Acute medicine needs to be available 365 days a year

Editor—The inexorable rise in medical admissions in the United Kingdom is well documented if poorly understood.¹ The increased activity has produced inevitable stresses at a time when bed numbers have fallen, the hours of work for doctors in training are being reduced, and the importance of formalised education in addition to experiential training is being increasingly recognised.²,³

The working practices of doctors and nurses in many acute units are changing radically in an attempt to cope with the increasing pressures.²,⁴,⁵ However, the management of acutely ill patients depends on many other groups as well, such as physiotherapists, radiographers, clerical staff, laboratory technicians, social workers, and hospital porters.

Patients do not present at hospitals exclusively on weekdays, when staffing levels are at their optimum. They become ill at weekends and on public holidays, when most hospitals run at minimum staffing levels. It is not surprising that hospitals have difficulties at the end of the year, when there are only four or five “normal” working days out of 14 at a time when admissions are at their highest. The time has come when this is no longer acceptable; staffing levels for all people involved in acute medicine must be consistent across the (seven day) week.

Efficient and safe medical care requires rapid availability of plain radiography and more sophisticated imaging such as ultrasound scanning and computed tomography as well as various biochemical, haematological, and bacteriological investigations. The pattern of availability varies, but many of these investigations are difficult to obtain at weekends. This is not acceptable if clinicians are to make correct diagnostic, therapeutic, and discharge decisions seven days a week.

Acutely ill patients deserve access to the best available technology according to clinical need and not to the day of the week. Moreover, tomorrow's doctors should be trained to practise medicine for this millennium rather than with facilities that may have been acceptable in the 1970s.

This is a critical problem that must be addressed if the NHS is to manage the increasing numbers of medical emergency admissions with the high bed occupancy rates that are found. It is essential that “seven days a week” medicine is practised if we are to provide an acceptable and safe level of acute care to our patients.