend hours would improve the quality of care, increase efficiency in the use of facilities, and give patients increased choice.

RAND Europe's work for the Boorman review on NHS health and well-being suggests that there is a strong association between the health and well-being of staff and the quality of patient care. This association is perceived by about 90 percent of the 11,000 NHS staff surveyed for the review and is corroborated by NHS productivity data. Our data analysis shows that NHS Trusts with better staff health and well-being (according to indicators such as lower staff turnover, lower absenteeism rates, and higher staff satisfaction) also appear to have better quality of care (for example, lower MRSA infection rates and better scores on composite quality indices such as the Annual Health Check). Such Trusts also typically have higher patient satisfaction.

With the proposed changes to working practices and limited resources available to NHS managers, it is likely that staff will be asked to work longer and more irregular hours. RAND Europe's analysis for the Boorman review shows that working longer hours has a strong association with reported negative measures of health and well-being, in particular higher absenteeism rates. These workers also appear to be at higher risk for experiencing stress and coming to work when unwell.

Finally, 80 percent of NHS staff members are women, who across the NHS have worse reported health and well-being than men. There are multiple reasons for this. Women are more likely to be caregivers, feel less supported by their managers, report higher rates of harassment, and, importantly, appear to have a greater need for flexible and part-time working arrangements.

The current proposals do not explicitly mention the health and well-being of staff as an important consideration in extending the hours of non-emergency service provision in the NHS. This may be an unfortunate oversight because there is a risk that these proposals will negatively affect the health and well-being of staff. This, in turn, could affect the quality of care offered in the NHS. While our analysis cannot predict the impact of these proposals on staff health and well-being and quality of care, we suggest that 24/7 working could have unintended consequences for patients.


Christian van Stolk is acting director of the Employment, Education and Social Policy team at RAND Europe. His research focuses on social and employment policies across Europe.

Commentary gives RAND researchers a platform to convey insights based on their professional expertise and often on their peer-reviewed research and analysis.