A major new study is to look at how providing more hospital services around the clock affects patient care – and how cost effective it is.
The research will investigate patient experiences and outcomes at Salford Royal NHS Foundation Trust over eight years to provide vital information on the benefits, costs and potential consequences of extending the hours of full operation.
It is funded by the National Institute for Health Research Health Services and Delivery Research (NIHR HS & DR) Programme and is a collaboration between Salford Royal, The University of Manchester, The University of York, The University of Bristol, and Haelo, an innovation and improvement centre, also based at Salford Royal.
Principal Investigator Professor Tim Doran said: “Nationally, patients attending hospitals outside of normal working hours, for example at night and at weekends, are more likely to receive poorer care and to have worse health outcomes than patients admitted during weekdays.
“Outside normal working hours fewer hospital staff are at work - in particular senior doctors - and a full clinical service is not available. Extending the hours for which hospitals are fully operational could therefore improve outcomes for patients.
“But it would also increase costs for the NHS, would mean staff have to work more anti-social hours, and could lead to us providing services that are under-used.”
Salford Royal has already led the way on extending its hours of full operation for acute medical patients and now provides a full service of consultant-led care in its Emergency Village – which includes A&E, the Emergency Assessment Unit and support services - from 7am to 11pm seven days a week.
The research will also assess whether the opening hours of patients’ GP surgeries are related to their attendance at hospital and their health outcomes.
The study will look at patient care in Salford from 2007 to 2015 but will also be extended to examine whether quality of care and patient outcomes varies with time of admission for all 24 Acute Hospital Trusts in the North West of England.
Professor Matthew Sutton, Professor of Health Economics at The University of Manchester, said: “This research will provide hospitals, local commissioners and the Department of Health with vital information on the costs, benefits and potential unintended consequences of extending the hours of full operation of the NHS.
“It’s a tricky area because services with the potential to meet patient demand are inter-related but often offered by different organisations. For example, the hours of operation of local general practices has an impact on the demand for services in A&E.”
Professor Doran added: “Patients have a right to expect the same high quality of care whenever they are admitted to hospital. We need to understand why patients admitted at night and at weekends have poorer outcomes, and whether these outcomes can be improved by extending normal hours of operation."
Notes for editors
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• Principal Investigator Professor Tim Doran is Professor of Health Policy at the University of York. He is a clinical epidemiologist with expertise in health policy and health service research.
• Salford Royal NHS Foundation Trust has an international reputation for innovation in health care improvement and is at the leading edge of electronic patient record linkage across primary and secondary care.
• This research aims to answer four key questions:
What is the impact of changes to fully-operational hours on access to services for different population and patient groups?
How do service re-configurations affect quality of care and patient outcomes for different population and patient groups?
How should staff be best deployed to deliver care throughout the week?
What balance of fully-operational hours represents the most cost-effective use of NHS resources?
• The National Institute for Health Research Health Services and Delivery Research (NIHR HS&DR) Programme was established to fund a broad range of research. It builds on the strengths and contributions of two NIHR research programmes: the Health Services Research (HSR) programme and the Service Delivery and Organisation (SDO) programme, which merged in January 2012. The programme aims to produce rigorous and relevant evidence on the quality, access and organisation of health services, including costs and outcomes. The programme will enhance the strategic focus on research that matters to the NHS. The HS&DR Programme is funded by the NIHR with specific contributions from the CSO in Scotland, NISCHR in Wales and the HSC R&D Division, Public Health Agency in Northern Ireland. www.nets.nihr.ac.uk/programmes/hsdr
• The National Institute for Health Research (NIHR) is funded by the Department of Health to improve the health and wealth of the nation through research. Since its establishment in April 2006, the NIHR has transformed research in the NHS. It has increased the volume of applied health research for the benefit of patients and the public, driven faster translation of basic science discoveries into tangible benefits for patients and the economy, and developed and supported the people who conduct and contribute to applied health research. The NIHR plays a key role in the Government’s strategy for economic growth, attracting investment by the life-sciences industries through its world-class infrastructure for health research. Together, the NIHR people, programmes, centres of excellence and systems represent the most integrated health research system in the world. For further information, visit the NIHR website (www.nihr.ac.uk).
• The future of 24/7 care: investigating the links between staffing levels, patient access and inequalities in health outcomes is a collaboration between Salford Royal NHS Foundation Trust, The University of Manchester, The University of York, The University of Bristol, and Haelo, an innovation and improvement centre, also based at Salford Royal.
• This article presents independent research funded by the National Institute for Health Research (NIHR). The views expressed are those of the author(s) and not necessarily those of the NHS, the NIHR or the Department of Health.