Association between elevated weekend mortality and the seven-day hospital services programme in England: a retrospective longitudinal study:A retrospective longitudinal study

BackgroundPatients admitted to hospital at weekends experience higher mortality rates than those admitted during the week. The NHS in England has taken the lead internationally with attempts to tackle this issue. Four priority clinical standards for emergency care have been introduced with the aim of reducing the ‘weekend effect’. We investigate whether implementation of this policy has been associated with changes in the weekend effect.MethodsRetrospective observational study of 120 hospital Trusts in England. We use data on Trusts’ performance against the clinical standards in 2015 and 2017, and estimates of Trusts’ weekend effects in risk-adjusted mortality in financial years 2015/16 and 2016/17. We examine whether adoption of the standards is associated with the weekend effect.ResultsWe detect little association between Trusts’ mortality weekend effects in 2016/17 and their performance against the clinical standards in 2017. Changes in achievement of the standards between 2015 and 2017 were not associated with changes in the weekend effect between 2015/16 and 2016/17.DiscussionLarge improvements in performance against all four standards have not translated into reductions in the weekend effect. We find no evidence that England’s policy is a beneficial way for health systems to respond to this phenomenon. Given the failure of the policy to achieve its aim, the current mandate for full compliance by 2020 requires urgent review.