Bioethics Blogs

#IminworkJeremy – the ethics of 24/7 consultant cover

By Dominic Wilkinson @Neonatalethics


At the bedside of a critically ill infant at 5am this morning I was tempted to tweet the latest meme, adding my voice to a chorus of NHS clinicians over the weekend. Last week, in a speech to the King’s fund, Health Minister Jeremy Hunt launched a drive towards 7 day NHS. In particular, he focused on consultant contracts, proposing that newly qualified hospital doctors will be required to work weekends as a condition of employment.

The motivation for the change in contract is recognition of the significant increase in mortality for patients who are admitted to hospital out of hours and on weekends. In one series from 2009/10 patients admitted to the NHS on Sunday were at a 16% higher risk of dying than those admitted on Wednesday. Hunt proposes that increased access to senior doctors would help prevent complications like these for seriously ill patients.

We should be concerned about lack of services on weekends and after hours. Our health system should provide high quality, timely and appropriate medical care at any time. Illnesses and medical emergencies don’t conveniently occur between 9am and 5pm Monday to Friday.

However, there has been a vigorous response to Hunt’s speech over the last few days on the part of health professionals. Why the protest? Many have highlighted that large numbers of hospital doctors already work weekends and night shifts, including many unpaid hours. Furthermore, the relationship between mortality and time of admission is complicated by the fact that patients needing admission during the night, or at weekend are often sicker than those admitted during office hours.

The views, opinions and positions expressed by these authors and blogs are theirs and do not necessarily represent that of the Bioethics Research Library and Kennedy Institute of Ethics or Georgetown University.